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diff --git a/old/4986.txt b/old/4986.txt new file mode 100644 index 0000000..7b2955d --- /dev/null +++ b/old/4986.txt @@ -0,0 +1,5904 @@ +The Project Gutenberg EBook of The Four Epochs of Woman's Life +by Anna M. Galbraith + +Copyright laws are changing all over the world. Be sure to check the +copyright laws for your country before downloading or redistributing +this or any other Project Gutenberg eBook. + +This header should be the first thing seen when viewing this Project +Gutenberg file. Please do not remove it. Do not change or edit the +header without written permission. + +Please read the "legal small print," and other information about the +eBook and Project Gutenberg at the bottom of this file. Included is +important information about your specific rights and restrictions in +how the file may be used. You can also find out about how to make a +donation to Project Gutenberg, and how to get involved. + + +**Welcome To The World of Free Plain Vanilla Electronic Texts** + +**eBooks Readable By Both Humans and By Computers, Since 1971** + +*****These eBooks Were Prepared By Thousands of Volunteers!***** + + +Title: The Four Epochs of Woman's Life + +Author: Anna M. Galbraith + +Release Date: January, 2004 [EBook #4986] +[Yes, we are more than one year ahead of schedule] +[This file was first posted on April 7, 2002] + +Edition: 10 + +Language: English + +Character set encoding: ASCII + +*** START OF THE PROJECT GUTENBERG EBOOK, THE FOUR EPOCHS OF WOMAN'S LIFE *** + + + + +This eBook was produced by Jim Weiler, xooqi.com + + + + THE FOUR EPOCHS OF WOMAN'S LIFE + + + A Study in Hygiene + + BY + +ANNA M. GALBRAITH, M.D. + + Author of "Hygiene and Physical Culture for Women"; Fellow of the New + York Academy of Medicine ; Ex-President of the Alumnae Association, + Woman's Medical College of Pennsylvania; Attending Physician, + Neorological Department, New York Orthopedic Hospstal and Dispensary. + _________________________________________________________________ + + WITH AN + + INTRODUCTORY NOTE + + by + + JOHN H. MUSSER, M.D. + + Late Professor of Clinical Medicine, University of Pennsylvania. + + "As in a building + Stone rests on stone, and wanting the foundation + All would be wanting, so in human life + Each action rests on the foregoing event + That made it possible, but is forgotten + And buried in the earth." + + -- LONGFELLOW. + _________________________________________________________________ + + INTRODUCTORY NOTE + _________________ + +IT has been well said that the bulwarks of a nation are the mothers. +Any contribution to the physical, and hence the mental, perfection of +woman should be welcomed alike by her own sex, by the thoughtful +citizen, by the political economist, and by the hygienist. Observation +of the truths, expressed in a modest, pleasing, and conclusive manner, +in the essay of Dr. Galbraith contribute to this end. These truths +should be known by every woman, and I gladly commend the essay to +their thoughtful consideration. + + JOHN H. MUSSER, M.D., + + Late Professer of Clinical Medicine + in the University of Pennsylvania. + _________________________________________________________________ + + PREFACE TO THE SECOND EDITION. + _________________ + +THE author takes this opportunity to thank the medical profession and +the laity for the very cordial reception which has been tendered the +first edition of this small volume. + +The necessity for the use of technical expressions in a book written +expressly for the laity must always be a matter of regret. And only +those who have attempted to write a similar work can fully appreciate +the truth of Herbert Spencer's remark, that "Nothing is so difficult +as to write an elementary book on scientific subjects." + +The author has added to this edition a section on "The Hygiene of +Puberty," one on "Hemorrhage at the Menopause a Significant Symptom of +Cancer," and one on "The Hygiene of the Menopause." + + ANNA M. GALBRAITH. + +15 WEST NINETY-FIRST STREET, NEW YORK. + _________________________________________________________________ + + PREFACE. + _________________ + + "Ignorance is the curse of God; + Knowledge, the wings wherewith we fly to heaven." + + -- "Henry VI." + +PERFECT health is essential to perfect happiness. The greater the +knowledge of the laws of nature, and the more closely these laws are +lived up to, so much nearer "ideal" will be the health and happiness +of the individual. Hence the necessity that these same laws should be +as familiar to the adult man and woman as the alphabet. Further, with +our present knowledge of the certain suffering, disease, and death +that are bred by ignorance of all these subjects, it is little less +than criminal to allow girls to reach the age of puberty without the +slightest knowledge of the menstrual function; young women to be +married in total ignorance of the ethics of married life; women to +become mothers without any conception of the duties of motherhood; +other women, as the time approaches, to live in dread apprehension of +"the change of life;" and many women unnecessarily to succumb to +disease at this time. + +The masses of women have at last awakened to a sense of the awful +penalties which they have paid for their ignorance of all those laws +of nature which govern their physical being, and to feel keenly the +necessity for instruction at least in the fundamental principles which +underlie the various epochs of their lives; and it is in response to a +widespread demand that this small volume has been written. + +This is preeminently the day of preventive medicine; and the physician +who can prevent the origin of disease is a greater benefactor than the +one who can lessen the mortality or suffering after the disease has +occurred. + + ANNA M. GALBRAITH. + +15 WEST NINETY-FIRST STREET, NEW YORK. + _________________________________________________________________ + + CONTENTS + _________________ + + INTRODUCTION + + EDUCATION AS THE CONTROLLING FACTOR IN THE PHYSICAL LIFE OF WOMAN + + Huxley's Definition of Education; the Correlation of Mind and Body; the + Emotional Nature; Age for Going to School; the Effect of the Study of the + Scientific Branches; Industrial Education + _________________ + + PART I.-- MAIDENHOOD + _________________________________________________________________ + + CHAPTER I. + + PUBERTY + + Sexual Development; Age of Puberty; Physical Changes at Puberty; First + Onset of Menstruation; Psychic Changes at Puberty + _________________________________________________________________ + + CHAPTER II. + + HYGIENE OF PUBERTY + + Home Life; Corsets; Shoes; Underwear; Nutrition; Diet; Water; + Constipation; School Life; Spinal Curvature; Exercise; Walking; Running + _________________________________________________________________ + + CHAPTER III. + + ANATOMY OF THE FEMALE GENERATIVE ORGANS + + The Vulva; the Hymen; Condition of the Hymen as a Proof of Virginity; the + Bladder; Vagina; Uterus; Respiratory Movements of the Uterus; Fallopian + Tubes; Ovaries + _________________________________________________________________ + + CHAPTER IV. + + PHYSIOLOGY OF THE FEMALE GENERATIVE ORGANS + + Ovulation; Etiology of Menstruation; Uterine Nerve-supply; the Function + of the Uterus; Stages of the Menstrual Cycle; Average Duration of the + Menstrual Flow; Character of the Flow; Relation of Ovulation to + Menstruation; the Menstrual Wave; Definition of Menstruation; Premonitory + Symptoms of the Flow; Hygiene of Menstruation + _________________________________________________________________ + + CHAPTER V. + + THE ANOMALIES OF MENSTRUATION + + Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea; Leucorrhea; + Pruritus Vulva + _________________________________________________________________ + + CHAPTER VI. + + THE MARRIAGE QUESTION + + Herbert Spencer's Definition of Love; What Constitutes a Suitable + Husband; Best Age for Marriage; Shall Cousins Marry? Contraindications to + Marriage; Do Reformed Profligates Make Good Husbands? the Proper Length + of Time for the Engagement; the Right Time of the Year to Marry; the + Selection of the Wedding Day + _________________ + + PART II.-- MARRIAGE + _________________________________________________________________ + + CHAPTER VII. + + THE ETHICS OF MARRIED LIFE + + The Wedding Journey; the Ethics of Married Life; Shall Husband and Wife + Occupy the Same Bed? the Consummation of Marriage; the Marital Relation; + Times when Marital Relations Should be Suspended + _________________________________________________________________ + + CHAPTER VIII. + + SEXUAL INSTINCT IN WOMEN + + Sexual Instinct in Women; Excessive Coitus; Causes of Sexual Excitability + _________________________________________________________________ + + CHAPTER IX. + + STERILITY + + Sterility; the Prevention of Conception and the Limitation of Offspring; + the Crime of Abortion; Infidelity in Women + _________________ + + PART III.-- MATERNITY + _________________________________________________________________ + + CHAPTER X. + + PREGNANCY + + Nature of Conception; Pregnancy Defined; Duration of Pregnancy; the Signs + of Pregnancy; Quickening; the Determination of Sex at Will; the Influence + of the Male Sexual Element on the Fernale Organism; Heredity; Hygiene of + Pregnancy; Causes of Miscarriage + _________________________________________________________________ + + CHAPTER XI. + + THE CONFINMENT + + Preparation for the Confinement; Signs of Approaching Labor; Symptoms of + Actual Labor; The Confinement-bed; the Process of Labor + _________________________________________________________________ + + CHAPTER XII. + + THE LYING-IN + + Management of the Lying-in; Lactation; Nursing + _________________________________________________________________ + + CHAPTER XIII. + + THE NEW-BORN INFANT + + The Infant's Toilet; the Crib; Feeding of Infants; the Wet-nurse; + Artificial Feeding; Characteristics of Healthy Infants; the Stools; + Constipation; Urination; Teething + _________________ + + PART IV.-- THE MENOPAUSE + _________________________________________________________________ + + CHAPTER XIV. + + THE MENOPAUSE + + Average Duration of the Menstrual Function; Duration of Menopause; the + Menopause; General Phenomena of the Menopause; Prominent Symptoms of + Menopause; Pathologic Conditions of Menopause; Hemorrhage at the + Menopause a Significant Symptom of Cancer; Causes of Suffering at + Menopause + _________________________________________________________________ + + CHAPTER XV. + + HYGIENE OF THE MENOPAUSE + + Diet; Constipation; Stimulants; the Kidneys; Skin; Turkish Baths; + Massage; Exercise; Profuse Menstruation; Hemorrhage; Mental Therapeutics + _________________________________________________________________ + + CHAPTER XVI. + + HINTS FOR HOME TREATMENT + + Indigestion; Constipation; Enemas; Diarrhea; Vaginal Douché, Baths; + Headache; Fainting; Hemorrhage + _________________ + + GLOSSARY + _________________ + + THE + +FOUR EPOCHS + + OF + + WOMAN'S LIFE + _________________ + +INTRODUCTION. + _________________ + + EDUCATION AS THE CONTROLLING FACTOR IN THE PHYSICAL LIFE OF WOMAN. + + Huxley's Definition of Education; the Correlation of Mind and Body; the + Emotional Nature; Age for Going to School; the Effect of the Study of + tuse Scientific Branches; Industrial Education. + + "What is man, + If his chief good, and market of his time, + Be but to sleep and feed? A beast; no more. + Sure, He that made us with such large discourse, + Looking before and after, gave us not + That capability and godlike reason + To fust in us unused." + + -- "Hamlet." + +THE word education is here used in its broadest sense, and is meant to +include the physical, mental, intellectual, and industrial. Huxley's +definition is as follows: "Education is the instruction of the +intellect in the laws of nature, under which I include not only things +and their forces, but men and their ways; and the fashioning of their +affections and of the will into an earnest and living desire to move +in harmony with these laws. That man, I think, has had a liberal +education who has been so trained in his youth that his body is the +ready servant of his will, and does with ease and pleasure all the +work that, as a mechanism, it is capable of; whose intellect is a +clear, cold, logic engine, to be turned to any kind of work, to spin +the gossamers as well as to forge the anchors of the mind; whose mind +is stored with the great and fundamental truths of nature and the laws +of her operations; one whose passions are trained to come to heel by a +vigorous will, the servant of a tender conscience; one who has learned +to love all beauty, whether of nature or of art, to hate all vileness, +and to respect others as himself." + +The Correlation of Mind and Body.-- It is of the utmost importance +that the mutual reaction of mind and body upon each other should be +thoroughly understood. This reaction is so constant, so intricate, and +so complex that it is at times difficult to say which is cause and +which effect. Does the depressed state of the mind cause the +indigestion, or is a torpid liver the real seat of the melancholia? + +The brain is the most delicately constructed organ in the entire body. +In the lower animals the brain is simply the great nerve-center which, +with its prolongation the spinal cord, presides over all the functions +of life which differentiate the animal from the vegetable. In the +human being the brain is much more highly developed and complicated; +and is, in addition, the seat of the mind, the intellect, and the +affections. Like all the other tissues of the body, the brain receives +its nourishment from the blood-vessels which pass through it, and its +healthy maintenance is in a direct ratio to the condition of its +blood-supply. + +A most interesting psychologic study is found in the case of cerebral +paralysis of young children, where there is mental defect amounting to +stupidity or imbecility, accompanied by extensive paralysis of the +body, so that the child is not able to sit up. With the gradual +improvement of the physical condition, so that the muscles become firm +and the child can sit, stand, and even walk, there is a corresponding +mental development; from being stupid and dull, the expression of the +face brightens and becomes intelligent; the child talks quite as well +as other children of its age, and sometimes becomes really +intellectually precocious. Here we see the development of the brain as +a direct result of the improved physical condition. In certain cases +of insanity, on the contrary, we find that the wasting away of the +body results from the disease of the brain, i. e., the disease of the +brain has wrought the wreck of the body. + +From these pathologic studies, or studies of how the diseased state of +the brain and body may be overcome by physical development, on the one +hand, and, on the other hand, how the healthy body may be wrecked by +disease of the brain, we will turn to a consideration of the effect of +the development of the mind and intellect upon the physical health. + +On a girl's entering Vassar College an exact and detailed physical +examination is made by the resident physician, a health record is kept +during her stay there, and at the time of her graduation a final +physical examination is made. As a result of these statistics Dr. +Thelberg says: "These statistics, now covering a number of years, show +that not only can girls profitably take a college education, that is +accomplished; but will prove that grave physical imperfections can be +corrected in the period between eighteen and twenty-two years of age, +coincidently with the development of the mind along the lines of +college work; the college work, if not excessive in amount, being a +real and most important factor in the physical development." + +But a still more striking proof can be cited of the beneficial result +of mental and intellectual occupation upon the bodily health. At +Vassar a great deal of attention is very properly paid to general +hygiene and the physical development, in addition to the natural +advantages of outdoor life in the country. + +Take, for example, a woman's medical college located in the city: the +four years' course places the greatest strain on both mind and body; +practically no time is left for recreation, and very much too little +time is spent in sleep; the amount of exercise taken is the minimum. +Yet in spite of all these disadvantages under which the young women +labor, a great many of them who enter far below par in health, or, +indeed, on the fair road to become chronic invalids, graduate very +greatly improved in health. + +The Emotional Nature.-- Formerly much more than now, owing to the +defective methods of her education and mode of life, the emotional +nature of woman was allowed to run riot. The child was coddled; the +girl was allowed to grow up without any of the discipline which young +men receive in their college and business life, and little or no +attention was paid to her physical development. The woman naturally +became a bundle of nerves, highly irritable, unreasonable, and +hysterical. All this reacted in the most detrimental manner upon her +physical health. + +The seed for much of this emotional hyperesthesia is sown in +childhood. From birth until the end of the eighth year should be one +grand holiday. During this time the child develops very rapidly, +especially during the first two years of life. And at the end of the +eighth year the brain has attained to within a few ounces of its full +weight. The muscular system has been developed together with the +coordination of motion. The child has learned to use a language fairly +well; she has developed an excellent memory and is most inquisitive +and acquisitive. + +Another method for undermining the healthy tone of the nervous system +is the intricate dances taught very young children and then placing +them on public exhibition, where they are wrought up to the highest +pitch. From a purely medical standpoint, children under eight years of +age should not be allowed to take dancing lessons. After this age a +moderate amount of dancing in a well-ventilated room is good exercise. + +Children's parties belong in the same category, and, on account of the +injurious effects on the nervous system, should be tabooed. They are +too exciting, and cause an overstimulation of the nervous system and a +precocious childhood and puberty. + +Instead of rearing an oversensitive hot - house plant that must be +fragile in the extreme, strive to rear a sturdy plant that can hold +its own amid the storms. The child should spend as much of its life as +possible in the open air, and in the warm months live out-of-doors. +City children should be taken to the seashore or country to spend +several months every summer. Together with outdoor sports, gymnastics +adapted to the age of the child should be begun early and continued +throughout life. Good muscular development is attended with good +digestion and a well-balanced nervous system. + +Until after the twelfth year there should be absolutely no difference +between the physical, mental, or industrial education of girls and +boys. And, still further, they should be encouraged to have their +sports together; this will improve the girls physically and broaden +them mentally, and will do a great deal to take the rough edges off +the boys. After this age it will be wise to allow slight barriers to +grow up, without calling the attention of any one to the fact, that +will cause the companionship to be less free and unrestrained. + +Age for Going to School.-- Although the child may be allowed to go to +kindergarten long before this time, it should not be allowed to enter +the school-room before eight years of age. And from eight to twelve +years, not more than four hours a day should be spent in study. After +this time it may be put down more closely to intellectual work; but no +more mental work should be required than will enable the girl to enter +college at eighteen. And eighteen years of age is as young as any girl +should be allowed to go to college; after this age the mind is more +matured and acquires knowledge more easily than before, while the +development of the body is less rapid. The physical system has become +more stable. The literature indulged in by girls under eighteen years +of age should be most carefully selected. + +The Effect of the Study of the Scientific Branches.-- A knowledge of +the laws of nature is essential to health; hence the necessity for the +study of the natural sciences-- anatomy, physiology, chemistry, +physics, and zoology. Aside from the intrinsic value of this +knowledge, it is almost universally conceded that these studies +develop the judgment; and no one will have the temerity to deny that a +lack of judgment must undermine the health as well as the success and +happiness of the individual. + +Industrial Education.-- When it is considered how intimate are the +relations between the physical and the psychic states, and how often +the psychic condition leads to actual disease, and that often of the +most incurable type, it needs no demonstration that a mental +occupation which will take the woman out of herself is a physical +necessity. Therefore when the girl has reached the subjective limit of +her intellectual education,-- that is, when she has reached the limit +of her capacity or taste,-- it is essential to her physical well-being +that she should turn her attention to some industrial occupation. This +may be housekeeping or any other occupation for which she has taste or +talent. A healthy mental occupation is an absolute necessity to +prevent the individual from becoming self-centered. And to become +self-centered is the first step on the certain road to chronic +invalidism. + +A most important part of an education is the knowledge of how to +procure the most perfect development of the body possible, and how to +maintain the health. This has not been touched upon here, since the +outlines for the general physical education have already been given in +"Hygiene and Physical Culture for Women,"* and the present volume +concerns itself only with the four critical epochs of woman's life. + +* By Anna M. Galbraith, M. D.; published by Dodd, Mead & Co. + +With this broad view of an education, as a means to procure the best +physique possible; a mind disciplined to meet to the greatest +advantage all the vicissitudes of life; an intellect developed along +the lines of its greatest possibilities; and an occupation chosen in +accordance with the tastes and talents of the individual; it becomes +an incontrovertible fact that the education is the controlling factor +in the physical life of every woman. + _________________________________________________________________ + + "Be not simply good; be good for something." + + THOREAU. + _________________ + + PART I.-- MAIDENHOOD. + _________________ + + CHAPTER I. + + PUBERTY. + + Sexual Development; Age of Puberty; Physical Changes at Puberty; First + Onset of Menstruation; Psychic Changes at Puberty. + + "Self-reverence, self-knowledge, self-control, + These three alone lead life to sovereign power." + + -- "OEnone." + +Sexual Development.-- Sexual development goes on during all the years +of childhood, but is not complete in the female sex until between the +twenty-second and the twenty-fifth year. If the child has no inherited +taint, and has been properly educated morally, physically, and +intellectually, it must follow that the structural development of the +pelvic organs has been normal; and normal organs always perform their +functions perfectly. + +The commencement of the ovarian function does not cause any more +profound change in the system and habits than does dentition. The +various epochs of life are generally spoken of as if they were +paroxysmal-- as though they were separated by some tremendous chasm, +which had to be leapt over or fallen into. Nature makes no such +egregious blunders; preparations for every change in life have been +going on for a very long time before the evidences of such change +become manifest. + +In a healthy girl the psychic and physical changes incident to puberty +occur so gradually as to escape the girl's own notice. The first and, +if the girl has not been properly prepared for it, always startling +change is the appearance of the menstrual flow. The mother who has not +told her daughter of this coming change in her life before it is due +has committed a serious error; it is no uncommon occurrence for girls +who know nothing of this function to get into a tub of cold water to +stop the flow; and if they stay in long enough, it generally does +stop, and the girl's health may be ruined for life. + +The opinion of Dr. Ely van de Warker is that "if healthy ovulation is +the outcome of healthy childhood, the function will obey the law of +periodicity year by year, and all this time the young woman will be +able to sustain uninterrupted physical and intellectual work as well +as the young man. Not that the laws of health may be violated with +impunity at puberty or any other time of a woman's life; but a law of +health is no more binding upon a young woman than it is upon a young +man; and there really is no such thing as one law for women and +another for men." + +Age of Puberty.-- In the temperate regions the age of puberty is +reached between the ages of twelve and fourteen years. The girl is +then said to be nubile; that is, as soon as menstruation appears it is +possible for her to bear children; but she is by no means sufficiently +developed to do so, as she herself will not be completely developed +physically or mentally before the age of twenty-two or twenty-five +years. + +Physical Changes at Puberty.-- The physical changes that gradually +take place, beginning at the time of puberty, are: the breasts, +pelvis, and neck enlarge; hair develops over the pubis and in the +arm-pits; the voice alters. As a rule, women continue to grow in +stature until the twenty-fifth year. It is said that brunettes develop +sooner than blondes, and that large women develop more slowly than +women of small stature; city girls develop younger than girls brought +up in the country. Whatever stimulates the emotions causes a premature +development of the sexual organs; as children's parties, late hours, +sensational novels, loose stories, the drama and the ball-room, talk +of beaux, of love and marriage, and children being surrounded with the +atmosphere of riper years. It is generally believed that early +stimulation of the sexual instincts leads to the premature +establishment of puberty, as do also spiced foods and alcoholic +beverages. + +First Onset of Menstruation.-- Sometimes the first menstrual discharge +appears suddenly, lasts for a few days, and then stops; it may appear +after an interval of two or three weeks, or not for several months. If +for several months the flow appears at the regular time, and the +quantity is about the same as the first, the menstrual habit may be +said to be established. The mode of onset varies considerably within +the limits of health. So long as the general health remains good, no +anxiety need be felt in regard to the establishment of the menstrual +function. + +In other cases there may be a discharge of blood at the first period, +and none afterward for several months; in other words, menstruation +may be established suddenly, intermittently, or gradually. It must be +remembered that certain pathologic conditions cause many disturbances +connected with the onset of puberty. + +Psychic Changes at Puberty.-- The angular, gawky feeling gradually +disappears; the girl becomes self-conscious; new impulses arise, and +she gives up many of the hoydenish ways of childhood. The girl's +imagination is more lively, and just at this time mathematics form an +excellent subject for mental occupation. The girl now begins to +question the whys and wherefores, and demands reasons for the course +that is laid out for her, and is full of ideas of her own; so that +while as a child she had accepted almost unquestioningly the commands +of her parents, she can be managed now only through the power of +reason. And this is just as it should be, for the girl has reached the +years of discretion, and now is the time when her reason and judgment +are capable of rapid cultivation. + + CHAPTER II. + + HYGIENE OF PUBERTY. + + Home Life; Corsets; Shoes; Underwear; Nutrition; Diet; Water; + Constipation; School Life; Spinal Curvature; Exercise; Walking; Running. + + "Every man is the architect of his own fortune." + + PSEUDO-SALLUST. + +Home Life.-- With beginning menstruation the equilibrium of the body +is very easily disturbed, so that even in the case of the healthy girl +some precautions should be taken and a rational regime should be +adhered to; while in the case of the delicate girl a still more +careful attention will have to be directed toward her weak points, in +order that she may develop into a healthy woman. + +For every girl at this time of life home is preeminently the place; so +that she may not only have the benefit of a mother's watchful care, +but also lead a life as free from conventionalities and as much in the +open air as possible. No girl should be sent away to school at this +period of rapid growth and development; nor should girls of the +working classes, when it can possibly be avoided, be sent out to fill +positions as clerks in illy ventilated stores, in factories, or as +domestics. If a girl can be kept at home until she is eighteen years +old, she will be a much stronger, healthier woman than would otherwise +be possible. + +Corsets.-- At this period of life it is particularly necessary that +the clothing should be warm and at the same time sufficiently loose to +prevent the constriction of any part of the body. And whatever the +adult woman may elect to do in the matter of wearing corsets herself, +she does her young daughter an irreparable injury by constricting and +moulding her growing body in these corset-splints. Corsets placed on +the young girl interfere with the functions of circulation, +respiration, digestion, and of the pelvic organs, also with muscular +development. In addition to all this, the girl is handicapped in +taking all outdoor exercises and athletic sports. + +The lungs, heart, and great blood-vessels are placed in and completely +fill an air-tight, distensiblecage, which is most distensible at its +base. + +The least chest girth of the adult woman-- that is, the under-arm +girth around the chest-- that is consistent with health is +twenty-eight inches; and this girth must be enlarged three inches in +forced inspiration. In ordinary respiration the waist expansion should +be one-half to one inch, while during great muscular activity it +should be from one and a half to three or four inches. One-third of +the lungs lie below the point of beginning corset pressure, so that +with tight corsets this amount of lung substance must be more or less +useless. + +It is self-evident that any restriction placed about the waist, by +preventing the full expansion of the ribs and the descent of the +diaphragm, will further embarrass the heart's action by diminishing +the amount of room it has to work in, at the same time that it +diminishes the amount of oxygen which is inspired. Fresh air is by far +the most important part of the daily food. It is in the lungs that the +blood throws off its carbonic acid and other impurities; but it is +able to do this only when the lungs are supplied with an abundance of +oxygen. Every inch which a woman adds to her chest measure adds to the +measure of her days. + +Great physical injury has followed women playing lawn-tennis while +tightly corseted. And although dancing is a much milder exercise, +since it frequently takes place in an overheated and poorly ventilated +room, fatal results occasionally occur from the same cause. + +Standing erect calls into action almost all the muscles of the trunk, +neck, and lower extremities. So long as the line of gravity falls +within the area of the feet, the muscular effort required is so slight +that it is little more than the tonicity contained in all living +muscle. The greater the displacement of the line of gravity, the +greater the muscular effort required to maintain the equilibrium of +the body. Up to a certain extent, exercising the muscle develops the +strength and size of the muscle. On the other hand, when a muscle +within the body is unused, it wastes; when used within certain limits, +it grows. But when the corset splint is applied to the body of the +young girl, it supplants the functions of the abdominal and back +muscles, which is to hold the trunk erect, and these muscles gradually +grow weak and waste. And so the liability to the various spinal +curvatures is increased. + +The original object of the corset was to give greater prominence to +the hips and abdomen. But fashions change! In "the French figure" or +straight-front corset now in vogue the pelvis is tilted forward, +producing a sinking in of the abdomen and a marked prominence of the +hips and sacrum, necessitating a compensatory curve of the spine which +increases the curvature forward at the small of the back-- a deformity +which, a few years ago, women were going to orthopedic surgeons to +have corrected. In this attitude the line passing through the centre +of gravity strikes the heels, the knees are hyper-extended, and the +muscles of the calves and thighs are rendered tense. + +By interfering with the muscular development and digestion, the girl +is very apt to become angular, flat-chested, anemic, and to have a +muddy complexion. And so the corset really defeats the object for +which it was put on-- that of giving the girl a good figure and +enhancing her beauty. + +There is no objection to girls wearing any of the various forms of +hygienic waists now on the market. + +Shoes.-- The feet are the part of the body to come in contact with the +greatest degree of cold, whether on the floor of the house or the +pavement of the street. Hence it is a matter of prime importance to +the entire body that the feet should be properly clad. + +The thick-soled, flat-heeled shoes which became popular with bicycling +and golf are most hygienic, and it is highly desirable that this style +of shoe should be adhered to for outdoor exercise. + +Underwear.-- In our cold and changeable climate the most suitable +undergarment is the "combination" woolen undersuit, which reaches from +neck to ankles and has long sleeves. Much greater warmth is afforded +when the undersuit is moderately tight fitting. Such a suit should be +worn the entire year, the grade of weight being adapted to the season. + +Nutrition.-- The nutrition of the body is dependent on the food +supply, digestion and excretion. The growing girl should eat more than +the adult woman, because of her more active life and of the fact that +the food which she takes must not only replace the worn-out material +of the body, but also provide new material needed for growth. +Insufficient food and food of defective quality and composition work +proportionately for more harm during the growing age. + +The full adult weight is not attained before the twenty-fifth year. +When the final growth of the body and development of the vital organs +is completed, the function of food is simply to replace waste with new +material and to furnish material for the development of force. + +Diet.-- The diet should be a mixed one, consisting of the various +kinds of fresh meats, fish, milk, eggs, poultry, vegetables, fruit, +and fat in the shape of cream, butter, and the fat of beef and mutton. +Animal food improves the condition of the muscles, which are made +firmer than they would be through a vegetable diet. Meat in general +has a more stimulating effect upon the system and is more +strengthening than vegetable food, and it gives rise to a sensation of +energy and activity. The common estimate is that meat should occupy +one-fourth and vegetable food three-fourths of a mixed diet. + +Common salt in moderate quantity is essential, but all highly spiced +or seasoned foods should be avoided, also pickles and vinegar. All +"sweets" are harmful, because they destroy the appetite for other +things and upset the digestion. Tea and coffee should be tabooed, as +well as all alcoholic beverages. + +Good digestion depends for the most part on serving the meals at the +same hour every day, eating leisurely, and masticating the food well. +There is a great tendency on the part of the school girl to sleep late +in the morning, then "bolt" her breakfast in order to get to school in +time. Nothing could be more pernicious to the digestion, unless it is +the eternal nibbling of candy. + +A healthy girl needs nothing between meals. A delicate girl will be +the better for a glass of milk in the middle of the morning and at +bed-time; or pure beef juice may be given instead. + +Water.-- Water is needed to keep the kidneys properly flushed. The +amount of urine secreted during the twenty-four hours should be three +pints. Of course it will be less than this if the quantity of water is +insufficient. In addition to the urine about ten ounces of water are +lost from the surface of the lungs, and eighteen ounces from the skin, +making a total of about five pints; and this quantity of water must be +taken daily in order to maintain the equilibrium of the body. The +solid food of a mixed diet contains from fifty to sixty per cent. of +water, so that about twenty-five ounces of water are taken into the +system daily as an integral part of the food. In addition, three pints +more should be taken as plain water. The bladder acts as a reservoir +for the urine, and should be emptied at least three or four times a +day. + +Constipation.-- In order to keep the digestive system in good +condition, the refuse matter which collects in the lower bowel must be +evacuated every day. And in order to secure this regular bowel +movement, regularity in the time of going to the toilet is a prime +necessity. And now is the time when the habits of a lifetime are being +formed. If a tendency to constipation exists, it can almost always be +overcome by increasing the amount of fruit and vegetables eaten, also +by eating cracked wheat, oatmeal, corn and graham bread; all of which +increase the peristaltic action of the intestines. The small amount of +water taken by girls and women is another fertile source of +constipation. + +School Life.-- When it is considered that fully one-half of the girl's +waking hours are spent in school or in study preparing for school, it +becomes evident that the girl's attitude at her desk should be the +correct one. The malpositions at the desk are the most frequent cause +of lateral curvatures, round shoulders, and flat chests. And these +deformities are more common in girls than they are in boys. + +The common faults of the desk and seat leading to these malpositions +are unsuitable shape of the back of the seat, too great a distance +between the seat and the desk, and the incorrect slope of the desk. + +The edge of the desk should slightly project over the edge of the +chair. The top of the desk should incline downward about ten degrees +toward the student, and be low enough to allow the forearm to rest on +it without raising the shoulder. The seat should be sufficiently deep +to support almost the entire thigh, and close enough to the floor to +allow the soles of the feet to rest firmly on it. The back of the +chair should be arched so as to support the hollow of the back, and +should reach just above the lower part of the shoulder-blades, and so +make it easy and comfortable for even a weakly child to sit upright. + +If the seat is too high, the feet do not rest on the floor, and so the +girl does not get the proper aid from the legs and feet to maintain an +erect position. If the desk is too high, the elbow can rest on it only +by curving the spine and raising the shoulder. The work is brought too +close to the eyes and causes extra strain. If the desk is too low, the +child stoops over it and becomes round-shouldered, and there is a +tendency to become short-sighted. + +The pupil should sit erect with the weight equally borne by both +buttocks; the legs should be straight before the trunk, and the feet +firmly resting on the floor. The book should be held about twelve +inches from the eyes. + +Spinal Curvatures.-- It should be distinctly borne in mind that +lateral curvature of the spine is a distortion of growth. The +deformity appears and is developed during the growing years. It is +more common in girls than in boys, for two reasons: that at the age +when lateral curvature is first seen, girls grow more rapidly than +boys; and their muscular system is less well developed. + +In most early cases the faulty attitudes are clearly the result of +muscular weakness. The growth in size has not been accompanied by a +corresponding development of the muscles. This condition is most +frequently met with in rapidly growing girls, and it is one of the +most common causes of lateral curvature. In these cases proper +gymnastics are indicated, but they should be prescribed and carried +out with much care. + +It is upon the erectness, suppleness, and strength of the spinal +column that most of the power and grace of the body depend. + +Lack of ventilation is a fertile cause of headache, anemia (or an +impoverished condition of the blood in iron and oxygen), and +dyspepsia. All these are rare before but common after twelve years of +age. + +Exercise.-- In physical culture the object aimed at should be the +symmetrical development of all the muscles of the body. Hence the +necessity for bringing every individual muscle into play, at first for +its development, and later for its maintenance. + +The tendency of almost all forms of exercise is to develop some +portion of the body at the expense of the rest. The most perfect form +of exercise is therefore that one which will most nearly call into +play all the muscles of the body. + +Walking.-- Walking is the only form of exercise which may be said to +be universal. In walking the muscles of the chest get little exercise, +and those of the spine and abdomen even less. In walking the arms +should swing easily at the sides, both from a physiological and an +esthetic point of view. If the girl is weak or is unaccustomed to take +any exercise, the guide for the amount of exercise taken at any one +time must be this: At the first sense of fatigue, stop at once and +rest, otherwise positive harm instead of good may be accomplished. The +girl who depends on walking for her outdoor exercise should walk at +least three miles every day, and walk at the rate of three miles an +hour. + +After acquiring as great a walking speed as is consistent with a +graceful and easy carriage, the running exercise should be begun, +gradually increasing the distance, but not the rate of speed. + +In exercising, all tight clothing about the neck, chest, and waist +must be removed. Pure air and full breathing are required during and +after exercise. Full breathing not only promotes the change of air in +the lungs, but also quickens the functions of the circulation and +digestion. Eating must be avoided shortly before or shortly after any +considerable exercise, as it impairs digestion. + +Running.-- Running is the best exercise for developing the breathing +capacity. While brisk walking is allowable, fast running is not. The +rule for running is to begin slowly, run moderately for perhaps fifty +feet, then increase the speed gradually; but in running for exercise, +never speed to the utmost. A five-mile gait is quite sufficient. The +run should be closed with the same moderation with which it was begun, +and the girl should never stop short, as this sudden arrest of action +gives a most undesirable shock to the heart. + +In beginning to take any form of exercise the intensity and duration +of the movements practiced must be increased very gradually, or +positive harm instead of good will be done. As soon as fatigue is +appreciable, the exercise should be discontinued and at once be +followed by complete rest. Rapid respiration, palpitation or +dizziness, headache, the face becoming pale or pinched or flushing +suddenly, a feeling of great heat or excessive perspiration, are all +danger signals showing that the exercise has already been carried too +far and should cease at once. Continued over-exertion carried to a +point of exhaustion leads to an obstinate irritability of the heart as +well as to organic lesions. + +Mountain-climbing, rowing, and bicycling call into play almost all the +muscles of the body. Of all the outdoor exercises for girls, swimming +is one of the most perfect. It not only calls into vigorous action +most of the muscles of the body, but spares many of those muscles that +are so commonly overworked, the most of the work being performed by +muscles that are so little used as to have become flabby and weak. + +Swimming and sea-bathing must be avoided by girls who have weak hearts +and in whom the reaction after a plunge into cold water is never +established; also by girls with heart disease or kidney disease. + +The principal outdoor games are croquet, archery, golf, tennis, +cricket, foot-ball, and base-ball. Of these, croquet is the mildest, +and is for that reason a good beginning exercise. Croquet, archery, +golf, and tennis are all defective in that they cause a greater +development of the right than of the left side of the body. + +As the greater majority of these outdoor exercises can only be +indulged in for seven months of the year, they should be supplemented +by exercises in the gymnasium for the remaining five winter months. + +There should be the greatest variety possible in the kinds of exercise +taken, not only to develop the body symmetrically, so as to obtain +strength, vigor, grace, celerity, and accuracy of movement, but also +because there is no such potent cause of fatigue as monotonous +repetition of the same act, whether physical or mental. + +It has been repeatedly proven that physical deterioration can be +overcome by exercise, and that by so doing the mental capacity is +greatly increased. + + CHAPTER III. + + ANATOMY OF THE GENERATIVE ORGANS. + + The Vulva; the Hymen; Condition, of the Hymen as a Proof of Virginity; + the Bladder; Vagina; Uterus; Respiratory Movements of the Uterus; + Fallopian Tubes; Ovaries. + + "He that respects himself is safe from others; + He wears a coat of mail that none can pierce." + + -- LONGFELLOW. + +The Vulva.-- The female generative organs consist of three groups-- +the external, the intermediate, and the internal. The vulva, or +external generative organs, comprises all those organs which are +external to the body. + +The vulva is pierced by two openings, the smallest and most anterior +of which is the external opening of the urethra, or excretory duct of +the bladder. This opening is surrounded by a slight eminence and has a +somewhat puckered aspect. + +The larger opening is the vaginal orifice. In the virgin this is +partially closed by the hymen. About one inch back of this is the +anus, or the external orifice of the large bowel. This part of the +bowel is known as the rectum. + +The Hymen.-- The hymen consists of a thin duplicature of mucous +membrane strengthened by fibrous tissue, and is stretched across the +posterior part of the vaginal orifice, which it partly occludes. +Rupture of the hymen usually, but not always, occurs during the first +sexual intercourse. In rare cases it is found intact at the time of +the birth of the first child. In women who have borne children the +vaginal orifice is surrounded by small irregular elevations; these are +the remains of the ruptured hymen, but are usually present only after +labor has taken place, since the torn hymen is converted into +eminences as the result of the pressure incident to child-bearing, and +not to coitus. + +The Condition of the Hymen as a Proof of Virginity.-- Formerly much +stress was laid on the condition of the hymen as a proof of virginity. +The hymen tightly closed, barely admitting the tip of a small +index-finger, is positive evidence of virginity. But the hymen may +lose its tone by a local catarrhal condition or by a general muscular +relaxation; it may then become so relaxed that the only positive +evidence rendered by the intact hymen is that the woman has not borne +a child. + +In a paper on the preservation of the hymen, Dr. Hannah M. Thompson +writes: "Further, if the hymen was intended as a guarantee of moral +character, and for moral protection, either of man or woman, would we +not have some reason for reflecting on the wisdom and righteousness of +a Creator who has failed to make equal provision, and to give a like +guarantee of an uncorrupted manhood? As physicians, we know too well +that where one woman enters the marriage relation tainted in body +there are thousands of men reeking with disease; and there is no +demonstrable test to distinguish these, no proof for the young woman +of the virginity or virtue of the young man." + +The Bladder.-- The female bladder is relatively broad and capacious, +and is also highly distensible. When the bladder is allowed to become +overdistended, it is carried backward and tends to cause a backward +displacement of the uterus. The urethra, or excretory duct of the +bladder, is about an inch and a half long, and lies firmly imbedded in +the anterior vaginal wall. + +The Vagina.-- The intermediate organ is the vagina. This is a +musculo-membranous canal which connects the external with the internal +organs of generation. The vagina lies in relation with the bladder and +the urethra in front, and with the rectum behind. The vagina is +sufficiently distensible to allow of the passage of so large a body as +the child. + +The Uterus.-- The internal organs of generation are the uterus, the +ovaries, and the Fallopian tubes. Of these, the ovaries and the uterus +are the essential female organs of generation. The virgin uterus is a +small, hollow, muscular organ, somewhat pear-shaped, whose cavity is +about one and a half inches deep. The uterus is divided by a natural +constriction into a body and a neck. The neck, or cervix, is somewhat +spindle-shaped, and has a canal running through its center which opens +by a small aperture-- the so-called external orifice,-- into the +vagina. In the virgin uterus the apposition of the anterior and +posterior walls reduces the cavity to little more than a longitudinal +cleft. With the advent of old age the whole organ suffers marked +atrophy. + +The uterus is situated in the middle of the pelvic cavity, between the +bladder and the lower bowel. It is held in place by broad elastic +bands which go to different sides of the pelvis; it is also in part +supported by the structures below and above it. But so loosely is the +uterus held that it is easily pushed about-- as, for instance, by a +full bladder or a packed bowel. And persistently allowing the bladder +to become overfull, and failure to have a daily evacuation of the +bowels, are prolific sources of displacements of the womb. + +Respiratory Movements of the Uterus.-- When no constrictions are +placed about the waist, the uterus moves freely up and down with every +respiration. So distinctly and with such regularity do these movements +take place that an operator by watching the movements of the uterus +can tell the effect that the anesthetic is having on the patient's +breathing. These so-called respiratory movements play a very important +role in the circulation of the uterus, and in the return of the venous +blood to the heart. + +Anything which interferes with these movements, as the use of corsets, +or of tight bands around the waist, prevents the free return of the +venous blood. The uterus becomes congested, and through the constant +abnormal weight of the organ itself, as well as the pressing down upon +it from above of the superincumbent organs, the uterus is pushed down +below its normal position, the ligaments whose duty it is to hold it +up become relaxed, and the unhappy woman suffers all the agonies that +are attendant on the "falling of the womb." For this reason the +disorder is frequently met with in women who have never borne children +as well as in those who have. + +The Fallopian Tubes.-- The Fallopian tubes extend from the upper, +rounded angles of the uterus, within and along the free margin of the +broad ligaments, for a distance of about two inches, to the vicinity +of the ovaries, where each one terminates in a funnel-shaped orifice +surrounded by a series of fringed processes. The lumen of the tube is +narrowest at its inner end, where it opens into the cavity of the +uterus by a minute orifice which scarcely admits a bristle; the +diameter of the canal gradually increases until it reaches its ovarian +extremity. The mucous lining of the tube is clothed by a single layer +of hair-like epithelium, whose current sweeps from the ovarian toward +the uterine end of the tube; and it is these movements which propel +the ovum from the ovary to the uterus. + +The Ovaries.-- The ovaries are two small bodies of an almond shape, +and lie on either side of the uterus. The bulk of the entire organ +consists of connective tissue, in which lie imbedded the Graafian +follicles or ovisacs, in which the ova are contained. These follicles +or ovisacs are minute cells which are packed immediately beneath the +surface, where they occur in all stages of development. With the +increase in size which accompanies their development the follicles +pass toward the surface, where they form a distinct projection, and at +this point will occur the final rupture of the sac and the escape of +the ovum. It is supposed that the ovum is grasped by the fringe-like +extremity of the Fallopian tube and is carried through it by the +movements of the ciliary epithelium to the uterus. + +The formation of new follicles continues only for a short time after +birth, when the Graafian follicles are the most numerous; the entire +number contained within the ovaries of the child being estimated at +over 70,000. In view of the unquestionably large number of follicles +in very young ovaries, and the relatively small number of ova which +reach maturity, the degeneration of many follicles after reaching a +certain degree of development seems certain. + + CHAPTER IV. + + PHYSIOLOGY OF THE FEMALE GENERATIVE ORGANS. + + Ovulation; Etiology of Menstruation; Uterine Nerve-supply; the Function + of the Uterus; Stages of the Menstrual Cycle; Average Duration of the + Menstrual Flow; Character of tahe Flow; Relation of Ovulation to + Menstruation; the Menstrual Wave; Definition of Menstruation; Premomitory + Symptoms of the Flow; Hygiene of Menstruution. + + "Toil and grow strong; by toil the flaccid nerves + Grow firm, and gain a more compacted tone." + + -- ARMSTRONG. + +Ovulation.-- At birth the formation of the ova is nearly completed; +the production of' new cells probably ceases after the second year. +The ovaries of the child of two years contain, therefore, the full +quota of ova, although the vast majority of these cells always remain +immature and undeveloped. While it is probable that a variable number +of the immature ova undergo partial development before puberty, yet +the advent of sexual maturity at that time marks the establishment of +the regular development of the Graafian follicles and their contained +ova, accompanied by the attendant phenomena of menstruation. + +During the entire child-bearing period, or from about the age of +fifteen to forty-five years, the development of the Graafian follicles +and the discharge of the ova are continually taking place. The +liberation of the ova usually takes place at definite times, which in +general coincide with the menstrual epochs, one or more ova being set +free at each period; but this is by no means invariable. + +The ripe human ovum or germ cell is a spheric cell, about 0.2 mm. in +diameter, consisting of granular protoplasm, in which lies a nucleus +which contains the germinal spot. The proper cell-wall is a structure +of great delicacy, outside of which is a secondary envelope. + +Menstruation.-- The etiology of menstruation has been variously +explained at different epochs. The chief theories have been that of +plethora, and the ovulation, the tubal, and the nerve theories. + +First, the Theory of Plethora.-- From the time of Hippocrates to 1835 +the theory prevailed that in the female body the formation of blood is +sufficiently rich to provide every four weeks for an overflow of the +same, the evacuation of which becomes a necessity. It was believed +that this excess of blood depended on an excess of formative power in +the woman. + +Second, the Ovulation Theory.-- This was distinctly formulated about +1845. It construed the menstrual hemorrhage as a subsidiary +phenomenon, entirely dependent on the periodic dehiscence of ovules. +The changes supposed to take place in the Graafian follicles at each +menstrual period were believed to involve a peculiar expenditure of +nerve force, which was so much dead loss to the individual life of the +woman. The growth of the Graafian vesicle and its contained ovum was +supposed to cause an irritation of the nerves of the ovary, which was +reflected to the entire nervous system. The gradual accumulation of +this irritation finally caused a reflex action which determined an +afflux of blood to the uterus and ovaries, which constitutes the +catamenial flow. + +The ovulation theory was refuted by the following facts: Ovulation may +and does occur without menstruation; women who have never menstruated +may conceive; conception may occur during lactation, without the +menses having returned since the last parturition; children at birth +have many ovules contained within the ovaries; ovulation may persist +for a time after the menopause, and even pregnancy has occurred, +although very rarely after this time; the menses may continue +regularly after the removal of the ovaries and Fallopian tubes; this +is exceptional, and, as a rule, the periods only continue for two or +three years at longest. + +Third, the Tubal Theory.-- Lawson Tait thought that thorough removal +of the tubes was far more essential in determining the menopause, and +that cases of periodically recurring hemorrhage after the removal of +the ovaries were to be explained by the fact that the tubes had not +been sufficiently removed. As an anatomic and surgical fact, the tubes +can never be wholly excised unless the upper part of the uterus is +also amputated. + +Fourth, the Nerve Theory of Menstruation.-- This is based upon the +following views: + +1. That menstruation is a process directly controlled by a +nerve-center situated in the lumbar region of the spinal cord. + +2. That the menstrual impulses reach the uterus through two sets of +nerves. + +3. That menstruation is the result of nerve irritation, vascular +congestion, and the subsequent relief of these by hemorrhagic +discharges. + +4. That hemorrhage from the uterus is the result either of a local +uterine condition, or of influences outside of the uterus acting +directly on the center. + +5. That the removal of the appendages arrests menstruation by +preventing the propagation of uterine influences to the center. + +Uterine Nerve Supply.-- One set of nerves causes contraction of the +muscular fibers of the uterus, while the other set transmits impulses +which bring about its vascular engorgement; and they are probably +concerned in bringing about the determination of blood to the uterus +and its appendages, which is so marked a feature of the menstrual +process. + +As the result of long-continued investigation, Johnstone has come to +the conclusion that the lining membrane of the uterus belongs to that +class of organs whose function it is to replace organic waste. +"Menstruation is a periodic wasting away of those corpuscles that are +too old to make a placenta." He has further found that, as compared +with the uteri of very many of the lower animals, the human uterus is +very scantily supplied with lymphatics, and the only way to rid the +uterus of the overripe, and therefore consequently useless, tissue is +to wash it out through the vagina by a blood-stream. The tough wall of +the human uterus and the increased blood-pressure caused by the erect +position cause the difference between menstruation in the human female +and rut in the lower animals. + +The strong light of recent investigations has necessitated the laying +aside of many time-honored theories; and as the close of the +nineteenth century has seen the emancipation of the uterus from the +thralldom of the ovary, so we may believe that the twentieth century +will find women of such fine physique as to prove the error of the +popular fallacy that the cause of woman's weakness lies in the +performance of her functions. + +The Function of the Uterus.-- The function of the uterus is to provide +a favorable place for the reception of the product of conception, +where it may be protected and nourished during the period of its +development. The purpose of menstruation is to keep the uterus in +suitable condition for the reception of this product of conception at +any time. It is now known that the menstrual flow is not the whole of +menstruation, and that the changes going on in the uterus are almost +as continuous as the process of digestion. The whole of the +reproductive life of woman has been divided into cycles of +twenty-eight days each; these cycles have been divided into four +stages. + +Stages of the Menstrual Cycle.-- The first or constructive stage is +one of preparation for the reception of the ovum. During this stage +the preparing of a decidua takes place, or building a nest for the +expected egg; there is a swelling of the mucous membrane, an +enlargement of the uterine glands, and an increase in the connective +tissue. It is thought that this stage lasts for one week; when +pregnancy does not occur, it is followed by degenerative changes. + +The second or destructive stage is marked by destructive changes which +give rise to the usual phenomena of the menstrual period; there is a +discharge of blood, mucus, and disintegrated mucous membrane. The +actively growing cells of the uterine lining membrane undergo rapid +destructive changes, the fabric of the half-formed decidua tumbles to +pieces, the turgid capillaries burst and pour out the menstrual flow, +which sweeps away all the useless debris. The irritation sets up +reflex uterine contractions, and so the blood is squeezed out of the +distended capillaries and washes away the degenerated cells. + +The third or reparative stage, as its name indicates, is one of +repair, in which by constructive changes the epithelial lining which +was thrown off is replaced by new, which is formed in from three to +four days. + +The fourth or quiescent stage includes the remaining twelve or +fourteen days of the menstrual cycle, and represents the quiescent +period prior to the initiative changes which mark the beginning of the +next period. + +Average Duration of the Menstrual Flow.-- The average duration of the +menstrual flow is five days, although the variations are considerable +in healthy women. A flow lasting any place from two to six days is +perfectly consistent with health; but a flow continuing less than two +or more than six days generally indicates local or general disease. + +Character of the Menstrual Flow.-- For the first few hours, or perhaps +for the first day, the flow is usually slight in quantity and light in +color; on the second and third days the flow reaches its height, and +is profuse and dark, but it should never be clotted; after this it +gradually ceases. The amount of the flow varies from five to ten +ounces. If less than five or six or more than eighteen napkins are +pretty well saturated through, the amount may be considered abnormal. + +Relation of Ovulation to Menstruation.-- It has not yet been decided +just in what relation the processes of ovulation and menstruation +stand to each other. It is supposed that the transit of the ovum to +the uterus occupies at least one week. It has been thought that the +decidua of a particular menstrual period is related, not to the ovum +discharged at that period, but to the ovum discharged at the preceding +period. + +The menstrual wave, or the wave of "supplementary nutrition,"[*] upon +which the menstrual process ultimately depends, was first established +by Dr. Mary Putnam Jacobi in the Boylston prize essay for 1876; +showing that menstrual life is associated with a wave of well-marked +vital energy, which manifests itself in a monthly fluctuation of the +tempera ture of the body, in the daily amount of the excretion of urea +and of carbonic acid, and of the rate and tension of the pulse. The +wave attains its maximum during the week preceding menstruation, and +slowly falls to its minimum, which is reached the week after +menstruation. + +* Dr. Goodman and Dr. Stephenson have since written on this subject, +and the "wave" is often known as the Stephenson wave. + +This wave indicates a periodic variation in the bodily metabolism, and +is probably directly influenced by the rhythmic activity of the +menstrual center. This observation would seem to be nullified by the +fact that the phenomena referred to have been found to occur in men as +well as in women; and that the lower animals also seem to show the +same periodic variations. "It is therefore evident that the phenomena +belong not to the function of menstruation, but to a general law of +vital energy." + +Definition of Menstruation.-- Menstruation may, then, be defined as +the periodic discharge of blood from the uterus, accompanied by the +shedding of the epithelium of the body, as well as that of the uterine +glands near their orifices. + +The sanguineous discharge is due partly to the oozing of blood from +the surfaces denuded of epithelium, and partly to active congestion. +The discharge from the uterus is largely augmented by mucus secreted +in increased quantity at this period from the enlarged uterine glands. + +The tubes take some part in the process of menstruation; their mucous +membrane is swollen, the epithelium is shed in places, and they are +filled with a thin bloody fiuid, containing blood-corpuscles and +cast-off epithelium cells. + +The menstrual wave continues from puberty to the menopause; it is a +nervous phenomenon. Ovulation is a progressive, non-periodic process; +it begins before birth and continues till the ovarian tissue is +atrophied or worn out. + +Premonitory Symptoms of the Flow.-- The premonitory symptoms of the +monthly flow should not be so marked as to cause the individual any +discomfort. The first indication of the return of the period should be +the appearance of the flow. There is generally a feeling of abdominal +fulness with some lassitude, and sometimes slight headache. The +temperature is lower and the pulse is slower than at other times. This +lowered tone of the system is an additional reason for increased care +against exposure in wet or cold weather. + +Hygiene of Menstruation.-- During the menstrual periods all cold baths +must be strictly prohibited, whether tub-baths or cold sponges. The +reason of this is that the application of cold to the surface causes a +driving in of the blood from the exterior of the body to the internal +organs; and at the menstrual periods there is already a congested +condition of the pelvic organs, and it must be remembered that +congestion is the first stage of inflammation. + +Hot or warm sponge-baths may be taken throughout the period; and the +vulva should be bathed with warm water twice a day through the entire +period of the flow, as this not only removes the clotted blood before +it decomposes and becomes the source of irritation, but also removes +other irritating matters, and prevents the nervousness that is caused +by a local irritation. + +It is strange how women who are scrupulously neat in all other +respects will allow the smegma to collect in and about the vulva; as a +matter of fact, for the purpose of cleanliness it is much more +necessary that the external genitals should be washed twice a day with +soap and water all through life than that the face should be washed +that often. + +Another question which is still sub judice is the necessity for and +the frequency with which vaginal douches should be taken; all +physicians are agreed that a vaginal douche taken immediately after +the menstrual period is beneficial, as it removes all the debris of +the flow, which is sometimes very irritating. + +Exercise.-- A moderate amount of exercise should be taken every day; +this is needed now quite as much as at any other time, and only good +can result from it. And no harm comes of a woman going out in the rain +or in cold weather; as has been shown, the menstrual process is going +on for a large part of the time, and the flow is only the external +appearance, but during the time of the flow the woman must be +unusually careful not to get her feet wet or to sit down with damp +clothing on. Violent exercise of all kinds is to be prohibited at this +time, as dancing, rides on the bicycle, gymnastics, and walks of over +three miles. The reason for this is very obvious; the uterus has now +reached the height of its turgescence, and is heavier than at any +other time, hence the danger that displacements or a very profuse flow +would be caused by any kind of violent exercise. + +Treatment.-- If the woman has been so unfortunate as to get caught out +in a heavy rain so that her clothes have been wet through, or if in +the cold weather she should come into the house thoroughly chilled, +the best thing to do is to take off her wet things as quickly as +possible, be well rubbed down with hot, rough towels, drink a cup of +hot tea, go to bed at once and place a hot-water bag over the abdomen. +She should remain in bed until the next morning, to the end that the +circulation may regain its equilibrium as quickly as possible by the +immediate relief of the pelvic congestion. If this exposure should +have caused the sudden cessation of the flow, a hot mustard foot-bath +should be taken. One tablespoonful of mustard is used to a gallon of +water as hot as can be borne; the pail should be made as full as can +be without running over, and a blanket wrapped around the pail and +woman, so as to cause a profuse perspiration; this should be kept up +for ten minutes; if the water cools off, hot water may be added. + + CHAPTER V. + + THE ANOMALIES OF MENSTRUATION. + + Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea; Leuchorrhea; + Pruritus Vulvae. + + "Defer not till to-morrow to be wise, + To-morrow's sun on thee may never rise." + + -- CONGREVE + +Menorrhagia and Metrorrhagia.-- By menorrhagia is meant an excessive +or too profuse menstrual flow; by metrorrhagia, a flow of blood +between the menstrual periods. Neither one constitutes a disease by +itself, but is a symptom of some pathologic condition. + +It has already been stated that the excretory organs, by constantly +eliminating from the system the worn-out material, keep the machine +healthy and in good working order. Kept within natural limits, this +elimination is the source of strength and health; beyond these limits, +the menstrual flow becomes an actual hemorrhage that, by draining away +the life, becomes the source of weakness and disease. + +No physician would dare to bleed a man or woman once a month, year in +and year out for thirty years; but, through ignorance or folly, this +is what many girls do for themselves. + +This excessive flow, aside from actual local disease, is brought about +by excessive muscular exercise during menstruation; by the use of all +stimulants, whether alcoholic beverages or quinin; as well as by the +thinness of the blood. + +When the flow is excessive, it must be considered a pathologic +condition, which needs the physician's attention. Rest in the +recumbent position is the first essential; the diet must be plain and +unstimulating, and attention must be paid to the condition of the +blood. + +The general diseases which generally cause this condition are anemia, +Bright's disease, malaria, the early stages of tuberculosis, and heart +disease. + +The local causes may be reflex, as powerful emotions; or due to local +disease of the uterus and its appendages, as the various inflammations +and displacements of the uterus, fibroid tumors, polypi, and cancer. + +Dysmenorrhea is painful menstruation. The most frequent forms are due +to uterine congestion; to mechanical causes, as a narrowing of the +cervical canal, particularly at its internal opening, or to a +constriction caused by the bending over of the uterus at the junction +of the body and the neck; or to ovarian irritation. + +The pain varies in intensity from slight discomfort to the most +intense uterine colic, which is experienced in the lower part of the +abdomen. In severe cases the general health becomes undermined, the +nervous system gives way, and hysteria and other disorders of the +nervous system result. + +The congestive variety usually occurs in patients who have previously +menstruated painlessly. The pain comes on suddenly with the flow and +ceases when the flow stops; it is very severe and is generally +accompanied by a diminution or a cessation of the flow. There is +severe headache, marked diminution in the secretion of the kidneys, +and general restlessness. The patient frequently experiences pain in +walking, is easily fatigued, has leucorrhea and an irritable bladder. + +In ovarian dysmenorrhea the pain precedes the flow for several days +and ceases when a free flow is established. The pain is of a dull +aching character, and may be felt on one or both sides of the abdomen, +according as one or both ovaries are involved. + +Amenorrhea.-- In amenorrhea the menstrual flow may not appear for some +years after it is normally due; or the flow may cease after some +months or years of continuance; or the flow may be abnormally scanty +or even absent. + +The menstrual flow is much later in appearing in some families than in +others, so that this may be considered as a family idiosyncrasy; and +if the girl's health is good, it need cause no anxiety. If, on the +contrary, the girl has severe headaches, or suffers in any way, the +physician should be summoned at once, as the absence of menstruation +may be indicative of some serious pathologic condition, + +A scanty flow is often indicative of thinness of the blood; on the +other hand, serious anemias often lead to profuse menorrhagias or +metrorrhagias, as has already been stated. The cause of the profound +anemia itself may be insufficient nutrition, overwork, or lack of +exercise. + +Scanty menstruation is often seen to occur in fevers, in the later +stages of consumption, in advanced Bright's disease, in malaria, or in +any other very serious disease. In these cases it seems to be a +conservative process on the part of nature in the run-down state of +the system. As consumption progresses menstruation generally ceases +absolutely, never to return again; and in this case nothing should be +done to try to induce a return of the flow. + +Great shock sometimes causes a sudden cessation of the flow; and +sometimes a sea-voyage, followed by the change of habitat, will cause +an obstinate form of amenorrhea. + +But it cannot be too well understood that, after the menstrual flow +has been regularly established, it continues with the greatest +regularity throughout the child-bearing period, unless the exposure to +wet or cold has been sufficiently severe to cause great indisposition +on the part of the woman. In this case it is possible that, if the +exposure took place just previous to the time of the expected flow, +one period may remain out. But except in case of serious illness,-- as +for example, typhoid fever,-- two or more periods do not fail to +appear except in the case of pregnancy. + +Leucorrhea.-- Leuchorrhea, or "whites," is a mucous or mucopurulent +discharge from the vagina; it may be a symptom of uterine or vaginal +disease. + +Immediately after the menstrual flow there is a well-marked vaginal +secretion which is whitish in appearance; it may be transparent or of +a milky color, and is sometimes very acrid. This secretion may also +precede the flow, and there is nothing abnormal in this. But any +discharge occurring between the periods sufficient to stain the +clothing-- the so-called whites or leucorrhea-- is abnormal, and is +caused by an inflammation of the vagina or the neighboring parts. In +addition to the discharge there is heat and swelling of the parts, +more or less local distress, and generally intense nervousness. + +If the disease is not cured, it may become chronic. The pain, heat, +and scalding disappear, but a copious discharge continues, and in this +stage the disease may be very obstinate and greatly reduces the +strength. The constant drain breaks down the system, producing pallor, +debility, pain in the back, palpitation, indigestion, and so forth. + +The character of the discharge in leucorrhea varies considerably, from +a whitish or mucous secretion, to a yellowish or mucopurulent +secretion, and is debilitating in proportion as it is profuse. It is +to be remembered that this is not in itself a disease, but indicates a +disease of some of the pelvic organs; and that all such inflammations +left to themselves incline to grow worse. + +A severe leucorrhea is generally attended with frequent and finally +painful micturition; pain in walking in the lower part of the abdomen, +which may become so severe as to compel the patient to go to bed. + +Pruritus Vulva.-- This is an intense and persistent itching of the +vulva, and is a symptom rather than a disease. It is not an infrequent +result of leucorrhea, the acrid discharge of the latter leading to an +irritation of the parts; this causes rubbing of the parts until a +veritable inflammation is produced. + +Other causes of pruritus vulvae are: The local congestion, such as +occurs at the menstrual period, or in certain cases of pelvic +inflammations, or in early pregnancy; constipation; sedentary habits; +congestion of the liver; incontinence of urine, and diabetes. When +dependent on the latter, the malady is most obstinate in yielding to +treatment. Indigestible foods or drinks, the rubbing of the clothes, +the friction of walking, and the heat of the bed act as exciting +causes in those predisposed to it. + +The essential treatment here is to at once ascertain and remove the +cause; aids in the treatment are vaginal douches and cooling lotions. + + CHAPTER VI. + + THE MARRIAGE QUESTION. + + Herbert Spencer's Definition of Love; What Constitutes a Suitable + Husband; Best Age for Marriage; Shall Cousins Marry? Contraindications to + Marriage; Do Reformed Profligates Make Good Husbands? the Proper Length + of Time for the Engagement; the Right Time of the Year to Marry; the + Selection of the Wedding Day. + + "Well, Brutus, thou art noble; yet, I see, + Thy honourable mettle may be wrought + From that it is disposed: Therefore, 'tis meet + That noble minds keep ever with their likes. + For who so firm that cannot be seduced?" + + -- "Julius Caesar." + +Herbert Spencer's Definition of Love.-- "Love is habitually spoken of +as though it were a simple feeling, whereas it is the most compound, +and therefore the most powerful, of all the feelings. Added to the +purely physical elements of it, are first to be noticed those highly +complex impressions produced by physical beauty; around which are +aggregated a variety of pleasurable ideas, not themselves amatory, but +which have an organized relation to the amatory feelings. With this +there is united the complex sentiment we term affection-- a sentiment +which, as it can exist between those of the same sex, must be regarded +as an independent sentiment, but one which is here greatly exalted. +Then there is the sentiment of admiration, respect, reverence, in +itself one of considerable power, and which in this relation becomes +in a high degree active. There comes next the feeling called the love +of approbation. To be preferred above all the world, and that by the +one admired above all others, is to have the love of approbation +gratified in a degree passing every other experience, especially as +there is added that indirect gratification of it which results from +the preference being witnessed by others. Further, the allied emotion +of self-esteem comes into play. To have succeeded in gaining such +attachment from and sway over another is a proof of power which cannot +fail to agreeably excite amour propre. Yet again, the proprietary +feeling has its share in the general activity. There is the pleasure +of possession, the two belonging to each other. Once more, the +relation allows of an extended liberty of action. Toward each other a +strained behavior is requisite. Around each there is a suitable +boundary that may not be crossed; an individuality on which none may +trespass. But in this case the barriers are thrown down, and the love +of unrestrained activity is gratified. Finally, there is an exaltation +of sympathies, egotistic pleasures of all kinds are doubled by +another's sympathetic participation, and the pleasures of another are +added to the egotistic pleasures. Thus around the physical feeling +forming the nucleus of the whole, are gathered the feelings produced +by personal beauty that constitutes simple attachments, of +self-esteem, of property, of love of freedom, of sympathy. These, all +greatly exalted and severally tending to reflect their excitements on +one another, unite to form the mental state we call love. And as each +of them is comprehensive of multidinous states of consciousness, we +may say that this passion fans into immense aggregate most of the +elementary excitations of which we are capable; and that hence results +its irresistible power." + +What Constitutes a Suitable Husband.-- It is desirable that the +husband shall be a few years older than the wife. Man is later in +coming to maturity, and also retains his sexual powers considerably +longer than woman; so that for these functions to cease about the same +time, the wife must be younger than the husband. A difference of from +two to five years is best; if the parties are young, it is not +essential that the husband should be much the wife's senior, as it is +later in life. The husband may be ten years older, but a greater +disparity of age than this is rarely compatible with congeniality of +tastes and dispositions, so essential to a happy married life. The +woman who risks her happiness with a man many years younger than +herself violates a precept of nature. + +The average stature of the man is about three inches greater than that +of the woman, and in the physiologic marriage any great deviation from +this should be avoided. + +The essentials for a happy marriage may be summed up as follows: that +the parties shall be of suitable age; that they shall be physically +well mated and in full sympathy with each other's views of life, of +the same social position, and of equal education. + +The Best Age for Marriage.-- The reproductive life begins with +puberty, but maturity is not reached before the age of twenty-one. It +is only then that the standard of development is reached that is most +compatible with the successful bearing of the grave responsibilities +of wifehood and motherhood. The too early exercise of the reproductive +functions leads to increased suffering on the part of the mother, +depresses her vitality, and increases her liability to disease. +Statistics show that the mortality is very much greater where girls +marry under twenty years of age. + +The offspring are apt to be small and ill developed, and die in large +numbers in early life; only a small percentage live long and robust +lives. In France it has been observed that where the fear of +conscription has caused many young people to marry the offspring were +lacking in vigor. Among the offspring of immature parents there is a +larger proportion of idiots, cripples, criminals, scrofulous, insane, +and tubercular than among the children of nubile parents. + +In our climate women are best fitted to become wives and mothers +between the ages of twenty-four and twenty-eight years. Before this +age neither their self-knowledge, their knowledge of the world, nor +their experience is sufficiently mature to fit them to wisely make the +choice of a companion for life, or to become mothers. After forty, +most women cannot hope for children. Men had better wait until between +the ages of twenty-seven and thirty years, before they undertake the +responsibilities of parenthood. + +Shall Cousins Marry?-- They might if both families were perfectly +healthy; but as few families are without some lurking predisposition +to disease, it is not well, as a rule, to run the risk of developing +this by too repeated unions. + +Contraindications to Marriage.-- Young women in whose family there is +a distinct history of such hereditary diseases as cancer, +tuberculosis, or insanity for two generations back, should not marry +at all. Not only is this a fearful legacy to hand down to their +children, but pregnancy and child-bearing very decidedly favor the +development of these diseases. + +Syphilis in either sex is a distinct bar to marriage; first, the party +married is sure to contract the disease, even though it may have been +supposed to have been cured. Fortunately, the children of such +marriages are generally still-born; still, they do sometimes live, and +are most pitiable and sickly objects. For any one to marry under these +conditions is a crime against society, against the State, and against +posterity. + +Women who have serious forms of heart disease, tuberculosis, or +Bright's disease would, by becoming pregnant, run a serious risk of +losing their lives toward the close of the pregnancy or at the time of +their confinement. In case of heart disease, the pulmonary congestion +that accompanies pregnancy, together with the encroachment of the +pregnant uterus on the cavity of the chest, would greatly add to the +embarrassment of the heart's action. + +In normal pregnancy there is some congestion of the kidneys; where +there is actual disease of the kidneys prior to the pregnancy, this +congestion is apt to become so severe as to threaten the woman's life. +These organic diseases are not to be confounded with functional +diseases which are dependent on some other cause; as palpitation of +the heart due to indigestion, or heart murmurs dependent on the thin +state of the blood, or congestion of the kidneys due to exposure to +cold;-- all of which may be cured by proper treatment. + +Should a woman with a fibroid tumor marry, she would run a great risk +to her life; she should have the tumor removed, or, if this is not +possible, she should give up all thoughts of marriage, since the +increased irritation and congestion consequent upon the marital +relations would tend to favor its growth. Should pregnancy ensue, +delivery might be attended with serious complications, as very +difficult labor, postpartum hemorrhage, or, as these tumors have but +little vitality, and the pressure to which they are subjected during +labor is liable to cause their death, disorganization, sloughing, and, +as a result, puerperal septicemia. + +Sometimes there is such a lack of development of the genital organs as +to prevent the woman from having children. + +Two persons with even a slight tendency to the same disease, either +inherited or acquired, should not intermarry, even if they are in +comparatively good health at the time. Their offspring would be quite +sure to inherit their diseased tendencies. + +Persons whose constitutions have been somewhat injured, but who are +not tainted with actual disease, may rear children much healthier than +themselves, provided their own lives are wisely regulated. If they are +growing better all the time, and are not too much broken in +constitution, it may be safe for them to marry. + +Among the Jews the physician is frequently consulted before +matrimonial alliances are contracted. This custom could not but be of +universal benefit; many local or general diseases would be eradicated +before marriage, and in this way much suffering and unhappiness would +be spared; or, in other cases, the patient would be advised of the +inadvisability of marriage. + +Do Reformed Profligates Make Good Husbands?-- The manner of life that +has been led by this class of men is such as to undermine their +health, if not to have rendered them physical wrecks. There is the +overindulgence in alcoholic beverages, and perhaps, added to this, +some drug habit. In addition to this, these men early in their career +are apt to become infected with some of the venereal diseases, or +perhaps with all of them-- gonorrhea, syphilis, and so forth; and +these diseases have the horrible characteristics of becoming latent. A +man who contracts this kind of a disease can never be really sure that +he is cured. All venereal diseases are highly contagious. + +It is now a well-established fact that gonnorrheal infection is not +only one of the most common causes of pelvic inflammations in women, +but that these same inflammations are of the most virulent types, +unless they are recognized and treated in the early stages. It is also +a well-known fact that a large percentage of married women suffer from +this disease. Sterility almost always results. + +In the case of a syphilitic parent, one or two children may be born, +but the offspring is generally sickly and diseased. Inebriety as well +as sexual excesses are both well recognized as distinct forms of +disease accompanied by degeneracy of brain tissue. It is nothing less +than criminal for such men to have children, since these children +would at least inherit the tendency to the same diseases, if they did +not actually have them; there is also a strong probability of such +children being born idiots or imbeciles. + +It is therefore self-evident that, instead of a reformed profligate +making a good husband, he must make a very diseased one. It has +therefore been suggested that the parents of the prospective bride +should demand from the intended groom a certificate of freedom from +all venereal diseases by a physician of their own selection. Also that +there should be legislation upon the subject, and that before a man is +granted a license of marriage, he should have a certificate from the +health officer of freedom from syphilis, gonorrhea, and tuberculosis. + +The Proper Length of Time for the Engagement.-- A period not shorter +than three months, nor longer than one year, should elapse between the +engagement and the marriage. + +There are strong physiologic reasons against long engagements: they +keep the affections and the passions in an excited and unnatural +condition, which after a time tends to weaken the nervous system and +undermine the health. These evil consequences are common to both +sexes. It is far better that the subject of marriage should not be +entertained at all unless the circumstances are such that the union +might with propriety be effected at once. + +The Right Time of the Year to Marry.-- When woman marries she enters +upon a new life, and a very trying one. Extreme heat and extreme cold +are both very taxing to the human economy. Midsummer and midwinter are +therefore both objectionable, but especially the former. + +The Selection of the Wedding-day.-- This is by common consent left to +the bride. She should select a time about ten or fifteen days after +the end of one of her menstrual periods, as this is the time of +comparative sterility, and it is most desirable that the first sexual +relations should be fruitless. + _________________ + + PART II.-- MARRIAGE. + _________________ + + CHAPTER VII. + + THE ETHICS OF MARRIED LIFE. + + The Wedding Journey; the Ethics of Married Life; Shall Husband and Wife + Occupy the Same Bed? the Comsummation of Marriage; the Marital Relation; + Times when Marital Relations Should be Suspended. + + "If it is possible to perfect mankind, the means of doing so will + be found in the medical sciences."-- DESCARTES. + +The Wedding-journey.-- The wedding-journey, which was formerly the +cause of so much discomfort to both husband and wife, has fortunately +gone out of vogue; and in its place has come the retirement to a quiet +country or seaside spot, away from the prying eyes of friends. Thus +the nervous strain incident to sight-seeing and travel is avoided. + +The Ethics of Married Life.-- It has been said that God set men and +women in pairs in order that they might perfect each other and +complete each other's happiness. The secret of all true happiness in +life lies in the spirit of altruism; one must be able to wholly forget +herself and to find her happiness in the welfare of others. + +The woman who exhausts herself physically and financially on the +preparation of her trousseau and her wedding does her husband a wrong +by bringing him a wife who is on the verge of nervous prostration. + +The secret of a happy married life depends to no small extent on the +very beginning: the relation is so entirely new, and much lies hidden +in the character of each that was never suspected by the other. + +Between husband and wife there must always be mutual concessions, +forbearance, and sympathy; a mutual helpfulness to attain all that is +best. This, of course, implies that the life of each is an open book +for the other to read; that there is an unreserved exchange of +thought; and that no privilege is claimed by the one that would not +willingly be accorded to the other. + +"How many men," says Balzac, "proceed with women as the monkey of +Cassan with the violin; they have broken the heart without knowing it, +as they have tarnished and disdained the jewel whose secret they never +understood. Almost all men are married in ignorance of women and of +love. They have commenced by forcing open the doors of a strange house +and have wished to be well received in its salon. But the most +ordinary artist knows that there exists between him and his +instrument-- his instrument which is made of wood or ivory-- a sort of +indefinable friendship. He knows by experience that it has taken years +to establish this mysterious rapport between an inert material and +himself. He could not have divined at the first stroke all its +resources and caprices, its faults and its virtues. His instrument +only became a soul for him and a source of melody after long study; he +only came to understand it as two friends after the most learned +interrogation. + +"So the world is full of young women who grow pale and feeble, sick +and suffering. The ones are a prey to inflammations more or less +severe; the others remain under the dominion of nervous attacks more +or less violent. All these husbands have caused their own unhappiness +and ruin. Never begin married life with a rape. To demand of a young +girl whom one has seen forty times in fifteen days to love you because +of the law, the king, and justice is an absurdity. + +"Love is the union of necessity and of sentiment. Happiness in +marriage is the result of perfect understanding between the spirits of +husband and wife. From this it happens that in order to be happy, a +man is obliged to bind himself to certain rules of delicacy and honor. +After taking advantage of the social laws which consecrate the +necessity, it is necessary to obey the secret laws of nature, in order +to make the sentiments flourish. If a man places his happiness on +being loved, it is necessary that he should love sincerely; nothing +resists a veritable passion." + +Shall Husband and Wife Occupy the Same Bed?-- Among civilized nations +custom differs in this regard; in Germany, for instance, the husband +and wife occupy separate beds in the same room; formerly in this +country it was almost the universal custom for husband and wife to +occupy the same bed. The current of opinion has changed in this +respect, and it is now considered in the highest interests of both +that they shall occupy not only separate beds, but separate rooms; +these rooms communicating through a door which connects their +respective dressing-rooms. This is unquestionably the best arrangement +from the hygienic as well as from the ethical point of view. Health +requires that one-third of the time shall be spent in sleep; the bed +was made for sleep; and the most refreshing sleep can only be obtained +by occupying the bed alone. If two persons occupy the same bed and one +is restless, the sleep of the other is necessarily disturbed. Again, +two persons occupying the same bed necessitates the same hour for +rising and retiring, which is not always convenient or agreeable. +Balzac writes on this subject: "To put the system of separate +bed-rooms into practice is to attain to the highest degree of +intellectual power and of virility. By what syllogism man arrived at +establishing as a custom that of man and wife sleeping together, a +practice so fatal to happiness, to health, to pleasure, and even to +self-love, would be curious to seek out." If for financial reasons it +is not possible to have separate bed-rooms, the German custom of +having separate beds should be adopted. + +The Consummation of Marriage.-- The consummation of marriage is often +attended with difficulty owing to the rigidity of the hymen; this, if +present, must usually be ruptured before connection takes place. Great +gentleness and care must be exercised by the husband if it does not +readily yield, the use of hot vaginal injections should be kept up for +several weeks before the trial is repeated. These usually relax the +parts very considerably; but if coitus is still found impossible, it +is better to consult a physician at once, when a simple operation will +generally remove the trouble and the woman is spared much suffering. +In no case is any violence on the part of the husband allowable, as it +might produce irreparable injuries. + +There is always more or less suffering on the part of the wife at +first, partly due to the rupture of the hymen, and partly to the +forcible dilatation of the vagina and she should be allowed a +sufficient time for nature to repair these injuries. By so doing, the +constitutional disturbances and the nervous disorders which are so +very prevalent may be prevented. Too frequent indulgence at this +period is a prolific source of inflammatory diseases, and often +occasions sterility and ill-health. + +The first nuptial relations should be fruitless, in order that any +indisposition arising therefrom should have had time to disappear +before the woman becomes pregnant. + +The Marital Relation.-- It is most important for the interest of both +parties that there should be chastity in the marriage relation as well +as out of it. Many young couples have had their lives ruined by +excessive sexual indulgence. The effect is usually most severe upon +the husband, yet the wife becomes weak, nervous, and excitable. Sexual +excess is also the grave of domestic affection. The general rule given +is that coitus should never take place oftener than every seven or ten +days. When coitus is succeeded by langour, depression, or malaise, it +has been indulged in too frequently. + +Among civilized people there are three widely diferent views as to the +proper course to be pursued: + +First, those who maintain that sexual intercourse should not take +place except for the propagation of the species. + +Second, those who believe that the act is a love relation, mutually +demanded and enjoyed by both sexes, and serving other purposes besides +that of procreation. + +Third, those who hold that sexual intercourse is a physical necessity +for the man, but not for the woman. + +The first theory, "that the sexual relations should never be sustained +save for the purpose of procreation," has many advocates. They teach +that there are other uses for the procreative element than the +generation of offspring, and far better uses than its waste in +pleasures. They claim that a life of total chastity increases the +physical and mental vigor; and there will result a procreation on the +mental and spiritual planes, instead of on the physical ones. + +They also claim that to woman belongs the creative power; that she +must choose when a new life shall be evolved; and that only by +adhering to this law can she be protected in the highest function of +her being-- the function of maternity. + +The adherents of the second theory, "that the act is a love relation, +mutually demanded and enjoyed by both sexes, and that it serves other +purposes besides that of procreation," claim that the female sexual +life indicates that the healthy woman is neither indifferent nor +passive in the generative act. It has much the same effect as in man-- +a powerful increase in her sensations, whole groups of muscles are set +in motion, and the uterus as well as the entire nervous system are in +an excited condition and activity. And that it is the province of the +mother to decide when a new life should begin. + +The third theory, "that sexual intercourse is a physical necessity for +the man, but not for the woman," is by far the most widely accepted. +We will consider, first, the practical results of this last theory; +and, second, the scientific basis on which it rests. + +It is generally acknowledged that this practice has done more to cause +domestic misery, sickness, and death than that dreadful scourge of the +human race, tuberculosis. + +This man, accustomed all his life to gratify his sexual passions +promisculously, marries a virtuous young girl. In her menstrual +periods she has had to do only with the secondary phenomena; with the +expulsion of the ova not at all. She has had no instruction in the +corresponding physiologic life of the man, and is astonished at the +male sexual indications, and is led to believe in their physiologic +necessities. The result is that she not only suffers physically, but +feels outraged and disgraced. She is liable to the chance of maternity +at any time; and such offspring will probably be sickly. + +Passion is presented to the young wife in so hideous a guise that it +will take the utmost consideration of her husband afterward to enable +her to completely overcome her repugnance. If she be worn and weary of +excesses in the early days of her married life, the husband will have +only himself to blame if he is bound all his life to an apathetic and +irresponsive wife. Husbands place great strains upon the affections of +their wives, and lower themselves almost past reinstatement in their +respect and esteem. + +Lastly, on what scientific basis does this "physilogic necessity" for +sexual gratification on the part of the male rest? Analogy with the +lower animals does not bear it out. Among animals, except in rare +instances under domestication, the female admits the male in sexual +embrace only for procreation. Among many savage tribes this same rule +has but few exceptions. The analogies between the male and the female +sexual organs; between seminal emissions and menstruation; between the +sexual life of the male and of the female, only go to accentuate the +fact that this so-called physiologic necessity on the part of the male +has arisen chiefly through the difference of education; so that it has +come to be that the woman is chaste and the man is degraded; that the +woman is too sentimental and the man too passionate. From a purely +medical standpoint, the most eminent physicians and physiologists of +the day all unite in advocating a chaste and continent life, simply +for the sake of the man's own health, independently of all other +considerations. + +Times when Marital Relations Should be Suspended.-- The marital +relations should always be suspended during the menstrual period. +During pregnancy intercourse should never, or at least very rarely, be +indulged in. At this time the mother needs to conserve all her +strength and energies for herself and child; and any sexual relations +during this time increase the sufferings of the mother and impair the +vitality of the child. It has been even suggested that much of the +pain during parturition would be avoided by entire continence during +pregnancy. Intercourse during the early months of pregnancy is a +frequent cause of abortion. Women who have supposed that they have +never been pregnant have in reality been having abortions every second +or third month. + +A woman should never be subjected to coitus until three months after +delivery. During lactation intercourse should never, or at least very +rarely, be indulged in; as the function of lactation makes a heavy +drain on the strength of the mother, and anything which would further +weaken her would tend to impoverish the quality of the milk and thus +the child would suffer. + + CHAPTER VIII. + + SEXUAL INSINCT IN WOMEN. + + Sexual Instinct in Women; Excessive Coitus; Causes of Sexual + Excitability. + + "Virtue, the strength and beauty of the soul, + Is the best gift of heaven." + + -- ARMSTRONG. + +Sexual Instinct in Women.-- After careful observation of the sexes in +the married state, it is found that the sexual appetence is less in +women than it is in men. Much of this difference in sexual appetence +is doubtless due to the chastity of their lives, coupled with and +resulting from the difference of education. The girl is taught +repression, and the boy expression; that girls must be chaste; that +chastity for boys is impossible. + +According to the intensity of the sexual instinct women have been +divided into three classes: A larger number than is supposed have +little or no sexual feeling. Second, those who are subject to strong +passion; this class is larger than the first, but small as compared +with the whole of their sex. Third, those in whom the sexual appetite +is moderate; this class comprises the vast majority of women. + +And, even granting to woman more pleasure in sexual indulgence than +usually comes to her by largest allowance, it is safe to say that in +nine cases out of ten maternity, with its early pains and later cares, +greatly lessens her power of enjoyment; and that for the larger part +of her married life she is either positively distressed by the +apparently necessary demands of her husband upon her, and irresponsive +to them, or kept to a cheerful response by a self-abnegation and +regard for his comfort, not to say fear of his moral aberration, which +is a positive drain upon her health and strength. + +Excessive Coitus.-- Those who are most frequently found to suffer from +venereal excesses are the newly married; especially if they have weak +constitutions and excitable temperaments. A great deal of mischief is +done by two persons of unequal constitutions being matched together; +the husband may exhaust the wife or vice versa, the weaker party being +constantly tempted to exceed their strength. In all sexual matters +there must be a consideration for others. It is not so much from +selfishness as from ignorance that such a mistake is made. The +ignorance comes from a lamentable morbid delicacy which prevails on +all sexual matters, and which prevents all open and rational +conversation on them, even between those who have the most intimate +knowledge of each other. + +When the conjugal act is repeated too often, the man will become +gradually conscious of diminished strength, diminished nerve force, +and diminished mental powers. Excess weakens a man's energies, and +enervates and effeminates him. Moreover, it renders him liable to an +infinity of diseases and a readier victim to death. + +Not only is the strength of the constitution lowered by the excessive +expenditure of force and matter requisite for the perpetuation of the +species, but this lowered standard of vitality is transmitted to +children. There can be but little doubt that this is one of the +reasons why so many healthy parents beget sickly children, who die +early. They have exhausted themselves of the material from which a new +life is created, and so it is not properly started at the beginning +and never reaches its highest development. To the truth of this +statement attests the mental imbecility, the pallid and attenuated +forms, of the children who are the earlier products of marriage. The +effect of excessive coitus in women is seen by the confirmed ill +health of so many women after marriage and repeated child-bearing. A +large number of these cases are dependent upon alteration and diseases +of the genitalia; but a considerable number are unconnected with local +disease, and in many other cases the health is never regained after +all local phenomena have disappeared. + +Sexual excitement in the woman causes certain congestion of the +genital organs; and at the time of the orgasm there is a reflex +movement which corresponds to erection, and which consists of a +peristaltic movement of the tubes and uterus; to the uterus also is +ascribed an act of suction by which the spermatozoa are drawn up into +its interior. Even when pregnancy does not follow, the too frequent +excitation and activity of the uterus in weak constitutions causes +illness, first of the genital organs and then of the nervous system. + +Local diseases caused in women by excessive coitus are: vaginal +catarrh, acute catarrh of the vulva, acute inflammation of the lining +membrane of the uterus as well as of the uterus itself, inflammation +of the ovaries, and even peritonitis. It is also known to be an +important factor in the origin of blood-tumors and of cancer of the +uterus. Especially is coitus at a time of great physical fatigue +liable to be provocative of uterine inflammations. Aside from ethical +considerations, coitus during the menstrual period may be the cause of +rupture of the impaired blood-vessels, thus causing blood-tumors. +Excessive coitus is a well-known cause of chronic inflammation of the +uterus; that is, a habitual congestion of the uterus is induced by +excessive sexual intercourse. This has been frequently mentioned by +authors as leading to enlargement of the uterus in the non-pregnant +condition; and it is a still more potent factor in the recently +impregnated organ, whose tissues are succulent and the vessels +enlarged, a condition inviting congestion and enhancing the +susceptibility to engorgement. + +The general manifestations of impaired health in women due to +excessive coitus are: chronic anemia, with malnutrition; impaired and +altered functions in all the organs, especially those of the nervous +system. Menorrhagia is apt to be induced by overstimulation of the +ovaries, together with exhaustion and sexual apathy. + +The source of so much misery is the increasing physical weakness of +the female and the increasing nervous weakness of the male, with an +increasing sexual excitability, two factors of tragic effect for the +wife. Here is seen the unfortunate result of teaching two kinds of +morals, one for men and another for women. + +Causes of Sexual Excitability.-- Too frequent genital irritation, +onanism, too frequent intercourse, alcohol, too rich and too highly +seasoned foods, lack of exercise. + +Treatment of Sexual Excitability.-- Avoid alcohol and precocious +puberty. Strictest attention must be paid to the diet; everything is +to be avoided which is difficult of digestion or which retards it. The +following articles of diet must all be avoided: cheese, foods seasoned +with pepper and curry, highly salted and acid foods, and all rich +foods; and meat must be eaten only in moderate quantities. +Constipation irritates the genitalia directly and increases the +inflammation. The close relation of Venus and Bacchus is known not +only in mythology. Carbonated waters are to be especially avoided, +such as soda, seltzers, Preblauer, Geisshubler, and acid waters; also +champagne and beer, heavy Italian, Spanish, and English wines. All +alcoholic drinks must be forbidden. + +As heavy gymnastics as the strength of the individual will admit, and +plenty of exercise out-of-doors must be taken. There must also be +constant mental and physical employment. In women sexual excitability +is often caused by local diseases, and passes off with their cure; if +not, she must use her will-power, and take the various forms of cold +baths. Sexual intercourse not oftener than once in two or three weeks, +and avoid all intimate approaches; if this is not sufficient, she will +have to leave her husband for a few months. + + CHAPTER IX. + + STERILITY. + + Sterility; the Prevention of Conception and the Limitation of Offspring; + the Crime of Abortion; Infidelity in Women. + + "Never let yourselves do evil that good may come. If you do, you + hinder the coming of the real, the perfect good in its due time." + + -- PHILLIPS BROOKS. + +Sterility.-- Conception is least apt to take place from the tenth day +after one period until the third day before the next; but there is +practically no time during a woman's sexual life when she may not be +impregnated; in this connection it must be remembered that the +spermatozoa stay alive in her for more than a week. + +During lactation women are generally sterile, especially in the first +months which follow the accouchement, because the vital forces are +then concentrated on the secretion of milk. + +The age of the wife at the time of marriage has much to do with the +expectation of children. As the age increases over twenty-five years +the interval between the marriage and the birth of the first child is +lengthened. For it has been ascertained that not only are women most +fecund between twenty and twenty-five years, but that they begin their +career of child-bearing sooner after marriage than either their +younger or older sisters. + +A wife who has had children and ceases to conceive for three years +will probably bear no more. + +When marriages are fruitless, the wife is almost always blamed; but it +is by no means the wife that is always at fault; many husbands are +absolutely sterile. Every man is not prolific who enjoys good health +and is vigorous. Gross states that in one case out of six the +sterility was due to the male. Kehrer, after a series of carefully +conducted experiments, has arrived at the conclusion that in at least +a third of the cases of sterile marriages the husband was the party at +fault, and that gonorrhea was the cause of the barrenness. + +Venereal diseases have their share of influence, and the gonorrheal +infection is a potent cause of sterility. It is by no means proved +that syphilis has any unfavorable influence on conception, though +abortions due to this are frequent. + +Gonorrhea often prevents conception by the inflammation traveling up +the womb, and along the Fallopian tubes to the ovaries, whose covering +is rendered thick and dense, so that the ovum cannot escape, or if it +does, the fimbriated end of the tube is so agglutinated that it cannot +grasp the ovum. + +Alcoholism is considered a cause of sterility. It evidently does +diminish the sexual potency in the male, and for this the female is +often blamed. + +It does not follow because a woman has not given birth to a child that +she has not conceived. The life of an infant for a long time after +birth is a frail one, and before birth its existence is extremely +precarious; it often perishes a few days after conception. A period +coming on a few days late, and at the same time one which is unusually +profuse, is the only evidence which the young wife may have of an +abortion. Among prostitutes, the frequent delay of menstruation, then +abundant hemorrhage, is in many cases only habitual abortion, and +leads to changes in the generative organs which must result in +sterility. A tendency to miscarriage may therefore be all that stands +in the way of having a family; this can frequently be remedied. + +Sexual incompatibility is well known to exist; prominent examples +being Augustus and Livia; Napoleon and Josephine. It is also a +well-known fact that frigidity is a cause of barrenness. A short +separation of husband and wife is often salutary in its influence upon +fertility. + +It is a well-established fact that the time immediately before the +period, but still more that immediately following the period, are the +most favorable times for conception to take place; the remaining quiet +in bed of the woman after the generative act is also favorable to +conception. + +The most frequent causes of sterility in women are inflammation of the +lining membrane of the uterus, or of the neck of the uterus, or of +both. The source of this condition in women who have had children is +most frequently due to parturition or abortion. In the newly married +it may be due to a previously existing slight uterine catarrh in a +displaced uterus, or it may be a manifestation of a run-down state of +the system. In a majority of the newly married, however, the +inflammation of the endometrium is probably due to the first efforts +at conjugal approach. Many young women as the result of the +preparation of the trosseau, augmented by a round of gaities at the +time of marriage, enter the married state in a condition bordering on +physical and nervous exhaustion; and then begin engorgements and +inflammations which lead to future suffering and to sterility. +Displacements and flexions of the uterus also cause sterility. Such +displacements of the neck of the uterus may occur that, instead of +lying in a pool of semen, as it should, it is above, in front of, or +away from it, and this may prevent conception. + +Vulvar and vaginal hyperesthesia, inflammations of the vulva, undue +shortness of the vagina, unless great care is exercised by the +husband, will induce painful coitus, and may bring about sterility by +favoring the formation of a copulation sac outside of the axis of the +uterine canal, and consequently misdirection of the semen. + +Scrofula, probably by its effects on the general condition, leading to +deficient development of the whole body, the genital organs included, +may be productive of sterility. + +The female being less passionate than the male, the orgasm comes on +later with her, or the male orgasm occurs so soon that she may not +reach that stage at all. If both were simultaneous, it is reasonable +to suppose that conception would be more likely to occur. + +Ovulation is doubtless more frequently performed in some women than in +others. Some women conceive with more or less regularity every fifteen +or eighteen months, and others at intervals of several years. + +The effect of repeated coition, provided that impregnation does not +take place at once, is to engorge the uterine vessels, to alter the +nature of the glandular secretions, to cause profound reflex +disturbances, and thus to produce such changes in the endometrium as +to lead to local inflammation and to general nervous exhaustion. +Backache, leucorrhea, and irritable bladder are the first symptoms of +this disorder; but frequently there are added to these, headache, +indigestion, rectal tenesmus, painful and profuse menstruation. In +many cases the disease continues in a mild catarrhal form, giving the +woman little inconvenience besides the slight leucorrheal discharge +which stains her clothing; but often this is indicative of such a +change of the lining membrane of the uterus as to render it unfit for +the fixation and development of the ovum, even should impregnation +take place. + +Under normal conditions, during the intermenstrual period, a plug of +clear viscid mucus, which is secreted by the glands of the cervical +canal, blocks up that passage, but is washed away each month by the +menstrual discharge. Under ordinary conditions this obstruction must +seriously interfere with the entrance of the spermatozoa into the +cavity of the uterus, and renders the former theory, recently revived +by Bossi, quite tenable, that impregnation is most likely to occur +just after the menstrual epoch. + +The vaginal secretion under certain pathologic conditions may become +so acid that it induces sterility. Women who suffer m severe vaginal +catarrh are frequently sterile, the spermatozoa being found dead in +the vagina some hours after copulation, although an examination a +shorter time afterward revealed them still alive. In cases where +conception takes place in spite of a very acid condition of the +vaginal secretion, it is probable that some of the spermatozoa enter +the uterus before the secretion has had time to act on them, or +possibly the spermatozoa being injected in a mass, the acid secretion +is unable to penetrate and kill them all. + +The reaction of the normal vaginal mucus is always acid, that of the +cervix alkaline; but as the result of the inflammatory condition, the +reaction of each is often intensified, especially that of the vagina, +which has an exceedingly sour and penetrating odor. This acid +discharge, bathing the neck of the uterus, penetrates more or less +into the cervical plug and causes coagulation of the alkaline mucus. + +The chief constituent of the semen is albumin; agents which affect +albuminous substances influence the functional activity of the +spermatozoa-- heat, concentrated acids, and probably concentrated +alkalies. In normal conditions the alkalinity of the seminal fiuid +seems to be sufficient to neutralize the acidity of the vaginal +secretions, so that the spermatozoa may remain seventeen days or more +(Bossi) within the vaginal canal, even during a menstrual period, +without having their vitality destroyed. + +When hyperacidity of the vaginal secretion is present, it is probable +that the fertilizing element is at once rendered inert; but should +some of the spermatozoa succeed in reaching the interior of the +cervical canal, the increased alkalinity of the secretion there would +in all probability put an end to all further progress. + +The conditions, then, which appear to prevent fecundation are: First, +the absence of the proper nidus for the ovum; second, the obstruction +of the cervical canal by a mucus plug; third, increased alkalinity of +the cervical secretion, often accompanied by the increased acidity of +the vaginal secretion. Three conditions must, then, be determined: +First, are there spermatozoa in the semen? Second, do they get into +the uterocervical canal? Third, do the secretions in the canal poison +the spermatozoa? + +"For those who are very anxious for offspring," wrote Marion Sims, "I +usually order sexual intercourse on the third, fifth, and seventh days +after the flow has ceased; and on the fifth and third days before its +return. For the most obvious reasons this would always be before going +to bed at night, instead of just before rising in the morning. The +horizontal position favors the retention of semen; the erect its +expulsion. I am satisfied that too frequent sexual indulgence is +fraught with mischief to both parties. It weakens the semen; in other +words, that this is not so rich in spermatozoa after too frequent +indulgence; and when carried to the extent of a debauch, the fiuid +ejaculated may be wholly destitute of spermatozoa. Thus it will be +seen that it will be much better to husband the resources of both man +and wife." + +The Prevention of Conception and the Limitation of Offspring.-- Some +of the contraindications to procreation are when either parent suffers +from a disease which is transmissible, and such diseases frequently +manifest themselves only after marriage; when the pregnancy would +endanger the mother's life, or even where the pregnancy is a nine +months' torture to her; where either parent is suffering from ill +health; or where for economical reasons no more children are desired. + +If there exists no condition in either parent or in their +circumstances why they should not have children, the next +consideration due to their children, is how the same may be procreated +under the most favorable conditions possible; this condition can only +be secured by making the circumtsances such that the mother shall be +able to choose the time for their conception when both parents are in +the best physical condition. That children should be brought into the +world haphazard, as the result of accident, is to degrade the human +race below that of the lower animals, where the female admits the male +only at the time of the rut, which in the majority of cases occurs +only once a year. + +Another requisite to bearing healthy children is that the pregnancies +shall not follow each other too rapidly. Aside from the consideration +for the health of the mother herself, she must be in good physical +condition to bear the healthiest children she is capable of giving +birth to; and for this there must be from two and a half to three +years between the successive pregnancies. The results of +overproduction on the children are frequently, that they are sickly, +short-lived, or suffer from rickets, cerebral paralysis, idiocy, or +imbecility. + +And last, but certainly not least, many women become chronic invalids, +or are hastened to premature graves, by having children as fast as +they possibly can. + +The most natural and moral way for the artificial prevention of +conception, when on account of ill health or for economic reasons no +more children are desired, is to abstain from sexual intercourse. But +in the majority of cases the husband will not agree to this, and so +the greatest number of methods have come to be used to prevent +conception. + +Perhaps the most frequent method use to prevent conception is +withdrawal before the ejaculation of semen. While this is most +injurious to the husband-- debility, nervous prostration, and even +paralysis are said to ensue-- the health of the wife also suffers. If, +this interrupted sexual congress is continued for years, there develop +gradual nervous disturbances on both sides, and a serious disease of +the uterus makes itself felt. The generative organs become engorged +with blood, but are not permitted to enjoy relaxation consequent upon +the full completion of the act. This engorgement may lead to undue +local nutrition, and diffuse growth and proliferation of the +connective tissue may take place. Hence the uterine walls become dense +and thickened and the nerves compressed. Of course, pain and +tenderness and a sense of bearing down will be the result. Flexions +and versions may be consequent upon the engorgement. The nerves become +shattered, and the woman will be fortunate if she contracts no serious +womb trouble. + +"It is strange," says John Stuart Mill, "that intemperance in drink or +any other appetite, should be condemned so readily, but that +incontinence in this respect should always meet not only with +indulgence, but with praise. Little improvement can be expected in +morality until the producing of too large families is regarded with +the same feeling as drunkenness, or any other physical excess." + +Sismondi writes: "When our true duties toward those whom we give life +are not obscured in the name of a sacred authority, no man will have +more children than he can properly bring up. If a woman has a right to +decide any question it is how many children she should bear. Whenever +it becomes unwise that the family should be increased, justice and +humanity require that the husband should impose on himself the same +restraint which is submitted to by the unmarried." + +In the opinion of Dr. Edward Reich, it is very much to be wished that +the function of conception should be placed under the domain of the +will. But the strongest appeal has been made for the sake of morality +itself; namely, to prevent the crime of abortion. Dr. Raciborski, of +Paris, took the position that the prevention of offspring to a certain +extent is not only legitimate, but it is to be recommended as a means +of public good. + +Continence, self-control, and a willingness to deny himself-- that is +what is required of the husband. But suffering women assure us that +this will not suffice; that men refuse to restrain themselves; that it +leads to loss of domestic happiness, to illegitimate amours; or that +it is injurious physically and mentally; that, in short, such advice +is useless because it is impracticable. + +Dr. Napheys writes: "Is it amiss to hope that science will find +resources, simple and certain, which will enable a woman to let reason +and sound judgment, not blind passions, control the increase of her +family?" + +The Crime of Abortion.-- From the moment of conception a new life +begins, a new individual exists; another child is added to the family. +The mother who deliberately sets about to destroy this life by want of +care, or by taking drugs, or by the use of instruments, commits a +great crime, and is just as guilty as if she strangled her new-born +infant. The crime she commits is child-murder. Women in their frenzy +at finding themselves in this condition, and with no slightest idea of +the sin that they are committing, are constantly guilty of committing +abortions on themselves, or going to professional abortionists to have +this crime of child-murder committed. This is another of the sins due +to the ignorance of the sex in all matters pertaining to reproduction; +and it is a fearfully prevalent one. + +Infidelity in Women.-- "We have now reached the last infernal circle +of the divine comedy of marriage; we are at the depths of the inferno. +There is something, I do not know what, terrible in the situation in +which a married woman finds herself when an illegitimate love has +ruined her for the duties of a wife and mother. As has been so well +and strongly expressed by Diderot, infidelity in woman is like +incredulity in a priest; it is the last step in human forfeitures; it +is for her the great social crime, for it implies all the others. + +"Weigh the sufferings of the future, the agonies of years by the +ecstasy of half an hour. If this conservative sentiment of the +creature, the fear of death, does not stop her, what could be expected +of laws? Oh, sublime infamy!"-- (Balzac). + _________________ + + PART III.-- MATERNITY. + _________________ + + CHAPTER X. + + PREGNANCY. + + Nature of Conception; Pregnancy Defined; Duration of Pregnancy; the Signs + of Pregnancy; Quickening; the Determination of Sex at Will; the Influence + of the Male Sexual Element on the Female Organism; Heredity; Hygiene of + Pregnancy; Causes of Miscarriage. + + "Happy he + With such a mother, faith in womankind + Beats with his bood, and trust in all things high + Comes easy to him, and though he trip and fall, + He shall not bind his soul with clay." + + -- TENNYSON. + +Nature of Conception.-- Conception, or impregnation, is the union of +the germ and the sperm cell, the result of which is a new being. On +coition, the semen being received into the female organs, which are at +that time in a state of turgescence, the spermatozoa, by means of +their own vibratile activity, find their way into the Fallopian tubes, +and here come in contact with the ovule. + +The ovule is a minute cell with a transparent membrane, within which +is the yolk containing the germinal vesicle. The spermatozoon +penetrates into the ovule and becomes fused with it. The processes of +development begin at once to occur. There is congestion of the uterine +mucous membrane out of proportion to the rest of the uterus; the ovum +finds lodging here, and becomes surrounded by a membrane which +incloses it in a separate sac. + +Pregnancy Defined.-- Pregnancy begins with conception and ends with +parturition; it provides for the nutrition and the expulsion of the +embryo and for its nutrition for a short time after birth. + +The average duration of pregnancy is ten lunar months, or two hundred +and eighty days. The date of the confinement is calculated by +reckoning from the date of the last menstrual flow; count backward +three months from the date of the first appearance of the last menses; +to this add twelve months and seven days, five days being for the +average menstrual duration and two days for the possibility of +fecundation. + +Duration of Pregnancy.-- Many difficulties are experienced in +determining the date of the expected confinement. As most pregnancies +occur in married women, we cannot base any calculations on a single +act of coitus. And even if there was but one, all physiologists agree +that there is a variable period in different women, and in the same +woman at different times, between insemination and the fertilization +of the ovum. It is the moment of fecundation, or the union of the germ +and sperm cells, which marks the beginning of pregnancy. The +uncertainty becomes still greater owing to our inadequate knowledge as +to the length of time during which the sexual elements, the ova and +the spermatozoa, retain their vitality after liberation from their +respective sources. While it is not certainly known, it is probable +that the ovum is capable of impregnation any time during its sojourn +within the oviduct and before reaching the uterus, or probably for a +period of about one week from the time of its escape from the Graafian +follicle. The remarkable vitality of the spermatozoa even under less +favorable circumstances-- direct observation shows that these elements +retain their movements for over nine days outside of the body-- +renders it almost certain that their powers of fertilization are +maintained for a long time after they are deposited within the healthy +female genital tract; it is believed that the spermatozoa are capable +of fertilization after a sojourn of three or more weeks within the +oviduct. + +Consideration of these facts renders apparent the impossibility of +fixing with certainty the date of the beginning of pregnancy, since +conception may result from the union of the ovum liberated at the +beginning of the period with the spermatozoon introduced at the end of +that time; or it may result from the meeting of the male elements +already within the oviduct with an ovum discharged a day or two before +the occurrence of the menstrual period. + +The Signs of Pregnancy.-- The cessation of the menstrual period is the +sign of the greatest value in women who have been regular; but it must +always be remembered that there may be an irregularity of menstruation +for the first few months after marriage. The appetite is capricious; +morning sickness or nausea in the morning on first getting up is a +very common symptom in the early months of pregnancy; enlargement of +the abdomen; in the first two months of pregnancy the abdomen is +flattened and the umbilicus is depressed; after this the abdomen +begins to enlarge. There is also an increase in the size of the +breasts, with a deepened color of their areolae and later a watery +secretion. The external genitals become swollen and of a bluish color. +Feeling of the fetal movements-- that is, the movements of the small +parts of the child in the womb-- by the mother is not always reliable, +since gas in the intestines has sometimes been mistaken for this. +These signs are more valuable when several exist together. + +The nausea and vomiting of pregnancy, the so-called morning sickness, +consists of nausea accompanied often by vomiting or retching of a +glairy fiuid, showing itself most frequently on rising in the morning, +but sometimes appearing after breakfast. It is aggravated by the +assumption of the erect position. It may begin within a few days, but +as a rule it does not show itself until the fourth week of pregnancy; +and it generally ceases about the fourth month, rarely persisting +throughout the entire time. In the majority of cases it does not +sensibly impair the health. It is a sympathetic disorder reflected +from the uterus; it is aggravated by indigestible food, by sexual +excitement, and by emotional disturbances; it is most marked in first +pregnancies and in women of highly emotional natures. It is not +infrequently due to some inflammation of the uterus or erosion about +the external orifice, and disappears on the removal of the cause. + +Mammary Changes.-- During pregnancy the mammary glands are in +immediate sympathy with the growing reproductive organs of the pelvis; +consequently a genuine physiologic enlargement commences in these +organs from the beginning of gestation. Their glandular structure +becomes larger, fuller, and firmer; a sensation of weight or pricking +is felt by the patient; the veins become more prominent. The nipples +also become enlarged, more elongated, and somewhat erect. Surrounding +the nipple is the areola; this becomes darker in color. + +In most women a drop of watery fiuid, the so-called colostrum, may be +squeezed out from the nipple at the end of the third month of +pregnancy. + +The signs of pregnancy are divided into the presumptive, the probable, +and the positive. The presumptive signs are: menstrual suppression, +morning sickness, irritable bladder, mental and emotional phenomena. +The probable signs are: mammary changes, abdominal enlargement, +changes in the neck of the womb, and certain changes which are felt on +bimanual examination. The positive signs are: feeling the various +parts of the fetus, active movements of the fetus, and hearing the +fetal heart sounds. + +Functional disturbances of the bladder are quite often noticeable in +the early part of the pregnancy. In the first part of the pregnancy +the bladder is dragged upon, and later it is pressed upon by the +enlarged uterus so that the bladder capacity is lessened and frequency +of urination is the result. In the fourth month, when the uterus +ascends into the abdominal cavity, these bladder symptoms subside, +until the very close of the pregnancy, when by the descent of the now +greatly enlarged uterus there may be even incontinence of urine. + +Changes in the Abdomen.-- During the first two months of the pregnancy +there is a flattening of the abdominal surface, due to the descent of +the uterus into the pelvic cavity, thus slightly dragging the bladder +downward and drawing the umbilicus inward. In the latter part of the +fourth month there is noticeable a slight abdominal enlargement, and +the umbilicus is no longer sunken. By the end of the fourth month the +base of the uterus has risen two inches above the symphysis, and at +the end of the thirty-eighth week it touches the lower extremity of +the breast-bone; the umbilicus has been for many weeks protruding; +during the last two weeks of pregnancy the uterus again descends and +the woman feels more comfortable. + +On the inspection of the abdomen of a pregnant woman there will be +noticed a brown line which extends from the umbilicus to the pubes, +and all over the surface the presence of striae, or long purple +grooves, due to the distention of the abdomen; on the sides of the +abdomen and down the thighs, red, blue, or white markings, like +cicatrices, may be seen. + +Quickening.-- Quickening is the sensation experienced by the mother as +the result of the active fetal movements of the child in the womb. +These movements are first felt between the eighteenth and the +twentieth week; the common rule is that quickening occurs at the +middle of pregnancy; that is, at four and a half months. As pregnancy +advances these active motions increase in frequency and become more +marked. When felt or seen by the physician, as can be done in the +sixth month, fetal movements constitute a positive sign of pregnancy. + +The Determination of Sex at Will.-- Although this has always been a +question of great interest, and the subject of much experimentation, +no rule can as yet be given by which the parents can know in advance +of the birth of the child what the sex will be. Dr. Schenck's theory +is that the ruling factor in determining the sex is the food partaken +of by the mother. + +Furst believes that the differentiation may occur before, during, and +a little while after the impregnation; that the chances of the +development of one or another sex in one and the same woman may vary +before final differentiation occurs. It is impossible to determine the +sex of the embryo before the tenth week of fetal life. The cause of +the differentiation, he believes, lies largely in the good or bad +state of the health of the parents; in the first instance there being +an excess of females, and in the latter an excess of males, relatively +speaking. He believes that there is an excess of male children when +conception takes place during the post-menstrual anemia. He has +investigated one hundred and ninety-three cases carefully in regard to +the probable date of conception after menstruation, and there is a +notable increase of male births over female in the cases where +conception occurred in the first five days after menstruation; that is +to say, where the woman is not so well nourished as later. + +Dr. J. Griffith Davis gives as the result of her experiments in this +direction, that when conception takes place three days before the +menstrual period or within forty-eight hours afterward, the child will +be a girl; when conception takes place ten days after the period, the +child will be a boy. + +Although there are a greater number of the female than the male sex in +all parts of the world where reliable statistics have been taken, in +all civilized countries the proportion of male births is greater than +that of females. There is a greater tendency of the male offspring to +die earlier, and this is seen even before birth, in the proportion of +three to two. For this reason the stronger sex as applied to men has +been regarded by some authors as a misnomer. They are physically +weaker in early life and succumb more readily to noxious influences. + +The relative age of the parents is said to be another factor in +determining the sex of the children. Seniority on the father's side +gives an excess of male children; equality in the age of the parents +gives a slight preponderance of females; seniority on the mother's +side gives an excess of females. Men, and especially scholars, who +pass a sedentary life and who exhaust their nervous force to a great +extent, beget more girls than boys; so, also, a very advanced age on +the part of the man diminishes the number of male offspring. + +The Influence of the Male Sexual Element on the Female Organism.-- Dr. +Alexander Harvey, of Aberdeen, has adopted the theory of fetal +inoculation. He believes that the effect is first due to the influence +of the male element upon the ovum, which, in consequence of the +subsequent close attachment and freely inter-communicating +blood-vessels between the modified embryo and the mother, inoculates +the condition of the mother with the qualities of the male; and so, on +the subsequent impregnation by another male, the offspring resembles +the first male and not its real parent. He even goes further, and says +that it is conceivable, by successive impregnations effected by him, +that the influence may be increased, and if so the younger children +begotten by him, rather than the elder, might be expected, ceteris +paribus, to bear their father's image. And as regards the mother, he +suggests the question, whether there is not something in the popular +notion that in the course of years the wife comes to resemble the +husband; and that not merely in respect of temper, disposition, or +habits of thought, but in bodily appearance, which may be referable to +this influence exerted by the husband on her constitution, through the +medium of the fetuses in utero. + + "Yet it shall be; thou shalt lower to his level day by day, + What is fine within thee growing coarse to sympathize with clay. + As the husband is the wife is; thou art mated with a clown, + And the grossness of his nature will have weight to drag thee + down. + He will hold thee, when his passion shall have spent its novel + force, + Something better than his dog, a little dearer than his horse." + +Darwin, on the other hand, considers it a most improbable hypothesis +that the mere blood of one individual should affect the reproductive +organs of another individual in such a manner as to affect the +subsequent offspring. The analogy, he says, from the direct action of +the foreign pollen on the ovaries and seed coats of the mother plant +strongly supports the belief that the male element acts directly on +the reproductive organs of the female, and not through the +intervention of the crossed embryo. + +Dr. John Brown, in reviewing the subject, says it must be conceded +that the male element has an influence on the female, over and above +its fertilizing influence upon the ovum. The limit of this influence +is at present unknown. + +Heredity.-- Girls are more apt to resemble their fathers in mental +traits, disposition, and constitution; while boys take after their +mothers. Boys procreated by intelligent mothers will be intelligent; +while it does not always follow that the sons of intelligent fathers +are intelligent. The poets Burns, Ben Johnson, Goethe, Walter Scott, +Byron, and Lamartine were all born of women remarkable for vivacity +and brilliance of language. + +Hygiene of Pregnancy.-- The health and perfection of the child depend +largely upon the health and perfection of the parents at the time of +its conception, as well as upon the condition of the mother during the +pregnancy. Even when both parents possess a strong constitution, but +one or both of them is suffering from a temporary exhaustion or +malaise, the child will be born below the standard of health it ought +to possess. Children born during the first year of married life seldom +equal in health the children born of the same parents later; they are +not only apt to be sickly, but the liability to premature death is +greatly increased. For this reason it is better that the first year of +married life should be allowed to pass without conception taking +place. A child begotten in an intoxicated or depraved condition of a +parent may be depraved itself in the same way, and is apt to be +feeble-minded or idiotic. + +It must be borne in mind that prenatal culture of some sort begins at +the time of conception; and that on the mental as well as on the +physical state of the mother, the health as well as the disposition of +the child will depend to no slight extent. The prospective mother who +constantly gives way to her feelings does a wrong to her unborn child. +The mother is at this time more impressionable, more nervous, and more +irritable than is natural to her; and while her family should make a +certain allowance for her condition, she, on her part, should not +allow herself to give way to her morbid feelings. The prospective +mother should not lead a life of self-indulgence, on the one hand, or, +on the other, should not be weighed down with cares; she should +interest herself in her usual duties, and be relieved of all anxiety +possible. + +Dress.-- The clothing must be loose, and all compression about the +waist and abdomen must be especially avoided. If the woman wears +corsets, she must take them off at once, and substitute a Ferris or +some similar hygienic waist. The corset prevents the proper +development of the abdominal muscles, which play so important a role +in the expulsion of the child from the womb, as well as in the proper +growth and development of the fetus itself. If the woman has already +borne children, and toward the end of the pregnancy the abdomen +becomes pendulous, she will very materially add to her comfort by +swearing a muslin abdominal bandage. + +A woolen undersuit, or undervest and drawers, with high neck and long +sleeves, must be worn winter and summer; the grade of the wool to be +adapted to the season of the year. The especial necessity for wearing +wool next the skin during the pregnancy is because of the intimate +relation between the skin and the kidneys. Any chilling of the body at +this time is apt to lead to the congestion of the kidneys. If there is +already any congestion of the kidneys present, or any abdominal pain, +in addition to the undersuit an abdominal bandage should be worn. +These bandages come woven in ribbed woolen, and fit the body snugly. +This bandage is to be constantly worn, and, of course, changed at +night. During the cold weather the stockings should also be of wool. +Under no circumstances are garters allowed to be worn, as they form a +constriction around the leg and interfere with the return of the +venous blood to the heart, and so increase the tendency to the +formation of the varicose veins. It is better not to use any means to +hold the stockings up; they will be kept sufficiently well in place by +the under-drawers. Low shoes should never be worn except in the +hottest weather. It is of the greatest importance that the woman +should be impressed with the necessity of the avoidance of taking +cold, since any lung or kidney trouble is a serious complication of +pregnancy. + +Diet.-- The diet is the same as that at any other time, only it is +more necessary to guard against anything which is likely to cause +indigestion. In other words, the diet should be plain, simple, and +easy of digestion; nutritious and partaken of at regular intervals. In +the latter part of pregnancy owing to the pressure of the enlarged +uterus on the stomach, the food may have to be partaken of in smaller +quantities and at shorter intervals. At this time also the appetite is +abnormally large. Where it does not disagree with the patient, milk is +the best adjuvant possible to the diet. + +Constipation.-- Constipation is the rule of pregnancy. This is due to +the great pressure that the enlarged uterus makes on the bowel; and as +important as it is at all times to keep the bowels regular, it is at +this time more necessary than ever that the woman should have the +bowels well evacuated every day. A retention of fecal matter in the +body causes the reabsorption into the blood of the toxic matters, with +the resulting headaches, dizziness, loss of appetite, and intense +nervousness. To obviate this tendency to constipation, plenty of fruit +and vegetables should be eaten, as well as cereals if the woman is +taking a good deal of outdoor exercise, otherwise the latter had +better be omitted. The woman should drink plenty of water-- at least +three pints a day; this acts as a laxative as well as to flush out the +kidneys. If, in spite of all these measures, constipation still +persists, as it probably will, a seidlitz powder can be taken the +first thing on rising in the morning; or from one teaspoonful to one +tablespoonful of the effervescing granules of the phosphate of soda in +a glass of water, also to be taken on rising in the morning; or +one-half grain of the solid extract of cascara sagrada night and +morning. The object of these is to keep the bowels open, but purgation +must always be avoided. + +Bladder Symptoms.-- If there is any irritability of the bladder, any +scalding on urination, or a very great frequency of emptying the +bladder in the early months of pregnancy, a physician should be +consulted at once; in the last months of pregnancy there is a desire +to evacuate the bladder frequently, and sometimes at the last there is +an incontinence of urine, which is due to the descent of the uterus +and the great pressure on the bladder; this condition disappears with +the confinement. + +Leucorrhea.-- If this is present to any marked degree, the vaginal +douche should be continued throughout the pregnancy; the temperature +of the douche should be from 110° to 112° F.; it must never be taken +very hot or very cold. The fountain syringe should be used, and the +bag should not be hung more than three feet above the bed, so that +there shall not be too much force to the stream of water. + +Baths.-- Warm tub-baths may be taken throughout the pregnancy, but +never oftener than twice a week, and the woman should never stay in +the tub longer than is absolutely necessary for the bath, as otherwise +the bath is too enervating. A daily sponge-bath of cool or cold salt +water at a temperature of from 80° to 70° F., and in the proportion of +a pint of rock or sea salt to a gallon of water is most invigorating, +and counteracts many of the nervous symptoms and promotes sleep and +good digestion. The temperature of the room in which this bath is +taken should be 72° F. Shower-baths cause too great a shock to the +nervous system, and they as well as foot-baths must be prohibited. +Sitz-baths at a temperature from 110° to 90° F. may be taken just +before retiring throughout the pregnancy. The frequency and duration +of the bath as well as the temperature should be regulated by the +attending physician. In cases of intense nervousness and insomnia +these baths have an excellent sedative effect. A pregnant woman must +never under any circumstances take ocean baths, since there is always +great danger that the shock of the waves will cause an abortion. +Sea-voyages should be avoided because of the severe nausea and +vomiting, as well as the danger that the lurching of the vessel may +cause miscarriage. + +The sewing-machine is a tabooed thing for the pregnant woman, because +of the jarring of the pelvis which it produces. Sweeping of heavy +carpets is also injurious. There must be no lifting of heavy pieces of +furniture, and especially no lifting from the floor, as it interferes +with the circulation in the uterus and is apt to produce miscarriage. + +Driving in an easy carriage over smooth roads is permissible; +dogcarts, or any conveyance which produces much jolting, must be +avoided; and while driving is good, the woman should not do her own +driving, on account of the danger of the jars that would be caused by +the sudden pulling of the horse upon the lines. Horseback-riding and +bicycling are, of course, forbidden, as are also golf, tennis, and +dancing. + +Exercise.-- Exercise in the open air should be taken every day, when +the weather is suitable, and walking is the best form of exercise. The +amount will be regulated to some extent by what the woman has been +accustomed to taking, and it should always stop short of fatigue. The +woman should live as much as possible in the open air, and she should +attend to her ordinary duties about the house. Long railway journeys +are always objectionable. + +Hemorrhoids or piles are very often troublesome toward the close of +the pregnancy. To overcome this, the patient should lie down +immediately after the bowel movement, and remain in the recumbent +position for ten or fifteen minutes. In addition, care should be taken +to secure a loose movement of the bowels. Should the piles come down, +applications of cloths wrung out of hot water, and held well pressed +against the bowel, should be made; the piles should then be pressed +back until the finger feels that the mass has been pushed above the +second constriction of the bowel, which is felt to exist at about two +inches above the sphincter ani muscle. Should these means not suffice, +the physician must be consulted at once. + +Swelling and pain of the external genitals and of the lower limbs are +best relieved by the recumbent position. Should the veins of the legs +be much enlarged or the feet swollen, the patient should have +compression made by the wearing of elastic stockings. Or in some cases +a bandage is sufficient; in this case the bandage may be made of +muslin; it should be three inches wide, and, beginning at the toes, +should extend up as high as the enlargement of the veins continues. +This bandage should be freshly applied every morning before rising. + +Pain caused by the stretching of the skin may be relieved by the +inunction of the skin with cottonseed or cocoanut oil. For severe pain +in the small of the back, rubbing with soap liniment or alcohol will +be found useful. + +Mental Occupation.-- Important as this always is, it is doubly so now. +The mind should be constantly and pleasantly occupied, but no severe +study should be indulged in. The emotional susceptibility is generally +somewhat increased. The pregnant woman, quite excitable and irritable, +readily responds to influences by which in the non-gravid condition +she could not be affected. Sometimes she feels unusually well, is +intellectually brightened and more active, and says she is positively +happier. At other times she is despondent and morose. + +Physiologists admit and observation proves that maternal emotions do +affect the development and the exterior of the fetus; likewise the +mental organization of the fetus may be affected. All unpleasant news, +frights, and physical shocks, also scenes of suffering and distress, +must be avoided, as the mind is particularly impressionable at this +time. Around the patient should be thrown a gentle and protective +care, and she should be treated with the considerate kindness which +her condition demands. Theatres and all places where there will be a +large assemblage of people should be avoided, as the close air and +general bad ventilation are apt to produce vertigo and sometimes +attacks of fainting. + +Sleep.-- During pregnancy a large amount of sleep is required; there +should be eight hours spent in sleep at night, and one hour every +afternoon. Pregnant women should never do any night watching. There is +unusual necessity for good ventilation during sleep at this time. + +The Marital Relation.-- Coitus is, as a rule, distasteful to pregnant +women. It is for the best interest of the wife as well as for that of +the child that all marital relation should be suspended at this time. +Even uncivilized nations have condemned the privilege of sexual +intercourse during pregnancy, and have visited punishment on the +offender. If these relations are not wholly suspended, they must at +least be at those periods which correspond to the time at which the +woman would have been unwell had she not been pregnant. To the +continuance of these relations throughout the pregnancy is due much of +the suffering of the wife, not only then, but at the time of the labor +as well; and the nourishment of the child is interfered with. + +Causes of Miscarriage.-- Hemorrhoids; straining at stool; excessive +intercourse in the newly married; nursing; ocean-bathing; +overexertion; overexcitement; a fall; any violent emotion; anger; +sudden or excessive joy; a fright; running; dancing; horseback-riding; +riding in a heavily built carriage over rough roads; great fatigue; +lifting heavy weights; the abuse of purgative medicines; disease or +displacements of the womb; and a general condition of ill health. + +The danger of miscarriage is greatest during the first three months of +pregnancy. Miscarriage is a fruitful source of disease and often of +danger to wives; it is said that thirty-seven out of every hundred +pregnant women miscarry. Miscarriage is most apt to occur during the +first pregnancy; and great care should be taken to prevent this, as +the habit is easily established, and after one miscarriage has +occurred, another is likely to follow, so that it is sometimes with +the greatest difficulty that the woman can be made to carry the fetus +to full term. Artificially produced abortions are not an infrequent +cause of sterility; the young wife becomes pregnant, and has an +abortion produced because she is not yet ready to give up all her +pleasures; and eventually when she does become very anxious to have a +child such an extent of uterine disease has been produced by the +abortions that she cannot conceive. + +To Prevent Miscarriage.-- The life must be free from all excitement, +and must be as quiet as possible without becoming monotonous; especial +care must be exercised at the return of the dates for the menstrual +periods. + +The symptoms of miscarriage are a show of blood, more or less profuse, +with intense abdominal pain; on the slightest show of blood the +patient should go to bed at once and the physician should be sent for. + + CHAPTER XI. + + THE CONFINEMENT. + + Preparation for the Confinement; Signs of Approaching Labor; Symptoms of + Actual Labor; the Confinement-bed; the Process of Labor. + + "To my conception one generation of educated mothers would do more + for the regeneration of the race than all other human agencies + combined; and it is an instruction of the head they need, and not + of the heart. The doctrine of responsibility has been ground into + Christian mothers above what they are able to bear." + + -- ISABELLE BEECHER HOOKER. + +Preparations for the Confinement.-- The right time to engage the +physician who is to take charge of the woman at her confinement is +just so soon as the woman knows that she is pregnant. It used to be +argued that, since giving birth to children was a physiologic process, +there was no necessity for the woman to consult the physician until he +was sent for when the labor pains began. Take the case of the woman +who is for the first time pregnant; she is absolutely at sea; she has +not the least idea how she ought to feel, what she ought to do or to +leave undone; the result is that she often has a miscarriage which is +the source of the greatest disappointment to her husband and herself, +or she suffers very unnecessarily throughout the entire pregnancy, has +a difficult labor, and perhaps gives birth to a sickly child. + +The educated physician will explain to her what symptoms are normal +and what are pathologic, and often he will be able to entirely cure +the latter. It is now a well-established fact that the most serious +complications of the pregnancy, and of the labor itself are caused by +severe congestion or disease of the kidneys. The condition of the +kidneys can only be determined by frequent examinations of the urine; +during the early months of pregnancy these examinations are made once +a month, and during the last month they are made every week. The +amount of urine passed in the normal condition is three pints a day. + +Nowhere, perhaps, is the constant vigilance of the physician so well +rewarded as in the careful oversight of the pregnant woman. She goes +through her entire pregnancy feeling well, and often the greatest +discomfort that she suffers is due to her size; her labor and her +lying-in are normal, and she gives birth to a healthy child. + +Engagement of the Nurse.-- This is generally left to the physician in +charge of the case, since he is responsible for the safe delivery of +the woman; but if the patient has any decided choice in the matter, it +is acceded to unless there should be some very valid objections, and +the physician always sends the nurse in view for that case to see the +patient in order to ascertain if she is personally agreeable to the +patient. + +Choice of Room for the Confinement and Lying-in.-- The room should be +light, sunny, and well ventilated; it should not be too near a +water-closet. In the city as quiet a room as possible should be +selected, and one that is well removed from the rest of the house, so +that if necessary perfect quiet can be maintained. The room should be +as cheery as possible. + +The dress of the mother during the lying-in consists of a merino +undervest, with high neck and long sleeves, and a nightgown, which +shall be open all the way down the front. The gowns should be made of +light muslin or of cambric; and there should be a sufficient number so +that they may be changed every day. + +Six abdominal bandages should be provided. These are made of light +muslin, and they should be eighteen inches wide and long enough to go +once and a third around the patient's hips at the sixth month of +pregnancy, or about one yard and a quarter long; they may be made +straight or to fit the patient at the sixth month. This bandage is +fastened down the front; it is applied directly after the labor, and +adds greatly to the patient's comfort during the lying-in. + +The vulvar pads used during the lying-in are the antiseptic absorbent +pads which can be obtained at any place where surgical dressings are +sold; they are made of absorbent cotton, covered with cheesecloth, and +sterilized. + +There must be a sufficiently generous supply of sheets so that they +can be changed every day, and the drawsheet as often as may be +required. Nothing is so important to a good lying-in as to have a +clean, well-ventilated room, and plenty of fresh bed-linen. +Cleanliness is the first requisite to antisepsis, and this is the +secret of avoiding puerperal fever. + +Articles to be provided for the confinement are: + 1. An oblong douche-pan of agate-ware. + 2. An agate bed-pan. + 3. A bath thermometer. + 4. Two pieces of rubber sheeting; one, one yard square, and the other + two yards square. + 5. Two sterilized bed-pads, 30 inches square by 3 to 4 inches thick. + 6. Three dozen antiseptic absorbent pads. + 7. One pound of sterilized absorbent cotton; twelve yards of + cheese-cloth. + 8. Six abdominal bandages, eighteen inches wide, preferably made to + fit the figure at the sixth month of gestation. + 9. Two hand-scrubs. +10. Four ounces of the tincture of green soap. +11. Bottle of corrosive sublimate tablets. +12. Four ounces of powdered boric acid. +13. Half a pint of good whisky. +14. Two ounces of aromatic spirits of ammonia. +15. Two ounces of aqua ammonia. +16. One pint of alcohol. +17. Two tubes sterilized white vaselin. +18. Plenty of large and small safety-pins. +19. Hot-water bag. +20. New fountain syringe, to hold four quarts; with glass nozle. +21. One small basin for vomited matter. +22. Two very large agate basins or wash-bowls for washing doctor's + hands and for antiseptic solutions. +23. Vessel for after-birth. +24. Three large pitchers; one for boiling water, one for cold boiled + water, and one for antiseptic solution. +25. Tumbler for boric acid solution for washing baby's eyes, with fine + old linen sterilized. +26. One dozen freshly laundered sheets, and two dozen towels. +27. Stocking-drawers, muslin. +28. Change of night-clothing warmed for the mother. +29. A warm blanket to receive the baby. +30. An infant bath-tub. +31. A large piece of oil-cloth to protect the floor.* + +* Van Horn & Co., Park Avenue and 41st Street, New York, keep an +obstetric outfit, containing many of the above articles, cleansed, +sterilized, and packed in a box ready for use, so that they remain +intact until needed. The price of this outfit is $16.50. + +Baby's Outfit.-- Four flannel bandages, to be made of fine, soft +flannel, four inches wide, to go once and a third around the body. The +edges may be pinked or whipped, but should never be hemmed; a tape is +sewed on double, the ends passing around the body, and so the bandage +is fastened without pinning. + +Six merino shirts, with high neck and long sleeves, made to button +down the front. + +Cotton diaper napkins, not too large; old soft ones are preferable. + +Long merino stockings which can be pinned to the napkin. + +Flannel petticoats, not too long; these may be made on muslin bands, +which are held up on the shoulders by means of straps. The essential +in all the clothing is that it should be sufficiently loose. + +Dress-slips should not be so elaborate that they cannot be washed and +changed with sufficient frequency; and not so long that the baby's +feet will be hampered in their movements by them. All of baby's +clothes but the dress should be fastened by safety-pins. + +Baby's basket should contain: + 1. One outfit of clothes. + 2. One tube of sterilized tape. + 3. A pair of blunt-pointed scissors. + 4. Large and small safety-pins. + 5. Pieces of fine old linen; old handkerchiefs are the best. + 6. A soft hair-brush. + 7. A powder box and puff, with talcum powder. + 8. Two tubes of sterilized white vaselin. + 9. Two soft towels. +10. Castile soap. +11. Single-bulb syringe; so-called "eye and ear syringe." +12. A woolen shawl or wrap. + +If there is no nurse available before the labor sets in, and it is +necessary for the patient to see to the sterilizing of the above +articles, she should first scrub off all pitchers, basins, and other +utensils, as well as the douche-pan, fountain syringe, and rubber +sheeting, with a brush and hot soap-suds; the hand-scrubs are to be +well washed; then each article should be pinned separately in coarse +towels, and put to boil for half an hour in an ordinary wash-boiler. +The articles so boiled are then dried without removing the towels, put +away, and not opened till the time of the labor. + +The abdominal bandages must be laundried and pinned up in separate +towels until they are needed. The cheese-cloth must be laundried and +then sterilized. + +The vulvar pads should be pinned in an old napkin, in packages of half +a dozen each; and one package is sterilized at a time by placing it in +the oven until the outer covering is scorched. The linen for the +baby's eyes and the cheese-cloth are treated in the same way; they are +to be cut up into small pieces and sterilized as needed. + +Signs of Approaching Labor.-- About two weeks before labor there is a +sinking of the womb. At the beginning of the ninth lunar month this +was at the end of the breast-bone; it now descends to a point midway +between this and the navel; the abdomen becomes smaller, the pressure +on the lungs is relieved, and the woman breathes more freely. But at +the same time that the woman is relieved of the pressure on the chest, +she experiences increase of the troubles in the lower extremities. +There is an increase of the bladder symptoms, with a desire for +frequent unrination. Constipation becomes more troublesome, and there +may be hemorrhoids; the veins of the lower extremities may become +greatly enlarged. + +There is an increased fullness of the external genitals and a greatly +augmented amount of mucous discharge. There is a feeling of anxiety +and nervousness, with depression of spirits. + +During the last two weeks of pregnancy patients are apt to have +cramp-like pains in the lower part of the abdomen. These are often +mistaken for labor pains. True labor pains are characterized by +starting in the back, extending around the abdomen and toward the +pubes and down the thighs; they come at more or less regular intervals +of half to three-quarters of an hour, and increase in intensity with a +decrease in the intervals. A strong pain is apt to be followed by two +weaker ones. The so-called false pains are irregular in their +occurrence. + +Symptoms of Actual Labor.-- First is generally the show; this is a +discharge of mucous tinged with blood; at the same time the true labor +pains set in. When the patient or nurse is in any doubt as to the +character of the pains, or when the show appears, the physician should +be summoned at once. Other symptoms are frequent desire to empty the +bladder and bowels, and a sensation of shivering. + +The Confinement-Bed.-- A single bed is much more convenient, but it is +rarely found in a private house. The double bed is arranged as +follows: The hair mattress is covered with a large rubber sheet, which +is pinned with safety-pins at the corners and tucked well under the +mattress; the rubber sheet must not be drawn too tightly for fear of +tearing. Over this comes the sheet, and over the upper half of the +bed, the draw-sheet; this is a sheet folded four double, which goes +across the bed so as to come under the hips of the patient, and is +tucked under the mattress at both sides. The object of this is so that +it may be frequently and easily changed without disturbing the +patient. The sheet, blanket, and spread which are to serve as a +covering after delivery are folded back and placed on the left side of +the bed. + +The lower right-hand corner of the bed-- the right side of the bed is +that side which is toward the right hand as one stands facing the +foot-board-- is arranged for the confinement; on this is fastened the +smaller rubber sheet, and over this the sheet is folded, and both are +fastened down with safety-pins. The pillow for the patient should be +placed at the upper and inner corner of the square. After the delivery +the patient is lifted to the upper part of the bed and the temporary +dressing is removed. A sheet and blanket are used for a covering +during the confinement. + +Before the labor begins it is well to fasten up the vest and gown, so +that they will not be soiled, as it is important that the patient +shall be moved as little as possible after the labor, as all movements +tend to increase the bleeding. + +The floor oilcloth must be spread at the side of the bed which is made +up for the confinement, and should extend slightly under the bed. + +A bureau in the room should contain the mother's and baby's clothing, +bed-linen, towels, and any other articles which will be needed, all +properly arranged. + +The clothing for the mother and baby will be placed where it will keep +warm, and the infant bathtub will be in readiness in case of sudden +need for it. + +All water used about the confinement must have been carefully +sterilized in advance. The best way to sterilize the water is by +boiling it in a large wash-boiler; whatever vessel is used must be +scrupulously clean, and ought to be new. The vessel is covered over, +and the water is allowed to boil for half an hour; it is then, still +covered, set aside to cool. There should be three gallons each of +sterilized hot and cold water; since in case of an emergency there +must be plenty of water ready for use. + +The various articles ordered in the confinement outfit will be at hand +ready for use. It is the duty of the nurse to have everything ready +for the doctor before his arrival. The patient should have a full warm +tub-bath, fresh night-clothes put on, and an enema should be at once +given to unload the bowels, and this even though there may have been a +bowel movement only a few hours previously. The patient should remain +in bed until the arrival of the doctor. After an examination has +assured the latter that all is right, she may be allowed to go around +the room, with a wrapper thrown on over the night-gown. + +Conveniently near the bed should be a small table, covered with one or +two freshly laundried towels. This table should have on it a +wash-basin, a hand-brush, soap and hot water, an antiseptic solution, +scissors, a ligature for the navel, and a suitable aseptic lubricant +for the hands. + +The Process of Labor.-- The process of labor is divided into three +stages. The first stage is that of dilatation; by which is meant the +stretching of the mouth of the womb so that the child may pass +through. At the first confinement this stage lasts about fifteen +hours; at subsequent labors the length of this stage is much shorter, +the average time being eight hours. The pains during this stage are +sharp and cutting, and they are accompanied by a slight show of blood. +The patient is fretful and nervous + +The second stage of labor is called that of expulsion, because in this +stage the uterus contracts down together with the abdominal muscles to +expel the child from the womb and the vagina into the world. The +duration of this stage in the first confinement is about an hour and a +half. + +The third stage of labor includes the time from the expulsion of the +child till the coming away of the after-birth; the average length of +this stage is from twenty minutes to half an hour. + +The average length of time for the first labor is seventeen hours; and +for subsequent labors from eight to eleven hours. + +The bag of waters is the sac of membranes in which the child is +inclosed. It contains a liquid in which the child floats; the object +of the water is to protect the child from sudden shocks or any kind of +injury during pregnancy. During labor this membrane with its contained +water serves as a dilating wedge to assist in the opening of the womb, +and it also protects the child from the direct contraction of the +uterus upon it. When the waters break prematurely, the labor is much +longer and more tedious; normally this should not occur before the +mouth of the womb is fully dilated. + +The pains of the second stage of labor are of a bearing down +character, and constantly increase in force and frequency; the climax +being reached as the head passes through the vulvar orifice. + +A child usually lies in the womb with the head downward; the reason of +this is that there is more room in the upper part of the uterus, and +as the small parts of the child as it is folded upon itself take up +the most space, they occupy this position, while the head lies just +above the pubes. The normal position of the child is: the head is +flexed on the chest, the legs on the thighs and the thighs on the +abdomen, and the hands are folded across the chest. And so the child +is usually born head first. + +During the stage of expulsion the head of the child is forced down +slightly during each pain, to recede a little during the intervals +between the pains; in this way the vagina and its external orifice are +gradually stretched so that the head of the child may pass through +without tearing the parts. If the head is allowed to pass through +suddenly, or where the labors are rapid, as in the case of women who +have given birth to several children, much mischief may be done by +tearing the soft parts. + +After the birth of the head there is a short interval of rest, when +the shoulders are born; the rest of the body easily slips out; and +with the expulsion of the after-birth the labor is over. + +At the very beginning of labor the patient should be given a full warm +tub-bath, and make an entire change of linen. She will usually prefer +to be dressed in her night-clothing, over which during the first stage +she may wear a loose wrapper; a sterilized napkin should be worn over +the vulva during this stage. During the first stage, as a rule, the +patient should not be confined to bed until the dilatation is well +advanced; she is generally more comfortable if she is allowed to move +around the room, and the pains are thereby advanced. + +The only way in which the physician can determine whether labor has +begun is by making an internal examination; and this will enable him +to decide as to whether it is necessary to remain or not. + +The nurse should always wear a wash dress in the confinement and +lying-in room. + +If the labor is long, nourishment in the form of beef-tea, broths, and +milk may be given. No stimulants should be given without the direction +of the physician. The frequent taking of cold water is permissible. + +At the beginning of the labor the family and friends must be excluded +from the room, and it must be kept as quiet and as cheerful as +possible. + +Toilet of the Patient.-- The newly born child is received in a small +blanket, is well wrapped, and laid in a warm place. The nurse then +turns her attention to the mother; the external genitals and soiled +parts of the body are cleansed with sterilized cheese-cloth wrung out +of an antiseptic solution; if the body-linen has become soiled, it is +also changed, and all blood-stained articles are removed from the bed. +The patient is then carefully lifted up on the permanent bed, and the +vulvar pad and the abdominal bandage are applied; after which the +patient is allowed to rest. + + CHAPTER XII. + + LYING-IN. + + Management of the Lying-in; Lactation; Nursing. + + "'Tis is ourselves that we are thus or thus. Our bodies are our + gardens; to the which, our wills are gardeners."-- "Othello." + +Management of the Lying-in.-- Immediately after the delivery the first +essential for the patient is absolute quiet and rest; the room must be +kept quiet and darkened, and ordinarily the patient is allowed to fall +into a light sleep. During the first few hours after labor the best +position for the mother is flat on the back, with only a small pillow +under the head. After the first twenty-four hours the patient may be +allowed to turn on the side as she prefers. Since absolute rest is the +first requisite for the patient, she must be left alone with the +nurse, who must see that she does not fall into too deep a sleep. If +the child's cries disturb the mother, it must be taken into another +room. + +The lying-in room must be kept free from all odors, all soiled +clothing must be at once removed from the room, and good ventilation +must be insured, being careful to prevent any drafts. + +While the patient is asleep, and after the baby has been attended to, +the nurse should place all blood-stained articles in cold water to +soak. If in the city, the after-birth may be burned in the furnace or +range; it should be well covered with coal. In the country the +after-birth can be buried in a deep hole. + +During the first two or three days the vulvar dressings should be +changed from every three to six hours, and at all times as often as +they are soiled. Each time that the dressing is renewed the external +genitals and their immediate surroundings are to be carefully cleansed +with sterilized water, and finally washed with a solution of boric +acid, in the proportion of one tablespoonful of boric acid to one +quart of water. It is convenient to keep this solution mixed and on +hand, as it takes some little time to prepare it; it should be kept in +a strength double that which is desired, so that it may be diluted +with warm water to give the desired temperature. This solution may be +poured over the parts from a small pitcher, the douche-pan having been +placed under the patient before the washing began. After labor the +vulva is very sensitive, so that while the greatest care must be used +to remove all clots of blood and the discharge, there must be no brisk +rubbing of the parts. No blood-stained linen should be permitted to +remain about the patient or the bed. + +Since the lying-in woman perspires freely, her skin ought to be +frequently cleansed by sponging with a weak solution of alcohol in +tepid water; this should be followed by friction with a towel until +the skin is in a glow. Cleanliness of the bed is promoted by the use +of a draw-sheet, which is a sheet folded to four thicknesses and +placed beneath the patient's hips in such a way that the upper edge of +the sheet shall come under the lower part of the pillows. Air and +light must be freely admitted at all times in order that the room may +be bright and cheerful. For the first few weeks the eyes of the +new-born infant should be shielded from all strong light. + +Visitors.-- For the first week after the confinement the patient +should see no visitors. Even the husband or mother should not remain +in the room long at a time. Nothing of a disagreeable nature should be +told to the patient; and whoever goes into the sick-room should always +carry the most cheerful manner, as it is highly necessary that the +patient should be kept mentally as well as physically quiet at this +time. + +Diet.-- For the first twenty-four hours the diet must be restricted to +liquids, and in most cases nothing is given until the patient has had +a few hours' rest. The first thing that is given to the patient should +be a cup of warm milk or tea. Milk is the best diet; this may be +varied with beef-tea, bouillon, mutton or chicken broth; any of these +broths may be made with rice or barley to vary the flavor, but these +must not be given to the patient. The patient should have six ounces +of the liquid every two hours during the day and every three hours +during the night. + +On the second day bread well toasted through may be added to any of +the liquids. On the third day stewed or baked apples should be added +to the diet. On the fourth day, and from this on, the patient will +have regular meals, but the diet must be a plain one. For breakfast, +stale bread, a soft-boiled egg, fruit, and a cup of tea, not too +strong. For dinner, which should always be given in the middle of the +day, an oyster-stew or clam broth, a lamb chop, or a very small piece +of beefsteak or chicken; but with these there must be no gravies or +dressings; a potato baked in the skin; raw tomatoes, if in season; +apple sauce or cranberry; celery; junket, plain corn-starch, lemon +jelly, plain cup-custard. From this list the diet must be arranged so +as to give as much variety as possible from day to day. Midway between +breakfast and dinner, and again in the middle of the afternoon, the +patient should have a glass of milk. The diet should be generous, but +simple. + +Urination.-- The feeble condition of the bladder in the first few +hours after delivery frequently leads to the retention of urine. Owing +to the copious secretion of urine which is so common at this time, +painful and injurious distention of the bladder may result. The +patient should therefore endeavor to pass her urine in at least six +hours after labor, whether she feels any inclination to do so or not; +the sound of running water or warm fomentations over the bladder, warm +water in the douche-pan, and moderate pressure applied by the hand +over the suprapubic region, are often effective in accomplishing the +desired result. If all these means fail, the catheter must be used as +the last resort. During the entire lying-in the bladder should be +emptied every six hours. + +Evacuation of the Bowels.-- There should be an evacuation of the +bowels in from twenty-four to thirty-six hours after the labor. For +this purpose a seidlitz powder may be given, or the liquid citrate of +magnesia. If this does not suffice, an enema of warm water, to which a +little soap or two teaspoonfuls of glycerin have been added, may be +given. Two pints of water should be prepared; the patient will retain +as much as she comfortably can, and as long as she can. The bowels +should be opened daily after the first day. + +After-pains are caused by the same physiologic process that causes +labor pains-- namely, by the contractions of the uterus. After the +first confinement the after-pains are, as a rule, not severe; +attention to the regular emptying of the bladder and bowels also +lessens the severity of the after-pains; these pains seldom last after +the second day. + +The Lochia.-- The discharges of the mother continue for about two +weeks, and are called lochia. For the first twenty-four hours they are +pure blood; the second and the third day they are of the character of +bloody water; from the fourth to the sixth day they have a, +greenish-yellow color, and from the tenth to the twelfth day they +become pure white. Soiled napkins and dressings should never be +allowed to remain in the patient's room. + +Duration of the Lying-in.-- This lasts for six weeks. During this time +the organs of generation are returning to their normal size and +condition. In order that the woman may be in the best condition +possible at the end of this time, it is essential that for the first +two weeks she should remain in bed; and so long as there is any blood +in the discharge the woman should not be allowed to sit up. The first +sitting up should be in bed, the patient being supported by a +bed-rest. During the second two weeks the patient may be allowed to +divide her time between the bed and the couch; in the latter part of +this time she may be allowed to go around her room a very little; and +for two weeks more she should remain on the same floor. The first +sitting up should not last more than half an hour. Getting up and +going around too soon after the confinement, "being too smart," is one +of the most prolific sources of falling of the womb, and all manner of +uterine trouble, by which the general health of the woman is greatly +impaired. + +Lactation.-- If it is at all possible, every mother should nurse her +own child; in the interests of both the mother and the child. So far +as the mother is concerned, the process of lactation is beneficial +because it hastens the return of the uterus to its normal size. +Wet-nurses are known tyrants, and if the quality of the milk has +anything to do with the disposition of the child, as is believed to be +the case, the idea is distasteful of having a woman who belongs to the +lower classes provide nourishment for your child; and artificial +feeding is one unmitigated trouble. + +A deficiency of the quantity or the quality of the mother's milk can +generally be remedied by the diet and attention to the health of the +mother; if the deficiency in quantity persists, the mother's milk can +be supplemented by artificial feeding. + +There may exist certain conditions of the mother in which nursing her +own infant would be inadvisable or even impossible. Syphilis +contracted late in the pregnancy, and tuberculosis, are +contraindications, owing to the danger of the mother infecting the +child. Inversion of the nipples, their excoriation, or persistent +sensitiveness may make it impossible. In marked general debility of +the mother from any cause whatever, it would be injurious to the +mother and the child. + +After the mother and the new-born infant have had some hours of rest +and sleep, it is advisable to apply the child to the breast, to +receive by this first effort the small quantity of milk which is an +especial provision to act as a natural purge and to start the bowels +of the child into a healthy activity; this also excites the milk +glands to secretion. The mother's milk in full supply may be expected +in from forty to sixty hours after delivery. + +Nursing.-- When the mother's nipples are of the normal size and well +formed, the healthy infant instinctively suckles at once when placed +at the breast, but sometimes it has to be taught; by squeezing out a +few drops of milk to wet the nipple, the child will usually take hold, +or a little sugar and water may be put on the nipple; a little +patience and tact are all that is necessary to insure success. But the +infant must be taught to nurse at once before the breasts become +engorged with milk. + +Under ordinary circumstances the child is to be kept at the breast for +one year. But if within this time the menstrual period should recur +and be profuse, or should the woman again become pregnant, the quality +of the milk becomes poor, and necessitates the immediate weaning of +the child; the character of the milk is also altered, and even its +secretion may be checked. Nervous agitation may so alter the quality +of the milk as to make it poisonous. A fretful temper, fits of anger, +grief, and sudden terror not only lessen the quantity of the milk, but +render it thin and unhealthful, inducing disturbances of the child's +bowels, diarrhea, and so forth. + +Position of the Mother When Nursing.-- When in bed in the recumbent +position, the mother should lie on that side from which the infant is +going to nurse; when up, the mother should sit erect. + +Care of the Nipples.-- Immediately after each nursing the nipples +should be washed off in a saturated solution of boric acid in cold +water, and dried with a soft cloth. If they are disposed to crack, +anoint them with cocoa-butter immediately after each cleansing. If the +skin of the nipple is very sensitive, a nipple-shield should be used +for the first few days; or should the nipple become sore at any time, +the shield can be resorted to. The nipple-shield must fit tightly; the +best ones are made of glass with a rubber tip. In the intervals of +nursing the nipple-shield should be kept in cold water after it has +been thoroughly cleansed by being brushed on both sides. + +The breasts are sometimes distended from an over-secretion of milk; +this is relieved by saline cathartics, by abstinence from liquids, and +by the use of a compression breast bandage. This is made of a straight +piece of muslin, with a shallow notch cut in one edge for the neck, +and, a deep one for each arm; the bandage is closely applied over the +breasts, and the ends pinned in front; it is also pinned over the +shoulders. + +In debilitated women the supply of milk may be insufficient; the most +reliable evidence of this is the fact that the infant ceases to gain +in weight. + + CHAPTER XIII. + + THE NEW-BORN INFANT. + + The Infant's Toilet; the Crib; Feeding of Infants; Artificial Feeding; + the Wet-nurse; Characteristics of Healthy Infants; the Stools; + Constipation; Urination; Dentition. + + "O thou child of many prayers, + Life hath quicksands; life hath snares." + + -- LONGFELLOW. + +The Infant's Toilet.-- So soon as the mother has been made +comfortable, the toilet of the infant is attended to. This should be +made near the register or stove; and the lap of the nurse should be +covered with a small flannel blanket. The baby's body will be found to +be covered over with a white, greasy, somewhat cheesy substance; some +sort of grease is needed for its removal; rendered lard, sweet oil, +and lanolin are the best; vaselin is less effective. All of this +cheesy substance must be at once removed; the most difficult parts +will be in the folds and creases. The nurse should grease the palms of +her hands, then take the head of the child between them, and +thoroughly grease it; particular attention must be given to the ears; +then come the neck, shoulders, arms, chest and back, groins, external +genital organs, and lower extremities. After the child has been +thoroughly gone over, the grease should be rubbed off with a soft +towel. + +A rectal injection of one tablespoonful of warm water is given at once +to unload the bowels of the meconium; this generally acts before the +baby's toilet is completed. The meconium is the first discharge from +the infant's bowels after birth, and that which had collected in the +intestines during the pregnancy. + +The Baby's Bath.-- The baby's bath-tub is filled about one-third full +of water at a temperature of 100° F., tested by the thermometer. The +baby is then gradually immersed in the water, with the exception of +the head; this is supported on the left wrist of the nurse, which +passes under the infant's neck, while her hand grasps the left +shoulder; with the right hand the nurse quickly rubs over the child's +head and body; the entire bath should not occupy over five minutes. +The infant is then lifted out into the lap of the nurse, on which is +spread a soft, warm towel, with which it is carefully dried. One of +the important points in giving the infant its bath is to be sure that +the groins, arm-pits, and genitals are thoroughly well dried; +otherwise excoriation at these parts is sure to occur. + +After this a daily tub-bath is given in the same way; soap is rarely +needed; when it is, castile soap should be used; its constant use is +not necessary and would only irritate the skin. These daily baths +strengthen the nervous system and prevent coughs and colds. The bath +should be given during the morning, one hour after feeding, and should +not last more than five minutes. The mother herself, just as soon as +she is able to go around, should superintend the bath; in this way she +is assured that if properly given, and will also recognize any +incipient affection of the child. These daily baths should be +continued till the child is four years old. Powder is not essential; +but if it is desired, a plain talcum powder may be used. + +The Dressing of the Cord.-- After the bath the ligature which was tied +around the cord at the birth of the child will be found slightly +loosened; this should first be made tight, and then the cord, doubled +back on itself, should be tied by the ends of the same ligature. A +square of soft sterilized linen or gauze is slit up to its center; the +cord is allowed to pass through this slit, which looks toward the +child's right; the stump of cord is laid on the left and the ends of +gauze are folded over this; the whole is kept in place by the +abdominal bandage. As there is some exudation from the cord, it is +necessary to change these dressings twice a day; as this exudation is +of a somewhat gluey nature, it will be found that the dressings stick +to the cord. In removing the gauze great care must be used not to make +any traction on the cord; when the infant is placed in the bath, the +water loosens the dressing and it falls off in the water; at other +times it must be removed with the greatest care. There should never be +any odor about the cord; it usually drops off about the fifth day. + +The process of ulceration by which the cord falls off leaves an open +surface on the child's body which offers an avenue for septic +infection. Great care must therefore be taken that the nurse's hands +or anything which comes in contact with this surface should be +perfectly clean. The dressings used must be thoroughly antiseptic. + +Care should be used not to fasten the abdominal bandage too tightly; +the bath is given on an empty stomach, and allowance should be made +for this; the binder should be loose enough to allow two or three +fingers to easily slip under it. + +The Meconium.-- The First discharge that comes from the bowels is of a +dark, greenish color, and should come away during the first +twenty-four hours; if it does not, the baby may suffer a good deal of +pain, and an enema of warm water must be given. As this substance is +very difficult to be washed out of napkins, the first ones used should +be old and afterward be burned. + +Cleansing.-- Every time the napkin needs to be changed, even if it is +only wet, the baby should be washed with warm water. A napkin should +never be used twice without washing; it chafes the child, and it is an +unsafe as well as a filthy practice; the napkin must always be removed +as soon as it is wet. + +The Infant's Toilet.-- After the application of the binder and napkin, +comes the undervest; the fingers of the nurse are passed up through +the sleeve to seize the infant's hand and pull it through; as soon as +it gets a little older the child will grasp a finger laid in its palm, +which greatly facilitates this part of the toilet. The stockings are +next put on and pinned with safety-pins to the napkin; then comes the +petticoat, the band of which is also loosely fastened with +safety-pins, and with the slip the toilet is complete. All the +clothing should be changed night and morning. + +The eyes and mouth should be washed out with separate pieces of gauze +or old linen. For the mouth, a small piece of cloth wet in warm water +is wrapped around the little finger of the right hand, going into the +left angle of the baby's mouth and coming out at the right, going +between the gums and cheeks as well as over the tongue. This procedure +should be gone through with every time preceding and following the +nursing, and in this way the milk is prevented from souring in the +mouth, and the digestion is kept in good condition. A sore mouth in a +baby indicates carelessness on the part of the nurse. + +A soft hair-brush may be used, but the scalp is too tender to permit +the use of a comb. + +After the toilet has been completed, the baby is laid in its crib, on +the right side of the body, and warmly covered. The weaker the baby, +the more attention must be paid to the external warmth. It may be +necessary to place a warm-water bottle in the crib, but this must +never touch the infant. + +The Crib.-- The infant must have its own crib, without rockers, and it +must on no account be put to sleep in the same bed with its mother. In +its early life it should never be taken out of its crib except to be +fed, to have its clothing changed, or to be bathed. There should be no +holding on the lap, no dangling, no carrying or fussing over the +new-born infant; and the more the baby is let alone, the better and +healthier it will be. If baby cries, look at once to see if it needs a +fresh napkin; if not, if any pins are sticking into it, if the +clothing is possibly too tight; if none of these things are wrong, +give it a sup of water and turn it over on the other side. The baby +often becomes restless by sleeping for several hours in the same +position. But on no account take the infant up out of its crib simply +because it cries. + +Cheerfulness and good nature on the part of the infant are dependent +on its general good health. A healthy infant should not have colic, +but if such is the case, there is a peculiar look of distress on the +face, which indicates that the child is in pain; what is needed is +warmth or medication according to the severity of the case, but never +floor walking. Begin the latter procedure, and you may hope to keep it +up for several years. + +Ventilation.-- The air is sometimes vitiated for children's uses in +various ways; their nervous susceptibilities are greater than those of +older people. A very little odor of tobacco may cause nausea and +discomfort to an infant in arms. The atmosphere of the room should be +sweet and pure and unscented. All scents and perfumes affect the +nervous system, and by constant excitation do it damage. A bouquet of +flowers renders the air of a closed room too heavy. + +Feeding of Infants.-- During the day the infant should be put to the +breast once every two hours, and once every three hours during the +night. This interval of time between the feeding is necessary in order +that there may be sufficient time given for digestion to take place. +Regurgitation of milk soon after feeding is a sign that the stomach +has been overfilled. As the infant usually falls asleep after nursing, +it is necessary to waken it up at the time for the next nursing, as +good digestion depends upon regularity of feeding. + +For the first nursing the infant may be put to the breast in from two +to six hours after the labor if the mother is sufficiently rested; +from ten to twenty minutes is long enough for each nursing. Before +each nursing the nipples should be carefully washed off with a +solution of boric acid. The first secretion of the breasts is +laxative; that is, it acts on the bowels, and makes is unnecessary to +give the infant anything to take for this purpose. The breasts should +be used alternately in feeding the infant, as this allows a longer +time for the accumulation of the milk. For the first few days the +infant needs very little food, and the mother's milk is generally +sufficient. + +The infant should be given a teaspoonful of cool water to drink two or +three times a day, as the milk does not quench the thirst. The water +should be sterilized by boiling, and be kept in an air-tight flask. + +At the end of the third month the intervals of nursing for the daytime +should be three hours, and the last nursing at night should be at +eleven o'clock, and the first nursing in the morning at five o'clock; +thus allowing the mother an interval of six hours of unbroken sleep. + +The best evidence of the proper nutrition of the child is a +progressive gain in weight. The child should be weighed every week. A +loss of a few ounces usually takes place during the first few days +after birth, so that the child does well if at the end of the first +week it weighs as much as it did at birth. After the first week the +weekly gain should not fall below five ounces. + +The Wet-nurse.-- When the mother for any reason whatever is not able +to nurse her child, the best substitute is a wet-nurse. Before she is +employed the wet-nurse should always be carefully examined by a +physician to insure her freedom from disease. The best age is between +twenty and thirty years, and the age of the child of the nurse should +be at least within a month of that of the child to be nursed. The best +sign of the good health of the nurse and of the condition of her milk +is furnished by the health of her own child. The breasts should be +well formed and the nipple of good shape. It is well, if possible, to +get a woman who has borne several children, as she will understand the +care of the child better. No woman who is not perfectly healthy is fit +to be a wet-nurse; and even after she has been engaged her health and +her habits must be watched over. + +Artificia1 Feeding.-- The first requisite in artificial feeding is +that the milk shall be made to correspond as nearly as possible to +that of the mother. For this purpose the following formula, prepared +by Rotch, of modified cow's milk is considered the best: + + Milk 2 ounces + Cream 3 ounces + Water 10 drams + Milk-sugar 6 3/4 drams + Lime-water 1 ounce + +To make one pint of the mixture for use in the twenty-four hours, take +the milk and cream as soon as it comes in the morning, and mix as +above directed. + +No less important than the correct proportions of the ingredients, is +freedom from disease germs and bacteria of putrefaction. Complete +sterilization is possible by prolonged boiling; but experience has +proved that under prolonged exposure to a temperature near the +boiling-point certain changes take place in the albuminoids of the +milk which greatly impair its digestibility. Full sterilization of +milk for infant feeding has therefore practically been abandoned. It +has been found that milk heated to 167° F. for twenty minutes, and +promptly chilled by placing on ice, remains practically sterile for +twenty-four hours, and it is spared the injurious changes which take +place at a higher temperature. This process is known as +Pasteurization. The Arnold steam sterilizer affords a convenient +method of sterilizing; if used with the cover removed, the steam +chamber being open, the temperature of the steam chamber does not +exceed 170° F. + +It is claimed that in the Arnold steam sterilizer, with the use of a +suitable gas stove, the water begins to boil at the end of two minutes +after the gas is lighted. A four-ounce bottle of milk at an initial +temperature of 70° F. in the open steam chamber attains a temperature +of 170° in just one hour. An exposure of about one hour and twenty +minutes in the steam chamber is therefore necessary for the +Pasteurization. + +The rules for sterilizing are as follows: + +First, clean the bottles thoroughly; then place them in cold water, +which is allowed to come to boil and boiled for ten minutes. + +Second, fill each with the milk you wish to use; put in the rubber +cork without the glass plug; this leaves a small opening in the rubber +cork; set the bottle in the basket, then in the boiler. + +Third, set in the refrigerator until needed for use. + +Fourth, when wanted for use, place a bottle of the milk so prepared in +the tin mug which accompanies the sterilizer; fill the mug with hot +water to the height of the milk in the bottle, heat the milk to the +temperature of 99° F., remove the rubber cork and put on the nipple, +when it is ready for use. + +Fifth, cleanse the bottle immediately after using; throw away any milk +that has not been used. + +Sixth, if the steaming process is preferred, place the basket without +the bottles in the boiler, fill the water up to, but not above, the +bottom of the basket, place the bottles in the basket, and proceed as +before. + +It is important that the milk should be sterilized or Pasteurized as +soon as it is served in the morning. Each bottle must be thoroughly +washed as soon as it is emptied. Milk sterilized in this way will keep +for days without spoiling, as it is hermetically sealed and all the +unhealthy germs have been removed. + +The most exact method for the artificial feeding of infants, and that +which most nearly approaches the mother's milk, is that used by the +"Walker-Gordon Laboratory," branches of which are to be found in many +of the large cities. + +Not only is the greatest care taken that the milk used shall be pure +and sterilized ready for use, but these laboratories are equipped by +special machinery which separates the important elements of the milk-- +namely, the fat, the milk-sugar, and the proteids. So that the +physician can modify the proportions of these various ingredients of +the milk to meet the necessity of the age and requirements of the +infant. + +When the milk contains too little sugar, the infant does not gain as +rapidly in weight as it would otherwise do. Too much sugar in the milk +is indicated by colic, thin, green, or acid stools, or eructations of +gas from the stomach. + +An excess of fat in the milk is indicated by vomiting; too little fat +causes constipation with dry hard stools. Proteids in excess are a +prolific cause of colic and also of diarrhea. + +Prescription blanks are furnished the physician, who fills out the +percentages of fat, milk-sugar, proteids, and alkalinity, to suit the +age, weight, and general condition of the child. He orders also the +amount to be given at each feeding, and the number of feedings to be +given in the twenty-four hours. Each bottle contains just the amount +to be given at one feeding. All that the mother needs to do is to +place the bottle in a receptacle containing warm water, until the milk +has attained a temperature of 99° F., remove the cotton stopper, and +put on the nipple, when it is ready for use. + +The Nursing Bottle.-- This should be of clear glass, with a rounded +bottom, and of such a shape as is easy to clean; so that no particles +will cling around a corner which cannot be reached. The graduated +bottle is the most convenient, as it enables the quantities of each of +the materials used in the preparation of the feeding to be mixed in +the bottle, doing away with the trouble of measuring before putting +into the bottle. + +Rubber Nipples.-- Two nipples should be kept for alternate use, and no +nipple should be used longer than two weeks. A soft rubber of conical +shape is best, with an opening at the top which is not too large, so +that the milk will not flow through, as it is desirable that the child +should obtain the milk by suction. So soon as the feeding is over, the +nipple should be removed from the bottle, and brushed on both sides +with a stiff brush. It should then be put in cold water, where it is +kept until it is again wanted. + +The baby should be fed slowly, from ten to twenty minutes being taken +for each feeding. Sucking from an empty bottle or with a nipple in the +mouth should never be permitted, as in this way the baby draws air +into its stomach, which will result in colic. Each flask should +contain only enough for one feeding. + +In lieu of the regular sterilizing apparatus, milk may be similarly +prepared by placing the milk in an ordinary glass fruit-jar with a +screw lid. This is placed in a colander over a pot of boiling water; +the milk should be allowed to boil in the open jar for two minutes; +the jar-lid is then screwed on, and it should steam for twenty minutes +longer. + +The capacity of the infant stomach at birth is about one ounce, which +is the average quantity of food that should be taken at one meal. The +average rate of increase in the amount of food is one and a half drams +a week for the first six months; subsequently somewhat less. The +intervals of feeding should be two hours at birth, and increased to +three hours at the end of the third month. The food should be given at +a temperature of 99° F. and fed directly from the sterilizing bottle. + +Fresh Air.-- In warm weather the baby is taken out-of-doors in from +three to four weeks after birth; in cold weather not before two to +three months. In the latter case it is prepared for the change by +being first dressed as for the street, with wrap and cap; the windows +of the room are then opened, and the infant is carried about here. In +the winter months when the baby is first taken out, it is better to +carry it in the arms, as it will be kept warmer in this way, and if it +does become chilled it will be more quickly noticed. + +Characteristics of the Healthy Infant.-- The average weight of an +infant at birth is about seven pounds, and its length is about twenty +inches; the extremes are four pounds or a little less up to eleven +pounds. The head and trunk of the child are developed out of +proportion to the limbs. + +The skin of the new-born infant varies from pinkish to red; about the +fourth day the color becomes somewhat yellowish; this tinge should +disappear about the end of the second week, and at the same time the +skin begins to peel off.This process lasts about two weeks longer, +when the baby's skin takes on its normal color. + +The shape of the head varies greatly, much being due to the amount of +pressure during labor; but this disappears in a few days. As a rule, +the large bones of the head are felt to be separated by membranous +ridges called sutures; there is one on the median line on the top of +the head, and at either end of the suture is a large open space, +called a fontanel. The largest one is at the front of the head, and is +called the anterior fontanel; it is about large enough to be covered +by the tips of two fingers, and is of a lozenge shape; this opening +does not close till the child is about eighteen months old. In a +healthy baby this fontanel should be on a level with the bones of the +head; a slight pulsation may be noticed in it, due to the pulsations +of the vessels of the brain. There is a much smaller three-cornered +fontanel at the back of the suture, and one behind either ear; these +soon close up with bone. + +A new-born baby cannot probably do any more than distinguish light +from darkness. Up to the sixth week there is an inability at +coordination of the ocular muscles; after this time the eyes begin to +move in an orderly manner, and they will follow a bright object moved +slowly in front of them. At about the end of the second month rapid +movements are perceived, as is evinced by the child's closing its eyes +quickly on an object suddenly approaching it. At three months the +child begins to recognize colors; the first recognized are yellow, +red, pure white, gray, and black. But the faculty of distinguishing +between colors is not perfected till the third year. The mother is +recognized about the third month. Hearing and a sense of smell develop +rapidly after birth; loud noises in its vicinity will cause a child to +start during the first day after birth. By the time the child has +reached three months of age it shows signs of having a mind of its +own, and is capable of exercising thought. It grasps for objects, and +indicates its likes and dislikes. At from eight to ten months it can +utter several syllables, and at the age of one year should be able to +say mama and papa; at two years it should be able to frame short +sentences. + +Weight of the Baby.-- By the end of the sixth month the child's weight +should be double what it was at birth; that is, about fourteen pounds; +at the end of the twelfth month be three times as much as at birth, or +about twenty pounds. + +Muscular Action.-- Muscular action in the new-born infant is entirely +involuntary, there being no voluntary acts until about the end of the +third month. Sucking and licking are largely instinctive. The +movements of the arms and legs are impulsive acts, and occur during +sleep, just as they did in the intra-uterine life. The act of raising +the head, which is attempted about the fourth month in healthy +children, is volitional, requiring not so much added strength of +muscle as power of coordination. As volition develops the power of +coordination gradually increases, and the child learns to perform +voluntary or purposeful acts. Voluntary grasping is done after the +fourth month. As the child learns to balance its head, it attempts to +sit up. This act is not successfully accomplished until about the +fortieth week; the child sits firmly alone when ten or eleven months +old. Before this time it is necessary to support the head and spine of +the child with the hand. By the third or fourth month the infant +should be able to grasp things. The child begins to creep about the +ninth month. The clothing should be so arranged as to allow entire +freedom of motion. + +It should be able to stand up by a chair by the tenth month, and be +able to walk alone at the end of the first year. It is important that +parents should know this, since not knowing what a normal baby ought +to be able to do, cases of birth palsy, or even an attack of paralysis +due to teething, are not infrequently overlooked, not only by the +mother, but even by the doctor, who attributes the inability of the +child to do what other children can do at this age simply to weakness, +which the child will outgrow; and thus the time passes in which the +most could be done to cure the child and to prevent the subsequent +deformity. + +A baby should not be forced to stand or walk; a very stout baby, on +account of its weight, will stand up and walk much later than a slight +one, the two being equally healthy. Or if a baby has been sick, it +will feel no inclination to stand up. Naturally, a child creeps before +it walks, and this develops the muscles of the lower limbs, so that +they will support the weight of the child in standing. By prematurely +forcing a child to stand up and walk, there is danger of causing +bow-legs, as the bones of the legs are still weak; the child should be +discouraged from standing up too much rather than encouraged to stand +up more. + +Sleep.-- A large proportion of the time of early infancy is spent in +sleep; for the first few weeks the infant only wakens up to be fed. +During sleep the eyelids should be tightly closed; a partial opening +of the lids, showing the whites of the eyes, is an indication of ill +health. Up to the age of six, children require twelve hours of sleep +at night, besides an hour or more in the middle of the day; the child +should be permitted to sleep as long in the morning as it will. + +Respiration.-- The healthy infant breathes on an average forty-four +times a minute; the only time the respirations can be satisfactorily +counted is during sleep. When the child is awake, the respirations are +hurried by slight movements of the body, crying, and so forth. The +average pulse of a newborn baby is one hundred and forty; this is +hurried by the same causes that hastens respirations; the pulse is +most easily counted at the anterior fontanel. The average temperature +of the infant is 99° F. When the tip of the nose and the extremities +are cold, it indicates a lowered vitality. + +The nature of the child's cry indicates, variously, hunger, temper, or +pain; the mother will soon learn to distinguish these varieties. If +the child cries because it is hungry, the cry ceases so soon as it is +fed. But a child is never to be fed simply because it cries; it must +be fed on the hour by the clock. If this rule is not strictly adhered +to, it will suffer all the forms of indigestion and colic that babies +are heir to. If it cries because of colic, there is a drawn look on +the face, and at the same time the legs are sharply flexed on the +thighs and the thighs on the abdomen. If the cries are due to earache, +the head will be rolled about from one side to the other. In either +case nothing will stop the cries until the pain is relieved. A baby +does not shed tears until the third month. + +The Stools.-- The stools of a very young baby fed on breast-milk +should be of a yellow or orange color. There should be three or four +evacuations daily; they should contain no curds. Stools of bottle-fed +babies are lighter in color and more offensive. + +Constipation.-- Constipation is not uncommon in infancy; it may be +overcome by the use of a soap suppository, or by an injection of warm +soap-suds into the bowel, or by an injection of oil and water, or by +gentle friction over the bowel, following the course of the large +intestine. + +To make the soap suppository, take a piece of castile soap about an +inch long, give it the shape of a cone not any larger than the end of +the little finger, and make it perfectly smooth. This is inserted to +about half of its length into the rectum and held there until it +causes the bowels to move. + +The bowel injection is best given by means of the single-bulb syringe, +known as the eye and ear syringe; the bulb holds about two +tablespoonfuls of liquid. This may be warm cotton-seed oil, sweet oil, +or glycerin one teaspoonful to warm water two tablespoonfuls. The +nozle should be small, smooth, and well oiled. It should be very +carefully introduced into the bowel, being directed a little to the +left side, and the bulb gently squeezed to force the contents into the +bowel. The injection is more effective if it is retained for a little +while; this is accomplished by making slight pressure on the anus with +a towel. + +Rubbing the abdomen for about ten minutes in the direction of the +large bowel is sometimes very effective in overcoming constipation; +begin in the right groin and rub up as far as the border of the ribs, +then across to the left, then down on the left side. + +Vomiting.-- Vomiting means often only that the stomach has been +overfilled, and may be relieved by withholding all food for a few +hours. + +Urination.-- The frequency of urination in a newborn baby will vary +greatly with the weather and other conditions; in cool weather it is +not unusual for the napkin to need changing almost every hour. Healthy +urine should not stain the napkin. The new-born infant secretes very +little urine until it begins to take nourishment freely. The bladder +is usually emptied during birth, and very often the bowels also, so +that if the child seems well and there is no malformation of the +parts, the family may be assured that the apparent retention of urine +is only temporary. + +The use of hot fomentations over the kidneys and bladder will often +hasten the evacuation of urine if it has been unduly delayed. If the +secretion seems highly concentrated, a drop of sweet spirits of niter +in a teaspoonful of water may be given every two hours. + +Teething.-- The first tooth generally appears about the end of the +fourth month; in delicate children they come later. As a rule, the +lower front teeth come first, coming in pairs, one tooth coming on +each side of the mouth; followed in about a month by the corresponding +teeth in the upper jaw. Preceding their appearance the gums become +swollen, hot, and painful, and the saliva forms in excess and runs +from the mouth. The child is irritable, flushed and restless; and +there usually occurs some disturbance of the bowels, commonly +diarrhea. This all indicates a nervous derangement, and calls for a +judicious diet and general careful oversight. The symptoms subside +when the teeth are through. During teething the child manifests a +desire to bite on something, and a soft rubber ring will give it great +comfort. + +The first set of teeth are twenty in number, and are usually cut in +groups, starting about the fourth month and continuing until between +the twentieth and thirtieth month, when the first dentition should be +complete. As a rule there is an interval of rest between the eruption +of the various groups. During dentition children are generally more +peevish and fretful than usual, but there should be no general +constitutional disturbance. During dentition it is of especial +importance to keep the bowels well opened; it is better to have them +too loose than costive; constipation at this time greatly increases +the tendency to convulsions. + +Bottle-fed babies are apt to cut their teeth later than those nursed +at the breast. The lack of appearance of any teeth before the end of +the first year indicates that the nutrition of the child is below par, +or, in other words, that the child has rickets. The permanent teeth +begin to appear about the sixth or seventh year. + _________________ + + PART IV.-- THE MENOPAUSE. + _________________ + + CHAPTER XIV. + + THE MENOPAUSE. + + Average Duration of the Menstrual Function; Duration of Menopause; the + Menopause; General Phenomena of the Menopause; Prominent Symptoms of + Menopause; Pathologic Conditions of the Menopause; Hemorrhage at the + Menopause a Significant Symptom of Cancer; Causes of Suffering at + Menopause. + + "Yet I doubt not through the ages one increasing purpose runs, + And the thoughts of men are widened with the process of the suns. + Knowledge comes, but wisdom lingers, and I linger on the shore, + And the individual withers, and the world is more and more. + Knowledge comes, but wisdom lingers, and he bears a laden breast, + Full of sad experience, moving toward the stillness of his rest." + + -- "Locksley Hall." + +Average Duration of Menstrual Function.-- The average duration of the +menstrual function is from thirty to thirty-two years. Raciborski +estimated the duration of menstrual life at about thirty-one years and +nine months. According to him, the mean age of puberty at Paris was +fourteen years and seven months; therefore, the average age of the +menopause was forty-six and one-half years. Tilt gives the average age +of the cessation of menstruation in 1082 cases as forty-five years and +nine months. The average age is between forty-five and fifty years. It +has been shown by Krieger, Kisch, and others, that the earlier the +menses appear, the later they cease, and vice versa. However, when the +first period is unusually early or late, the menopause comes very +early. Also that the sexual function is usually abolished earlier in +the laboring classes, who are compelled to work hard and who have many +cares, than in the well-to-do and rich. + +Race does unquestionably influence the duration, but given a sound +healthy race, which is not too much enervated with civilization, and +the menstrual process will, equally with the total physical vigor and +the vitality, be increased. At the present day there is an increased +sexual vitality, which shows itself in the fact that the duration of +menstrual life has been increased three to four years during the past +generation. The inference can be fairly deduced that vigorous vitality +causes prolongation of the menstrual process and the actual age. + +Duration of Menopause.-- By the menopause or climacteric is understood +the whole period from the beginning irregularities in the time of +appearance of the menstrual flow until its actual cessation. The +average duration of the menopause is from two and a half to three +years. + +The Menopause.-- The menopause is a physiologic and conservative +process. It occurs at a time of life when all the tissues are most +stable and the nutrition of the body is at its best. Other physiologic +changes which occur at the same time are decrease in the size of the +spleen and lymphatic glands, the muscular coats of the intestine +atrophy, and lessened peristalsis ensues; hence the increased tendency +to constipation. These are not the degenerations of age, but the +blood-supplying, blood-making, and blood-elaborating organs of the +body have completed the growth of the organism, done their work, and +are striking a balance with the needs of the economy. + +The object of each metamorphic or developmental epoch is a critical +readjustment of the organism, in order to insure the greatest possible +amount of health for each subsequent period of life. In the vast +majority of cases this object is quietly effected, but sometimes the +constitution only rallies after having been severely shaken for a +varying period. + +General Phenomena of the Menopause.-- Borner states that while many +women pass this period without noting any change in their former +condition, and are conscious of the occurrence of the change of life +only by reason of the absence of the menstrual flow, others suffer for +years with a host of troubles. + +One of the most essential changes is that of the woman s psychic +condition-- from slight vagaries, loss of interest in the daily +affairs of life, to melancholia and insanity. + +"Two factors are generally taken into account: first, the sudden +cessation of the menses; second, the reflections of the patient caused +by her condition, meditations on the loss of youth and sexual power, +and anxiety in view of the dangers of the climacteric. It cannot be +denied that there is some truth in the supposed sad thoughts about the +beginning of old age, and the depression caused by them can scarcely +be considered abnormal" (Borner). + +Napier believes that it is extremely rare for the cessation to occur +without some physical discomfort or some disturbance of the nervous +system, but adds that: "Some women, however, cease menstruating with +very slight inconvenience." As a rule, the woman misses one, two, or +more periods, then a menstruation of almost normal quantity and +duration; and this is again repeated at gradually longer intervals, +and with a diminished flow, until actual cessation occurs. + +The periods cease owing to the degeneration and disappearance of the +glandular tissues of the uterus, and secondarily to similar changes in +the ovaries and other glands. This is followed by an atrophy of all +the structures of the genitalia. + +An increase in the size of the uterus, from increase in the amount of +blood, is frequently noticed at the beginning of the menopause; later +it becomes smaller in all its dimensions. The wall becomes thinner; +the cervix becomes shorter and thinner, sometimes hard, sometimes +flabby as a membrane. But the distinguishing feature of the menopastic +uterus is atrophy of its lining membrane. + +The changes in the uterus and Fallopian tubes are earlier than those +in the ovaries, so that ovulation, though lessened in activity, may +persist for a considerable time after menstruation has ceased. Ovarian +atrophy has been referred to senile rather than menopastic changes. + +Atrophy of the ovaries occurs very gradually. Peuch found that in one +case the ovaries were of normal size three years after the +establishment of the menopause. Kiwisch describes the structural +change in this gland as consisting, on the one hand, of an increase of +the connective-tissue stroma; and, on the other hand, the Graafian +vesicles themselves undergo retrograde change. In consequence of these +microscopic changes, which take place very slowly, the entire organ +becomes harder and smaller. + +Napier believes that the ovaries secrete specialized substances which +aid in determining menstruation; and that in a less degree the +utricular glands and the glands of the Fallopian tubes share in this +action. He considers that this is probably secondary to the chain of +peripheral irritation from the uterine glands, but that this secretion +is none the less an essential feature of the menstrual process. + +In support of this view he calls attention to the pigmentation of the +skin which occurs during pregnancy and chlorosis, showing that the +absence of the catamenia results in the retention in the blood of some +substance which would normally be excreted at this time. + +Other atrophic changes in the genitalia are shriveling of the vulva, +with prolapse of the vagina or uterus from relaxation of the ligaments +and loss of the natural support afforded by the changed perineal body. + +Uterine catarrh occurs almost invariably, and only ceases in advanced +years. Displacements of all kinds are frequent, but on account of the +now greatly diminished weight of the uterus, these are insignificant. + +The vagina is at first almost always hyperemic, but this disappears as +the vessels successively atrophy. The vagina gradually becomes +narrower and shorter. The mucous membrane loses its rugae and presents +a pale, grayish, blanched hue. + +The researches of Byron Robinson, made by the dissection of a number +of old women, show that after the menopause not only is there an +atrophy of the genital organs, but that the hypogastric plexus of the +great sympathetic nervous system also shrinks away. "It becomes +smaller and firmer, and no doubt some strands disappear. On this fact +must he based the pathologic symptoms accompanying the cessation of +the menstrual function." + +The importance of the genital organs is shown by the vast nerve-supply +sent to them. When this great nerve-tract becomes atrophic, so that it +can no longer transmit the higher physiologic orders, all parts of the +sympathetic system must be unbalanced, until a new line, the next line +of least resistance is established. And Robinson believes that this is +the explanation of the many pathologic manifestations of every viscus +at the menopause; that is, "the irritation which arises by trying to +pass more nervous impulses over plexuses than normal gives origin to +what is unfortunately known as functional disease. It is just as +organic as any disease, only we are unable to detect it." + +Chemical changes in the blood and tissues are constant vital +phenomena; increased oxidation causes increased activity of the +circulation, increase of temperature, increase of urea and carbonic +acid in the economy from retrograde changes, and, finally, during +menstrual life the flow of blood from the uterus carried off the +effete materials from the highly charged system. + +The elimination of albuminoids, as shown by the altered condition of +the blood after menstruation, is greater than can be accounted for by +the blood discharged. When the menopause is attained suddenly, the +retention of such albuminoid substances must act toxically. Hence the +resulting clinical fact that sudden cessation of the menses is, in the +majority of cases, attended with pronounced symptoms of discomfort, +and it is in these cases that untoward results are most likely. + +James Oliver believes that the catamenial flow eliminates from the +body substances whose presence in the blood would exert a deleterious +influence on the animal economy. + +The Prominent Symptoms of the Menopause.-- Christopher Martin holds +that the symptoms of the change of life are produced largely by a +condition of instability and increased excitability of certain other +cerebrospinal centers directly brought about by failure of the +menstrual center, and adds: "It is probable that the ovaries, like the +liver and thyroid gland, modify the blood circulating through them, +and add to the blood some peculiar product of their metabolism. It may +be that some of the climacteric symptoms are due to the loss of this +substance from the system." + +Arthur Johnstone's theory of the symptoms of the menopause is that the +lining membrane of the uterus atrophies and becomes old cicatricial +tissue, and sinks into quiet decay. The nervous system begins to +readjust itself; but no longer having free outlet through the soft, +lymphoid tissues of the uterus, the wave pressure meets with +resistance and a choppy sea results. Vertigos, bilious attacks, and so +forth are nothing more than reflex waves. The weakest organ of the +individual is the one that generally suffers. And that the kidneys, +which all along have borne the brunt of life, should now show positive +signs of disease is natural. + +The etiology and pathology of the menopause lie in the sympathetic +nervous system. And it is by the breaking up of the harmony of +previous processes that nervous disturbances are produced. + +After the cessation of the flow, over 8% of women suffer from +"flashes"; this symptom is caused by irritation of the heart and +vasomotor centers. The blood-vessels of the head and neck seem to be +most affected, yet the skin of the whole body shares in the +disturbance. Besides the vasomotor and heat center being disturbed, +the sweat center is irritated. The flushes and flashes are followed by +various degrees of sweating, which varies from a slight moisture to +great drops. + +Nervous irritability is a prominent symptom in 8% of women at the time +of the menopause. Most of the pain arises around the stomach; that is, +the solar plexus. Digestive disturbances are very common at this time; +they may be in the shape of fermentation, diarrhea, or constipation, +accompanied by congestion of the liver. + +Tilt holds the very plausible view that the too strong reaction of the +sexual organs on the central ganglia of the sympathetic nervous system +is their principal cause of disease. Puberty, menstruation, pregnancy, +lactation, or the menopause almost always entail some derangement of +this system which is sometimes sufficiently severe to lead to insanity +and suicide. Debility underlies all affections of the sympathetic +nervous system, in the same way as nervous irritability underlies all +cerebral diseases. Sometimes there is an overpowering sense of +exhaustion pervading the whole system. + +Forms of climacteric insanity are delirium, mania, hypochondriasis, +melancholia, irresponsible impulses, and the perversion of moral +instincts. + +"If the reproductive apparatus does not act on the brain by the +instrumentality of the circulating organs of the blood, it must do so +by means of the nerves. The genital apparatus is richly endowed with +nerves from the sympathetic system, and I have shown how frequently +evident signs of disturbance in these centers coincided or alternated +with headaches, nervousness, hysteria, and epilepsy. What wonder, +then, if the same powerful influence of the sexual organs, through the +instrumentality of the sympathetic system, should at times produce a +permanent derangement of the mental and moral faculties. I am thus led +to look on the sympathetic nervous center as a source of vital power +producing reflex morbid phenomena, in accordance with variable +cerebral predisposition" (Tilt). + +Another very frequent symptom of the menopause is distress in the +region of the heart, with palpitation and shortness of breath. It may +be caused by the condition of the blood, whether it be impoverished-- +anemia-- or too rich in red globules; by reflex irritation of the +pneumogastric or sympathetic nerves; by overexertion; or by +alcoholism. It may also be due to general debility; the woman resists +fatigue less easily, and she experiences a general malaise. To the +palpitations are rapidly added faintness and shortness of breath. The +sleep is troubled with distress in the region of the heart. It is said +that women in whom the menopause occurs early are more liable to +tachycardia than those who menstruate later in life; and that it +occurs with especial frequency when the menopause has been prematurely +induced by surgical operation or by disease. It is believed that this +functional heart trouble is caused by the increased connective-tissue +fibers of the sexual organs acting in some unknown way on the terminal +fibers of the sympathetic; and it is not infrequently due to the +formation of scar tissue at the seat of a cervical laceration, and has +often been promptly and permanently relieved by removing the +cicatricial tissue and suturing the wound. The cause acts by producing +a transitory paralysis of the inhibitory fibers of the pneumogastric +nerve. + +Pathologic Conditions of the Menopause.-- Perhaps the most alarming +symptom of the menopause is hemorrhage. It may be due to general or +local causes. Among the general causes are diseases of the heart, +lungs, spleen, and kidneys. Local causes of hemorrhage are: +inflammation of the lining membrane of the uterus, chronic pelvic +inflammations, faulty uterine positions, erosions and ulcerations of +the mouth of the uterus, fibroid tumors, and cancer. All competent +observers agree that cancer in women is much commoner from forty to +fifty years than at any other age. + +Hemorrhages occupy the foremost place among the pathologic phenomena +of the genital tract during the menopause. Hemorrhage has been +attributed in many instances to the senile rigidity and friability of +the uterine vessels, which are not in a condition to offer sufficient +resistance to the blood-pressure which is brought to bear on their +walls; there is also softening and relaxation of the uterine tissue. +Additional causes are found in the circulatory disturbances in the +pelvic organs, whereby the outflow of blood from the pelvic vessels is +hindered a chronic congestion in the uterine vessels is produced. It +has also been attributed to early and profuse menstruation, frequent +and difficult labors, frequent abortions, and excess in drinking. + +The third and last variety includes those cases which may be referred +to some disease of the pelvic organs themselves. Anatomic changes may +lead up to pathologic conditions. A chief feature characteristic of +uterine disease is malnutrition from atrophy-- a sudden curtailing of +the blood-supply from the degeneration of the genital-nerve apparatus +and consequent impaired vitality of tissue from defective nourishment. +The anatomic changes in the glands and substance of the uterus also +favor the irritation, and the development of new growths, which may be +malignant or benign-- as cancers, fibroid growths, and so forth. + +Hemorrhage at the Menopause a Significant Symptom of Cancer.-- Not +only should any excessive and prolonged bleeding at the time of the +menopause be a source of great anxiety to the woman, but even the +irregular appearance of a slight show of blood just sufficient to keep +the clothing stained, or a slight bleeding following coition; since +all of these are symptoms of very great gravity, and demand an +immediate local examination and appropriate treatment. + +The widespread belief among the laity that hemorrhage at the time of +the menopause is a normal condition, and that if left alone it will +stop in the course of a few years, is most erroneous and fatal. On +this altar of ignorance thousands of women sacrifice their lives every +year. The case-book of any gynecologist will testify to the truth of +this statement. The following three cases will serve to illustrate +different types of hemorrhage in cancer patients, in no one of which +did the patient even suspect that she was suffering from anything more +serious than the "vagaries of the menopause." + +Case I.-- Woman aged seventy years; came on account of incontinence of +urine, which had been troublesome for two years. The menopause +occurred at fifty. She stated that three or four years previous to her +visit, she had had a return of the flow of blood, perhaps twice in the +first year, and that during the past year there had been a flow every +month-- about the same that there used to be. This she took to be a +return of the menstrual period. She said, further, that there was a +constant bleeding-- enough to necessitate the wearing of a napkin-- +and an occasional severe hemorrhage; that she could not take long +walks or drives because of the excessive flow which followed. + +The case was one of cancer of the uterus which had spread to all the +pelvic viscera; and in addition to this, the patient's general +condition was such that any operation was out of the question. Yet the +patient had never thought of the possibility of any uterine trouble +sufficiently serious to make a local examination necessary. It was +only the loss of control over the bladder that drove her to seek a +physician's advice. + +Case II.-- Woman aged fifty-three years came to consult me because of +pain, hemorrhage, and loss of weight. There had never been any +cessation of the menstrual period. She said that she began to have +irregular hemorrhages three years previously, and that they were +constantly becoming more frequent and more alarming, and that, in +addition to this, there was a constant discharge of blood, which +necessitated her wearing a napkin all the time. She also stated that +for the preceding six months the pain had been so severe that she had +not had one solid night's sleep, and that in that time she had lost +forty pounds in weight. + +This patient was in the very last stages of cancer of the uterus, and +all that could be done for her was to make her comfortable. She had +given birth to one child which caused a deep tear of the neck of the +womb; and it is probable that this neglected tear was the primary +cause of the cancer, which began in the neck of the womb. + +Case III.-- Woman aged forty-five years; married, but had never had +any children. She said that the periods were normal as to duration and +amount, but that for the past two years they had two days ahead of +time, and that for the past four months she had been having just +enough irregular bleeding between the periods to keep her clothing +stained. + +On examination a diagnosis of cancer of the uterus was made. The +pathological examination proved this to be a most malignant type of +cancer of the neck of the womb. The entire uterus and appendages were +at once removed. And although the patient made an excellent recovery +from the operation, she succumbed to the disease one year after the +operation was performed. + +These cases have been cited at length because they are all typical and +because of the variety of symptoms and the great difference of age. +Only in one of the cases was there any very severe pain, and it was +really the pain, which had become unendurable, which caused the +patient to seek relief. + +It is the concensus of opinion of the medical profession that cancer +of the uterus is one of the common causes of death among women; that +the cancer rate of mortality has increased during the last four +decades; that it is most common near the time of the menopause; and +that there is a direct causal relation between cancer of the neck of +the womb and the traumatisms which occur during childbirth. + +The symptoms of cancer of the uterus are hemorrhage, a more or less +offensive discharge, and pain. The quantity of blood may vary from a +slight amount which occasionally stains the clothing to a profuse +hemorrhage. In the married, bleeding following coition is always a +suggestive symptom. During the menopause any irregular or profuse +bleeding should excite suspicion. After the cessation of the menopause +any bleeding whatsoever, whether slight or profuse, should always be +regarded as a danger signal which demands an immediate and thorough +local examination. The same is true of any offensive vaginal +discharge. Pain is frequently so late a symptom that to wait for its +appearance means that the favorable time to perform an operation has +passed by. Emaciation is also a symptom of advanced disease. + +Cancer is chiefly a disease of the climacteric; when there is a +diminished power on the part of the tissues to resist adverse +influence. It affects the debilitated and overworked, but it is also +found in the well nourished and in the comparatively young. + +Cancer always begins as a local disease, and when it occurs in the +uterus, it is easily accessible and eradicable in its earliest stages; +that is, if the disease is discovered in its incipiency, an operation +will remove all the diseased tissue. If, on the contrary, the disease +is left to nature, the growth spreads out into the surrounding viscera +like the roots of a tree in the earth, and the cancer may be literally +said to eat into the tissues which it invades. At the same time the +germs of the disease begin to be carried all through the body, and the +entire constitution is affected. + +Prophylaxis, or the Prevention of Cancer.-- All pelvic inflammations +should be promptly treated, and not allowed to become chronic. +Leucorrhea is a symptom of inflammation, the true cause of which can +be determined only by local examination. Women who have given birth to +children-- and this is more especially necessary as they near the age +of forty years-- should be carefully examined for tears of the neck of +the womb. If these tears are extensive they should be repaired, as it +is certain that malignant growths frequently do follow local injuries +and traumatisms. + +Any irregular or profuse bleeding demands an immediate investigation +by means of a local examination. + +A stormy, irregular, or delayed menopause should excite in the woman a +suspicion of some abnormal condition. + +The importance of women being carefully watched by gynecologists at +this period of their lives cannot be too emphatically stated, for upon +the early recognition of cancer depends the only hope of radical cure +of the disease. It is estimated that at the present time not less than +95 per cent. of all cases of cancer of the uterus come under the +observation of the profession at a stage of the disease when all +prospect of permanent relief is out of the question. + +It is a deplorable state of affairs that women, not knowing what a +normal climacteric is, attribute all hemorrhages, no matter how +severe, to the change of life. Therefore, regarding the hemorrhage as +a necessary evil, they fail to consult a specialist until the +favorable time for eradicating the disease by means of an operation +has passed. And whatever knowledge science may bring in the future as +to the cure of cancer, at present it is a fact universally agreed upon +that early operation, while the cancer is still local, is the only +radical cure for the disease. + +Pruritus Vulvae. Perhaps one of the most annoying and obstinate +symptoms of the menopause is pruritus vulvae. This is sometimes caused +by sugar in the urine; there is a congestion of the liver which +results in sugar being thrown into the system and this is eliminated +by the kidneys. It is quite possible that this is due to the altered +circulatory conditions of the menopause. + +Kidney Disease.-- The last pathologic condition which we will mention +is kidney disease. Le Gendre believes that the menopause exerts a +deleterious effect on the kidneys, whether this be a congestion, +followed by a diminution in the quantity of urine, or a sort of +auto-intoxication due to the retention of a poison in the system that +has been prevented from leaving by the ordinary path. + +Armstrong says that in almost all cases at the time of the menopause +the amount of urine passed is below normal, the specific gravity is +increased, and that the urine contains urates and almost always uric +acid in excess. Further, that the functions of digestion and +assimilation and the various metabolic changes are so largely under +the control of the nerve-centers that nothing seems more likely than +that so great a disturbance of that system as takes place at the +menopause should cause secondary derangements of these most important +functions. That being so, the blood becomes loaded with waste +products, and the usual symptoms follow-- gout and so forth. + +It has been a grave question in the mind of the medical profession +whether the dangers that certainly do attend the menopause are natural +or acquired; that is, could these dangers be averted by any +precautions or hygienic measures on the part of women, or are these +dangers a necessary accompaniment of this period of life? + +Tilt has reached the conclusion that: "The best way to avoid the +dangers of this critical time is to meet its approach with a healthy +constitution. A marked want of strength prevents the regular +succession of the vital phenomena by which all critical periods are +carried on. And as the change of life is marked by debility, when this +is grafted on constitutional weakness, loss of power will be of long +duration. All complaints remain chronic because there is not stamina +enough to carry them through their stages." + +Causes of Suffering at Menopause.-- Dusourd, whose practice lay in an +agricultural district in the south of France, as well as Tilt, +believes that peasant women suffer little at this time. Their health +is generally good when the menopause comes on and they are little +liable to nervous disorders. The poor of large towns suffer much at +this epoch-- the necessity of working hard, the anxieties of poverty +and their unhygienic surroundings. But by a fortunate compensation the +necessity for working hard prevents or cures the nervous affections +which so often assail the rich at this period. + +Tilt's cases showed that women who suffered much at the menopause had +previously suffered at puberty and at the menstrual periods. And among +thirty-nine cases where there was no suffering at the menopause, there +was the same immunity from suffering at puberty and at the menstrual +epochs. + +Tilt's statistics were, or course, taken from English women. In +forty-four cases of my own, all women past the menopause, the average +age of the first menstruation was fourteen years and four months; and +the average age of the actual cessation of the menstrual flow was +forty-eight years and five and two-thirds months. Subtracting from +this the average age of the first menstruation, we have as the mean +age of menstrual life thirty-four years one and two-thirds months; +that is, the average duration of the menstrual function was from two +to four years longer than that usually given. + +A further investigation in order to ascertain any possible relation +between the age of marriage and the number of pregnancies and the +sufferings of the menopause elicited the following statistics. The +average age of marriage was twenty-five years and ten months. Of the +four women who were married after thirty-eight years, all were +sterile; among the remaining there was an average of slightly above +three children each. Forty per cent. of all these cases had one or +more miscarriages. Nine had habitually suffered from severe +dysmenorrhea, eleven had slight dysmenorrhea, and twenty-two had never +felt the slightest inconvenience. + +In a list of fifty-two cases, eight were added to the list already +given, all of whom had passed the menopause. Five were perfectly +healthy and had never suffered the slightest inconvenience. Of these, +one was single and only one had one miscarriage. Ten had suffered at +the time of the menopause from slight malaise, but not sufficiently to +call in a medical attendant. Thirty-seven were more or less seriously +ill; thirty of these needed local as well as constitutional treatment, +and seven constitutional treatment only. + +The prominent symptoms of the climacteric were as follows: Marked +debility, 24; intense nervousness, 31; nervous prostration, 9; +melancholia, 10; headache, 14; neuralgia, 6; hysteria, 7; irritable +heart, 11; tachycardia, 8; insomnia, 19; indigestion, 32; +constipation, 28; diarrhea, 3; leucorrhea, 38; rheumatism, 21; gout, +1; Bright's disease, 12; hemorrhage, 6; alcoholism, 2; corpulency, 2. + +As a result of the study of these cases, the most striking feature was +the relation of miscarriages to the sufferings and ill health at the +time of the menopause. Of the nineteen women who had miscarriages, +only one did not suffer in some way at the time of the menopause. Four +suffered only slightly, and fourteen suffered extremely, not only +during the menopause, but in the post-climacteric period as well. And +the next most striking feature was that the prominent symptoms of the +menopause are preeminently reflex or the functional diseases of the +nervous system. + +Tilt believes that single women suffer less than other women at the +time of the menopause. He further writes: "As at puberty, from the +ignorance in which it is still thought right to leave young women, so +at the change of life, women often suffer from ignorance of what may +occur, or from exaggerated notions of the perils which await them. It +would be well if they were made to understand that if in tolerable +health, provided that they will conform to judicious rules, they have +only blessings to expect from the change of life. Most unfortunately, +the individual not cognizant of the invisible changes going on in the +economy does not adapt the mode of life to the new conditions of the +organism, and the weakened and lessened amount of the digestive fluids +is unable to master the large quantities of food. The absorbents +refuse to take more than is needed to repair the tissues. The +atrophying muscles of the digestive tube, unable to hurry on the mixed +products of indigestion; fermentation; and micro-organisms inciting +fermentations and elaborating toxic alkaloids, poison and disorder the +functions of life. Man's outdoor life enables him to escape many of +these evils. + +"Woman's enervating mode of life, the continued introspection, coupled +with the peculiar changes in the nutrition of the body at this time, +render the nervous system peculiarly impressionable and liable to the +manifold forms of diseases. 'The woman is told that she must be calm +and patient, and in time the tomb-builder will alleviate all her +sufferings.' This critical period may be dangerous to those who are +always ailing, for habitiual sufferers at the menstrual periods, and +for those affected with uterine diseases. If, on the first indication +of the change of life, women who are in fair health carefully followed +a regimen and pursued a line of life in harmony with the physiologic +processes on which this change depends, disease would be prevented. +But as the change concerns a natural function, it is left to nature; +no additional precautions are taken, and advice is sought only when +the mischief is done." + +It is not wise to marry during this period. On the first appearance of +the irregularities of the menopause the amount of food and stimulants +to which women have been accustomed should be curtailed rather than +augmented. The system requires supporting by medicine and regimen-- +as, baths, mental and moral hygiene, and occupation-- rather than +stimulating by spirits. + +We have seen that, in accordance with the plethric theory, which +prevailed until 1835, and with the nerve theory, which is based on the +latest anatomic and physiologic researches, menstruation is a +physiologic process to get rid of effete material, and is therefore an +excretion. + +At the end of perhaps thirty years, by a conservative process of +nature, the child-bearing period ceases and the organism is readjusted +to the end that the woman's vitality may all be conserved for her own +individual life. + +Each metamorphic or developmental period of life-- dentition, puberty, +and the menopause-- throws a special strain on the nervous system, and +the recent studies of the sympathetic nervous system at the time of +the menopause show that very extensive anatomic changes occur at this +time. That being the case, the woman must lead such a life as will +insure her having on hand a large reserve force necessary to meet +these heavy demands. Tilt's observations show that women who have +experienced no suffering at puberty or, at the menstrual periods do +not suffer at the menopause. It is therefore evident that the time to +begin this preparation is in childhood. + +That single women suffer less than married women would suggest that +excessive coitus and the occurrence of abortions, frequent +child-bearing, and lesions as the result of pregnancies, many of which +lesions could have been prevented or cured by the timely aid of the +physician, are the combined sources of much of the suffering at the +time of the menopause. + +That the most frequent and serious disturbances are those of the +nervous system, and that from their mode of life and habits of +introspection the rich suffer more from these ailments than the poor, +must cause serious consideration of the physiologic necessity for a +definite occupation for the daughters as well as for the sons of the +rich. + +The frequency with which Bright's disease is found at the time of the +menopause is dependent not so much on the local physiologic changes +which are taking place as on the time of life. Loomis says that it was +not until life-insurance examinations became so common that the +frequency with which kidney disease existed in persons who believed +themselves well was even imagined. And as a result of his observations +in these cases, and of a large number of autopsies conducted at the +Bellevue, he stated that it was his belief that 90% of men and women +over forty years of age suffer from some form of Bright's disease. +That being the case, it would seem that after this period of life at +least as much attention should be directed to the kidneys as to the +teeth, and that a semi-annual examination of the urine should be made. + +Although the menopause is a physiologic occurrence, yet, owing to the +many pathologic changes which are liable to take place at this time, +the woman should be as carefully watched during the menopause by the +gynecologist as the pregnant woman now is by the obstetrician. If the +same care were taken, in the majority of cases, the dangers attending +the menopause would be avoided, and the woman would be prepared to +enjoy a healthy and useful post-climacteric period of life. + + CHAPTER XV. + + HYGIENE OF THE MENOPAUSE. + + Diet; Constipation; Stimulants; the Kidneys; the Skin; Turkish Baths; + Massage; Exercise; Profuse Menstruation; Hemorrhage; Mental Therapeutics. + + "'Tis the breathing time of day." + + -- "Hamlet." + +Hygiene of the Menopause.-- The changes which occur in all the organs +of the body at the time of the menopause are retrograde, and therefore +just the opposite of those which occur at the time of puberty. This +fact should be borne in mind in the matter of alimentation. All that +is now needed is to make the repair equal to the waste. + +Diet.-- Unless the woman is taking a great deal of active exercise, it +is better to diminish the amount of meat eaten, and to increase the +vegetable food and take more fluids. Unless the effect of the meat +eaten is counterbalanced by active outdoor exercise, it produces an +excess of waste matter, which accumulates and causes biliousness, and +sometimes rheumatism and gout. A vegetable diet is less taxing to the +excretory organs than an animal diet. + +Indigestion is at this time of life apt to appear in the form of +fermentation, which may assume the gastric or intestinal type. The +chief causes of the formation of gases are the lessened peristaltic +action of the intestines, the increased tendency to congestion of the +liver and to obstinate constipation. + +All dishes rich in sugar, as cake, candy, preserves, and jelly, should +be indulged in with moderation; or where there is a tendency to +fermentative indigestion, they should be wholly avoided. + +All dishes known to be difficult of digestion, as hot breads, pastry, +cheese, fried dishes, and rich salads, should be cut off the menu, +since these readily overtax an already weakened digestive system. + +If there is a hereditary tendency to rheumatism or gout, the disease +is most apt to take on an active form at this time. In either case the +manifestation of the disease indicates an excess of uric acid in the +system, and a diet becomes a necessity. Pickles, all highly spiced +articles of food, and vinegar must be omitted from the bill of fare. +The vinegar may be replaced in salad-dressings by lemon juice. +Tomatoes, rhubarb, strawberries and grapefruit are contra-indicated; +also all articles of food rich in sugar. + +In chronic cases animal food cannot, as a rule, be excluded from the +dietary, but must be limited in quantity. Fish, eggs, and fowl may be +eaten, also a moderate amount of lean meat in the form of beef, lamb, +and mutton. Milk may be indulged in freely. The diet should consist +principally of easily digested fresh green vegetables. The amount of +tea and coffee should be limited. All malt liquors, sweet wines, and +champagne must be absolutely prohibited. + +Constipation.-- A daily free evacuation of the bowels is essential to +good health. Where constipation exists, and the woman is full-blooded, +with a tendency to a rush of blood to the head, saline laxatives are +indicated. But if the woman is constipated and anemic, cascara sagrada +is a better laxative; while cod-liver oil acts as a laxative and at +the same time improves the quality of the blood. + +Stimulants.-- Women resort to alcoholic stimulants as an analgesic to +relieve pain, whether physical or mental; as a narcotic to produce +sleep; and as a spur to a failing appetite or bodily powers. + +The majority of women patients say that they first used alcohol in the +shape of whisky, brandy or gin to relieve pain at the time of the +menstrual period. The pain that is caused at this time by a chilling +of the body would be as effectually relieved by drinking a cup of hot +tea; while if the pain is intense and constant, recurring every month, +it is doubtless caused by some local inflammation, and the use of +alcohol only veils the real trouble, and the woman loses valuable time +by not consulting a physician at once. + +As to the use of alcohol to blunt the nervous sensibility due to +mental suffering, it is the testimony of the entire medical profession +that this is the greatest cause of inebriety or drunkenness among +women of all classes of society. + +Sleeplessness generally arises from some well-defined physical cause-- +very frequently from inaction of the liver-- and the proper remedial +agents should be used to remove the cause. + +While at first the use of alcoholic beverages increases the appetite, +as the amount taken is increased, distaste for food is created, the +system languishes under an insufficient food-supply, and the original +aim of increasing the appetite is defeated. + +As to taking stimulants to do more work than one could otherwise +accomplish, it is by means of stimulants that woman can accomplish her +physiological ruin more quickly than is possible in any other way. And +the early symptoms of chronic alcoholism show themselves in the form +of neuralgia, insomnia, palpitation of the heart, and muscular +tremors. + +The Kidneys.-- On account of the prevalence of some form of Bright's +disease after forty years of life, the kidneys should be carefully +watched at this time. And in order to keep them in good condition they +must be well flushed with water every day. Three pints of urine should +be excreted daily, and three pints of water as such must be taken into +the system daily. The urine should be examined by the physician every +six months. In this way kidney disease is often discovered in its +incipiency, which otherwise might run into a serious form of Bright's +disease. + +The Skin.-- It must be remembered that the skin is one of the +excretory organs of the body, and the pores should be kept well open +by the various forms of baths. + +The Turkish bath or some modification of it will often be found to be +particularly useful. Massage with alcohol after the bath lessens the +tendency to take cold. For a woman who is anemic or run down, it is +well to follow the Turkish with the Roman bath, which is an inunction +with almond oil or cocoa-butter. A much more thorough massage is given +with the Roman bath than with the "alcohol rub." It is often necessary +to modify the Turkish bath by omitting the steam-room and shortening +the time spent in the hot dry air. In ordinary cases the time spent in +the hot dry-room should be only that necessary for producing a free +perspiration. This time varies in different individuals from ten to +twenty minutes. No woman should go to a Turkish bath without first +consulting her physician, since if the woman has a weak heart, the +bath may be the source of positive danger. Comparatively few women are +strong enough to take the cold plunge. + +Massage.-- Massage, well given by a skilful masseuse twice a week, +will greatly tone up the nervous and circulatory systems. Women who +are very stout and who have sluggish livers with obstinate +constipation will find massage particularly beneficial. + +Exercise.-- Daily exercise in the open air is absolutely essential to +every woman's good health. The minimum amount of outdoor exercise +compatible with health is an hour's walk, at the rate of three miles +an hour. If the woman has never taken any exercise, she must begin +with a very short walk and stop on the first sign of fatigue. +Gradually increase the distance and the speed until the three miles is +reached. + +Profuse Menstruation.-- If the menstrual flow is unusually profuse or +lasts beyond the regular time, the woman should stay quietly in bed +until the flow ceases. All exercise increases the flow. + +The flow now becomes less in quantity, and the periods more infrequent +than formerly. Hemorrhage must always be regarded as a danger-signal +the significance of which can scarcely be overestimated. To +immediately consult a specialist on the appearance of any +irregularities of the flow would, in the opinion of the most eminent +gynecologists of the day, be the means of saving thousands of women's +lives every year. + +Mental Therapeutics.-- It is particularly necessary at this time of +life that the mind should be pleasantly occupied. Her children have +passed the age when they need her constant supervision, and the mother +must take some relaxation from her home cares, in the form of social +diversions, amusements, outdoor life, and change of scene. Any mental +occupation that will take the woman out of herself is the best +possible safeguard against a state of introspection which conjures up +a host of evil fantasies, and which is the first step in the downward +road to a fixed and permanent melancholia. + + "Hang sorrow, care will kill a cat; + And therefore let 's be merry." + + CHAPTER XVI. + + HINTS FOR HOME TREATMENT + + Indigestion; Constipation; Diarrhea; Enemas; Vaginal Douche; Baths; + Headache; Fainting; Hemorrhage. + + "Woman is woman's natural ally." + + -- EURIPIDES. + +Indigestion.-- The chief causes of indigestion are: eating rapidly, +eating at irregular hours, eating indigestible foods, constipation, +and lack of exercise. No one who values her good health will allow +herself to be hurried through a meal, nor will she allow the +perplexities of life to be thrust upon her at the table for solution. +The first requisite for the digestion of foods is that they should be +well masticated, so that the digestive fluids may act on the finely +divided particles to the greatest possible advantage. And while +digestion is going on all mental labor should be held in abeyance, in +order to avoid drawing the blood away from the stomach to the brain. +Furthermore, it is a well-known fact that digestion is best performed +when the meals are served at regular hours. + +Constipation leads to the formation of gases in the intestines, to +fermentation, and to the absorption of toxic materials by the blood. + +Through lack of exercise, the appetite fails, the liver becomes +torpid, and the muscular and nervous systems lose their tone. + +The exercise which the housekeeper gets in going around her house is +not sufficient. Daily exercise in the open air is essential to health; +as this is to supplement the indoor exercise, the amount taken will +vary in proportion to the former. For teachers or those who have a +sedentary occupation an hour's active exercise in the open air-- a +three-mile walk-- should be supplemented by active gymnastic exercise. + +For people in good health, a mixed diet-- that is to say, a diet +consisting of meat, vegetables, and fruit-- is the best. If the +individual is not well, then the diet must be adapted to meet the +needs of that particular case. + +Hot breads, all articles of food fried in fats, salads, and pastry are +difficult to digest. Tea is very constipating, and when taken in +excessive quantities renders the individual nervous. An excess of +coffee leads to congestion of the liver. + +Where indigestion exists, the simplest and most sensible remedies are +to regulate the diet, and avoid eating between meals. By drinking a +glass of water as hot as it can be sipped one hour before each meal, +the mucus is washed out of the stomach, the stomach is empty on coming +to the table, and in the best possible condition for the gastric juice +to act on the food-stuffs. + +Constipation.-- Constipation is the rule with the average American +woman; the causes are their corsets, the tight bands of their +clothing, lack of exercise, and the fact that they drink too little +water and too much tea. The most rational means to overcome it is to +drink more water; at least three pints a day should be taken, in +addition to soups, tea and coffee, and so forth; the water must be +taken into the system as such. Then attention must be given to the +diet; plenty of fruit should be eaten, vegetables, and coarse bread. + +Regularity in this, as in all other habits of life, is most essential, +and the individual should go to the toilet at the same hour every day, +even if there is no inclination to have a bowel movement, and thus the +habit will be established; the most convenient time is directly after +breakfast. + +Medical Treatment.-- But if all these means have failed, medicines +must be resorted to. Cold water is a better laxative than hot; to a +glassful of cold water add from one teaspoonful to one tablespoonful +of the effervescing granules of the phosphate of soda, and take this +the first thing on rising in the morning. This preparation of soda is +particularly useful because it acts slightly on the liver. Other +laxatives are: a seidlitz powder dissolved in a glass of cold water on +rising; a wineglass or more of Hunyadi Janos, also taken on rising. +Any of these may be taken with safety by pregnant women. For children +the simplest laxative is one teaspoonful of Husband's milk of +magnesia, to be taken in one glass of water on rising. + +Enemas.-- Perhaps one of the most common methods used by the laity for +the relief of constipation is the rectal injection, or enema. Enemas +habitually given to unload the bowels are productive of much harm by +overdistending the rectum, so that in time the rectum fails to react +to the normal stimulus-- namely, the presence of the feces-- as it +otherwise would. But by some means or other the bowels must be well +moved once every twenty-four hours. And it is much better to use an +enema than to go to bed without a bowel movement. If the woman is +going around, so that she can give the enema to herself, the most +effective way to take it is in the knee-chest position or an +approximation to this. Either a fountain or bulb syringe may be used +for this purpose; a quart of water at a temperature of 110° F. should +be prepared by making it into a suds with castile soap, or one +tablespoonful of glycerin may be added to one pint of water. The nozle +to be used is the smallest one that comes with the syringe, the +so-called infant's nozle; this is quite large enough, and its +insertion is not nearly so painful as the larger ones; the nozle must +be well greased with vaselin. When everything is ready, the patient +gets down on her knees with the shoulders near the floor, having first +loosened all of her bands and taken off her corsets; the nozle is +introduced as far as it will go into the rectum, and if a bulb syringe +is used the water must be very gradually squeezed into the rectum, +otherwise it will not retain so much; or if the fountain syringe is +used, it must not be hung too high. So soon as the patient feels that +she has taken all that she can retain, she should lie down on the left +side, and retain the water as long as possible, as it is thus rendered +more effective. An enema so taken will be very much more effective +than one taken in the ordinary manner of sitting on the toilet. In the +method just described more water can be used and it will be longer +retained; it can be felt to go up along the course of the large bowel, +and it will often be found very effective when the ordinary enema +fails. This enema will often be found to be a very valuable aid in +curing an obstinate chronic diarrhea, which is kept up by particles of +feces remaining in the folds of the large intestine. If the patient is +confined to bed, she should lie on the left side, with a heavy towel +folded under her to prevent the bed from becoming wet; when the nurse +withdraws the nozle she should make pressure on the anus with the +towel, to help the patient to retain the water as long as possible. +But should the patient have gone so long without a bowel movement that +all these means fail, it will be necessary to precede the water enema +with one of oil; or still more effective is the following combination: +take one teaspoonful of the spirits of turpentine, the yolk of one +egg, and two tablespoonfuls of olive oil, and beat well together, and +add to these one pint of water at a temperature of 110° F. +Constipation, however, of so obstinate a character as this demands a +physician's attention. + +Diarrhea.-- A diarrhea may be acute or chronic; the treatment is +essentially different. For an acute attack accompanied by frequent +stools and severe abdominal pain the first thing to do is to go to +bed. If there is nausea, drink a glass of water as hot as can be +taken, at once; for the diet, a glass of scalded milk, not boiled but +just allowed to come to the boiling-point, every two hours; and +nothing else should be taken until the diarrhea is well in check. If +the pain is severe, a spice plaster over the abdomen will be found to +be very comforting. It is made as follows: take of powdered allspice, +cinnamon, cloves, and ginger each two tablespoonfuls, and two +teaspoonfuls of cayenne pepper; mix well together in a bowl; then +quilt in a piece of flannel large enough to cover the abdomen; when +ready for use, dip in hot whisky and apply as hot as the patient can +bear; cover over with a large napkin, as the plaster produces a deep +stain which does not wash out; keep on as long as necessary. If the +rest in bed and the milk diet kept up for twenty-four hours do not +suffice to cure the diarrhea, it is not wise to take any risks, but +send for your doctor at once. Or if there should be any blood in the +stools, do not wait for anything, but send for the doctor without +delay. + +For a chronic diarrhea an enema given in the knee-chest position, as +already described, will often be found a most efficient remedy. In +diarrheas the use of fruits and vegetables should be avoided; the best +diet after the milk is bread well toasted through, toast-water, +soft-boiled eggs, beefsteak, oyster stew, and clam broth. + +Vaginal Douche.-- To be of service except for mere cleansing purposes +the douche must be taken in the horizontal position, either on a couch +or, if it is not cold, on the floor. Of course, this position +necessitates the use of a douche-pan. The douche-pan is best of +agate-ware, oblong in shape, and with a broad strip which comes under +the nates. On lying down to take the douche the nates must come down +well over the pan and the clothing must be pushed well up to prevent +the water from seeping up the back. To make the woman more comfortable +there should be a pillow under the head, and she must have a shawl or +some light woolen material to throw over her while taking the douche +to prevent chilling; thus doing more harm than good. + +There are two forms of syringes on the market: the bag or fountain +syringe, which is hung up sufficiently high-- about three feet above +the patient-- to cause the water to flow; and the bulb syringe, in +which the bulb has to be constantly squeezed by the hand, which is +tiresome to many women, but this is a much more convenient form to +have in traveling. During pregnancy the fountain syringe only should +be used, and it should be hung as low as will enable the water to +flow. For a woman who has never taken douches it is well to begin with +a temperature of 110° F., gradually increasing the temperature to 118° +or 120°; this is as high as the woman should attempt to go, for a +higher temperature would burn her, leaving the vulva so sensitive that +she would only be able to take cool douches for a long time after +this; a bath thermometer should be used in all cases to test the +temperature, so that the woman knows exactly what she is doing. + +In cases of inflammation of the uterus or its adnexa four quarts of +water should be used, and the douche should be taken in the horizontal +position. The water thus acts as a hot poultice about the uterus, and +the woman will find on rising that some water flows out from the +vagina. Ordinarily plain hot water is all that is necessary to use, +but where the discharge is acrid and scalding, the plain hot-water +douche should be followed by a warm douche containing one teaspoonful +of borax to a pint of water. The best time for taking a douche is at +night just before retiring; there is also less danger of taking cold +when the douche is taken at this time. + +The scalding sensations at the vulva may be due to the acidity of the +urine, in which case it will be increased just after urination; or it +may be due to an acrid discharge from the vagina. A little observation +on the part of the patient will enable her to distinguish which is the +real cause. If there is any trouble with the urine, it should be +carefully examined at once, as some congestion or inflammation of the +kidneys is not infrequently present, which if attended to might be +cured, and which if allowed to run on unattended to, may develop into +a serious form of Bright's disease. + +The genitals should be washed with soap and water night and morning. +Women who do not suffer from leuchorrhea need not take a vaginal +douche more than once a week; after the menstrual flow the vaginal +injection is advised to remove the detritus of the flow. + +Baths.-- The most ordinary forms of baths used may be classified under +sponge-, shower-, sitz-, and tub-baths. The sponge-bath as ordinarily +taken is of service for cleansing purposes, and if the water be cold +it tones up the system to some extent, and is so a preventive against +taking cold. The effect of this bath will be found to be vastly more +beneficial if salt is added to the bath in the proportion of a pint of +salt to a gallon of water; either sea-salt may be used or the ordinary +coarse salt. It is most advantageously taken sitting in a bath or +hat-tub, so that the entire surface of the body will be wet at the +same time, and the water can be allowed to run down the back and over +the chest. It is well to begin these baths at a temperature of 80° F. +and to gradually decrease this until the bath is taken at 70°, which +is about the temperature of running water, and the bath should be kept +up at this. For most people the best time to take the bath is just +before retiring; this bath is not only very strengthening, but also is +excellent in cases of insomnia and nervousness. + +Shower-baths.-- These may be taken after a hot bath, or taken alone +after violent muscular exercise. The body should be quickly scrubbed +off and the shower should be warm at the beginning and gradually +allowed to become cold, stooping over so as to get the full force of +the shower on the spine and over the region of the stomach and heart. +They will be found to be most refreshing after great muscular fatigue, +and, when taken after the hot tub-bath, greatly lessen the +susceptibility of the individual to taking cold. + +Sitz-baths.-- These are given for their local effect in cases of +inflammation; whether this inflammation be of the kidneys, bladder, or +of the uterus and its adnexa. A sitz-tub is necessary to properly take +this form of bath. The water should be used as hot as is comfortable +to the patient, from 105° to 110° F., hot water being added as the +first cools off; a pint of salt should be added to the gallon of +water, and the patient should remain in this from five to eight +minutes. A blanket should be wrapped about the patient so that she +will be thrown into a perspiration; it is almost needless to say that +the only time for taking this bath is just before retiring, and that +this bath does make the woman more susceptible to taking cold, so that +it is necessary to wear an abdominal woolen bandage day and night. + +Tub-baths.-- The tub-bath ought not, as a rule, be taken more than +twice a week, unless the cold plunge is used, which may be taken every +day. If the tub-bath is taken hot, the woman should remain in it not +much longer than is necessary to scrub off with a flesh-brush; this +bath should be followed either with a cold shower-bath, or the water +in the tub be gradually allowed to cool off until it is down to 70° F. + +Headaches.-- Headaches, aside from those of acute illness, may be +roughly divided into three classes: first, those which are due to +indigestion; second, neuralgic headaches; and, third, those due to +pelvic inflammations. The headaches due to indigestion are usually +located over the eyes and all over the forehead; they are more or less +constant and are accompanied by other symptoms of indigestion, and +very often by constipation. The feces are allowed to remain in the +bowels overlong, the toxic matters are taken up by the blood, and +headaches and vertigo result. + +Neuralgic headaches are of an entirely different character; the pains +are here of a lancinating character, and are not confined to any one +region of the head. As a rule, they are accompanied by neuralgic pains +in other parts of the body. Neuralgia generally means a rundown state +of the system from overwork, worry, or malaria, and tonics and +cod-deliver oil are indicated. + +A constant dull pain on the top of the head or in the back of the neck +generally indicates some uterine inflammation, and can only be cured +by removing the cause. In any case it is very evident that taking the +various "headache powders" with which the market is flooded will never +cure the woman of her headaches; and many of these powders are very +dangerous, especially where the heart is weak, as most of them are +heart-depressants. + +Fainting.-- Fainting may be due to a weak heart, to heart disease, or +to sudden shock, as on receiving a bad piece of news; during pregnancy +the close air of a room may cause a woman to faint. The first thing to +be done is to lay the woman down on the floor or bed with nothing +under her head; loosen all her clothes about the neck and waist, and +throw the windows open so that she will get plenty of fresh air. If +she is able to drink, give her one teaspoonful of aromatic spirits of +ammonia in four tablespoonfuls of cold water. If the feet are cold, +place hot-water bottles to them to improve the circulation. And if at +the end of fifteen minutes she does not show signs of decided +improvement, give her two tablespoonfuls of whisky in an equal +quantity of hot water. In the meantime the physician will have been +summoned. These attacks of fainting often occur in a crowded +ball-room, and are due to tight lacing and the poor ventilation of the +room. + +Hemorrhage.-- A profuse hemorrhage is the most alarming as well as the +most dangerous thing which can befall a woman, and the very nearest +doctor should be summoned until the family physician can be gotten +there. The woman should be made to lie down wherever she may happen to +be, her clothes loosened, the windows thrown open, so that she will +not only have plenty of fresh air, but that the air shall be cool. If +the blood is coming from the mouth, give her pieces of ice to hold in +it; if she coughs up the blood, it would be well to put a bag of +ice-cold water or cloths wrung out of ice-water on the chest. If the +woman is suffering from a uterine hemorrhage, have her take at once a +hot vaginal douche, from 118° to 120° F., and have the foot of the bed +raised. The head should always be kept low. + +Women hold their health in their own hands to a far greater extent +than they have ever dreamed of; and if the majority of women suffer, +it is very often their own fault, either because they have disregarded +nearly every law of health, or have allowed trivial ailments to go on +until they were almost incurable. + _______ + + "The broad mountain-top, with its sunlight and free air, is + possible to all of us, if we choose to struggle on and reach it." + + -- Phillips Brooks. + _________________ + + GLOSSARY. + _________________ + +Abortion. The expulsion of the fetus before the end of the third lunar +month. +Afferent Nerves. Those nerves which convey the impressions to the +nerve-centers. +After-pains. The pains which follow labor and which are caused by the +contractions of the uterus. +Amenorrhea. Absence of the menstrual flow. +Anemia. The so-called thinness of the blood, due to a deficiency of +red blood-corpuscles. +Antisepsis. The use of chemical substances which have the power of +destroying germs. +Anus. The external circular outlet of the rectum or distal part of the +large intestine. +Appendages, Uterine. The Fallopian tubes, the ligaments of the uterus, +and the ovaries. +Atrophy. A progressive diminution in the bulk of an organ or tissue. +Automatic. Involuntary, mechanical. + +Bulbi Vestibuli. A plexus of veins on each side of the vestibule. + +Capillaries. The terminal and very finest branches of the +blood-vessels. +Catamenial Flow. See Menstruation. +Cellular Tissue. A loose, transparent tissue which surrounds the +muscles and organs of the body. +Cerebrum. The upper and larger portion of the brain. +Chlorosis. Anemia of young women about the time of puberty. +Climacteric. See Menopause. +Clitoris. A small, elongated, erectile organ situated at the upper +part of the vulva. +Cohabitation. See Coitus. +Coition. See Coitus. +Coitus. Syn., coition, copulation, cohabitation, sexual congress, +sexual intercourse. The carnal union of the sexes. +Colostrum. A thin albuminous fluid which appears in the breasts at the +fourth month of pregnancy. +Conception, or impregnation, is the union of the germ and sperm cell +which results in a new being. +Confinement. Childbed, the expulsion of the child from the womb. +Congestion. The abnormal accumulation of blood in a part. +Constipation. Costiveness; a state in which there is not a free daily +evacuation of the bowels, or where the evacuations are hard or +expelled with difficulty. +Continence. Abstinence from or moderation in sexual indulgence. +Copulation. See Coitus. +Cord, Umbilical. The cord which connects the fetus with the mother. +Through the blood-vessels contained in this cord the child receives +nourishment. +Corpuscle. A very small particle. + +Decidua. A membranous sac formed in the uterus during gestation, and +thrown off after parturition. +Defecation. The act by which the contents of the bowel are expelled +from the body. +Dehiscence. The splitting open of an organ. +Dentition. The cutting of the teeth. +Dysmenorrhea. Painful and difficult menstruation. +Dystocia. A difficult labor. + +Embryo. The name applied to the very earliest stages of the child in +utero; that is, up to about the time of quickening. +Endometrium. The lining membrane of the uterus. +Epithelium. A layer of minute cells which forms the covering of many +membranes. +Erection. The state of a part which, having been soft, becomes rigid +and elevated by the accumulation of blood within its tissues. + +Fallopian Tubes. Two very small tubes extending from the upper angles +of the uterus to the ovaries and serving to convey the ova from the +ovaries to the uterus. +Feces. Stools; the normal discharge from the bowels. +Fetus. The child in utero from the time of quickening to that of +birth. +Fomentations. The application of cloths which have previously been +dipped in hot water. +Function. An action of an organ which could be performed only by that +organ, and which is necessary to the well-being of the individual. + +Generative Organs. Syn., genital, reproductive, sexual; those organs +in the male and female by means of which a new being is created. +Genital. See Generative. +Gestation. See pregnancy. +Gonorrhea. A highly contagious venereal disease, characterized by an +inflammatory discharge of mucus from the urethra and prepuce in the +male, and from the urethra and the vagina in the female. +Graafian Follicles. Minute ovarian vesicles which contain the ova. + +Hemorrhoids. Piles or tumors at or within the anus, and consisting of +enlarged veins. +Hymen. The semilunar fold situated at the outer orifice of the vagina +in the virgin. +Hypertrophy. The increased activity of a part which leads to an +increase in its bulk. +Hypochondriasis. Morbid feelings concerning the health and simulating +disease. + +Impregnation. See Conception. +Infectious. See Contagious. + +Katabolic Nerves are those nerves which stimulate the breaking down of +tissue. + +Labia Majora. Two thick folds of skin which extend backward from the +mons veneris. +Labia Minora. Nymphae; two very delicate folds of skin which are +inside of and protected by the labia majora. +Labor. See Parturition. +Lactation. The secretion of milk; nursing, suckling the child. +Lactiferous Ducts. The milk ducts. +Leucorrhea. Whites; a whitish or yellowish discharge from the vagina. +Lochia. A discharge which follows labor and which lasts for about two +weeks. +Lying-in. The period which follows childbed. +Lymphatics. The vessels in which the lymph is carried. + +Mammae. The mammary glands; the breasts. +Marital Relations. See Coitus. +Massage. A systematic kneading of the muscles. +Meatus Urinarius. The external orifice of the urethra. +Meconium. The first discharge from the infant's bowel after birth, and +which had collected in the intestines during the pregnancy. +Medulla. The base of the brain at its junction with the spinal cord. +Menopause. Climacteric, change of life, the time of the natural +cessation of the monthly sickness. +Menorrhagia. An excessive menstrual flow. +Menstruation. Menstrual period, menstrual flow, menses, monthly +sickness, the monthly discharge of blood from the uterus, which, with +certain exceptions, recurs monthly from about the age of thirteen to +forty-six years. +Metabolism. Transformation changes. +Metamorphoses. Changes of shape or structure. +Metrorrhagia. A flow of blood between the menstrual periods. +Micturition. The act of passing water. +Miscarriage. The expulsion of the fetus between the twelfth and +twenty-eighth weeks. +Molecular. Belonging to the molecules, or the minutest portion of +anything. +Mons Veneris. The uppermost part of the vulva, which is a fatty +cushion covered with hair. + +Nerve-center. A nerve station from which orders are transmitted and +where orders are received. +Nubile. Puberty, that period of life in which young people of both +sexes are capable of procreating children. +Nymphae. See Labia minora. + +Ovaries. Two small ovoid bodies, one on each side of the uterus, in +which the ova are formed. +Oviduct. See Fallopian tobe. +Ovulation. The formation of the ova in the ovary, and the discharge of +the same. +Ovule. See Ovum. +Ovum. Germ cell, a small, round vesicle situated in the ovaries, and +which, when fecundated, constitutes the rudiments of the embryo. + +Parturition. Labor, delivery, child-birth, the expulsion of the child +from the womb. +Pathologic. Relating to the diseased condition of tie body. +Pelvis. The bony cavity situated at the lower end of the spinal column +and supported by the thighs. +Periodicity. The recurrence of physiologic phenomena at regular +intervals. +Periphery. The circumference of an organ. +Peristaltic Action. An alternate contraction, making small, and +enlargement of the bowel; it is by this means that foods, etc., are +forced along its passage. +Peritoneum. A serous membrane which lines the abdominal cavity, and +wholly or in part envelopes the organs contained in it; it also partly +covers the organs contained in the pelvic cavity. +Phenomena. Remarkable appearances. +Physical. Pertaining to the body. +Placenta. After-birth, a soft, spongy, vascular body adherent to the +uterus, and which is connected with the embryo through the umbilical +cord. +Plethora. A condition marked by a superabundance of blood. +Postpartum Hemorrhage. Hemorrhage following labor. +Pregnant. Enceinte, gravid; the state of a woman who is with child. +Premature Labor. The expulsion of the fetus between the end of the +twenty-eighth week and the time that labor ought to have occurred. +Propagation. The spreading or extension of a thing. +Pruritus Vulva. An intense itching of the privates, or vulva. +Psychic. Pertaining or belonging to the mind. +Puberty. Sexual maturity; nubility; that period of life in which young +people of both sexes are capable of procreating children. +Pubes or Pubis. The lowest and middle part of the pelvis in its +anterior surface. +Puerperium. The lying-in after child-birth. + +Quickening. The sensation experienced by the mother as the result of +active fetal movements in the womb. + +Rectum. The lower extremity of the large intestine. +Reflex. The reflection of an impulse from a nerve-center which has +been received from elsewhere by that center. +Reproduction. See Generative. +Respiration. Breathing. +Rugs. Wrinkles. +Rut. The copulation of animals. + +Septicemia, Puerperal. Childbed fever. +Sexual. That which relates to sex. See Generative. +Smegma. A cheesy substance which may collect about the vulva. +Spermatozoa. The essential male fertilizing elements. +Sympathetic Nervous System. Presides over involuntary acts; as +digestion, breathing, etc. +Syphilis. A venereal disease which is highly contagious by coition, +contact with the lips, etc. + +Tachycardia. Distress in the region of the heart, with palpitation and +shortness of breath. + +Umbilicus. Navel. +Urea. The most important of the solid constituents of the urine. +Ureters. The ducts leading from the kidneys to the bladder. +Urethra. The excretory duct from the bladder for the escape of the +urine. +Urination. The act of passing water. +Uterosacral Ligaments. Ligaments which pass from the uterus to the +sacrum, and assist in holding the uterus in position. +Uterus. Womb; the hollow, pear-shaped pelvic organ which is destined +to retain the child from the moment of its conception until the time +of its expulsion at birth. +Utricular Glands. Glands of the uterus. + +Vagina. The canal which connects the female internal and external +organs of generation. +Vascular. Pertaining to the blood-vessels. +Vasomotor Nervous System. Comprises the brain, spinal cord, and the +nerves given off from the cord: this system presides over voluntary +acts, that is, those acts which are under the control of the will. +Vestibule. A smooth cavity that exists in the female between the +perineum and the nymphae. +Viscera. The contents of the large cavities of the body. +Vulva. The external genitals, private parts, the female external +organs of generation. +Vulvitis. Inflammation of the vulva. + + + + +*** END OF THE PROJECT GUTENBERG EBOOK, THE FOUR EPOCHS OF WOMAN'S LIFE *** + +This file should be named 4986.txt or 4986.zip + +Project Gutenberg eBooks are often created from several printed +editions, all of which are confirmed as Public Domain in the US +unless a copyright notice is included. Thus, we usually do not +keep eBooks in compliance with any particular paper edition. + +We are now trying to release all our eBooks one year in advance +of the official release dates, leaving time for better editing. +Please be encouraged to tell us about any error or corrections, +even years after the official publication date. + +Please note neither this listing nor its contents are final til +midnight of the last day of the month of any such announcement. +The official release date of all Project Gutenberg eBooks is at +Midnight, Central Time, of the last day of the stated month. 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