CHAPTER VI.

THE MARRIAGE QUESTION.

Herbert Spencer's Definition of Love; What Constitutes a Suitable

Husband; Best Age for Marriage; Shall Cousins Marry? Contraindications to

Marriage; Do Reformed Profligates Make Good Husbands? the Proper Length

of Time for the Engagement; the Right Time of the Year to Marry; the

Selection of the Wedding Day.

"Well, Brutus, thou art noble; yet, I see,

Thy honourable mettle may be wrought

From that it is disposed: Therefore, 'tis meet

That noble minds keep ever with their likes.

For who so firm that cannot be seduced?"

-- "Julius Caesar."

Herbert Spencer's Definition of Love.-- "Love is habitually spoken of

as though it were a simple feeling, whereas it is the most compound,

and therefore the most powerful, of all the feelings. Added to the

purely physical elements of it, are first to be noticed those highly

complex impressions produced by physical beauty; around which are

aggregated a variety of pleasurable ideas, not themselves amatory, but

which have an organized relation to the amatory feelings. With this

there is united the complex sentiment we term affection-- a sentiment

which, as it can exist between those of the same sex, must be regarded

as an independent sentiment, but one which is here greatly exalted.

Then there is the sentiment of admiration, respect, reverence, in

itself one of considerable power, and which in this relation becomes

in a high degree active. There comes next the feeling called the love

of approbation. To be preferred above all the world, and that by the

one admired above all others, is to have the love of approbation

gratified in a degree passing every other experience, especially as

there is added that indirect gratification of it which results from

the preference being witnessed by others. Further, the allied emotion

of self-esteem comes into play. To have succeeded in gaining such

attachment from and sway over another is a proof of power which cannot

fail to agreeably excite amour propre. Yet again, the proprietary

feeling has its share in the general activity. There is the pleasure

of possession, the two belonging to each other. Once more, the

relation allows of an extended liberty of action. Toward each other a

strained behavior is requisite. Around each there is a suitable

boundary that may not be crossed; an individuality on which none may

trespass. But in this case the barriers are thrown down, and the love

of unrestrained activity is gratified. Finally, there is an exaltation

of sympathies, egotistic pleasures of all kinds are doubled by

another's sympathetic participation, and the pleasures of another are

added to the egotistic pleasures. Thus around the physical feeling

forming the nucleus of the whole, are gathered the feelings produced

by personal beauty that constitutes simple attachments, of

self-esteem, of property, of love of freedom, of sympathy. These, all

greatly exalted and severally tending to reflect their excitements on

one another, unite to form the mental state we call love. And as each

of them is comprehensive of multidinous states of consciousness, we

may say that this passion fans into immense aggregate most of the

elementary excitations of which we are capable; and that hence results

its irresistible power."

What Constitutes a Suitable Husband.-- It is desirable that the

husband shall be a few years older than the wife. Man is later in

coming to maturity, and also retains his sexual powers considerably

longer than woman; so that for these functions to cease about the same

time, the wife must be younger than the husband. A difference of from

two to five years is best; if the parties are young, it is not

essential that the husband should be much the wife's senior, as it is

later in life. The husband may be ten years older, but a greater

disparity of age than this is rarely compatible with congeniality of

tastes and dispositions, so essential to a happy married life. The

woman who risks her happiness with a man many years younger than

herself violates a precept of nature.

The average stature of the man is about three inches greater than that

of the woman, and in the physiologic marriage any great deviation from

this should be avoided.

The essentials for a happy marriage may be summed up as follows: that

the parties shall be of suitable age; that they shall be physically

well mated and in full sympathy with each other's views of life, of

the same social position, and of equal education.

The Best Age for Marriage.-- The reproductive life begins with

puberty, but maturity is not reached before the age of twenty-one. It

is only then that the standard of development is reached that is most

compatible with the successful bearing of the grave responsibilities

of wifehood and motherhood. The too early exercise of the reproductive

functions leads to increased suffering on the part of the mother,

depresses her vitality, and increases her liability to disease.

Statistics show that the mortality is very much greater where girls

marry under twenty years of age.

The offspring are apt to be small and ill developed, and die in large

numbers in early life; only a small percentage live long and robust

lives. In France it has been observed that where the fear of

conscription has caused many young people to marry the offspring were

lacking in vigor. Among the offspring of immature parents there is a

larger proportion of idiots, cripples, criminals, scrofulous, insane,

and tubercular than among the children of nubile parents.

In our climate women are best fitted to become wives and mothers

between the ages of twenty-four and twenty-eight years. Before this

age neither their self-knowledge, their knowledge of the world, nor

their experience is sufficiently mature to fit them to wisely make the

choice of a companion for life, or to become mothers. After forty,

most women cannot hope for children. Men had better wait until between

the ages of twenty-seven and thirty years, before they undertake the

responsibilities of parenthood.

Shall Cousins Marry?-- They might if both families were perfectly

healthy; but as few families are without some lurking predisposition

to disease, it is not well, as a rule, to run the risk of developing

this by too repeated unions.

Contraindications to Marriage.-- Young women in whose family there is

a distinct history of such hereditary diseases as cancer,

tuberculosis, or insanity for two generations back, should not marry

at all. Not only is this a fearful legacy to hand down to their

children, but pregnancy and child-bearing very decidedly favor the

development of these diseases.

Syphilis in either sex is a distinct bar to marriage; first, the party

married is sure to contract the disease, even though it may have been

supposed to have been cured. Fortunately, the children of such

marriages are generally still-born; still, they do sometimes live, and

are most pitiable and sickly objects. For any one to marry under these

conditions is a crime against society, against the State, and against

posterity.

Women who have serious forms of heart disease, tuberculosis, or

Bright's disease would, by becoming pregnant, run a serious risk of

losing their lives toward the close of the pregnancy or at the time of

their confinement. In case of heart disease, the pulmonary congestion

that accompanies pregnancy, together with the encroachment of the

pregnant uterus on the cavity of the chest, would greatly add to the

embarrassment of the heart's action.

In normal pregnancy there is some congestion of the kidneys; where

there is actual disease of the kidneys prior to the pregnancy, this

congestion is apt to become so severe as to threaten the woman's life.

These organic diseases are not to be confounded with functional

diseases which are dependent on some other cause; as palpitation of

the heart due to indigestion, or heart murmurs dependent on the thin

state of the blood, or congestion of the kidneys due to exposure to

cold;-- all of which may be cured by proper treatment.

Should a woman with a fibroid tumor marry, she would run a great risk

to her life; she should have the tumor removed, or, if this is not

possible, she should give up all thoughts of marriage, since the

increased irritation and congestion consequent upon the marital

relations would tend to favor its growth. Should pregnancy ensue,

delivery might be attended with serious complications, as very

difficult labor, postpartum hemorrhage, or, as these tumors have but

little vitality, and the pressure to which they are subjected during

labor is liable to cause their death, disorganization, sloughing, and,

as a result, puerperal septicemia.

Sometimes there is such a lack of development of the genital organs as

to prevent the woman from having children.

Two persons with even a slight tendency to the same disease, either

inherited or acquired, should not intermarry, even if they are in

comparatively good health at the time. Their offspring would be quite

sure to inherit their diseased tendencies.

Persons whose constitutions have been somewhat injured, but who are

not tainted with actual disease, may rear children much healthier than

themselves, provided their own lives are wisely regulated. If they are

growing better all the time, and are not too much broken in

constitution, it may be safe for them to marry.

Among the Jews the physician is frequently consulted before

matrimonial alliances are contracted. This custom could not but be of

universal benefit; many local or general diseases would be eradicated

before marriage, and in this way much suffering and unhappiness would

be spared; or, in other cases, the patient would be advised of the

inadvisability of marriage.

Do Reformed Profligates Make Good Husbands?-- The manner of life that

has been led by this class of men is such as to undermine their

health, if not to have rendered them physical wrecks. There is the

overindulgence in alcoholic beverages, and perhaps, added to this,

some drug habit. In addition to this, these men early in their career

are apt to become infected with some of the venereal diseases, or

perhaps with all of them-- gonorrhea, syphilis, and so forth; and

these diseases have the horrible characteristics of becoming latent. A

man who contracts this kind of a disease can never be really sure that

he is cured. All venereal diseases are highly contagious.

It is now a well-established fact that gonnorrheal infection is not

only one of the most common causes of pelvic inflammations in women,

but that these same inflammations are of the most virulent types,

unless they are recognized and treated in the early stages. It is also

a well-known fact that a large percentage of married women suffer from

this disease. Sterility almost always results.

In the case of a syphilitic parent, one or two children may be born,

but the offspring is generally sickly and diseased. Inebriety as well

as sexual excesses are both well recognized as distinct forms of

disease accompanied by degeneracy of brain tissue. It is nothing less

than criminal for such men to have children, since these children

would at least inherit the tendency to the same diseases, if they did

not actually have them; there is also a strong probability of such

children being born idiots or imbeciles.

It is therefore self-evident that, instead of a reformed profligate

making a good husband, he must make a very diseased one. It has

therefore been suggested that the parents of the prospective bride

should demand from the intended groom a certificate of freedom from

all venereal diseases by a physician of their own selection. Also that

there should be legislation upon the subject, and that before a man is

granted a license of marriage, he should have a certificate from the

health officer of freedom from syphilis, gonorrhea, and tuberculosis.

The Proper Length of Time for the Engagement.-- A period not shorter

than three months, nor longer than one year, should elapse between the

engagement and the marriage.

There are strong physiologic reasons against long engagements: they

keep the affections and the passions in an excited and unnatural

condition, which after a time tends to weaken the nervous system and

undermine the health. These evil consequences are common to both

sexes. It is far better that the subject of marriage should not be

entertained at all unless the circumstances are such that the union

might with propriety be effected at once.

The Right Time of the Year to Marry.-- When woman marries she enters

upon a new life, and a very trying one. Extreme heat and extreme cold

are both very taxing to the human economy. Midsummer and midwinter are

therefore both objectionable, but especially the former.

The Selection of the Wedding-day.-- This is by common consent left to

the bride. She should select a time about ten or fifteen days after

the end of one of her menstrual periods, as this is the time of

comparative sterility, and it is most desirable that the first sexual

relations should be fruitless.

_________________

PART II.-- MARRIAGE.

_________________

CHAPTER VII.

THE ETHICS OF MARRIED LIFE.

The Wedding Journey; the Ethics of Married Life; Shall Husband and Wife

Occupy the Same Bed? the Comsummation of Marriage; the Marital Relation;

Times when Marital Relations Should be Suspended.

"If it is possible to perfect mankind, the means of doing so will

be found in the medical sciences."-- DESCARTES.

The Wedding-journey.-- The wedding-journey, which was formerly the

cause of so much discomfort to both husband and wife, has fortunately

gone out of vogue; and in its place has come the retirement to a quiet

country or seaside spot, away from the prying eyes of friends. Thus

the nervous strain incident to sight-seeing and travel is avoided.

The Ethics of Married Life.-- It has been said that God set men and

women in pairs in order that they might perfect each other and

complete each other's happiness. The secret of all true happiness in

life lies in the spirit of altruism; one must be able to wholly forget

herself and to find her happiness in the welfare of others.

The woman who exhausts herself physically and financially on the

preparation of her trousseau and her wedding does her husband a wrong

by bringing him a wife who is on the verge of nervous prostration.

The secret of a happy married life depends to no small extent on the

very beginning: the relation is so entirely new, and much lies hidden

in the character of each that was never suspected by the other.

Between husband and wife there must always be mutual concessions,

forbearance, and sympathy; a mutual helpfulness to attain all that is

best. This, of course, implies that the life of each is an open book

for the other to read; that there is an unreserved exchange of

thought; and that no privilege is claimed by the one that would not

willingly be accorded to the other.

"How many men," says Balzac, "proceed with women as the monkey of

Cassan with the violin; they have broken the heart without knowing it,

as they have tarnished and disdained the jewel whose secret they never

understood. Almost all men are married in ignorance of women and of

love. They have commenced by forcing open the doors of a strange house

and have wished to be well received in its salon. But the most

ordinary artist knows that there exists between him and his

instrument-- his instrument which is made of wood or ivory-- a sort of

indefinable friendship. He knows by experience that it has taken years

to establish this mysterious rapport between an inert material and

himself. He could not have divined at the first stroke all its

resources and caprices, its faults and its virtues. His instrument

only became a soul for him and a source of melody after long study; he

only came to understand it as two friends after the most learned

interrogation.

"So the world is full of young women who grow pale and feeble, sick

and suffering. The ones are a prey to inflammations more or less

severe; the others remain under the dominion of nervous attacks more

or less violent. All these husbands have caused their own unhappiness

and ruin. Never begin married life with a rape. To demand of a young

girl whom one has seen forty times in fifteen days to love you because

of the law, the king, and justice is an absurdity.

"Love is the union of necessity and of sentiment. Happiness in

marriage is the result of perfect understanding between the spirits of

husband and wife. From this it happens that in order to be happy, a

man is obliged to bind himself to certain rules of delicacy and honor.

After taking advantage of the social laws which consecrate the

necessity, it is necessary to obey the secret laws of nature, in order

to make the sentiments flourish. If a man places his happiness on

being loved, it is necessary that he should love sincerely; nothing

resists a veritable passion."

Shall Husband and Wife Occupy the Same Bed?-- Among civilized nations

custom differs in this regard; in Germany, for instance, the husband

and wife occupy separate beds in the same room; formerly in this

country it was almost the universal custom for husband and wife to

occupy the same bed. The current of opinion has changed in this

respect, and it is now considered in the highest interests of both

that they shall occupy not only separate beds, but separate rooms;

these rooms communicating through a door which connects their

respective dressing-rooms. This is unquestionably the best arrangement

from the hygienic as well as from the ethical point of view. Health

requires that one-third of the time shall be spent in sleep; the bed

was made for sleep; and the most refreshing sleep can only be obtained

by occupying the bed alone. If two persons occupy the same bed and one

is restless, the sleep of the other is necessarily disturbed. Again,

two persons occupying the same bed necessitates the same hour for

rising and retiring, which is not always convenient or agreeable.

Balzac writes on this subject: "To put the system of separate

bed-rooms into practice is to attain to the highest degree of

intellectual power and of virility. By what syllogism man arrived at

establishing as a custom that of man and wife sleeping together, a

practice so fatal to happiness, to health, to pleasure, and even to

self-love, would be curious to seek out." If for financial reasons it

is not possible to have separate bed-rooms, the German custom of

having separate beds should be adopted.

The Consummation of Marriage.-- The consummation of marriage is often

attended with difficulty owing to the rigidity of the hymen; this, if

present, must usually be ruptured before connection takes place. Great

gentleness and care must be exercised by the husband if it does not

readily yield, the use of hot vaginal injections should be kept up for

several weeks before the trial is repeated. These usually relax the

parts very considerably; but if coitus is still found impossible, it

is better to consult a physician at once, when a simple operation will

generally remove the trouble and the woman is spared much suffering.

In no case is any violence on the part of the husband allowable, as it

might produce irreparable injuries.

There is always more or less suffering on the part of the wife at

first, partly due to the rupture of the hymen, and partly to the

forcible dilatation of the vagina and she should be allowed a

sufficient time for nature to repair these injuries. By so doing, the

constitutional disturbances and the nervous disorders which are so

very prevalent may be prevented. Too frequent indulgence at this

period is a prolific source of inflammatory diseases, and often

occasions sterility and ill-health.

The first nuptial relations should be fruitless, in order that any

indisposition arising therefrom should have had time to disappear

before the woman becomes pregnant.

The Marital Relation.-- It is most important for the interest of both

parties that there should be chastity in the marriage relation as well

as out of it. Many young couples have had their lives ruined by

excessive sexual indulgence. The effect is usually most severe upon

the husband, yet the wife becomes weak, nervous, and excitable. Sexual

excess is also the grave of domestic affection. The general rule given

is that coitus should never take place oftener than every seven or ten

days. When coitus is succeeded by langour, depression, or malaise, it

has been indulged in too frequently.

Among civilized people there are three widely diferent views as to the

proper course to be pursued:

First, those who maintain that sexual intercourse should not take

place except for the propagation of the species.

Second, those who believe that the act is a love relation, mutually

demanded and enjoyed by both sexes, and serving other purposes besides

that of procreation.

Third, those who hold that sexual intercourse is a physical necessity

for the man, but not for the woman.

The first theory, "that the sexual relations should never be sustained

save for the purpose of procreation," has many advocates. They teach

that there are other uses for the procreative element than the

generation of offspring, and far better uses than its waste in

pleasures. They claim that a life of total chastity increases the

physical and mental vigor; and there will result a procreation on the

mental and spiritual planes, instead of on the physical ones.

They also claim that to woman belongs the creative power; that she

must choose when a new life shall be evolved; and that only by

adhering to this law can she be protected in the highest function of

her being-- the function of maternity.

The adherents of the second theory, "that the act is a love relation,

mutually demanded and enjoyed by both sexes, and that it serves other

purposes besides that of procreation," claim that the female sexual

life indicates that the healthy woman is neither indifferent nor

passive in the generative act. It has much the same effect as in man--

a powerful increase in her sensations, whole groups of muscles are set

in motion, and the uterus as well as the entire nervous system are in

an excited condition and activity. And that it is the province of the

mother to decide when a new life should begin.

The third theory, "that sexual intercourse is a physical necessity for

the man, but not for the woman," is by far the most widely accepted.

We will consider, first, the practical results of this last theory;

and, second, the scientific basis on which it rests.

It is generally acknowledged that this practice has done more to cause

domestic misery, sickness, and death than that dreadful scourge of the

human race, tuberculosis.

This man, accustomed all his life to gratify his sexual passions

promisculously, marries a virtuous young girl. In her menstrual

periods she has had to do only with the secondary phenomena; with the

expulsion of the ova not at all. She has had no instruction in the

corresponding physiologic life of the man, and is astonished at the

male sexual indications, and is led to believe in their physiologic

necessities. The result is that she not only suffers physically, but

feels outraged and disgraced. She is liable to the chance of maternity

at any time; and such offspring will probably be sickly.

Passion is presented to the young wife in so hideous a guise that it

will take the utmost consideration of her husband afterward to enable

her to completely overcome her repugnance. If she be worn and weary of

excesses in the early days of her married life, the husband will have

only himself to blame if he is bound all his life to an apathetic and

irresponsive wife. Husbands place great strains upon the affections of

their wives, and lower themselves almost past reinstatement in their

respect and esteem.

Lastly, on what scientific basis does this "physilogic necessity" for

sexual gratification on the part of the male rest? Analogy with the

lower animals does not bear it out. Among animals, except in rare

instances under domestication, the female admits the male in sexual

embrace only for procreation. Among many savage tribes this same rule

has but few exceptions. The analogies between the male and the female

sexual organs; between seminal emissions and menstruation; between the

sexual life of the male and of the female, only go to accentuate the

fact that this so-called physiologic necessity on the part of the male

has arisen chiefly through the difference of education; so that it has

come to be that the woman is chaste and the man is degraded; that the

woman is too sentimental and the man too passionate. From a purely

medical standpoint, the most eminent physicians and physiologists of

the day all unite in advocating a chaste and continent life, simply

for the sake of the man's own health, independently of all other

considerations.

Times when Marital Relations Should be Suspended.-- The marital

relations should always be suspended during the menstrual period.

During pregnancy intercourse should never, or at least very rarely, be

indulged in. At this time the mother needs to conserve all her

strength and energies for herself and child; and any sexual relations

during this time increase the sufferings of the mother and impair the

vitality of the child. It has been even suggested that much of the

pain during parturition would be avoided by entire continence during

pregnancy. Intercourse during the early months of pregnancy is a

frequent cause of abortion. Women who have supposed that they have

never been pregnant have in reality been having abortions every second

or third month.

A woman should never be subjected to coitus until three months after

delivery. During lactation intercourse should never, or at least very

rarely, be indulged in; as the function of lactation makes a heavy

drain on the strength of the mother, and anything which would further

weaken her would tend to impoverish the quality of the milk and thus

the child would suffer.

CHAPTER VIII.

SEXUAL INSINCT IN WOMEN.

Sexual Instinct in Women; Excessive Coitus; Causes of Sexual

Excitability.

"Virtue, the strength and beauty of the soul,

Is the best gift of heaven."

-- ARMSTRONG.

Sexual Instinct in Women.-- After careful observation of the sexes in

the married state, it is found that the sexual appetence is less in

women than it is in men. Much of this difference in sexual appetence

is doubtless due to the chastity of their lives, coupled with and

resulting from the difference of education. The girl is taught

repression, and the boy expression; that girls must be chaste; that

chastity for boys is impossible.

According to the intensity of the sexual instinct women have been

divided into three classes: A larger number than is supposed have

little or no sexual feeling. Second, those who are subject to strong

passion; this class is larger than the first, but small as compared

with the whole of their sex. Third, those in whom the sexual appetite

is moderate; this class comprises the vast majority of women.

And, even granting to woman more pleasure in sexual indulgence than

usually comes to her by largest allowance, it is safe to say that in

nine cases out of ten maternity, with its early pains and later cares,

greatly lessens her power of enjoyment; and that for the larger part

of her married life she is either positively distressed by the

apparently necessary demands of her husband upon her, and irresponsive

to them, or kept to a cheerful response by a self-abnegation and

regard for his comfort, not to say fear of his moral aberration, which

is a positive drain upon her health and strength.

Excessive Coitus.-- Those who are most frequently found to suffer from

venereal excesses are the newly married; especially if they have weak

constitutions and excitable temperaments. A great deal of mischief is

done by two persons of unequal constitutions being matched together;

the husband may exhaust the wife or vice versa, the weaker party being

constantly tempted to exceed their strength. In all sexual matters

there must be a consideration for others. It is not so much from

selfishness as from ignorance that such a mistake is made. The

ignorance comes from a lamentable morbid delicacy which prevails on

all sexual matters, and which prevents all open and rational

conversation on them, even between those who have the most intimate

knowledge of each other.

When the conjugal act is repeated too often, the man will become

gradually conscious of diminished strength, diminished nerve force,

and diminished mental powers. Excess weakens a man's energies, and

enervates and effeminates him. Moreover, it renders him liable to an

infinity of diseases and a readier victim to death.

Not only is the strength of the constitution lowered by the excessive

expenditure of force and matter requisite for the perpetuation of the

species, but this lowered standard of vitality is transmitted to

children. There can be but little doubt that this is one of the

reasons why so many healthy parents beget sickly children, who die

early. They have exhausted themselves of the material from which a new

life is created, and so it is not properly started at the beginning

and never reaches its highest development. To the truth of this

statement attests the mental imbecility, the pallid and attenuated

forms, of the children who are the earlier products of marriage. The

effect of excessive coitus in women is seen by the confirmed ill

health of so many women after marriage and repeated child-bearing. A

large number of these cases are dependent upon alteration and diseases

of the genitalia; but a considerable number are unconnected with local

disease, and in many other cases the health is never regained after

all local phenomena have disappeared.

Sexual excitement in the woman causes certain congestion of the

genital organs; and at the time of the orgasm there is a reflex

movement which corresponds to erection, and which consists of a

peristaltic movement of the tubes and uterus; to the uterus also is

ascribed an act of suction by which the spermatozoa are drawn up into

its interior. Even when pregnancy does not follow, the too frequent

excitation and activity of the uterus in weak constitutions causes

illness, first of the genital organs and then of the nervous system.

Local diseases caused in women by excessive coitus are: vaginal

catarrh, acute catarrh of the vulva, acute inflammation of the lining

membrane of the uterus as well as of the uterus itself, inflammation

of the ovaries, and even peritonitis. It is also known to be an

important factor in the origin of blood-tumors and of cancer of the

uterus. Especially is coitus at a time of great physical fatigue

liable to be provocative of uterine inflammations. Aside from ethical

considerations, coitus during the menstrual period may be the cause of

rupture of the impaired blood-vessels, thus causing blood-tumors.

Excessive coitus is a well-known cause of chronic inflammation of the

uterus; that is, a habitual congestion of the uterus is induced by

excessive sexual intercourse. This has been frequently mentioned by

authors as leading to enlargement of the uterus in the non-pregnant

condition; and it is a still more potent factor in the recently

impregnated organ, whose tissues are succulent and the vessels

enlarged, a condition inviting congestion and enhancing the

susceptibility to engorgement.

The general manifestations of impaired health in women due to

excessive coitus are: chronic anemia, with malnutrition; impaired and

altered functions in all the organs, especially those of the nervous

system. Menorrhagia is apt to be induced by overstimulation of the

ovaries, together with exhaustion and sexual apathy.

The source of so much misery is the increasing physical weakness of

the female and the increasing nervous weakness of the male, with an

increasing sexual excitability, two factors of tragic effect for the

wife. Here is seen the unfortunate result of teaching two kinds of

morals, one for men and another for women.

Causes of Sexual Excitability.-- Too frequent genital irritation,

onanism, too frequent intercourse, alcohol, too rich and too highly

seasoned foods, lack of exercise.

Treatment of Sexual Excitability.-- Avoid alcohol and precocious

puberty. Strictest attention must be paid to the diet; everything is

to be avoided which is difficult of digestion or which retards it. The

following articles of diet must all be avoided: cheese, foods seasoned

with pepper and curry, highly salted and acid foods, and all rich

foods; and meat must be eaten only in moderate quantities.

Constipation irritates the genitalia directly and increases the

inflammation. The close relation of Venus and Bacchus is known not

only in mythology. Carbonated waters are to be especially avoided,

such as soda, seltzers, Preblauer, Geisshubler, and acid waters; also

champagne and beer, heavy Italian, Spanish, and English wines. All

alcoholic drinks must be forbidden.

As heavy gymnastics as the strength of the individual will admit, and

plenty of exercise out-of-doors must be taken. There must also be

constant mental and physical employment. In women sexual excitability

is often caused by local diseases, and passes off with their cure; if

not, she must use her will-power, and take the various forms of cold

baths. Sexual intercourse not oftener than once in two or three weeks,

and avoid all intimate approaches; if this is not sufficient, she will

have to leave her husband for a few months.

CHAPTER IX.

STERILITY.

Sterility; the Prevention of Conception and the Limitation of Offspring;

the Crime of Abortion; Infidelity in Women.

"Never let yourselves do evil that good may come. If you do, you

hinder the coming of the real, the perfect good in its due time."

-- PHILLIPS BROOKS.

Sterility.-- Conception is least apt to take place from the tenth day

after one period until the third day before the next; but there is

practically no time during a woman's sexual life when she may not be

impregnated; in this connection it must be remembered that the

spermatozoa stay alive in her for more than a week.

During lactation women are generally sterile, especially in the first

months which follow the accouchement, because the vital forces are

then concentrated on the secretion of milk.

The age of the wife at the time of marriage has much to do with the

expectation of children. As the age increases over twenty-five years

the interval between the marriage and the birth of the first child is

lengthened. For it has been ascertained that not only are women most

fecund between twenty and twenty-five years, but that they begin their

career of child-bearing sooner after marriage than either their

younger or older sisters.

A wife who has had children and ceases to conceive for three years

will probably bear no more.

When marriages are fruitless, the wife is almost always blamed; but it

is by no means the wife that is always at fault; many husbands are

absolutely sterile. Every man is not prolific who enjoys good health

and is vigorous. Gross states that in one case out of six the

sterility was due to the male. Kehrer, after a series of carefully

conducted experiments, has arrived at the conclusion that in at least

a third of the cases of sterile marriages the husband was the party at

fault, and that gonorrhea was the cause of the barrenness.

Venereal diseases have their share of influence, and the gonorrheal

infection is a potent cause of sterility. It is by no means proved

that syphilis has any unfavorable influence on conception, though

abortions due to this are frequent.

Gonorrhea often prevents conception by the inflammation traveling up

the womb, and along the Fallopian tubes to the ovaries, whose covering

is rendered thick and dense, so that the ovum cannot escape, or if it

does, the fimbriated end of the tube is so agglutinated that it cannot

grasp the ovum.

Alcoholism is considered a cause of sterility. It evidently does

diminish the sexual potency in the male, and for this the female is

often blamed.

It does not follow because a woman has not given birth to a child that

she has not conceived. The life of an infant for a long time after

birth is a frail one, and before birth its existence is extremely

precarious; it often perishes a few days after conception. A period

coming on a few days late, and at the same time one which is unusually

profuse, is the only evidence which the young wife may have of an

abortion. Among prostitutes, the frequent delay of menstruation, then

abundant hemorrhage, is in many cases only habitual abortion, and

leads to changes in the generative organs which must result in

sterility. A tendency to miscarriage may therefore be all that stands

in the way of having a family; this can frequently be remedied.

Sexual incompatibility is well known to exist; prominent examples

being Augustus and Livia; Napoleon and Josephine. It is also a

well-known fact that frigidity is a cause of barrenness. A short

separation of husband and wife is often salutary in its influence upon

fertility.

It is a well-established fact that the time immediately before the

period, but still more that immediately following the period, are the

most favorable times for conception to take place; the remaining quiet

in bed of the woman after the generative act is also favorable to

conception.

The most frequent causes of sterility in women are inflammation of the

lining membrane of the uterus, or of the neck of the uterus, or of

both. The source of this condition in women who have had children is

most frequently due to parturition or abortion. In the newly married

it may be due to a previously existing slight uterine catarrh in a

displaced uterus, or it may be a manifestation of a run-down state of

the system. In a majority of the newly married, however, the

inflammation of the endometrium is probably due to the first efforts

at conjugal approach. Many young women as the result of the

preparation of the trosseau, augmented by a round of gaities at the

time of marriage, enter the married state in a condition bordering on

physical and nervous exhaustion; and then begin engorgements and

inflammations which lead to future suffering and to sterility.

Displacements and flexions of the uterus also cause sterility. Such

displacements of the neck of the uterus may occur that, instead of

lying in a pool of semen, as it should, it is above, in front of, or

away from it, and this may prevent conception.

Vulvar and vaginal hyperesthesia, inflammations of the vulva, undue

shortness of the vagina, unless great care is exercised by the

husband, will induce painful coitus, and may bring about sterility by

favoring the formation of a copulation sac outside of the axis of the

uterine canal, and consequently misdirection of the semen.

Scrofula, probably by its effects on the general condition, leading to

deficient development of the whole body, the genital organs included,

may be productive of sterility.

The female being less passionate than the male, the orgasm comes on

later with her, or the male orgasm occurs so soon that she may not

reach that stage at all. If both were simultaneous, it is reasonable

to suppose that conception would be more likely to occur.

Ovulation is doubtless more frequently performed in some women than in

others. Some women conceive with more or less regularity every fifteen

or eighteen months, and others at intervals of several years.

The effect of repeated coition, provided that impregnation does not

take place at once, is to engorge the uterine vessels, to alter the

nature of the glandular secretions, to cause profound reflex

disturbances, and thus to produce such changes in the endometrium as

to lead to local inflammation and to general nervous exhaustion.

Backache, leucorrhea, and irritable bladder are the first symptoms of

this disorder; but frequently there are added to these, headache,

indigestion, rectal tenesmus, painful and profuse menstruation. In

many cases the disease continues in a mild catarrhal form, giving the

woman little inconvenience besides the slight leucorrheal discharge

which stains her clothing; but often this is indicative of such a

change of the lining membrane of the uterus as to render it unfit for

the fixation and development of the ovum, even should impregnation

take place.

Under normal conditions, during the intermenstrual period, a plug of

clear viscid mucus, which is secreted by the glands of the cervical

canal, blocks up that passage, but is washed away each month by the

menstrual discharge. Under ordinary conditions this obstruction must

seriously interfere with the entrance of the spermatozoa into the

cavity of the uterus, and renders the former theory, recently revived

by Bossi, quite tenable, that impregnation is most likely to occur

just after the menstrual epoch.

The vaginal secretion under certain pathologic conditions may become

so acid that it induces sterility. Women who suffer m severe vaginal

catarrh are frequently sterile, the spermatozoa being found dead in

the vagina some hours after copulation, although an examination a

shorter time afterward revealed them still alive. In cases where

conception takes place in spite of a very acid condition of the

vaginal secretion, it is probable that some of the spermatozoa enter

the uterus before the secretion has had time to act on them, or

possibly the spermatozoa being injected in a mass, the acid secretion

is unable to penetrate and kill them all.

The reaction of the normal vaginal mucus is always acid, that of the

cervix alkaline; but as the result of the inflammatory condition, the

reaction of each is often intensified, especially that of the vagina,

which has an exceedingly sour and penetrating odor. This acid

discharge, bathing the neck of the uterus, penetrates more or less

into the cervical plug and causes coagulation of the alkaline mucus.

The chief constituent of the semen is albumin; agents which affect

albuminous substances influence the functional activity of the

spermatozoa-- heat, concentrated acids, and probably concentrated

alkalies. In normal conditions the alkalinity of the seminal fiuid

seems to be sufficient to neutralize the acidity of the vaginal

secretions, so that the spermatozoa may remain seventeen days or more

(Bossi) within the vaginal canal, even during a menstrual period,

without having their vitality destroyed.

When hyperacidity of the vaginal secretion is present, it is probable

that the fertilizing element is at once rendered inert; but should

some of the spermatozoa succeed in reaching the interior of the

cervical canal, the increased alkalinity of the secretion there would

in all probability put an end to all further progress.

The conditions, then, which appear to prevent fecundation are: First,

the absence of the proper nidus for the ovum; second, the obstruction

of the cervical canal by a mucus plug; third, increased alkalinity of

the cervical secretion, often accompanied by the increased acidity of

the vaginal secretion. Three conditions must, then, be determined:

First, are there spermatozoa in the semen? Second, do they get into

the uterocervical canal? Third, do the secretions in the canal poison

the spermatozoa?

"For those who are very anxious for offspring," wrote Marion Sims, "I

usually order sexual intercourse on the third, fifth, and seventh days

after the flow has ceased; and on the fifth and third days before its

return. For the most obvious reasons this would always be before going

to bed at night, instead of just before rising in the morning. The

horizontal position favors the retention of semen; the erect its

expulsion. I am satisfied that too frequent sexual indulgence is

fraught with mischief to both parties. It weakens the semen; in other

words, that this is not so rich in spermatozoa after too frequent

indulgence; and when carried to the extent of a debauch, the fiuid

ejaculated may be wholly destitute of spermatozoa. Thus it will be

seen that it will be much better to husband the resources of both man

and wife."

The Prevention of Conception and the Limitation of Offspring.-- Some

of the contraindications to procreation are when either parent suffers

from a disease which is transmissible, and such diseases frequently

manifest themselves only after marriage; when the pregnancy would

endanger the mother's life, or even where the pregnancy is a nine

months' torture to her; where either parent is suffering from ill

health; or where for economical reasons no more children are desired.

If there exists no condition in either parent or in their

circumstances why they should not have children, the next

consideration due to their children, is how the same may be procreated

under the most favorable conditions possible; this condition can only

be secured by making the circumtsances such that the mother shall be

able to choose the time for their conception when both parents are in

the best physical condition. That children should be brought into the

world haphazard, as the result of accident, is to degrade the human

race below that of the lower animals, where the female admits the male

only at the time of the rut, which in the majority of cases occurs

only once a year.

Another requisite to bearing healthy children is that the pregnancies

shall not follow each other too rapidly. Aside from the consideration

for the health of the mother herself, she must be in good physical

condition to bear the healthiest children she is capable of giving

birth to; and for this there must be from two and a half to three

years between the successive pregnancies. The results of

overproduction on the children are frequently, that they are sickly,

short-lived, or suffer from rickets, cerebral paralysis, idiocy, or

imbecility.

And last, but certainly not least, many women become chronic invalids,

or are hastened to premature graves, by having children as fast as

they possibly can.

The most natural and moral way for the artificial prevention of

conception, when on account of ill health or for economic reasons no

more children are desired, is to abstain from sexual intercourse. But

in the majority of cases the husband will not agree to this, and so

the greatest number of methods have come to be used to prevent

conception.

Perhaps the most frequent method use to prevent conception is

withdrawal before the ejaculation of semen. While this is most

injurious to the husband-- debility, nervous prostration, and even

paralysis are said to ensue-- the health of the wife also suffers. If,

this interrupted sexual congress is continued for years, there develop

gradual nervous disturbances on both sides, and a serious disease of

the uterus makes itself felt. The generative organs become engorged

with blood, but are not permitted to enjoy relaxation consequent upon

the full completion of the act. This engorgement may lead to undue

local nutrition, and diffuse growth and proliferation of the

connective tissue may take place. Hence the uterine walls become dense

and thickened and the nerves compressed. Of course, pain and

tenderness and a sense of bearing down will be the result. Flexions

and versions may be consequent upon the engorgement. The nerves become

shattered, and the woman will be fortunate if she contracts no serious

womb trouble.

"It is strange," says John Stuart Mill, "that intemperance in drink or

any other appetite, should be condemned so readily, but that

incontinence in this respect should always meet not only with

indulgence, but with praise. Little improvement can be expected in

morality until the producing of too large families is regarded with

the same feeling as drunkenness, or any other physical excess."

Sismondi writes: "When our true duties toward those whom we give life

are not obscured in the name of a sacred authority, no man will have

more children than he can properly bring up. If a woman has a right to

decide any question it is how many children she should bear. Whenever

it becomes unwise that the family should be increased, justice and

humanity require that the husband should impose on himself the same

restraint which is submitted to by the unmarried."

In the opinion of Dr. Edward Reich, it is very much to be wished that

the function of conception should be placed under the domain of the

will. But the strongest appeal has been made for the sake of morality

itself; namely, to prevent the crime of abortion. Dr. Raciborski, of

Paris, took the position that the prevention of offspring to a certain

extent is not only legitimate, but it is to be recommended as a means

of public good.

Continence, self-control, and a willingness to deny himself-- that is

what is required of the husband. But suffering women assure us that

this will not suffice; that men refuse to restrain themselves; that it

leads to loss of domestic happiness, to illegitimate amours; or that

it is injurious physically and mentally; that, in short, such advice

is useless because it is impracticable.

Dr. Napheys writes: "Is it amiss to hope that science will find

resources, simple and certain, which will enable a woman to let reason

and sound judgment, not blind passions, control the increase of her

family?"

The Crime of Abortion.-- From the moment of conception a new life

begins, a new individual exists; another child is added to the family.

The mother who deliberately sets about to destroy this life by want of

care, or by taking drugs, or by the use of instruments, commits a

great crime, and is just as guilty as if she strangled her new-born

infant. The crime she commits is child-murder. Women in their frenzy

at finding themselves in this condition, and with no slightest idea of

the sin that they are committing, are constantly guilty of committing

abortions on themselves, or going to professional abortionists to have

this crime of child-murder committed. This is another of the sins due

to the ignorance of the sex in all matters pertaining to reproduction;

and it is a fearfully prevalent one.

Infidelity in Women.-- "We have now reached the last infernal circle

of the divine comedy of marriage; we are at the depths of the inferno.

There is something, I do not know what, terrible in the situation in

which a married woman finds herself when an illegitimate love has

ruined her for the duties of a wife and mother. As has been so well

and strongly expressed by Diderot, infidelity in woman is like

incredulity in a priest; it is the last step in human forfeitures; it

is for her the great social crime, for it implies all the others.

"Weigh the sufferings of the future, the agonies of years by the

ecstasy of half an hour. If this conservative sentiment of the

creature, the fear of death, does not stop her, what could be expected

of laws? Oh, sublime infamy!"-- (Balzac).

_________________

PART III.-- MATERNITY.

_________________

CHAPTER X.

PREGNANCY.

Nature of Conception; Pregnancy Defined; Duration of Pregnancy; the Signs

of Pregnancy; Quickening; the Determination of Sex at Will; the Influence

of the Male Sexual Element on the Female Organism; Heredity; Hygiene of

Pregnancy; Causes of Miscarriage.

"Happy he

With such a mother, faith in womankind

Beats with his bood, and trust in all things high

Comes easy to him, and though he trip and fall,

He shall not bind his soul with clay."

-- TENNYSON.

Nature of Conception.-- Conception, or impregnation, is the union of

the germ and the sperm cell, the result of which is a new being. On

coition, the semen being received into the female organs, which are at

that time in a state of turgescence, the spermatozoa, by means of

their own vibratile activity, find their way into the Fallopian tubes,

and here come in contact with the ovule.

The ovule is a minute cell with a transparent membrane, within which

is the yolk containing the germinal vesicle. The spermatozoon

penetrates into the ovule and becomes fused with it. The processes of

development begin at once to occur. There is congestion of the uterine

mucous membrane out of proportion to the rest of the uterus; the ovum

finds lodging here, and becomes surrounded by a membrane which

incloses it in a separate sac.

Pregnancy Defined.-- Pregnancy begins with conception and ends with

parturition; it provides for the nutrition and the expulsion of the

embryo and for its nutrition for a short time after birth.

The average duration of pregnancy is ten lunar months, or two hundred

and eighty days. The date of the confinement is calculated by

reckoning from the date of the last menstrual flow; count backward

three months from the date of the first appearance of the last menses;

to this add twelve months and seven days, five days being for the

average menstrual duration and two days for the possibility of

fecundation.

Duration of Pregnancy.-- Many difficulties are experienced in

determining the date of the expected confinement. As most pregnancies

occur in married women, we cannot base any calculations on a single

act of coitus. And even if there was but one, all physiologists agree

that there is a variable period in different women, and in the same

woman at different times, between insemination and the fertilization

of the ovum. It is the moment of fecundation, or the union of the germ

and sperm cells, which marks the beginning of pregnancy. The

uncertainty becomes still greater owing to our inadequate knowledge as

to the length of time during which the sexual elements, the ova and

the spermatozoa, retain their vitality after liberation from their

respective sources. While it is not certainly known, it is probable

that the ovum is capable of impregnation any time during its sojourn

within the oviduct and before reaching the uterus, or probably for a

period of about one week from the time of its escape from the Graafian

follicle. The remarkable vitality of the spermatozoa even under less

favorable circumstances-- direct observation shows that these elements

retain their movements for over nine days outside of the body--

renders it almost certain that their powers of fertilization are

maintained for a long time after they are deposited within the healthy

female genital tract; it is believed that the spermatozoa are capable

of fertilization after a sojourn of three or more weeks within the

oviduct.

Consideration of these facts renders apparent the impossibility of

fixing with certainty the date of the beginning of pregnancy, since

conception may result from the union of the ovum liberated at the

beginning of the period with the spermatozoon introduced at the end of

that time; or it may result from the meeting of the male elements

already within the oviduct with an ovum discharged a day or two before

the occurrence of the menstrual period.

The Signs of Pregnancy.-- The cessation of the menstrual period is the

sign of the greatest value in women who have been regular; but it must

always be remembered that there may be an irregularity of menstruation

for the first few months after marriage. The appetite is capricious;

morning sickness or nausea in the morning on first getting up is a

very common symptom in the early months of pregnancy; enlargement of

the abdomen; in the first two months of pregnancy the abdomen is

flattened and the umbilicus is depressed; after this the abdomen

begins to enlarge. There is also an increase in the size of the

breasts, with a deepened color of their areolae and later a watery

secretion. The external genitals become swollen and of a bluish color.

Feeling of the fetal movements-- that is, the movements of the small

parts of the child in the womb-- by the mother is not always reliable,

since gas in the intestines has sometimes been mistaken for this.

These signs are more valuable when several exist together.

The nausea and vomiting of pregnancy, the so-called morning sickness,

consists of nausea accompanied often by vomiting or retching of a

glairy fiuid, showing itself most frequently on rising in the morning,

but sometimes appearing after breakfast. It is aggravated by the

assumption of the erect position. It may begin within a few days, but

as a rule it does not show itself until the fourth week of pregnancy;

and it generally ceases about the fourth month, rarely persisting

throughout the entire time. In the majority of cases it does not

sensibly impair the health. It is a sympathetic disorder reflected

from the uterus; it is aggravated by indigestible food, by sexual

excitement, and by emotional disturbances; it is most marked in first

pregnancies and in women of highly emotional natures. It is not

infrequently due to some inflammation of the uterus or erosion about

the external orifice, and disappears on the removal of the cause.

Mammary Changes.-- During pregnancy the mammary glands are in

immediate sympathy with the growing reproductive organs of the pelvis;

consequently a genuine physiologic enlargement commences in these

organs from the beginning of gestation. Their glandular structure

becomes larger, fuller, and firmer; a sensation of weight or pricking

is felt by the patient; the veins become more prominent. The nipples

also become enlarged, more elongated, and somewhat erect. Surrounding

the nipple is the areola; this becomes darker in color.

In most women a drop of watery fiuid, the so-called colostrum, may be

squeezed out from the nipple at the end of the third month of

pregnancy.

The signs of pregnancy are divided into the presumptive, the probable,

and the positive. The presumptive signs are: menstrual suppression,

morning sickness, irritable bladder, mental and emotional phenomena.

The probable signs are: mammary changes, abdominal enlargement,

changes in the neck of the womb, and certain changes which are felt on

bimanual examination. The positive signs are: feeling the various

parts of the fetus, active movements of the fetus, and hearing the

fetal heart sounds.

Functional disturbances of the bladder are quite often noticeable in

the early part of the pregnancy. In the first part of the pregnancy

the bladder is dragged upon, and later it is pressed upon by the

enlarged uterus so that the bladder capacity is lessened and frequency

of urination is the result. In the fourth month, when the uterus

ascends into the abdominal cavity, these bladder symptoms subside,

until the very close of the pregnancy, when by the descent of the now

greatly enlarged uterus there may be even incontinence of urine.

Changes in the Abdomen.-- During the first two months of the pregnancy

there is a flattening of the abdominal surface, due to the descent of

the uterus into the pelvic cavity, thus slightly dragging the bladder

downward and drawing the umbilicus inward. In the latter part of the

fourth month there is noticeable a slight abdominal enlargement, and

the umbilicus is no longer sunken. By the end of the fourth month the

base of the uterus has risen two inches above the symphysis, and at

the end of the thirty-eighth week it touches the lower extremity of

the breast-bone; the umbilicus has been for many weeks protruding;

during the last two weeks of pregnancy the uterus again descends and

the woman feels more comfortable.

On the inspection of the abdomen of a pregnant woman there will be

noticed a brown line which extends from the umbilicus to the pubes,

and all over the surface the presence of striae, or long purple

grooves, due to the distention of the abdomen; on the sides of the

abdomen and down the thighs, red, blue, or white markings, like

cicatrices, may be seen.

Quickening.-- Quickening is the sensation experienced by the mother as

the result of the active fetal movements of the child in the womb.

These movements are first felt between the eighteenth and the

twentieth week; the common rule is that quickening occurs at the

middle of pregnancy; that is, at four and a half months. As pregnancy

advances these active motions increase in frequency and become more

marked. When felt or seen by the physician, as can be done in the

sixth month, fetal movements constitute a positive sign of pregnancy.

The Determination of Sex at Will.-- Although this has always been a

question of great interest, and the subject of much experimentation,

no rule can as yet be given by which the parents can know in advance

of the birth of the child what the sex will be. Dr. Schenck's theory

is that the ruling factor in determining the sex is the food partaken

of by the mother.

Furst believes that the differentiation may occur before, during, and

a little while after the impregnation; that the chances of the

development of one or another sex in one and the same woman may vary

before final differentiation occurs. It is impossible to determine the

sex of the embryo before the tenth week of fetal life. The cause of

the differentiation, he believes, lies largely in the good or bad

state of the health of the parents; in the first instance there being

an excess of females, and in the latter an excess of males, relatively

speaking. He believes that there is an excess of male children when

conception takes place during the post-menstrual anemia. He has

investigated one hundred and ninety-three cases carefully in regard to

the probable date of conception after menstruation, and there is a

notable increase of male births over female in the cases where

conception occurred in the first five days after menstruation; that is

to say, where the woman is not so well nourished as later.

Dr. J. Griffith Davis gives as the result of her experiments in this

direction, that when conception takes place three days before the

menstrual period or within forty-eight hours afterward, the child will

be a girl; when conception takes place ten days after the period, the

child will be a boy.

Although there are a greater number of the female than the male sex in

all parts of the world where reliable statistics have been taken, in

all civilized countries the proportion of male births is greater than

that of females. There is a greater tendency of the male offspring to

die earlier, and this is seen even before birth, in the proportion of

three to two. For this reason the stronger sex as applied to men has

been regarded by some authors as a misnomer. They are physically

weaker in early life and succumb more readily to noxious influences.

The relative age of the parents is said to be another factor in

determining the sex of the children. Seniority on the father's side

gives an excess of male children; equality in the age of the parents

gives a slight preponderance of females; seniority on the mother's

side gives an excess of females. Men, and especially scholars, who

pass a sedentary life and who exhaust their nervous force to a great

extent, beget more girls than boys; so, also, a very advanced age on

the part of the man diminishes the number of male offspring.

The Influence of the Male Sexual Element on the Female Organism.-- Dr.

Alexander Harvey, of Aberdeen, has adopted the theory of fetal

inoculation. He believes that the effect is first due to the influence

of the male element upon the ovum, which, in consequence of the

subsequent close attachment and freely inter-communicating

blood-vessels between the modified embryo and the mother, inoculates

the condition of the mother with the qualities of the male; and so, on

the subsequent impregnation by another male, the offspring resembles

the first male and not its real parent. He even goes further, and says

that it is conceivable, by successive impregnations effected by him,

that the influence may be increased, and if so the younger children

begotten by him, rather than the elder, might be expected, ceteris

paribus, to bear their father's image. And as regards the mother, he

suggests the question, whether there is not something in the popular

notion that in the course of years the wife comes to resemble the

husband; and that not merely in respect of temper, disposition, or

habits of thought, but in bodily appearance, which may be referable to

this influence exerted by the husband on her constitution, through the

medium of the fetuses in utero.

"Yet it shall be; thou shalt lower to his level day by day,

What is fine within thee growing coarse to sympathize with clay.

As the husband is the wife is; thou art mated with a clown,

And the grossness of his nature will have weight to drag thee

down.

He will hold thee, when his passion shall have spent its novel

force,

Something better than his dog, a little dearer than his horse."

Darwin, on the other hand, considers it a most improbable hypothesis

that the mere blood of one individual should affect the reproductive

organs of another individual in such a manner as to affect the

subsequent offspring. The analogy, he says, from the direct action of

the foreign pollen on the ovaries and seed coats of the mother plant

strongly supports the belief that the male element acts directly on

the reproductive organs of the female, and not through the

intervention of the crossed embryo.

Dr. John Brown, in reviewing the subject, says it must be conceded

that the male element has an influence on the female, over and above

its fertilizing influence upon the ovum. The limit of this influence

is at present unknown.

Heredity.-- Girls are more apt to resemble their fathers in mental

traits, disposition, and constitution; while boys take after their

mothers. Boys procreated by intelligent mothers will be intelligent;

while it does not always follow that the sons of intelligent fathers

are intelligent. The poets Burns, Ben Johnson, Goethe, Walter Scott,

Byron, and Lamartine were all born of women remarkable for vivacity

and brilliance of language.

Hygiene of Pregnancy.-- The health and perfection of the child depend

largely upon the health and perfection of the parents at the time of

its conception, as well as upon the condition of the mother during the

pregnancy. Even when both parents possess a strong constitution, but

one or both of them is suffering from a temporary exhaustion or

malaise, the child will be born below the standard of health it ought

to possess. Children born during the first year of married life seldom

equal in health the children born of the same parents later; they are

not only apt to be sickly, but the liability to premature death is

greatly increased. For this reason it is better that the first year of

married life should be allowed to pass without conception taking

place. A child begotten in an intoxicated or depraved condition of a

parent may be depraved itself in the same way, and is apt to be

feeble-minded or idiotic.

It must be borne in mind that prenatal culture of some sort begins at

the time of conception; and that on the mental as well as on the

physical state of the mother, the health as well as the disposition of

the child will depend to no slight extent. The prospective mother who

constantly gives way to her feelings does a wrong to her unborn child.

The mother is at this time more impressionable, more nervous, and more

irritable than is natural to her; and while her family should make a

certain allowance for her condition, she, on her part, should not

allow herself to give way to her morbid feelings. The prospective

mother should not lead a life of self-indulgence, on the one hand, or,

on the other, should not be weighed down with cares; she should

interest herself in her usual duties, and be relieved of all anxiety

possible.

Dress.-- The clothing must be loose, and all compression about the

waist and abdomen must be especially avoided. If the woman wears

corsets, she must take them off at once, and substitute a Ferris or

some similar hygienic waist. The corset prevents the proper

development of the abdominal muscles, which play so important a role

in the expulsion of the child from the womb, as well as in the proper

growth and development of the fetus itself. If the woman has already

borne children, and toward the end of the pregnancy the abdomen

becomes pendulous, she will very materially add to her comfort by

swearing a muslin abdominal bandage.

A woolen undersuit, or undervest and drawers, with high neck and long

sleeves, must be worn winter and summer; the grade of the wool to be

adapted to the season of the year. The especial necessity for wearing

wool next the skin during the pregnancy is because of the intimate

relation between the skin and the kidneys. Any chilling of the body at

this time is apt to lead to the congestion of the kidneys. If there is

already any congestion of the kidneys present, or any abdominal pain,

in addition to the undersuit an abdominal bandage should be worn.

These bandages come woven in ribbed woolen, and fit the body snugly.

This bandage is to be constantly worn, and, of course, changed at

night. During the cold weather the stockings should also be of wool.

Under no circumstances are garters allowed to be worn, as they form a

constriction around the leg and interfere with the return of the

venous blood to the heart, and so increase the tendency to the

formation of the varicose veins. It is better not to use any means to

hold the stockings up; they will be kept sufficiently well in place by

the under-drawers. Low shoes should never be worn except in the

hottest weather. It is of the greatest importance that the woman

should be impressed with the necessity of the avoidance of taking

cold, since any lung or kidney trouble is a serious complication of

pregnancy.

Diet.-- The diet is the same as that at any other time, only it is

more necessary to guard against anything which is likely to cause

indigestion. In other words, the diet should be plain, simple, and

easy of digestion; nutritious and partaken of at regular intervals. In

the latter part of pregnancy owing to the pressure of the enlarged

uterus on the stomach, the food may have to be partaken of in smaller

quantities and at shorter intervals. At this time also the appetite is

abnormally large. Where it does not disagree with the patient, milk is

the best adjuvant possible to the diet.

Constipation.-- Constipation is the rule of pregnancy. This is due to

the great pressure that the enlarged uterus makes on the bowel; and as

important as it is at all times to keep the bowels regular, it is at

this time more necessary than ever that the woman should have the

bowels well evacuated every day. A retention of fecal matter in the

body causes the reabsorption into the blood of the toxic matters, with

the resulting headaches, dizziness, loss of appetite, and intense

nervousness. To obviate this tendency to constipation, plenty of fruit

and vegetables should be eaten, as well as cereals if the woman is

taking a good deal of outdoor exercise, otherwise the latter had

better be omitted. The woman should drink plenty of water-- at least

three pints a day; this acts as a laxative as well as to flush out the

kidneys. If, in spite of all these measures, constipation still

persists, as it probably will, a seidlitz powder can be taken the

first thing on rising in the morning; or from one teaspoonful to one

tablespoonful of the effervescing granules of the phosphate of soda in

a glass of water, also to be taken on rising in the morning; or

one-half grain of the solid extract of cascara sagrada night and

morning. The object of these is to keep the bowels open, but purgation

must always be avoided.

Bladder Symptoms.-- If there is any irritability of the bladder, any

scalding on urination, or a very great frequency of emptying the

bladder in the early months of pregnancy, a physician should be

consulted at once; in the last months of pregnancy there is a desire

to evacuate the bladder frequently, and sometimes at the last there is

an incontinence of urine, which is due to the descent of the uterus

and the great pressure on the bladder; this condition disappears with

the confinement.

Leucorrhea.-- If this is present to any marked degree, the vaginal

douche should be continued throughout the pregnancy; the temperature

of the douche should be from 110∞ to 112∞ F.; it must never be taken

very hot or very cold. The fountain syringe should be used, and the

bag should not be hung more than three feet above the bed, so that

there shall not be too much force to the stream of water.

Baths.-- Warm tub-baths may be taken throughout the pregnancy, but

never oftener than twice a week, and the woman should never stay in

the tub longer than is absolutely necessary for the bath, as otherwise

the bath is too enervating. A daily sponge-bath of cool or cold salt

water at a temperature of from 80∞ to 70∞ F., and in the proportion of

a pint of rock or sea salt to a gallon of water is most invigorating,

and counteracts many of the nervous symptoms and promotes sleep and

good digestion. The temperature of the room in which this bath is

taken should be 72∞ F. Shower-baths cause too great a shock to the

nervous system, and they as well as foot-baths must be prohibited.

Sitz-baths at a temperature from 110∞ to 90∞ F. may be taken just

before retiring throughout the pregnancy. The frequency and duration

of the bath as well as the temperature should be regulated by the

attending physician. In cases of intense nervousness and insomnia

these baths have an excellent sedative effect. A pregnant woman must

never under any circumstances take ocean baths, since there is always

great danger that the shock of the waves will cause an abortion.

Sea-voyages should be avoided because of the severe nausea and

vomiting, as well as the danger that the lurching of the vessel may

cause miscarriage.

The sewing-machine is a tabooed thing for the pregnant woman, because

of the jarring of the pelvis which it produces. Sweeping of heavy

carpets is also injurious. There must be no lifting of heavy pieces of

furniture, and especially no lifting from the floor, as it interferes

with the circulation in the uterus and is apt to produce miscarriage.

Driving in an easy carriage over smooth roads is permissible;

dogcarts, or any conveyance which produces much jolting, must be

avoided; and while driving is good, the woman should not do her own

driving, on account of the danger of the jars that would be caused by

the sudden pulling of the horse upon the lines. Horseback-riding and

bicycling are, of course, forbidden, as are also golf, tennis, and

dancing.

Exercise.-- Exercise in the open air should be taken every day, when

the weather is suitable, and walking is the best form of exercise. The

amount will be regulated to some extent by what the woman has been

accustomed to taking, and it should always stop short of fatigue. The

woman should live as much as possible in the open air, and she should

attend to her ordinary duties about the house. Long railway journeys

are always objectionable.

Hemorrhoids or piles are very often troublesome toward the close of

the pregnancy. To overcome this, the patient should lie down

immediately after the bowel movement, and remain in the recumbent

position for ten or fifteen minutes. In addition, care should be taken

to secure a loose movement of the bowels. Should the piles come down,

applications of cloths wrung out of hot water, and held well pressed

against the bowel, should be made; the piles should then be pressed

back until the finger feels that the mass has been pushed above the

second constriction of the bowel, which is felt to exist at about two

inches above the sphincter ani muscle. Should these means not suffice,

the physician must be consulted at once.

Swelling and pain of the external genitals and of the lower limbs are

best relieved by the recumbent position. Should the veins of the legs

be much enlarged or the feet swollen, the patient should have

compression made by the wearing of elastic stockings. Or in some cases

a bandage is sufficient; in this case the bandage may be made of

muslin; it should be three inches wide, and, beginning at the toes,

should extend up as high as the enlargement of the veins continues.

This bandage should be freshly applied every morning before rising.

Pain caused by the stretching of the skin may be relieved by the

inunction of the skin with cottonseed or cocoanut oil. For severe pain

in the small of the back, rubbing with soap liniment or alcohol will

be found useful.

Mental Occupation.-- Important as this always is, it is doubly so now.

The mind should be constantly and pleasantly occupied, but no severe

study should be indulged in. The emotional susceptibility is generally

somewhat increased. The pregnant woman, quite excitable and irritable,

readily responds to influences by which in the non-gravid condition

she could not be affected. Sometimes she feels unusually well, is

intellectually brightened and more active, and says she is positively

happier. At other times she is despondent and morose.

Physiologists admit and observation proves that maternal emotions do

affect the development and the exterior of the fetus; likewise the

mental organization of the fetus may be affected. All unpleasant news,

frights, and physical shocks, also scenes of suffering and distress,

must be avoided, as the mind is particularly impressionable at this

time. Around the patient should be thrown a gentle and protective

care, and she should be treated with the considerate kindness which

her condition demands. Theatres and all places where there will be a

large assemblage of people should be avoided, as the close air and

general bad ventilation are apt to produce vertigo and sometimes

attacks of fainting.

Sleep.-- During pregnancy a large amount of sleep is required; there

should be eight hours spent in sleep at night, and one hour every

afternoon. Pregnant women should never do any night watching. There is

unusual necessity for good ventilation during sleep at this time.

The Marital Relation.-- Coitus is, as a rule, distasteful to pregnant

women. It is for the best interest of the wife as well as for that of

the child that all marital relation should be suspended at this time.

Even uncivilized nations have condemned the privilege of sexual

intercourse during pregnancy, and have visited punishment on the

offender. If these relations are not wholly suspended, they must at

least be at those periods which correspond to the time at which the

woman would have been unwell had she not been pregnant. To the

continuance of these relations throughout the pregnancy is due much of

the suffering of the wife, not only then, but at the time of the labor

as well; and the nourishment of the child is interfered with.

Causes of Miscarriage.-- Hemorrhoids; straining at stool; excessive

intercourse in the newly married; nursing; ocean-bathing;

overexertion; overexcitement; a fall; any violent emotion; anger;

sudden or excessive joy; a fright; running; dancing; horseback-riding;

riding in a heavily built carriage over rough roads; great fatigue;

lifting heavy weights; the abuse of purgative medicines; disease or

displacements of the womb; and a general condition of ill health.

The danger of miscarriage is greatest during the first three months of

pregnancy. Miscarriage is a fruitful source of disease and often of

danger to wives; it is said that thirty-seven out of every hundred

pregnant women miscarry. Miscarriage is most apt to occur during the

first pregnancy; and great care should be taken to prevent this, as

the habit is easily established, and after one miscarriage has

occurred, another is likely to follow, so that it is sometimes with

the greatest difficulty that the woman can be made to carry the fetus

to full term. Artificially produced abortions are not an infrequent

cause of sterility; the young wife becomes pregnant, and has an

abortion produced because she is not yet ready to give up all her

pleasures; and eventually when she does become very anxious to have a

child such an extent of uterine disease has been produced by the

abortions that she cannot conceive.

To Prevent Miscarriage.-- The life must be free from all excitement,

and must be as quiet as possible without becoming monotonous; especial

care must be exercised at the return of the dates for the menstrual

periods.

The symptoms of miscarriage are a show of blood, more or less profuse,

with intense abdominal pain; on the slightest show of blood the

patient should go to bed at once and the physician should be sent for.

CHAPTER XI.

THE CONFINEMENT.

Preparation for the Confinement; Signs of Approaching Labor; Symptoms of

Actual Labor; the Confinement-bed; the Process of Labor.

"To my conception one generation of educated mothers would do more

for the regeneration of the race than all other human agencies

combined; and it is an instruction of the head they need, and not

of the heart. The doctrine of responsibility has been ground into

Christian mothers above what they are able to bear."

-- ISABELLE BEECHER HOOKER.

Preparations for the Confinement.-- The right time to engage the

physician who is to take charge of the woman at her confinement is

just so soon as the woman knows that she is pregnant. It used to be

argued that, since giving birth to children was a physiologic process,

there was no necessity for the woman to consult the physician until he

was sent for when the labor pains began. Take the case of the woman

who is for the first time pregnant; she is absolutely at sea; she has

not the least idea how she ought to feel, what she ought to do or to

leave undone; the result is that she often has a miscarriage which is

the source of the greatest disappointment to her husband and herself,

or she suffers very unnecessarily throughout the entire pregnancy, has

a difficult labor, and perhaps gives birth to a sickly child.

The educated physician will explain to her what symptoms are normal

and what are pathologic, and often he will be able to entirely cure

the latter. It is now a well-established fact that the most serious

complications of the pregnancy, and of the labor itself are caused by

severe congestion or disease of the kidneys. The condition of the

kidneys can only be determined by frequent examinations of the urine;

during the early months of pregnancy these examinations are made once

a month, and during the last month they are made every week. The

amount of urine passed in the normal condition is three pints a day.

Nowhere, perhaps, is the constant vigilance of the physician so well

rewarded as in the careful oversight of the pregnant woman. She goes

through her entire pregnancy feeling well, and often the greatest

discomfort that she suffers is due to her size; her labor and her

lying-in are normal, and she gives birth to a healthy child.

Engagement of the Nurse.-- This is generally left to the physician in

charge of the case, since he is responsible for the safe delivery of

the woman; but if the patient has any decided choice in the matter, it

is acceded to unless there should be some very valid objections, and

the physician always sends the nurse in view for that case to see the

patient in order to ascertain if she is personally agreeable to the

patient.

Choice of Room for the Confinement and Lying-in.-- The room should be

light, sunny, and well ventilated; it should not be too near a

water-closet. In the city as quiet a room as possible should be

selected, and one that is well removed from the rest of the house, so

that if necessary perfect quiet can be maintained. The room should be

as cheery as possible.

The dress of the mother during the lying-in consists of a merino

undervest, with high neck and long sleeves, and a nightgown, which

shall be open all the way down the front. The gowns should be made of

light muslin or of cambric; and there should be a sufficient number so

that they may be changed every day.

Six abdominal bandages should be provided. These are made of light

muslin, and they should be eighteen inches wide and long enough to go

once and a third around the patient's hips at the sixth month of

pregnancy, or about one yard and a quarter long; they may be made

straight or to fit the patient at the sixth month. This bandage is

fastened down the front; it is applied directly after the labor, and

adds greatly to the patient's comfort during the lying-in.

The vulvar pads used during the lying-in are the antiseptic absorbent

pads which can be obtained at any place where surgical dressings are

sold; they are made of absorbent cotton, covered with cheesecloth, and

sterilized.

There must be a sufficiently generous supply of sheets so that they

can be changed every day, and the drawsheet as often as may be

required. Nothing is so important to a good lying-in as to have a

clean, well-ventilated room, and plenty of fresh bed-linen.

Cleanliness is the first requisite to antisepsis, and this is the

secret of avoiding puerperal fever.

Articles to be provided for the confinement are:

1. An oblong douche-pan of agate-ware.

2. An agate bed-pan.

3. A bath thermometer.

4. Two pieces of rubber sheeting; one, one yard square, and the other

two yards square.

5. Two sterilized bed-pads, 30 inches square by 3 to 4 inches thick.

6. Three dozen antiseptic absorbent pads.

7. One pound of sterilized absorbent cotton; twelve yards of

cheese-cloth.

8. Six abdominal bandages, eighteen inches wide, preferably made to

fit the figure at the sixth month of gestation.

9. Two hand-scrubs.

10. Four ounces of the tincture of green soap.

11. Bottle of corrosive sublimate tablets.

12. Four ounces of powdered boric acid.

13. Half a pint of good whisky.

14. Two ounces of aromatic spirits of ammonia.

15. Two ounces of aqua ammonia.

16. One pint of alcohol.

17. Two tubes sterilized white vaselin.

18. Plenty of large and small safety-pins.

19. Hot-water bag.

20. New fountain syringe, to hold four quarts; with glass nozle.

21. One small basin for vomited matter.

22. Two very large agate basins or wash-bowls for washing doctor's

hands and for antiseptic solutions.

23. Vessel for after-birth.

24. Three large pitchers; one for boiling water, one for cold boiled

water, and one for antiseptic solution.

25. Tumbler for boric acid solution for washing baby's eyes, with fine

old linen sterilized.

26. One dozen freshly laundered sheets, and two dozen towels.

27. Stocking-drawers, muslin.

28. Change of night-clothing warmed for the mother.

29. A warm blanket to receive the baby.

30. An infant bath-tub.

31. A large piece of oil-cloth to protect the floor.*

* Van Horn & Co., Park Avenue and 41st Street, New York, keep an

obstetric outfit, containing many of the above articles, cleansed,

sterilized, and packed in a box ready for use, so that they remain

intact until needed. The price of this outfit is $16.50.

Baby's Outfit.-- Four flannel bandages, to be made of fine, soft

flannel, four inches wide, to go once and a third around the body. The

edges may be pinked or whipped, but should never be hemmed; a tape is

sewed on double, the ends passing around the body, and so the bandage

is fastened without pinning.

Six merino shirts, with high neck and long sleeves, made to button

down the front.

Cotton diaper napkins, not too large; old soft ones are preferable.

Long merino stockings which can be pinned to the napkin.

Flannel petticoats, not too long; these may be made on muslin bands,

which are held up on the shoulders by means of straps. The essential

in all the clothing is that it should be sufficiently loose.

Dress-slips should not be so elaborate that they cannot be washed and

changed with sufficient frequency; and not so long that the baby's

feet will be hampered in their movements by them. All of baby's

clothes but the dress should be fastened by safety-pins.

Baby's basket should contain:

1. One outfit of clothes.

2. One tube of sterilized tape.

3. A pair of blunt-pointed scissors.

4. Large and small safety-pins.

5. Pieces of fine old linen; old handkerchiefs are the best.

6. A soft hair-brush.

7. A powder box and puff, with talcum powder.

8. Two tubes of sterilized white vaselin.

9. Two soft towels.

10. Castile soap.

11. Single-bulb syringe; so-called "eye and ear syringe."

12. A woolen shawl or wrap.

If there is no nurse available before the labor sets in, and it is

necessary for the patient to see to the sterilizing of the above

articles, she should first scrub off all pitchers, basins, and other

utensils, as well as the douche-pan, fountain syringe, and rubber

sheeting, with a brush and hot soap-suds; the hand-scrubs are to be

well washed; then each article should be pinned separately in coarse

towels, and put to boil for half an hour in an ordinary wash-boiler.

The articles so boiled are then dried without removing the towels, put

away, and not opened till the time of the labor.

The abdominal bandages must be laundried and pinned up in separate

towels until they are needed. The cheese-cloth must be laundried and

then sterilized.

The vulvar pads should be pinned in an old napkin, in packages of half

a dozen each; and one package is sterilized at a time by placing it in

the oven until the outer covering is scorched. The linen for the

baby's eyes and the cheese-cloth are treated in the same way; they are

to be cut up into small pieces and sterilized as needed.

Signs of Approaching Labor.-- About two weeks before labor there is a

sinking of the womb. At the beginning of the ninth lunar month this

was at the end of the breast-bone; it now descends to a point midway

between this and the navel; the abdomen becomes smaller, the pressure

on the lungs is relieved, and the woman breathes more freely. But at

the same time that the woman is relieved of the pressure on the chest,

she experiences increase of the troubles in the lower extremities.

There is an increase of the bladder symptoms, with a desire for

frequent unrination. Constipation becomes more troublesome, and there

may be hemorrhoids; the veins of the lower extremities may become

greatly enlarged.

There is an increased fullness of the external genitals and a greatly

augmented amount of mucous discharge. There is a feeling of anxiety

and nervousness, with depression of spirits.

During the last two weeks of pregnancy patients are apt to have

cramp-like pains in the lower part of the abdomen. These are often

mistaken for labor pains. True labor pains are characterized by

starting in the back, extending around the abdomen and toward the

pubes and down the thighs; they come at more or less regular intervals

of half to three-quarters of an hour, and increase in intensity with a

decrease in the intervals. A strong pain is apt to be followed by two

weaker ones. The so-called false pains are irregular in their

occurrence.

Symptoms of Actual Labor.-- First is generally the show; this is a

discharge of mucous tinged with blood; at the same time the true labor

pains set in. When the patient or nurse is in any doubt as to the

character of the pains, or when the show appears, the physician should

be summoned at once. Other symptoms are frequent desire to empty the

bladder and bowels, and a sensation of shivering.

The Confinement-Bed.-- A single bed is much more convenient, but it is

rarely found in a private house. The double bed is arranged as

follows: The hair mattress is covered with a large rubber sheet, which

is pinned with safety-pins at the corners and tucked well under the

mattress; the rubber sheet must not be drawn too tightly for fear of

tearing. Over this comes the sheet, and over the upper half of the

bed, the draw-sheet; this is a sheet folded four double, which goes

across the bed so as to come under the hips of the patient, and is

tucked under the mattress at both sides. The object of this is so that

it may be frequently and easily changed without disturbing the

patient. The sheet, blanket, and spread which are to serve as a

covering after delivery are folded back and placed on the left side of

the bed.

The lower right-hand corner of the bed-- the right side of the bed is

that side which is toward the right hand as one stands facing the

foot-board-- is arranged for the confinement; on this is fastened the

smaller rubber sheet, and over this the sheet is folded, and both are

fastened down with safety-pins. The pillow for the patient should be

placed at the upper and inner corner of the square. After the delivery

the patient is lifted to the upper part of the bed and the temporary

dressing is removed. A sheet and blanket are used for a covering

during the confinement.

Before the labor begins it is well to fasten up the vest and gown, so

that they will not be soiled, as it is important that the patient

shall be moved as little as possible after the labor, as all movements

tend to increase the bleeding.

The floor oilcloth must be spread at the side of the bed which is made

up for the confinement, and should extend slightly under the bed.

A bureau in the room should contain the mother's and baby's clothing,

bed-linen, towels, and any other articles which will be needed, all

properly arranged.

The clothing for the mother and baby will be placed where it will keep

warm, and the infant bathtub will be in readiness in case of sudden

need for it.

All water used about the confinement must have been carefully

sterilized in advance. The best way to sterilize the water is by

boiling it in a large wash-boiler; whatever vessel is used must be

scrupulously clean, and ought to be new. The vessel is covered over,

and the water is allowed to boil for half an hour; it is then, still

covered, set aside to cool. There should be three gallons each of

sterilized hot and cold water; since in case of an emergency there

must be plenty of water ready for use.

The various articles ordered in the confinement outfit will be at hand

ready for use. It is the duty of the nurse to have everything ready

for the doctor before his arrival. The patient should have a full warm

tub-bath, fresh night-clothes put on, and an enema should be at once

given to unload the bowels, and this even though there may have been a

bowel movement only a few hours previously. The patient should remain

in bed until the arrival of the doctor. After an examination has

assured the latter that all is right, she may be allowed to go around

the room, with a wrapper thrown on over the night-gown.

Conveniently near the bed should be a small table, covered with one or

two freshly laundried towels. This table should have on it a

wash-basin, a hand-brush, soap and hot water, an antiseptic solution,

scissors, a ligature for the navel, and a suitable aseptic lubricant

for the hands.

The Process of Labor.-- The process of labor is divided into three

stages. The first stage is that of dilatation; by which is meant the

stretching of the mouth of the womb so that the child may pass

through. At the first confinement this stage lasts about fifteen

hours; at subsequent labors the length of this stage is much shorter,

the average time being eight hours. The pains during this stage are

sharp and cutting, and they are accompanied by a slight show of blood.

The patient is fretful and nervous

The second stage of labor is called that of expulsion, because in this

stage the uterus contracts down together with the abdominal muscles to

expel the child from the womb and the vagina into the world. The

duration of this stage in the first confinement is about an hour and a

half.

The third stage of labor includes the time from the expulsion of the

child till the coming away of the after-birth; the average length of

this stage is from twenty minutes to half an hour.

The average length of time for the first labor is seventeen hours; and

for subsequent labors from eight to eleven hours.

The bag of waters is the sac of membranes in which the child is

inclosed. It contains a liquid in which the child floats; the object

of the water is to protect the child from sudden shocks or any kind of

injury during pregnancy. During labor this membrane with its contained

water serves as a dilating wedge to assist in the opening of the womb,

and it also protects the child from the direct contraction of the

uterus upon it. When the waters break prematurely, the labor is much

longer and more tedious; normally this should not occur before the

mouth of the womb is fully dilated.

The pains of the second stage of labor are of a bearing down

character, and constantly increase in force and frequency; the climax

being reached as the head passes through the vulvar orifice.

A child usually lies in the womb with the head downward; the reason of

this is that there is more room in the upper part of the uterus, and

as the small parts of the child as it is folded upon itself take up

the most space, they occupy this position, while the head lies just

above the pubes. The normal position of the child is: the head is

flexed on the chest, the legs on the thighs and the thighs on the

abdomen, and the hands are folded across the chest. And so the child

is usually born head first.

During the stage of expulsion the head of the child is forced down

slightly during each pain, to recede a little during the intervals

between the pains; in this way the vagina and its external orifice are

gradually stretched so that the head of the child may pass through

without tearing the parts. If the head is allowed to pass through

suddenly, or where the labors are rapid, as in the case of women who

have given birth to several children, much mischief may be done by

tearing the soft parts.

After the birth of the head there is a short interval of rest, when

the shoulders are born; the rest of the body easily slips out; and

with the expulsion of the after-birth the labor is over.

At the very beginning of labor the patient should be given a full warm

tub-bath, and make an entire change of linen. She will usually prefer

to be dressed in her night-clothing, over which during the first stage

she may wear a loose wrapper; a sterilized napkin should be worn over

the vulva during this stage. During the first stage, as a rule, the

patient should not be confined to bed until the dilatation is well

advanced; she is generally more comfortable if she is allowed to move

around the room, and the pains are thereby advanced.

The only way in which the physician can determine whether labor has

begun is by making an internal examination; and this will enable him

to decide as to whether it is necessary to remain or not.

The nurse should always wear a wash dress in the confinement and

lying-in room.

If the labor is long, nourishment in the form of beef-tea, broths, and

milk may be given. No stimulants should be given without the direction

of the physician. The frequent taking of cold water is permissible.

At the beginning of the labor the family and friends must be excluded

from the room, and it must be kept as quiet and as cheerful as

possible.

Toilet of the Patient.-- The newly born child is received in a small

blanket, is well wrapped, and laid in a warm place. The nurse then

turns her attention to the mother; the external genitals and soiled

parts of the body are cleansed with sterilized cheese-cloth wrung out

of an antiseptic solution; if the body-linen has become soiled, it is

also changed, and all blood-stained articles are removed from the bed.

The patient is then carefully lifted up on the permanent bed, and the

vulvar pad and the abdominal bandage are applied; after which the

patient is allowed to rest.

CHAPTER XII.

LYING-IN.

Management of the Lying-in; Lactation; Nursing.

"'Tis is ourselves that we are thus or thus. Our bodies are our

gardens; to the which, our wills are gardeners."-- "Othello."

Management of the Lying-in.-- Immediately after the delivery the first

essential for the patient is absolute quiet and rest; the room must be

kept quiet and darkened, and ordinarily the patient is allowed to fall

into a light sleep. During the first few hours after labor the best

position for the mother is flat on the back, with only a small pillow

under the head. After the first twenty-four hours the patient may be

allowed to turn on the side as she prefers. Since absolute rest is the

first requisite for the patient, she must be left alone with the

nurse, who must see that she does not fall into too deep a sleep. If

the child's cries disturb the mother, it must be taken into another

room.

The lying-in room must be kept free from all odors, all soiled

clothing must be at once removed from the room, and good ventilation

must be insured, being careful to prevent any drafts.

While the patient is asleep, and after the baby has been attended to,

the nurse should place all blood-stained articles in cold water to

soak. If in the city, the after-birth may be burned in the furnace or

range; it should be well covered with coal. In the country the

after-birth can be buried in a deep hole.

During the first two or three days the vulvar dressings should be

changed from every three to six hours, and at all times as often as

they are soiled. Each time that the dressing is renewed the external

genitals and their immediate surroundings are to be carefully cleansed

with sterilized water, and finally washed with a solution of boric

acid, in the proportion of one tablespoonful of boric acid to one

quart of water. It is convenient to keep this solution mixed and on

hand, as it takes some little time to prepare it; it should be kept in

a strength double that which is desired, so that it may be diluted

with warm water to give the desired temperature. This solution may be

poured over the parts from a small pitcher, the douche-pan having been

placed under the patient before the washing began. After labor the

vulva is very sensitive, so that while the greatest care must be used

to remove all clots of blood and the discharge, there must be no brisk

rubbing of the parts. No blood-stained linen should be permitted to

remain about the patient or the bed.

Since the lying-in woman perspires freely, her skin ought to be

frequently cleansed by sponging with a weak solution of alcohol in

tepid water; this should be followed by friction with a towel until

the skin is in a glow. Cleanliness of the bed is promoted by the use

of a draw-sheet, which is a sheet folded to four thicknesses and

placed beneath the patient's hips in such a way that the upper edge of

the sheet shall come under the lower part of the pillows. Air and

light must be freely admitted at all times in order that the room may

be bright and cheerful. For the first few weeks the eyes of the

new-born infant should be shielded from all strong light.

Visitors.-- For the first week after the confinement the patient

should see no visitors. Even the husband or mother should not remain

in the room long at a time. Nothing of a disagreeable nature should be

told to the patient; and whoever goes into the sick-room should always

carry the most cheerful manner, as it is highly necessary that the

patient should be kept mentally as well as physically quiet at this

time.

Diet.-- For the first twenty-four hours the diet must be restricted to

liquids, and in most cases nothing is given until the patient has had

a few hours' rest. The first thing that is given to the patient should

be a cup of warm milk or tea. Milk is the best diet; this may be

varied with beef-tea, bouillon, mutton or chicken broth; any of these

broths may be made with rice or barley to vary the flavor, but these

must not be given to the patient. The patient should have six ounces

of the liquid every two hours during the day and every three hours

during the night.

On the second day bread well toasted through may be added to any of

the liquids. On the third day stewed or baked apples should be added

to the diet. On the fourth day, and from this on, the patient will

have regular meals, but the diet must be a plain one. For breakfast,

stale bread, a soft-boiled egg, fruit, and a cup of tea, not too

strong. For dinner, which should always be given in the middle of the

day, an oyster-stew or clam broth, a lamb chop, or a very small piece

of beefsteak or chicken; but with these there must be no gravies or

dressings; a potato baked in the skin; raw tomatoes, if in season;

apple sauce or cranberry; celery; junket, plain corn-starch, lemon

jelly, plain cup-custard. From this list the diet must be arranged so

as to give as much variety as possible from day to day. Midway between

breakfast and dinner, and again in the middle of the afternoon, the

patient should have a glass of milk. The diet should be generous, but

simple.

Urination.-- The feeble condition of the bladder in the first few

hours after delivery frequently leads to the retention of urine. Owing

to the copious secretion of urine which is so common at this time,

painful and injurious distention of the bladder may result. The

patient should therefore endeavor to pass her urine in at least six

hours after labor, whether she feels any inclination to do so or not;

the sound of running water or warm fomentations over the bladder, warm

water in the douche-pan, and moderate pressure applied by the hand

over the suprapubic region, are often effective in accomplishing the

desired result. If all these means fail, the catheter must be used as

the last resort. During the entire lying-in the bladder should be

emptied every six hours.

Evacuation of the Bowels.-- There should be an evacuation of the

bowels in from twenty-four to thirty-six hours after the labor. For

this purpose a seidlitz powder may be given, or the liquid citrate of

magnesia. If this does not suffice, an enema of warm water, to which a

little soap or two teaspoonfuls of glycerin have been added, may be

given. Two pints of water should be prepared; the patient will retain

as much as she comfortably can, and as long as she can. The bowels

should be opened daily after the first day.

After-pains are caused by the same physiologic process that causes

labor pains-- namely, by the contractions of the uterus. After the

first confinement the after-pains are, as a rule, not severe;

attention to the regular emptying of the bladder and bowels also

lessens the severity of the after-pains; these pains seldom last after

the second day.

The Lochia.-- The discharges of the mother continue for about two

weeks, and are called lochia. For the first twenty-four hours they are

pure blood; the second and the third day they are of the character of

bloody water; from the fourth to the sixth day they have a,

greenish-yellow color, and from the tenth to the twelfth day they

become pure white. Soiled napkins and dressings should never be

allowed to remain in the patient's room.

Duration of the Lying-in.-- This lasts for six weeks. During this time

the organs of generation are returning to their normal size and

condition. In order that the woman may be in the best condition

possible at the end of this time, it is essential that for the first

two weeks she should remain in bed; and so long as there is any blood

in the discharge the woman should not be allowed to sit up. The first

sitting up should be in bed, the patient being supported by a

bed-rest. During the second two weeks the patient may be allowed to

divide her time between the bed and the couch; in the latter part of

this time she may be allowed to go around her room a very little; and

for two weeks more she should remain on the same floor. The first

sitting up should not last more than half an hour. Getting up and

going around too soon after the confinement, "being too smart," is one

of the most prolific sources of falling of the womb, and all manner of

uterine trouble, by which the general health of the woman is greatly

impaired.

Lactation.-- If it is at all possible, every mother should nurse her

own child; in the interests of both the mother and the child. So far

as the mother is concerned, the process of lactation is beneficial

because it hastens the return of the uterus to its normal size.

Wet-nurses are known tyrants, and if the quality of the milk has

anything to do with the disposition of the child, as is believed to be

the case, the idea is distasteful of having a woman who belongs to the

lower classes provide nourishment for your child; and artificial

feeding is one unmitigated trouble.

A deficiency of the quantity or the quality of the mother's milk can

generally be remedied by the diet and attention to the health of the

mother; if the deficiency in quantity persists, the mother's milk can

be supplemented by artificial feeding.

There may exist certain conditions of the mother in which nursing her

own infant would be inadvisable or even impossible. Syphilis

contracted late in the pregnancy, and tuberculosis, are

contraindications, owing to the danger of the mother infecting the

child. Inversion of the nipples, their excoriation, or persistent

sensitiveness may make it impossible. In marked general debility of

the mother from any cause whatever, it would be injurious to the

mother and the child.