The Four Epochs of Woman's Life; A Study in Hygiene

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Title: The Four Epochs of Woman's Life; A Study in Hygiene
Author: Galbraith, Anna M. (Anna Mary)
Language: English
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THE FOUR EPOCHS OF WOMAN'S LIFE

A Study in Hygiene

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

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

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.

"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.

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