After the mother and the new-born infant have had some hours of rest

and sleep, it is advisable to apply the child to the breast, to

receive by this first effort the small quantity of milk which is an

especial provision to act as a natural purge and to start the bowels

of the child into a healthy activity; this also excites the milk

glands to secretion. The mother's milk in full supply may be expected

in from forty to sixty hours after delivery.

Nursing.-- When the mother's nipples are of the normal size and well

formed, the healthy infant instinctively suckles at once when placed

at the breast, but sometimes it has to be taught; by squeezing out a

few drops of milk to wet the nipple, the child will usually take hold,

or a little sugar and water may be put on the nipple; a little

patience and tact are all that is necessary to insure success. But the

infant must be taught to nurse at once before the breasts become

engorged with milk.

Under ordinary circumstances the child is to be kept at the breast for

one year. But if within this time the menstrual period should recur

and be profuse, or should the woman again become pregnant, the quality

of the milk becomes poor, and necessitates the immediate weaning of

the child; the character of the milk is also altered, and even its

secretion may be checked. Nervous agitation may so alter the quality

of the milk as to make it poisonous. A fretful temper, fits of anger,

grief, and sudden terror not only lessen the quantity of the milk, but

render it thin and unhealthful, inducing disturbances of the child's

bowels, diarrhea, and so forth.

Position of the Mother When Nursing.-- When in bed in the recumbent

position, the mother should lie on that side from which the infant is

going to nurse; when up, the mother should sit erect.

Care of the Nipples.-- Immediately after each nursing the nipples

should be washed off in a saturated solution of boric acid in cold

water, and dried with a soft cloth. If they are disposed to crack,

anoint them with cocoa-butter immediately after each cleansing. If the

skin of the nipple is very sensitive, a nipple-shield should be used

for the first few days; or should the nipple become sore at any time,

the shield can be resorted to. The nipple-shield must fit tightly; the

best ones are made of glass with a rubber tip. In the intervals of

nursing the nipple-shield should be kept in cold water after it has

been thoroughly cleansed by being brushed on both sides.

The breasts are sometimes distended from an over-secretion of milk;

this is relieved by saline cathartics, by abstinence from liquids, and

by the use of a compression breast bandage. This is made of a straight

piece of muslin, with a shallow notch cut in one edge for the neck,

and, a deep one for each arm; the bandage is closely applied over the

breasts, and the ends pinned in front; it is also pinned over the

shoulders.

In debilitated women the supply of milk may be insufficient; the most

reliable evidence of this is the fact that the infant ceases to gain

in weight.

CHAPTER XIII.

THE NEW-BORN INFANT.

The Infant's Toilet; the Crib; Feeding of Infants; Artificial Feeding;

the Wet-nurse; Characteristics of Healthy Infants; the Stools;

Constipation; Urination; Dentition.

"O thou child of many prayers,

Life hath quicksands; life hath snares."

-- LONGFELLOW.

The Infant's Toilet.-- So soon as the mother has been made

comfortable, the toilet of the infant is attended to. This should be

made near the register or stove; and the lap of the nurse should be

covered with a small flannel blanket. The baby's body will be found to

be covered over with a white, greasy, somewhat cheesy substance; some

sort of grease is needed for its removal; rendered lard, sweet oil,

and lanolin are the best; vaselin is less effective. All of this

cheesy substance must be at once removed; the most difficult parts

will be in the folds and creases. The nurse should grease the palms of

her hands, then take the head of the child between them, and

thoroughly grease it; particular attention must be given to the ears;

then come the neck, shoulders, arms, chest and back, groins, external

genital organs, and lower extremities. After the child has been

thoroughly gone over, the grease should be rubbed off with a soft

towel.

A rectal injection of one tablespoonful of warm water is given at once

to unload the bowels of the meconium; this generally acts before the

baby's toilet is completed. The meconium is the first discharge from

the infant's bowels after birth, and that which had collected in the

intestines during the pregnancy.

The Baby's Bath.-- The baby's bath-tub is filled about one-third full

of water at a temperature of 100∞ F., tested by the thermometer. The

baby is then gradually immersed in the water, with the exception of

the head; this is supported on the left wrist of the nurse, which

passes under the infant's neck, while her hand grasps the left

shoulder; with the right hand the nurse quickly rubs over the child's

head and body; the entire bath should not occupy over five minutes.

The infant is then lifted out into the lap of the nurse, on which is

spread a soft, warm towel, with which it is carefully dried. One of

the important points in giving the infant its bath is to be sure that

the groins, arm-pits, and genitals are thoroughly well dried;

otherwise excoriation at these parts is sure to occur.

After this a daily tub-bath is given in the same way; soap is rarely

needed; when it is, castile soap should be used; its constant use is

not necessary and would only irritate the skin. These daily baths

strengthen the nervous system and prevent coughs and colds. The bath

should be given during the morning, one hour after feeding, and should

not last more than five minutes. The mother herself, just as soon as

she is able to go around, should superintend the bath; in this way she

is assured that if properly given, and will also recognize any

incipient affection of the child. These daily baths should be

continued till the child is four years old. Powder is not essential;

but if it is desired, a plain talcum powder may be used.

The Dressing of the Cord.-- After the bath the ligature which was tied

around the cord at the birth of the child will be found slightly

loosened; this should first be made tight, and then the cord, doubled

back on itself, should be tied by the ends of the same ligature. A

square of soft sterilized linen or gauze is slit up to its center; the

cord is allowed to pass through this slit, which looks toward the

child's right; the stump of cord is laid on the left and the ends of

gauze are folded over this; the whole is kept in place by the

abdominal bandage. As there is some exudation from the cord, it is

necessary to change these dressings twice a day; as this exudation is

of a somewhat gluey nature, it will be found that the dressings stick

to the cord. In removing the gauze great care must be used not to make

any traction on the cord; when the infant is placed in the bath, the

water loosens the dressing and it falls off in the water; at other

times it must be removed with the greatest care. There should never be

any odor about the cord; it usually drops off about the fifth day.

The process of ulceration by which the cord falls off leaves an open

surface on the child's body which offers an avenue for septic

infection. Great care must therefore be taken that the nurse's hands

or anything which comes in contact with this surface should be

perfectly clean. The dressings used must be thoroughly antiseptic.

Care should be used not to fasten the abdominal bandage too tightly;

the bath is given on an empty stomach, and allowance should be made

for this; the binder should be loose enough to allow two or three

fingers to easily slip under it.

The Meconium.-- The First discharge that comes from the bowels is of a

dark, greenish color, and should come away during the first

twenty-four hours; if it does not, the baby may suffer a good deal of

pain, and an enema of warm water must be given. As this substance is

very difficult to be washed out of napkins, the first ones used should

be old and afterward be burned.

Cleansing.-- Every time the napkin needs to be changed, even if it is

only wet, the baby should be washed with warm water. A napkin should

never be used twice without washing; it chafes the child, and it is an

unsafe as well as a filthy practice; the napkin must always be removed

as soon as it is wet.

The Infant's Toilet.-- After the application of the binder and napkin,

comes the undervest; the fingers of the nurse are passed up through

the sleeve to seize the infant's hand and pull it through; as soon as

it gets a little older the child will grasp a finger laid in its palm,

which greatly facilitates this part of the toilet. The stockings are

next put on and pinned with safety-pins to the napkin; then comes the

petticoat, the band of which is also loosely fastened with

safety-pins, and with the slip the toilet is complete. All the

clothing should be changed night and morning.

The eyes and mouth should be washed out with separate pieces of gauze

or old linen. For the mouth, a small piece of cloth wet in warm water

is wrapped around the little finger of the right hand, going into the

left angle of the baby's mouth and coming out at the right, going

between the gums and cheeks as well as over the tongue. This procedure

should be gone through with every time preceding and following the

nursing, and in this way the milk is prevented from souring in the

mouth, and the digestion is kept in good condition. A sore mouth in a

baby indicates carelessness on the part of the nurse.

A soft hair-brush may be used, but the scalp is too tender to permit

the use of a comb.

After the toilet has been completed, the baby is laid in its crib, on

the right side of the body, and warmly covered. The weaker the baby,

the more attention must be paid to the external warmth. It may be

necessary to place a warm-water bottle in the crib, but this must

never touch the infant.

The Crib.-- The infant must have its own crib, without rockers, and it

must on no account be put to sleep in the same bed with its mother. In

its early life it should never be taken out of its crib except to be

fed, to have its clothing changed, or to be bathed. There should be no

holding on the lap, no dangling, no carrying or fussing over the

new-born infant; and the more the baby is let alone, the better and

healthier it will be. If baby cries, look at once to see if it needs a

fresh napkin; if not, if any pins are sticking into it, if the

clothing is possibly too tight; if none of these things are wrong,

give it a sup of water and turn it over on the other side. The baby

often becomes restless by sleeping for several hours in the same

position. But on no account take the infant up out of its crib simply

because it cries.

Cheerfulness and good nature on the part of the infant are dependent

on its general good health. A healthy infant should not have colic,

but if such is the case, there is a peculiar look of distress on the

face, which indicates that the child is in pain; what is needed is

warmth or medication according to the severity of the case, but never

floor walking. Begin the latter procedure, and you may hope to keep it

up for several years.

Ventilation.-- The air is sometimes vitiated for children's uses in

various ways; their nervous susceptibilities are greater than those of

older people. A very little odor of tobacco may cause nausea and

discomfort to an infant in arms. The atmosphere of the room should be

sweet and pure and unscented. All scents and perfumes affect the

nervous system, and by constant excitation do it damage. A bouquet of

flowers renders the air of a closed room too heavy.

Feeding of Infants.-- During the day the infant should be put to the

breast once every two hours, and once every three hours during the

night. This interval of time between the feeding is necessary in order

that there may be sufficient time given for digestion to take place.

Regurgitation of milk soon after feeding is a sign that the stomach

has been overfilled. As the infant usually falls asleep after nursing,

it is necessary to waken it up at the time for the next nursing, as

good digestion depends upon regularity of feeding.

For the first nursing the infant may be put to the breast in from two

to six hours after the labor if the mother is sufficiently rested;

from ten to twenty minutes is long enough for each nursing. Before

each nursing the nipples should be carefully washed off with a

solution of boric acid. The first secretion of the breasts is

laxative; that is, it acts on the bowels, and makes is unnecessary to

give the infant anything to take for this purpose. The breasts should

be used alternately in feeding the infant, as this allows a longer

time for the accumulation of the milk. For the first few days the

infant needs very little food, and the mother's milk is generally

sufficient.

The infant should be given a teaspoonful of cool water to drink two or

three times a day, as the milk does not quench the thirst. The water

should be sterilized by boiling, and be kept in an air-tight flask.

At the end of the third month the intervals of nursing for the daytime

should be three hours, and the last nursing at night should be at

eleven o'clock, and the first nursing in the morning at five o'clock;

thus allowing the mother an interval of six hours of unbroken sleep.

The best evidence of the proper nutrition of the child is a

progressive gain in weight. The child should be weighed every week. A

loss of a few ounces usually takes place during the first few days

after birth, so that the child does well if at the end of the first

week it weighs as much as it did at birth. After the first week the

weekly gain should not fall below five ounces.

The Wet-nurse.-- When the mother for any reason whatever is not able

to nurse her child, the best substitute is a wet-nurse. Before she is

employed the wet-nurse should always be carefully examined by a

physician to insure her freedom from disease. The best age is between

twenty and thirty years, and the age of the child of the nurse should

be at least within a month of that of the child to be nursed. The best

sign of the good health of the nurse and of the condition of her milk

is furnished by the health of her own child. The breasts should be

well formed and the nipple of good shape. It is well, if possible, to

get a woman who has borne several children, as she will understand the

care of the child better. No woman who is not perfectly healthy is fit

to be a wet-nurse; and even after she has been engaged her health and

her habits must be watched over.

Artificia1 Feeding.-- The first requisite in artificial feeding is

that the milk shall be made to correspond as nearly as possible to

that of the mother. For this purpose the following formula, prepared

by Rotch, of modified cow's milk is considered the best:

Milk 2 ounces

Cream 3 ounces

Water 10 drams

Milk-sugar 6 3/4 drams

Lime-water 1 ounce

To make one pint of the mixture for use in the twenty-four hours, take

the milk and cream as soon as it comes in the morning, and mix as

above directed.

No less important than the correct proportions of the ingredients, is

freedom from disease germs and bacteria of putrefaction. Complete

sterilization is possible by prolonged boiling; but experience has

proved that under prolonged exposure to a temperature near the

boiling-point certain changes take place in the albuminoids of the

milk which greatly impair its digestibility. Full sterilization of

milk for infant feeding has therefore practically been abandoned. It

has been found that milk heated to 167∞ F. for twenty minutes, and

promptly chilled by placing on ice, remains practically sterile for

twenty-four hours, and it is spared the injurious changes which take

place at a higher temperature. This process is known as

Pasteurization. The Arnold steam sterilizer affords a convenient

method of sterilizing; if used with the cover removed, the steam

chamber being open, the temperature of the steam chamber does not

exceed 170∞ F.

It is claimed that in the Arnold steam sterilizer, with the use of a

suitable gas stove, the water begins to boil at the end of two minutes

after the gas is lighted. A four-ounce bottle of milk at an initial

temperature of 70∞ F. in the open steam chamber attains a temperature

of 170∞ in just one hour. An exposure of about one hour and twenty

minutes in the steam chamber is therefore necessary for the

Pasteurization.

The rules for sterilizing are as follows:

First, clean the bottles thoroughly; then place them in cold water,

which is allowed to come to boil and boiled for ten minutes.

Second, fill each with the milk you wish to use; put in the rubber

cork without the glass plug; this leaves a small opening in the rubber

cork; set the bottle in the basket, then in the boiler.

Third, set in the refrigerator until needed for use.

Fourth, when wanted for use, place a bottle of the milk so prepared in

the tin mug which accompanies the sterilizer; fill the mug with hot

water to the height of the milk in the bottle, heat the milk to the

temperature of 99∞ F., remove the rubber cork and put on the nipple,

when it is ready for use.

Fifth, cleanse the bottle immediately after using; throw away any milk

that has not been used.

Sixth, if the steaming process is preferred, place the basket without

the bottles in the boiler, fill the water up to, but not above, the

bottom of the basket, place the bottles in the basket, and proceed as

before.

It is important that the milk should be sterilized or Pasteurized as

soon as it is served in the morning. Each bottle must be thoroughly

washed as soon as it is emptied. Milk sterilized in this way will keep

for days without spoiling, as it is hermetically sealed and all the

unhealthy germs have been removed.

The most exact method for the artificial feeding of infants, and that

which most nearly approaches the mother's milk, is that used by the

"Walker-Gordon Laboratory," branches of which are to be found in many

of the large cities.

Not only is the greatest care taken that the milk used shall be pure

and sterilized ready for use, but these laboratories are equipped by

special machinery which separates the important elements of the milk--

namely, the fat, the milk-sugar, and the proteids. So that the

physician can modify the proportions of these various ingredients of

the milk to meet the necessity of the age and requirements of the

infant.

When the milk contains too little sugar, the infant does not gain as

rapidly in weight as it would otherwise do. Too much sugar in the milk

is indicated by colic, thin, green, or acid stools, or eructations of

gas from the stomach.

An excess of fat in the milk is indicated by vomiting; too little fat

causes constipation with dry hard stools. Proteids in excess are a

prolific cause of colic and also of diarrhea.

Prescription blanks are furnished the physician, who fills out the

percentages of fat, milk-sugar, proteids, and alkalinity, to suit the

age, weight, and general condition of the child. He orders also the

amount to be given at each feeding, and the number of feedings to be

given in the twenty-four hours. Each bottle contains just the amount

to be given at one feeding. All that the mother needs to do is to

place the bottle in a receptacle containing warm water, until the milk

has attained a temperature of 99∞ F., remove the cotton stopper, and

put on the nipple, when it is ready for use.

The Nursing Bottle.-- This should be of clear glass, with a rounded

bottom, and of such a shape as is easy to clean; so that no particles

will cling around a corner which cannot be reached. The graduated

bottle is the most convenient, as it enables the quantities of each of

the materials used in the preparation of the feeding to be mixed in

the bottle, doing away with the trouble of measuring before putting

into the bottle.

Rubber Nipples.-- Two nipples should be kept for alternate use, and no

nipple should be used longer than two weeks. A soft rubber of conical

shape is best, with an opening at the top which is not too large, so

that the milk will not flow through, as it is desirable that the child

should obtain the milk by suction. So soon as the feeding is over, the

nipple should be removed from the bottle, and brushed on both sides

with a stiff brush. It should then be put in cold water, where it is

kept until it is again wanted.

The baby should be fed slowly, from ten to twenty minutes being taken

for each feeding. Sucking from an empty bottle or with a nipple in the

mouth should never be permitted, as in this way the baby draws air

into its stomach, which will result in colic. Each flask should

contain only enough for one feeding.

In lieu of the regular sterilizing apparatus, milk may be similarly

prepared by placing the milk in an ordinary glass fruit-jar with a

screw lid. This is placed in a colander over a pot of boiling water;

the milk should be allowed to boil in the open jar for two minutes;

the jar-lid is then screwed on, and it should steam for twenty minutes

longer.

The capacity of the infant stomach at birth is about one ounce, which

is the average quantity of food that should be taken at one meal. The

average rate of increase in the amount of food is one and a half drams

a week for the first six months; subsequently somewhat less. The

intervals of feeding should be two hours at birth, and increased to

three hours at the end of the third month. The food should be given at

a temperature of 99∞ F. and fed directly from the sterilizing bottle.

Fresh Air.-- In warm weather the baby is taken out-of-doors in from

three to four weeks after birth; in cold weather not before two to

three months. In the latter case it is prepared for the change by

being first dressed as for the street, with wrap and cap; the windows

of the room are then opened, and the infant is carried about here. In

the winter months when the baby is first taken out, it is better to

carry it in the arms, as it will be kept warmer in this way, and if it

does become chilled it will be more quickly noticed.

Characteristics of the Healthy Infant.-- The average weight of an

infant at birth is about seven pounds, and its length is about twenty

inches; the extremes are four pounds or a little less up to eleven

pounds. The head and trunk of the child are developed out of

proportion to the limbs.

The skin of the new-born infant varies from pinkish to red; about the

fourth day the color becomes somewhat yellowish; this tinge should

disappear about the end of the second week, and at the same time the

skin begins to peel off.This process lasts about two weeks longer,

when the baby's skin takes on its normal color.

The shape of the head varies greatly, much being due to the amount of

pressure during labor; but this disappears in a few days. As a rule,

the large bones of the head are felt to be separated by membranous

ridges called sutures; there is one on the median line on the top of

the head, and at either end of the suture is a large open space,

called a fontanel. The largest one is at the front of the head, and is

called the anterior fontanel; it is about large enough to be covered

by the tips of two fingers, and is of a lozenge shape; this opening

does not close till the child is about eighteen months old. In a

healthy baby this fontanel should be on a level with the bones of the

head; a slight pulsation may be noticed in it, due to the pulsations

of the vessels of the brain. There is a much smaller three-cornered

fontanel at the back of the suture, and one behind either ear; these

soon close up with bone.

A new-born baby cannot probably do any more than distinguish light

from darkness. Up to the sixth week there is an inability at

coordination of the ocular muscles; after this time the eyes begin to

move in an orderly manner, and they will follow a bright object moved

slowly in front of them. At about the end of the second month rapid

movements are perceived, as is evinced by the child's closing its eyes

quickly on an object suddenly approaching it. At three months the

child begins to recognize colors; the first recognized are yellow,

red, pure white, gray, and black. But the faculty of distinguishing

between colors is not perfected till the third year. The mother is

recognized about the third month. Hearing and a sense of smell develop

rapidly after birth; loud noises in its vicinity will cause a child to

start during the first day after birth. By the time the child has

reached three months of age it shows signs of having a mind of its

own, and is capable of exercising thought. It grasps for objects, and

indicates its likes and dislikes. At from eight to ten months it can

utter several syllables, and at the age of one year should be able to

say mama and papa; at two years it should be able to frame short

sentences.

Weight of the Baby.-- By the end of the sixth month the child's weight

should be double what it was at birth; that is, about fourteen pounds;

at the end of the twelfth month be three times as much as at birth, or

about twenty pounds.

Muscular Action.-- Muscular action in the new-born infant is entirely

involuntary, there being no voluntary acts until about the end of the

third month. Sucking and licking are largely instinctive. The

movements of the arms and legs are impulsive acts, and occur during

sleep, just as they did in the intra-uterine life. The act of raising

the head, which is attempted about the fourth month in healthy

children, is volitional, requiring not so much added strength of

muscle as power of coordination. As volition develops the power of

coordination gradually increases, and the child learns to perform

voluntary or purposeful acts. Voluntary grasping is done after the

fourth month. As the child learns to balance its head, it attempts to

sit up. This act is not successfully accomplished until about the

fortieth week; the child sits firmly alone when ten or eleven months

old. Before this time it is necessary to support the head and spine of

the child with the hand. By the third or fourth month the infant

should be able to grasp things. The child begins to creep about the

ninth month. The clothing should be so arranged as to allow entire

freedom of motion.

It should be able to stand up by a chair by the tenth month, and be

able to walk alone at the end of the first year. It is important that

parents should know this, since not knowing what a normal baby ought

to be able to do, cases of birth palsy, or even an attack of paralysis

due to teething, are not infrequently overlooked, not only by the

mother, but even by the doctor, who attributes the inability of the

child to do what other children can do at this age simply to weakness,

which the child will outgrow; and thus the time passes in which the

most could be done to cure the child and to prevent the subsequent

deformity.

A baby should not be forced to stand or walk; a very stout baby, on

account of its weight, will stand up and walk much later than a slight

one, the two being equally healthy. Or if a baby has been sick, it

will feel no inclination to stand up. Naturally, a child creeps before

it walks, and this develops the muscles of the lower limbs, so that

they will support the weight of the child in standing. By prematurely

forcing a child to stand up and walk, there is danger of causing

bow-legs, as the bones of the legs are still weak; the child should be

discouraged from standing up too much rather than encouraged to stand

up more.

Sleep.-- A large proportion of the time of early infancy is spent in

sleep; for the first few weeks the infant only wakens up to be fed.

During sleep the eyelids should be tightly closed; a partial opening

of the lids, showing the whites of the eyes, is an indication of ill

health. Up to the age of six, children require twelve hours of sleep

at night, besides an hour or more in the middle of the day; the child

should be permitted to sleep as long in the morning as it will.

Respiration.-- The healthy infant breathes on an average forty-four

times a minute; the only time the respirations can be satisfactorily

counted is during sleep. When the child is awake, the respirations are

hurried by slight movements of the body, crying, and so forth. The

average pulse of a newborn baby is one hundred and forty; this is

hurried by the same causes that hastens respirations; the pulse is

most easily counted at the anterior fontanel. The average temperature

of the infant is 99∞ F. When the tip of the nose and the extremities

are cold, it indicates a lowered vitality.

The nature of the child's cry indicates, variously, hunger, temper, or

pain; the mother will soon learn to distinguish these varieties. If

the child cries because it is hungry, the cry ceases so soon as it is

fed. But a child is never to be fed simply because it cries; it must

be fed on the hour by the clock. If this rule is not strictly adhered

to, it will suffer all the forms of indigestion and colic that babies

are heir to. If it cries because of colic, there is a drawn look on

the face, and at the same time the legs are sharply flexed on the

thighs and the thighs on the abdomen. If the cries are due to earache,

the head will be rolled about from one side to the other. In either

case nothing will stop the cries until the pain is relieved. A baby

does not shed tears until the third month.

The Stools.-- The stools of a very young baby fed on breast-milk

should be of a yellow or orange color. There should be three or four

evacuations daily; they should contain no curds. Stools of bottle-fed

babies are lighter in color and more offensive.

Constipation.-- Constipation is not uncommon in infancy; it may be

overcome by the use of a soap suppository, or by an injection of warm

soap-suds into the bowel, or by an injection of oil and water, or by

gentle friction over the bowel, following the course of the large

intestine.

To make the soap suppository, take a piece of castile soap about an

inch long, give it the shape of a cone not any larger than the end of

the little finger, and make it perfectly smooth. This is inserted to

about half of its length into the rectum and held there until it

causes the bowels to move.

The bowel injection is best given by means of the single-bulb syringe,

known as the eye and ear syringe; the bulb holds about two

tablespoonfuls of liquid. This may be warm cotton-seed oil, sweet oil,

or glycerin one teaspoonful to warm water two tablespoonfuls. The

nozle should be small, smooth, and well oiled. It should be very

carefully introduced into the bowel, being directed a little to the

left side, and the bulb gently squeezed to force the contents into the

bowel. The injection is more effective if it is retained for a little

while; this is accomplished by making slight pressure on the anus with

a towel.

Rubbing the abdomen for about ten minutes in the direction of the

large bowel is sometimes very effective in overcoming constipation;

begin in the right groin and rub up as far as the border of the ribs,

then across to the left, then down on the left side.

Vomiting.-- Vomiting means often only that the stomach has been

overfilled, and may be relieved by withholding all food for a few

hours.

Urination.-- The frequency of urination in a newborn baby will vary

greatly with the weather and other conditions; in cool weather it is

not unusual for the napkin to need changing almost every hour. Healthy

urine should not stain the napkin. The new-born infant secretes very

little urine until it begins to take nourishment freely. The bladder

is usually emptied during birth, and very often the bowels also, so

that if the child seems well and there is no malformation of the

parts, the family may be assured that the apparent retention of urine

is only temporary.

The use of hot fomentations over the kidneys and bladder will often

hasten the evacuation of urine if it has been unduly delayed. If the

secretion seems highly concentrated, a drop of sweet spirits of niter

in a teaspoonful of water may be given every two hours.

Teething.-- The first tooth generally appears about the end of the

fourth month; in delicate children they come later. As a rule, the

lower front teeth come first, coming in pairs, one tooth coming on

each side of the mouth; followed in about a month by the corresponding

teeth in the upper jaw. Preceding their appearance the gums become

swollen, hot, and painful, and the saliva forms in excess and runs

from the mouth. The child is irritable, flushed and restless; and

there usually occurs some disturbance of the bowels, commonly

diarrhea. This all indicates a nervous derangement, and calls for a

judicious diet and general careful oversight. The symptoms subside

when the teeth are through. During teething the child manifests a

desire to bite on something, and a soft rubber ring will give it great

comfort.

The first set of teeth are twenty in number, and are usually cut in

groups, starting about the fourth month and continuing until between

the twentieth and thirtieth month, when the first dentition should be

complete. As a rule there is an interval of rest between the eruption

of the various groups. During dentition children are generally more

peevish and fretful than usual, but there should be no general

constitutional disturbance. During dentition it is of especial

importance to keep the bowels well opened; it is better to have them

too loose than costive; constipation at this time greatly increases

the tendency to convulsions.

Bottle-fed babies are apt to cut their teeth later than those nursed

at the breast. The lack of appearance of any teeth before the end of

the first year indicates that the nutrition of the child is below par,

or, in other words, that the child has rickets. The permanent teeth

begin to appear about the sixth or seventh year.

_________________

PART IV.-- THE MENOPAUSE.

_________________

CHAPTER XIV.

THE MENOPAUSE.

Average Duration of the Menstrual Function; Duration of Menopause; the

Menopause; General Phenomena of the Menopause; Prominent Symptoms of

Menopause; Pathologic Conditions of the Menopause; Hemorrhage at the

Menopause a Significant Symptom of Cancer; Causes of Suffering at

Menopause.

"Yet I doubt not through the ages one increasing purpose runs,

And the thoughts of men are widened with the process of the suns.

Knowledge comes, but wisdom lingers, and I linger on the shore,

And the individual withers, and the world is more and more.

Knowledge comes, but wisdom lingers, and he bears a laden breast,

Full of sad experience, moving toward the stillness of his rest."

-- "Locksley Hall."

Average Duration of Menstrual Function.-- The average duration of the

menstrual function is from thirty to thirty-two years. Raciborski

estimated the duration of menstrual life at about thirty-one years and

nine months. According to him, the mean age of puberty at Paris was

fourteen years and seven months; therefore, the average age of the

menopause was forty-six and one-half years. Tilt gives the average age

of the cessation of menstruation in 1082 cases as forty-five years and

nine months. The average age is between forty-five and fifty years. It

has been shown by Krieger, Kisch, and others, that the earlier the

menses appear, the later they cease, and vice versa. However, when the

first period is unusually early or late, the menopause comes very

early. Also that the sexual function is usually abolished earlier in

the laboring classes, who are compelled to work hard and who have many

cares, than in the well-to-do and rich.

Race does unquestionably influence the duration, but given a sound

healthy race, which is not too much enervated with civilization, and

the menstrual process will, equally with the total physical vigor and

the vitality, be increased. At the present day there is an increased

sexual vitality, which shows itself in the fact that the duration of

menstrual life has been increased three to four years during the past

generation. The inference can be fairly deduced that vigorous vitality

causes prolongation of the menstrual process and the actual age.

Duration of Menopause.-- By the menopause or climacteric is understood

the whole period from the beginning irregularities in the time of

appearance of the menstrual flow until its actual cessation. The

average duration of the menopause is from two and a half to three

years.

The Menopause.-- The menopause is a physiologic and conservative

process. It occurs at a time of life when all the tissues are most

stable and the nutrition of the body is at its best. Other physiologic

changes which occur at the same time are decrease in the size of the

spleen and lymphatic glands, the muscular coats of the intestine

atrophy, and lessened peristalsis ensues; hence the increased tendency

to constipation. These are not the degenerations of age, but the

blood-supplying, blood-making, and blood-elaborating organs of the

body have completed the growth of the organism, done their work, and

are striking a balance with the needs of the economy.

The object of each metamorphic or developmental epoch is a critical

readjustment of the organism, in order to insure the greatest possible

amount of health for each subsequent period of life. In the vast

majority of cases this object is quietly effected, but sometimes the

constitution only rallies after having been severely shaken for a

varying period.

General Phenomena of the Menopause.-- Borner states that while many

women pass this period without noting any change in their former

condition, and are conscious of the occurrence of the change of life

only by reason of the absence of the menstrual flow, others suffer for

years with a host of troubles.

One of the most essential changes is that of the woman s psychic

condition-- from slight vagaries, loss of interest in the daily

affairs of life, to melancholia and insanity.

"Two factors are generally taken into account: first, the sudden

cessation of the menses; second, the reflections of the patient caused

by her condition, meditations on the loss of youth and sexual power,

and anxiety in view of the dangers of the climacteric. It cannot be

denied that there is some truth in the supposed sad thoughts about the

beginning of old age, and the depression caused by them can scarcely

be considered abnormal" (Borner).

Napier believes that it is extremely rare for the cessation to occur

without some physical discomfort or some disturbance of the nervous

system, but adds that: "Some women, however, cease menstruating with

very slight inconvenience." As a rule, the woman misses one, two, or

more periods, then a menstruation of almost normal quantity and

duration; and this is again repeated at gradually longer intervals,

and with a diminished flow, until actual cessation occurs.

The periods cease owing to the degeneration and disappearance of the

glandular tissues of the uterus, and secondarily to similar changes in

the ovaries and other glands. This is followed by an atrophy of all

the structures of the genitalia.

An increase in the size of the uterus, from increase in the amount of

blood, is frequently noticed at the beginning of the menopause; later

it becomes smaller in all its dimensions. The wall becomes thinner;

the cervix becomes shorter and thinner, sometimes hard, sometimes

flabby as a membrane. But the distinguishing feature of the menopastic

uterus is atrophy of its lining membrane.

The changes in the uterus and Fallopian tubes are earlier than those

in the ovaries, so that ovulation, though lessened in activity, may

persist for a considerable time after menstruation has ceased. Ovarian

atrophy has been referred to senile rather than menopastic changes.

Atrophy of the ovaries occurs very gradually. Peuch found that in one

case the ovaries were of normal size three years after the

establishment of the menopause. Kiwisch describes the structural

change in this gland as consisting, on the one hand, of an increase of

the connective-tissue stroma; and, on the other hand, the Graafian

vesicles themselves undergo retrograde change. In consequence of these

microscopic changes, which take place very slowly, the entire organ

becomes harder and smaller.

Napier believes that the ovaries secrete specialized substances which

aid in determining menstruation; and that in a less degree the

utricular glands and the glands of the Fallopian tubes share in this

action. He considers that this is probably secondary to the chain of

peripheral irritation from the uterine glands, but that this secretion

is none the less an essential feature of the menstrual process.

In support of this view he calls attention to the pigmentation of the

skin which occurs during pregnancy and chlorosis, showing that the

absence of the catamenia results in the retention in the blood of some

substance which would normally be excreted at this time.

Other atrophic changes in the genitalia are shriveling of the vulva,

with prolapse of the vagina or uterus from relaxation of the ligaments

and loss of the natural support afforded by the changed perineal body.

Uterine catarrh occurs almost invariably, and only ceases in advanced

years. Displacements of all kinds are frequent, but on account of the

now greatly diminished weight of the uterus, these are insignificant.

The vagina is at first almost always hyperemic, but this disappears as

the vessels successively atrophy. The vagina gradually becomes

narrower and shorter. The mucous membrane loses its rugae and presents

a pale, grayish, blanched hue.

The researches of Byron Robinson, made by the dissection of a number

of old women, show that after the menopause not only is there an

atrophy of the genital organs, but that the hypogastric plexus of the

great sympathetic nervous system also shrinks away. "It becomes

smaller and firmer, and no doubt some strands disappear. On this fact

must he based the pathologic symptoms accompanying the cessation of

the menstrual function."

The importance of the genital organs is shown by the vast nerve-supply

sent to them. When this great nerve-tract becomes atrophic, so that it

can no longer transmit the higher physiologic orders, all parts of the

sympathetic system must be unbalanced, until a new line, the next line

of least resistance is established. And Robinson believes that this is

the explanation of the many pathologic manifestations of every viscus

at the menopause; that is, "the irritation which arises by trying to

pass more nervous impulses over plexuses than normal gives origin to

what is unfortunately known as functional disease. It is just as

organic as any disease, only we are unable to detect it."

Chemical changes in the blood and tissues are constant vital

phenomena; increased oxidation causes increased activity of the

circulation, increase of temperature, increase of urea and carbonic

acid in the economy from retrograde changes, and, finally, during

menstrual life the flow of blood from the uterus carried off the

effete materials from the highly charged system.

The elimination of albuminoids, as shown by the altered condition of

the blood after menstruation, is greater than can be accounted for by

the blood discharged. When the menopause is attained suddenly, the

retention of such albuminoid substances must act toxically. Hence the

resulting clinical fact that sudden cessation of the menses is, in the

majority of cases, attended with pronounced symptoms of discomfort,

and it is in these cases that untoward results are most likely.

James Oliver believes that the catamenial flow eliminates from the

body substances whose presence in the blood would exert a deleterious

influence on the animal economy.

The Prominent Symptoms of the Menopause.-- Christopher Martin holds

that the symptoms of the change of life are produced largely by a

condition of instability and increased excitability of certain other

cerebrospinal centers directly brought about by failure of the

menstrual center, and adds: "It is probable that the ovaries, like the

liver and thyroid gland, modify the blood circulating through them,

and add to the blood some peculiar product of their metabolism. It may

be that some of the climacteric symptoms are due to the loss of this

substance from the system."

Arthur Johnstone's theory of the symptoms of the menopause is that the

lining membrane of the uterus atrophies and becomes old cicatricial

tissue, and sinks into quiet decay. The nervous system begins to

readjust itself; but no longer having free outlet through the soft,

lymphoid tissues of the uterus, the wave pressure meets with

resistance and a choppy sea results. Vertigos, bilious attacks, and so

forth are nothing more than reflex waves. The weakest organ of the

individual is the one that generally suffers. And that the kidneys,

which all along have borne the brunt of life, should now show positive

signs of disease is natural.

The etiology and pathology of the menopause lie in the sympathetic

nervous system. And it is by the breaking up of the harmony of

previous processes that nervous disturbances are produced.

After the cessation of the flow, over 8% of women suffer from

"flashes"; this symptom is caused by irritation of the heart and

vasomotor centers. The blood-vessels of the head and neck seem to be

most affected, yet the skin of the whole body shares in the

disturbance. Besides the vasomotor and heat center being disturbed,

the sweat center is irritated. The flushes and flashes are followed by

various degrees of sweating, which varies from a slight moisture to

great drops.

Nervous irritability is a prominent symptom in 8% of women at the time

of the menopause. Most of the pain arises around the stomach; that is,

the solar plexus. Digestive disturbances are very common at this time;

they may be in the shape of fermentation, diarrhea, or constipation,

accompanied by congestion of the liver.

Tilt holds the very plausible view that the too strong reaction of the

sexual organs on the central ganglia of the sympathetic nervous system

is their principal cause of disease. Puberty, menstruation, pregnancy,

lactation, or the menopause almost always entail some derangement of

this system which is sometimes sufficiently severe to lead to insanity

and suicide. Debility underlies all affections of the sympathetic

nervous system, in the same way as nervous irritability underlies all

cerebral diseases. Sometimes there is an overpowering sense of

exhaustion pervading the whole system.

Forms of climacteric insanity are delirium, mania, hypochondriasis,

melancholia, irresponsible impulses, and the perversion of moral

instincts.

"If the reproductive apparatus does not act on the brain by the

instrumentality of the circulating organs of the blood, it must do so

by means of the nerves. The genital apparatus is richly endowed with

nerves from the sympathetic system, and I have shown how frequently

evident signs of disturbance in these centers coincided or alternated

with headaches, nervousness, hysteria, and epilepsy. What wonder,

then, if the same powerful influence of the sexual organs, through the

instrumentality of the sympathetic system, should at times produce a

permanent derangement of the mental and moral faculties. I am thus led

to look on the sympathetic nervous center as a source of vital power

producing reflex morbid phenomena, in accordance with variable

cerebral predisposition" (Tilt).

Another very frequent symptom of the menopause is distress in the

region of the heart, with palpitation and shortness of breath. It may

be caused by the condition of the blood, whether it be impoverished--

anemia-- or too rich in red globules; by reflex irritation of the

pneumogastric or sympathetic nerves; by overexertion; or by

alcoholism. It may also be due to general debility; the woman resists

fatigue less easily, and she experiences a general malaise. To the

palpitations are rapidly added faintness and shortness of breath. The

sleep is troubled with distress in the region of the heart. It is said

that women in whom the menopause occurs early are more liable to

tachycardia than those who menstruate later in life; and that it

occurs with especial frequency when the menopause has been prematurely

induced by surgical operation or by disease. It is believed that this

functional heart trouble is caused by the increased connective-tissue

fibers of the sexual organs acting in some unknown way on the terminal

fibers of the sympathetic; and it is not infrequently due to the

formation of scar tissue at the seat of a cervical laceration, and has

often been promptly and permanently relieved by removing the

cicatricial tissue and suturing the wound. The cause acts by producing

a transitory paralysis of the inhibitory fibers of the pneumogastric

nerve.

Pathologic Conditions of the Menopause.-- Perhaps the most alarming

symptom of the menopause is hemorrhage. It may be due to general or

local causes. Among the general causes are diseases of the heart,

lungs, spleen, and kidneys. Local causes of hemorrhage are:

inflammation of the lining membrane of the uterus, chronic pelvic

inflammations, faulty uterine positions, erosions and ulcerations of

the mouth of the uterus, fibroid tumors, and cancer. All competent

observers agree that cancer in women is much commoner from forty to

fifty years than at any other age.

Hemorrhages occupy the foremost place among the pathologic phenomena

of the genital tract during the menopause. Hemorrhage has been

attributed in many instances to the senile rigidity and friability of

the uterine vessels, which are not in a condition to offer sufficient

resistance to the blood-pressure which is brought to bear on their

walls; there is also softening and relaxation of the uterine tissue.

Additional causes are found in the circulatory disturbances in the

pelvic organs, whereby the outflow of blood from the pelvic vessels is

hindered a chronic congestion in the uterine vessels is produced. It

has also been attributed to early and profuse menstruation, frequent

and difficult labors, frequent abortions, and excess in drinking.

The third and last variety includes those cases which may be referred

to some disease of the pelvic organs themselves. Anatomic changes may

lead up to pathologic conditions. A chief feature characteristic of

uterine disease is malnutrition from atrophy-- a sudden curtailing of

the blood-supply from the degeneration of the genital-nerve apparatus

and consequent impaired vitality of tissue from defective nourishment.

The anatomic changes in the glands and substance of the uterus also

favor the irritation, and the development of new growths, which may be

malignant or benign-- as cancers, fibroid growths, and so forth.

Hemorrhage at the Menopause a Significant Symptom of Cancer.-- Not

only should any excessive and prolonged bleeding at the time of the

menopause be a source of great anxiety to the woman, but even the

irregular appearance of a slight show of blood just sufficient to keep

the clothing stained, or a slight bleeding following coition; since

all of these are symptoms of very great gravity, and demand an

immediate local examination and appropriate treatment.

The widespread belief among the laity that hemorrhage at the time of

the menopause is a normal condition, and that if left alone it will

stop in the course of a few years, is most erroneous and fatal. On

this altar of ignorance thousands of women sacrifice their lives every

year. The case-book of any gynecologist will testify to the truth of

this statement. The following three cases will serve to illustrate

different types of hemorrhage in cancer patients, in no one of which

did the patient even suspect that she was suffering from anything more

serious than the "vagaries of the menopause."

Case I.-- Woman aged seventy years; came on account of incontinence of

urine, which had been troublesome for two years. The menopause

occurred at fifty. She stated that three or four years previous to her

visit, she had had a return of the flow of blood, perhaps twice in the

first year, and that during the past year there had been a flow every

month-- about the same that there used to be. This she took to be a

return of the menstrual period. She said, further, that there was a

constant bleeding-- enough to necessitate the wearing of a napkin--

and an occasional severe hemorrhage; that she could not take long

walks or drives because of the excessive flow which followed.

The case was one of cancer of the uterus which had spread to all the

pelvic viscera; and in addition to this, the patient's general

condition was such that any operation was out of the question. Yet the

patient had never thought of the possibility of any uterine trouble

sufficiently serious to make a local examination necessary. It was

only the loss of control over the bladder that drove her to seek a

physician's advice.

Case II.-- Woman aged fifty-three years came to consult me because of

pain, hemorrhage, and loss of weight. There had never been any

cessation of the menstrual period. She said that she began to have

irregular hemorrhages three years previously, and that they were

constantly becoming more frequent and more alarming, and that, in

addition to this, there was a constant discharge of blood, which

necessitated her wearing a napkin all the time. She also stated that

for the preceding six months the pain had been so severe that she had

not had one solid night's sleep, and that in that time she had lost

forty pounds in weight.

This patient was in the very last stages of cancer of the uterus, and

all that could be done for her was to make her comfortable. She had

given birth to one child which caused a deep tear of the neck of the

womb; and it is probable that this neglected tear was the primary

cause of the cancer, which began in the neck of the womb.

Case III.-- Woman aged forty-five years; married, but had never had

any children. She said that the periods were normal as to duration and

amount, but that for the past two years they had two days ahead of

time, and that for the past four months she had been having just

enough irregular bleeding between the periods to keep her clothing

stained.

On examination a diagnosis of cancer of the uterus was made. The

pathological examination proved this to be a most malignant type of

cancer of the neck of the womb. The entire uterus and appendages were

at once removed. And although the patient made an excellent recovery

from the operation, she succumbed to the disease one year after the

operation was performed.

These cases have been cited at length because they are all typical and

because of the variety of symptoms and the great difference of age.

Only in one of the cases was there any very severe pain, and it was

really the pain, which had become unendurable, which caused the

patient to seek relief.

It is the concensus of opinion of the medical profession that cancer

of the uterus is one of the common causes of death among women; that

the cancer rate of mortality has increased during the last four

decades; that it is most common near the time of the menopause; and

that there is a direct causal relation between cancer of the neck of

the womb and the traumatisms which occur during childbirth.

The symptoms of cancer of the uterus are hemorrhage, a more or less

offensive discharge, and pain. The quantity of blood may vary from a

slight amount which occasionally stains the clothing to a profuse

hemorrhage. In the married, bleeding following coition is always a

suggestive symptom. During the menopause any irregular or profuse

bleeding should excite suspicion. After the cessation of the menopause

any bleeding whatsoever, whether slight or profuse, should always be

regarded as a danger signal which demands an immediate and thorough

local examination. The same is true of any offensive vaginal

discharge. Pain is frequently so late a symptom that to wait for its

appearance means that the favorable time to perform an operation has

passed by. Emaciation is also a symptom of advanced disease.

Cancer is chiefly a disease of the climacteric; when there is a

diminished power on the part of the tissues to resist adverse

influence. It affects the debilitated and overworked, but it is also

found in the well nourished and in the comparatively young.

Cancer always begins as a local disease, and when it occurs in the

uterus, it is easily accessible and eradicable in its earliest stages;

that is, if the disease is discovered in its incipiency, an operation

will remove all the diseased tissue. If, on the contrary, the disease

is left to nature, the growth spreads out into the surrounding viscera

like the roots of a tree in the earth, and the cancer may be literally

said to eat into the tissues which it invades. At the same time the

germs of the disease begin to be carried all through the body, and the

entire constitution is affected.

Prophylaxis, or the Prevention of Cancer.-- All pelvic inflammations

should be promptly treated, and not allowed to become chronic.

Leucorrhea is a symptom of inflammation, the true cause of which can

be determined only by local examination. Women who have given birth to

children-- and this is more especially necessary as they near the age

of forty years-- should be carefully examined for tears of the neck of

the womb. If these tears are extensive they should be repaired, as it

is certain that malignant growths frequently do follow local injuries

and traumatisms.

Any irregular or profuse bleeding demands an immediate investigation

by means of a local examination.

A stormy, irregular, or delayed menopause should excite in the woman a

suspicion of some abnormal condition.

The importance of women being carefully watched by gynecologists at

this period of their lives cannot be too emphatically stated, for upon

the early recognition of cancer depends the only hope of radical cure

of the disease. It is estimated that at the present time not less than

95 per cent. of all cases of cancer of the uterus come under the

observation of the profession at a stage of the disease when all

prospect of permanent relief is out of the question.

It is a deplorable state of affairs that women, not knowing what a

normal climacteric is, attribute all hemorrhages, no matter how

severe, to the change of life. Therefore, regarding the hemorrhage as

a necessary evil, they fail to consult a specialist until the

favorable time for eradicating the disease by means of an operation

has passed. And whatever knowledge science may bring in the future as

to the cure of cancer, at present it is a fact universally agreed upon

that early operation, while the cancer is still local, is the only

radical cure for the disease.

Pruritus Vulvae. Perhaps one of the most annoying and obstinate

symptoms of the menopause is pruritus vulvae. This is sometimes caused

by sugar in the urine; there is a congestion of the liver which

results in sugar being thrown into the system and this is eliminated

by the kidneys. It is quite possible that this is due to the altered

circulatory conditions of the menopause.

Kidney Disease.-- The last pathologic condition which we will mention

is kidney disease. Le Gendre believes that the menopause exerts a

deleterious effect on the kidneys, whether this be a congestion,

followed by a diminution in the quantity of urine, or a sort of

auto-intoxication due to the retention of a poison in the system that

has been prevented from leaving by the ordinary path.

Armstrong says that in almost all cases at the time of the menopause

the amount of urine passed is below normal, the specific gravity is

increased, and that the urine contains urates and almost always uric

acid in excess. Further, that the functions of digestion and

assimilation and the various metabolic changes are so largely under

the control of the nerve-centers that nothing seems more likely than

that so great a disturbance of that system as takes place at the

menopause should cause secondary derangements of these most important

functions. That being so, the blood becomes loaded with waste

products, and the usual symptoms follow-- gout and so forth.

It has been a grave question in the mind of the medical profession

whether the dangers that certainly do attend the menopause are natural

or acquired; that is, could these dangers be averted by any

precautions or hygienic measures on the part of women, or are these

dangers a necessary accompaniment of this period of life?

Tilt has reached the conclusion that: "The best way to avoid the

dangers of this critical time is to meet its approach with a healthy

constitution. A marked want of strength prevents the regular

succession of the vital phenomena by which all critical periods are

carried on. And as the change of life is marked by debility, when this

is grafted on constitutional weakness, loss of power will be of long

duration. All complaints remain chronic because there is not stamina

enough to carry them through their stages."

Causes of Suffering at Menopause.-- Dusourd, whose practice lay in an

agricultural district in the south of France, as well as Tilt,

believes that peasant women suffer little at this time. Their health

is generally good when the menopause comes on and they are little

liable to nervous disorders. The poor of large towns suffer much at

this epoch-- the necessity of working hard, the anxieties of poverty

and their unhygienic surroundings. But by a fortunate compensation the

necessity for working hard prevents or cures the nervous affections

which so often assail the rich at this period.

Tilt's cases showed that women who suffered much at the menopause had

previously suffered at puberty and at the menstrual periods. And among

thirty-nine cases where there was no suffering at the menopause, there

was the same immunity from suffering at puberty and at the menstrual

epochs.

Tilt's statistics were, or course, taken from English women. In

forty-four cases of my own, all women past the menopause, the average

age of the first menstruation was fourteen years and four months; and

the average age of the actual cessation of the menstrual flow was

forty-eight years and five and two-thirds months. Subtracting from

this the average age of the first menstruation, we have as the mean

age of menstrual life thirty-four years one and two-thirds months;

that is, the average duration of the menstrual function was from two

to four years longer than that usually given.

A further investigation in order to ascertain any possible relation

between the age of marriage and the number of pregnancies and the

sufferings of the menopause elicited the following statistics. The

average age of marriage was twenty-five years and ten months. Of the

four women who were married after thirty-eight years, all were

sterile; among the remaining there was an average of slightly above

three children each. Forty per cent. of all these cases had one or

more miscarriages. Nine had habitually suffered from severe

dysmenorrhea, eleven had slight dysmenorrhea, and twenty-two had never

felt the slightest inconvenience.

In a list of fifty-two cases, eight were added to the list already

given, all of whom had passed the menopause. Five were perfectly

healthy and had never suffered the slightest inconvenience. Of these,

one was single and only one had one miscarriage. Ten had suffered at

the time of the menopause from slight malaise, but not sufficiently to

call in a medical attendant. Thirty-seven were more or less seriously

ill; thirty of these needed local as well as constitutional treatment,

and seven constitutional treatment only.

The prominent symptoms of the climacteric were as follows: Marked

debility, 24; intense nervousness, 31; nervous prostration, 9;

melancholia, 10; headache, 14; neuralgia, 6; hysteria, 7; irritable

heart, 11; tachycardia, 8; insomnia, 19; indigestion, 32;

constipation, 28; diarrhea, 3; leucorrhea, 38; rheumatism, 21; gout,

1; Bright's disease, 12; hemorrhage, 6; alcoholism, 2; corpulency, 2.

As a result of the study of these cases, the most striking feature was

the relation of miscarriages to the sufferings and ill health at the

time of the menopause. Of the nineteen women who had miscarriages,

only one did not suffer in some way at the time of the menopause. Four

suffered only slightly, and fourteen suffered extremely, not only

during the menopause, but in the post-climacteric period as well. And

the next most striking feature was that the prominent symptoms of the

menopause are preeminently reflex or the functional diseases of the

nervous system.

Tilt believes that single women suffer less than other women at the

time of the menopause. He further writes: "As at puberty, from the

ignorance in which it is still thought right to leave young women, so

at the change of life, women often suffer from ignorance of what may

occur, or from exaggerated notions of the perils which await them. It

would be well if they were made to understand that if in tolerable

health, provided that they will conform to judicious rules, they have

only blessings to expect from the change of life. Most unfortunately,

the individual not cognizant of the invisible changes going on in the

economy does not adapt the mode of life to the new conditions of the

organism, and the weakened and lessened amount of the digestive fluids

is unable to master the large quantities of food. The absorbents

refuse to take more than is needed to repair the tissues. The

atrophying muscles of the digestive tube, unable to hurry on the mixed

products of indigestion; fermentation; and micro-organisms inciting

fermentations and elaborating toxic alkaloids, poison and disorder the

functions of life. Man's outdoor life enables him to escape many of

these evils.

"Woman's enervating mode of life, the continued introspection, coupled

with the peculiar changes in the nutrition of the body at this time,

render the nervous system peculiarly impressionable and liable to the

manifold forms of diseases. 'The woman is told that she must be calm

and patient, and in time the tomb-builder will alleviate all her

sufferings.' This critical period may be dangerous to those who are

always ailing, for habitiual sufferers at the menstrual periods, and

for those affected with uterine diseases. If, on the first indication

of the change of life, women who are in fair health carefully followed

a regimen and pursued a line of life in harmony with the physiologic

processes on which this change depends, disease would be prevented.

But as the change concerns a natural function, it is left to nature;

no additional precautions are taken, and advice is sought only when

the mischief is done."

It is not wise to marry during this period. On the first appearance of

the irregularities of the menopause the amount of food and stimulants

to which women have been accustomed should be curtailed rather than

augmented. The system requires supporting by medicine and regimen--

as, baths, mental and moral hygiene, and occupation-- rather than

stimulating by spirits.

We have seen that, in accordance with the plethric theory, which

prevailed until 1835, and with the nerve theory, which is based on the

latest anatomic and physiologic researches, menstruation is a

physiologic process to get rid of effete material, and is therefore an

excretion.

At the end of perhaps thirty years, by a conservative process of

nature, the child-bearing period ceases and the organism is readjusted

to the end that the woman's vitality may all be conserved for her own

individual life.

Each metamorphic or developmental period of life-- dentition, puberty,

and the menopause-- throws a special strain on the nervous system, and

the recent studies of the sympathetic nervous system at the time of

the menopause show that very extensive anatomic changes occur at this

time. That being the case, the woman must lead such a life as will

insure her having on hand a large reserve force necessary to meet

these heavy demands. Tilt's observations show that women who have

experienced no suffering at puberty or, at the menstrual periods do

not suffer at the menopause. It is therefore evident that the time to

begin this preparation is in childhood.

That single women suffer less than married women would suggest that

excessive coitus and the occurrence of abortions, frequent

child-bearing, and lesions as the result of pregnancies, many of which

lesions could have been prevented or cured by the timely aid of the

physician, are the combined sources of much of the suffering at the

time of the menopause.

That the most frequent and serious disturbances are those of the

nervous system, and that from their mode of life and habits of

introspection the rich suffer more from these ailments than the poor,

must cause serious consideration of the physiologic necessity for a

definite occupation for the daughters as well as for the sons of the

rich.

The frequency with which Bright's disease is found at the time of the

menopause is dependent not so much on the local physiologic changes

which are taking place as on the time of life. Loomis says that it was

not until life-insurance examinations became so common that the

frequency with which kidney disease existed in persons who believed

themselves well was even imagined. And as a result of his observations

in these cases, and of a large number of autopsies conducted at the

Bellevue, he stated that it was his belief that 90% of men and women

over forty years of age suffer from some form of Bright's disease.

That being the case, it would seem that after this period of life at

least as much attention should be directed to the kidneys as to the

teeth, and that a semi-annual examination of the urine should be made.

Although the menopause is a physiologic occurrence, yet, owing to the

many pathologic changes which are liable to take place at this time,

the woman should be as carefully watched during the menopause by the

gynecologist as the pregnant woman now is by the obstetrician. If the

same care were taken, in the majority of cases, the dangers attending

the menopause would be avoided, and the woman would be prepared to

enjoy a healthy and useful post-climacteric period of life.

CHAPTER XV.

HYGIENE OF THE MENOPAUSE.

Diet; Constipation; Stimulants; the Kidneys; the Skin; Turkish Baths;

Massage; Exercise; Profuse Menstruation; Hemorrhage; Mental Therapeutics.

"'Tis the breathing time of day."

-- "Hamlet."

Hygiene of the Menopause.-- The changes which occur in all the organs

of the body at the time of the menopause are retrograde, and therefore

just the opposite of those which occur at the time of puberty. This

fact should be borne in mind in the matter of alimentation. All that

is now needed is to make the repair equal to the waste.

Diet.-- Unless the woman is taking a great deal of active exercise, it

is better to diminish the amount of meat eaten, and to increase the

vegetable food and take more fluids. Unless the effect of the meat

eaten is counterbalanced by active outdoor exercise, it produces an

excess of waste matter, which accumulates and causes biliousness, and

sometimes rheumatism and gout. A vegetable diet is less taxing to the

excretory organs than an animal diet.

Indigestion is at this time of life apt to appear in the form of

fermentation, which may assume the gastric or intestinal type. The

chief causes of the formation of gases are the lessened peristaltic

action of the intestines, the increased tendency to congestion of the

liver and to obstinate constipation.

All dishes rich in sugar, as cake, candy, preserves, and jelly, should

be indulged in with moderation; or where there is a tendency to

fermentative indigestion, they should be wholly avoided.

All dishes known to be difficult of digestion, as hot breads, pastry,

cheese, fried dishes, and rich salads, should be cut off the menu,

since these readily overtax an already weakened digestive system.

If there is a hereditary tendency to rheumatism or gout, the disease

is most apt to take on an active form at this time. In either case the

manifestation of the disease indicates an excess of uric acid in the

system, and a diet becomes a necessity. Pickles, all highly spiced

articles of food, and vinegar must be omitted from the bill of fare.

The vinegar may be replaced in salad-dressings by lemon juice.

Tomatoes, rhubarb, strawberries and grapefruit are contra-indicated;

also all articles of food rich in sugar.

In chronic cases animal food cannot, as a rule, be excluded from the

dietary, but must be limited in quantity. Fish, eggs, and fowl may be

eaten, also a moderate amount of lean meat in the form of beef, lamb,

and mutton. Milk may be indulged in freely. The diet should consist

principally of easily digested fresh green vegetables. The amount of

tea and coffee should be limited. All malt liquors, sweet wines, and

champagne must be absolutely prohibited.

Constipation.-- A daily free evacuation of the bowels is essential to

good health. Where constipation exists, and the woman is full-blooded,

with a tendency to a rush of blood to the head, saline laxatives are

indicated. But if the woman is constipated and anemic, cascara sagrada

is a better laxative; while cod-liver oil acts as a laxative and at

the same time improves the quality of the blood.

Stimulants.-- Women resort to alcoholic stimulants as an analgesic to

relieve pain, whether physical or mental; as a narcotic to produce

sleep; and as a spur to a failing appetite or bodily powers.

The majority of women patients say that they first used alcohol in the

shape of whisky, brandy or gin to relieve pain at the time of the

menstrual period. The pain that is caused at this time by a chilling

of the body would be as effectually relieved by drinking a cup of hot

tea; while if the pain is intense and constant, recurring every month,

it is doubtless caused by some local inflammation, and the use of

alcohol only veils the real trouble, and the woman loses valuable time

by not consulting a physician at once.

As to the use of alcohol to blunt the nervous sensibility due to

mental suffering, it is the testimony of the entire medical profession

that this is the greatest cause of inebriety or drunkenness among

women of all classes of society.

Sleeplessness generally arises from some well-defined physical cause--

very frequently from inaction of the liver-- and the proper remedial

agents should be used to remove the cause.

While at first the use of alcoholic beverages increases the appetite,

as the amount taken is increased, distaste for food is created, the

system languishes under an insufficient food-supply, and the original

aim of increasing the appetite is defeated.

As to taking stimulants to do more work than one could otherwise

accomplish, it is by means of stimulants that woman can accomplish her

physiological ruin more quickly than is possible in any other way. And

the early symptoms of chronic alcoholism show themselves in the form

of neuralgia, insomnia, palpitation of the heart, and muscular

tremors.

The Kidneys.-- On account of the prevalence of some form of Bright's

disease after forty years of life, the kidneys should be carefully

watched at this time. And in order to keep them in good condition they

must be well flushed with water every day. Three pints of urine should

be excreted daily, and three pints of water as such must be taken into

the system daily. The urine should be examined by the physician every

six months. In this way kidney disease is often discovered in its

incipiency, which otherwise might run into a serious form of Bright's

disease.

The Skin.-- It must be remembered that the skin is one of the

excretory organs of the body, and the pores should be kept well open

by the various forms of baths.

The Turkish bath or some modification of it will often be found to be

particularly useful. Massage with alcohol after the bath lessens the

tendency to take cold. For a woman who is anemic or run down, it is

well to follow the Turkish with the Roman bath, which is an inunction

with almond oil or cocoa-butter. A much more thorough massage is given

with the Roman bath than with the "alcohol rub." It is often necessary

to modify the Turkish bath by omitting the steam-room and shortening

the time spent in the hot dry air. In ordinary cases the time spent in

the hot dry-room should be only that necessary for producing a free

perspiration. This time varies in different individuals from ten to

twenty minutes. No woman should go to a Turkish bath without first

consulting her physician, since if the woman has a weak heart, the

bath may be the source of positive danger. Comparatively few women are

strong enough to take the cold plunge.

Massage.-- Massage, well given by a skilful masseuse twice a week,

will greatly tone up the nervous and circulatory systems. Women who

are very stout and who have sluggish livers with obstinate

constipation will find massage particularly beneficial.

Exercise.-- Daily exercise in the open air is absolutely essential to

every woman's good health. The minimum amount of outdoor exercise

compatible with health is an hour's walk, at the rate of three miles

an hour. If the woman has never taken any exercise, she must begin

with a very short walk and stop on the first sign of fatigue.

Gradually increase the distance and the speed until the three miles is

reached.

Profuse Menstruation.-- If the menstrual flow is unusually profuse or

lasts beyond the regular time, the woman should stay quietly in bed

until the flow ceases. All exercise increases the flow.

The flow now becomes less in quantity, and the periods more infrequent

than formerly. Hemorrhage must always be regarded as a danger-signal

the significance of which can scarcely be overestimated. To

immediately consult a specialist on the appearance of any

irregularities of the flow would, in the opinion of the most eminent

gynecologists of the day, be the means of saving thousands of women's

lives every year.

Mental Therapeutics.-- It is particularly necessary at this time of

life that the mind should be pleasantly occupied. Her children have

passed the age when they need her constant supervision, and the mother

must take some relaxation from her home cares, in the form of social

diversions, amusements, outdoor life, and change of scene. Any mental

occupation that will take the woman out of herself is the best

possible safeguard against a state of introspection which conjures up

a host of evil fantasies, and which is the first step in the downward

road to a fixed and permanent melancholia.

"Hang sorrow, care will kill a cat;

And therefore let 's be merry."

CHAPTER XVI.

HINTS FOR HOME TREATMENT

Indigestion; Constipation; Diarrhea; Enemas; Vaginal Douche; Baths;

Headache; Fainting; Hemorrhage.

"Woman is woman's natural ally."

-- EURIPIDES.

Indigestion.-- The chief causes of indigestion are: eating rapidly,

eating at irregular hours, eating indigestible foods, constipation,

and lack of exercise. No one who values her good health will allow

herself to be hurried through a meal, nor will she allow the

perplexities of life to be thrust upon her at the table for solution.

The first requisite for the digestion of foods is that they should be

well masticated, so that the digestive fluids may act on the finely

divided particles to the greatest possible advantage. And while

digestion is going on all mental labor should be held in abeyance, in

order to avoid drawing the blood away from the stomach to the brain.

Furthermore, it is a well-known fact that digestion is best performed

when the meals are served at regular hours.

Constipation leads to the formation of gases in the intestines, to

fermentation, and to the absorption of toxic materials by the blood.

Through lack of exercise, the appetite fails, the liver becomes

torpid, and the muscular and nervous systems lose their tone.

The exercise which the housekeeper gets in going around her house is

not sufficient. Daily exercise in the open air is essential to health;

as this is to supplement the indoor exercise, the amount taken will

vary in proportion to the former. For teachers or those who have a

sedentary occupation an hour's active exercise in the open air-- a

three-mile walk-- should be supplemented by active gymnastic exercise.

For people in good health, a mixed diet-- that is to say, a diet

consisting of meat, vegetables, and fruit-- is the best. If the

individual is not well, then the diet must be adapted to meet the

needs of that particular case.

Hot breads, all articles of food fried in fats, salads, and pastry are

difficult to digest. Tea is very constipating, and when taken in

excessive quantities renders the individual nervous. An excess of

coffee leads to congestion of the liver.

Where indigestion exists, the simplest and most sensible remedies are

to regulate the diet, and avoid eating between meals. By drinking a

glass of water as hot as it can be sipped one hour before each meal,

the mucus is washed out of the stomach, the stomach is empty on coming

to the table, and in the best possible condition for the gastric juice

to act on the food-stuffs.

Constipation.-- Constipation is the rule with the average American

woman; the causes are their corsets, the tight bands of their

clothing, lack of exercise, and the fact that they drink too little

water and too much tea. The most rational means to overcome it is to

drink more water; at least three pints a day should be taken, in

addition to soups, tea and coffee, and so forth; the water must be

taken into the system as such. Then attention must be given to the

diet; plenty of fruit should be eaten, vegetables, and coarse bread.

Regularity in this, as in all other habits of life, is most essential,

and the individual should go to the toilet at the same hour every day,

even if there is no inclination to have a bowel movement, and thus the

habit will be established; the most convenient time is directly after

breakfast.

Medical Treatment.-- But if all these means have failed, medicines

must be resorted to. Cold water is a better laxative than hot; to a

glassful of cold water add from one teaspoonful to one tablespoonful

of the effervescing granules of the phosphate of soda, and take this

the first thing on rising in the morning. This preparation of soda is

particularly useful because it acts slightly on the liver. Other

laxatives are: a seidlitz powder dissolved in a glass of cold water on

rising; a wineglass or more of Hunyadi Janos, also taken on rising.

Any of these may be taken with safety by pregnant women. For children

the simplest laxative is one teaspoonful of Husband's milk of

magnesia, to be taken in one glass of water on rising.

Enemas.-- Perhaps one of the most common methods used by the laity for

the relief of constipation is the rectal injection, or enema. Enemas

habitually given to unload the bowels are productive of much harm by

overdistending the rectum, so that in time the rectum fails to react

to the normal stimulus-- namely, the presence of the feces-- as it

otherwise would. But by some means or other the bowels must be well

moved once every twenty-four hours. And it is much better to use an

enema than to go to bed without a bowel movement. If the woman is

going around, so that she can give the enema to herself, the most

effective way to take it is in the knee-chest position or an

approximation to this. Either a fountain or bulb syringe may be used

for this purpose; a quart of water at a temperature of 110∞ F. should

be prepared by making it into a suds with castile soap, or one

tablespoonful of glycerin may be added to one pint of water. The nozle

to be used is the smallest one that comes with the syringe, the

so-called infant's nozle; this is quite large enough, and its

insertion is not nearly so painful as the larger ones; the nozle must

be well greased with vaselin. When everything is ready, the patient

gets down on her knees with the shoulders near the floor, having first

loosened all of her bands and taken off her corsets; the nozle is

introduced as far as it will go into the rectum, and if a bulb syringe

is used the water must be very gradually squeezed into the rectum,

otherwise it will not retain so much; or if the fountain syringe is

used, it must not be hung too high. So soon as the patient feels that

she has taken all that she can retain, she should lie down on the left

side, and retain the water as long as possible, as it is thus rendered

more effective. An enema so taken will be very much more effective

than one taken in the ordinary manner of sitting on the toilet. In the

method just described more water can be used and it will be longer

retained; it can be felt to go up along the course of the large bowel,

and it will often be found very effective when the ordinary enema

fails. This enema will often be found to be a very valuable aid in

curing an obstinate chronic diarrhea, which is kept up by particles of

feces remaining in the folds of the large intestine. If the patient is

confined to bed, she should lie on the left side, with a heavy towel

folded under her to prevent the bed from becoming wet; when the nurse

withdraws the nozle she should make pressure on the anus with the

towel, to help the patient to retain the water as long as possible.

But should the patient have gone so long without a bowel movement that

all these means fail, it will be necessary to precede the water enema

with one of oil; or still more effective is the following combination:

take one teaspoonful of the spirits of turpentine, the yolk of one

egg, and two tablespoonfuls of olive oil, and beat well together, and

add to these one pint of water at a temperature of 110∞ F.

Constipation, however, of so obstinate a character as this demands a

physician's attention.

Diarrhea.-- A diarrhea may be acute or chronic; the treatment is

essentially different. For an acute attack accompanied by frequent

stools and severe abdominal pain the first thing to do is to go to

bed. If there is nausea, drink a glass of water as hot as can be

taken, at once; for the diet, a glass of scalded milk, not boiled but

just allowed to come to the boiling-point, every two hours; and

nothing else should be taken until the diarrhea is well in check. If

the pain is severe, a spice plaster over the abdomen will be found to

be very comforting. It is made as follows: take of powdered allspice,

cinnamon, cloves, and ginger each two tablespoonfuls, and two

teaspoonfuls of cayenne pepper; mix well together in a bowl; then

quilt in a piece of flannel large enough to cover the abdomen; when

ready for use, dip in hot whisky and apply as hot as the patient can

bear; cover over with a large napkin, as the plaster produces a deep

stain which does not wash out; keep on as long as necessary. If the

rest in bed and the milk diet kept up for twenty-four hours do not

suffice to cure the diarrhea, it is not wise to take any risks, but

send for your doctor at once. Or if there should be any blood in the

stools, do not wait for anything, but send for the doctor without

delay.

For a chronic diarrhea an enema given in the knee-chest position, as

already described, will often be found a most efficient remedy. In

diarrheas the use of fruits and vegetables should be avoided; the best

diet after the milk is bread well toasted through, toast-water,

soft-boiled eggs, beefsteak, oyster stew, and clam broth.

Vaginal Douche.-- To be of service except for mere cleansing purposes

the douche must be taken in the horizontal position, either on a couch

or, if it is not cold, on the floor. Of course, this position

necessitates the use of a douche-pan. The douche-pan is best of

agate-ware, oblong in shape, and with a broad strip which comes under

the nates. On lying down to take the douche the nates must come down

well over the pan and the clothing must be pushed well up to prevent

the water from seeping up the back. To make the woman more comfortable

there should be a pillow under the head, and she must have a shawl or

some light woolen material to throw over her while taking the douche

to prevent chilling; thus doing more harm than good.

There are two forms of syringes on the market: the bag or fountain

syringe, which is hung up sufficiently high-- about three feet above

the patient-- to cause the water to flow; and the bulb syringe, in

which the bulb has to be constantly squeezed by the hand, which is

tiresome to many women, but this is a much more convenient form to

have in traveling. During pregnancy the fountain syringe only should

be used, and it should be hung as low as will enable the water to

flow. For a woman who has never taken douches it is well to begin with

a temperature of 110∞ F., gradually increasing the temperature to 118∞

or 120∞; this is as high as the woman should attempt to go, for a

higher temperature would burn her, leaving the vulva so sensitive that

she would only be able to take cool douches for a long time after

this; a bath thermometer should be used in all cases to test the

temperature, so that the woman knows exactly what she is doing.

In cases of inflammation of the uterus or its adnexa four quarts of

water should be used, and the douche should be taken in the horizontal

position. The water thus acts as a hot poultice about the uterus, and

the woman will find on rising that some water flows out from the

vagina. Ordinarily plain hot water is all that is necessary to use,

but where the discharge is acrid and scalding, the plain hot-water

douche should be followed by a warm douche containing one teaspoonful

of borax to a pint of water. The best time for taking a douche is at

night just before retiring; there is also less danger of taking cold

when the douche is taken at this time.

The scalding sensations at the vulva may be due to the acidity of the

urine, in which case it will be increased just after urination; or it

may be due to an acrid discharge from the vagina. A little observation

on the part of the patient will enable her to distinguish which is the

real cause. If there is any trouble with the urine, it should be

carefully examined at once, as some congestion or inflammation of the

kidneys is not infrequently present, which if attended to might be

cured, and which if allowed to run on unattended to, may develop into

a serious form of Bright's disease.

The genitals should be washed with soap and water night and morning.

Women who do not suffer from leuchorrhea need not take a vaginal

douche more than once a week; after the menstrual flow the vaginal

injection is advised to remove the detritus of the flow.

Baths.-- The most ordinary forms of baths used may be classified under

sponge-, shower-, sitz-, and tub-baths. The sponge-bath as ordinarily

taken is of service for cleansing purposes, and if the water be cold

it tones up the system to some extent, and is so a preventive against

taking cold. The effect of this bath will be found to be vastly more

beneficial if salt is added to the bath in the proportion of a pint of

salt to a gallon of water; either sea-salt may be used or the ordinary

coarse salt. It is most advantageously taken sitting in a bath or

hat-tub, so that the entire surface of the body will be wet at the

same time, and the water can be allowed to run down the back and over

the chest. It is well to begin these baths at a temperature of 80∞ F.

and to gradually decrease this until the bath is taken at 70∞, which

is about the temperature of running water, and the bath should be kept

up at this. For most people the best time to take the bath is just

before retiring; this bath is not only very strengthening, but also is

excellent in cases of insomnia and nervousness.

Shower-baths.-- These may be taken after a hot bath, or taken alone

after violent muscular exercise. The body should be quickly scrubbed

off and the shower should be warm at the beginning and gradually

allowed to become cold, stooping over so as to get the full force of

the shower on the spine and over the region of the stomach and heart.

They will be found to be most refreshing after great muscular fatigue,

and, when taken after the hot tub-bath, greatly lessen the

susceptibility of the individual to taking cold.

Sitz-baths.-- These are given for their local effect in cases of

inflammation; whether this inflammation be of the kidneys, bladder, or

of the uterus and its adnexa. A sitz-tub is necessary to properly take

this form of bath. The water should be used as hot as is comfortable

to the patient, from 105∞ to 110∞ F., hot water being added as the

first cools off; a pint of salt should be added to the gallon of

water, and the patient should remain in this from five to eight

minutes. A blanket should be wrapped about the patient so that she

will be thrown into a perspiration; it is almost needless to say that

the only time for taking this bath is just before retiring, and that

this bath does make the woman more susceptible to taking cold, so that

it is necessary to wear an abdominal woolen bandage day and night.

Tub-baths.-- The tub-bath ought not, as a rule, be taken more than

twice a week, unless the cold plunge is used, which may be taken every

day. If the tub-bath is taken hot, the woman should remain in it not

much longer than is necessary to scrub off with a flesh-brush; this

bath should be followed either with a cold shower-bath, or the water

in the tub be gradually allowed to cool off until it is down to 70∞ F.

Headaches.-- Headaches, aside from those of acute illness, may be

roughly divided into three classes: first, those which are due to

indigestion; second, neuralgic headaches; and, third, those due to

pelvic inflammations. The headaches due to indigestion are usually

located over the eyes and all over the forehead; they are more or less

constant and are accompanied by other symptoms of indigestion, and

very often by constipation. The feces are allowed to remain in the

bowels overlong, the toxic matters are taken up by the blood, and

headaches and vertigo result.

Neuralgic headaches are of an entirely different character; the pains

are here of a lancinating character, and are not confined to any one

region of the head. As a rule, they are accompanied by neuralgic pains

in other parts of the body. Neuralgia generally means a rundown state

of the system from overwork, worry, or malaria, and tonics and

cod-deliver oil are indicated.

A constant dull pain on the top of the head or in the back of the neck

generally indicates some uterine inflammation, and can only be cured

by removing the cause. In any case it is very evident that taking the

various "headache powders" with which the market is flooded will never

cure the woman of her headaches; and many of these powders are very

dangerous, especially where the heart is weak, as most of them are

heart-depressants.

Fainting.-- Fainting may be due to a weak heart, to heart disease, or

to sudden shock, as on receiving a bad piece of news; during pregnancy

the close air of a room may cause a woman to faint. The first thing to

be done is to lay the woman down on the floor or bed with nothing

under her head; loosen all her clothes about the neck and waist, and

throw the windows open so that she will get plenty of fresh air. If

she is able to drink, give her one teaspoonful of aromatic spirits of

ammonia in four tablespoonfuls of cold water. If the feet are cold,

place hot-water bottles to them to improve the circulation. And if at

the end of fifteen minutes she does not show signs of decided

improvement, give her two tablespoonfuls of whisky in an equal

quantity of hot water. In the meantime the physician will have been

summoned. These attacks of fainting often occur in a crowded

ball-room, and are due to tight lacing and the poor ventilation of the

room.

Hemorrhage.-- A profuse hemorrhage is the most alarming as well as the

most dangerous thing which can befall a woman, and the very nearest

doctor should be summoned until the family physician can be gotten

there. The woman should be made to lie down wherever she may happen to

be, her clothes loosened, the windows thrown open, so that she will

not only have plenty of fresh air, but that the air shall be cool. If

the blood is coming from the mouth, give her pieces of ice to hold in

it; if she coughs up the blood, it would be well to put a bag of

ice-cold water or cloths wrung out of ice-water on the chest. If the

woman is suffering from a uterine hemorrhage, have her take at once a

hot vaginal douche, from 118∞ to 120∞ F., and have the foot of the bed

raised. The head should always be kept low.

Women hold their health in their own hands to a far greater extent

than they have ever dreamed of; and if the majority of women suffer,

it is very often their own fault, either because they have disregarded

nearly every law of health, or have allowed trivial ailments to go on

until they were almost incurable.

_______

"The broad mountain-top, with its sunlight and free air, is

possible to all of us, if we choose to struggle on and reach it."

-- Phillips Brooks.

_________________

GLOSSARY.

_________________

Abortion. The expulsion of the fetus before the end of the third lunar

month.

Afferent Nerves. Those nerves which convey the impressions to the

nerve-centers.

After-pains. The pains which follow labor and which are caused by the

contractions of the uterus.

Amenorrhea. Absence of the menstrual flow.

Anemia. The so-called thinness of the blood, due to a deficiency of

red blood-corpuscles.

Antisepsis. The use of chemical substances which have the power of

destroying germs.

Anus. The external circular outlet of the rectum or distal part of the

large intestine.

Appendages, Uterine. The Fallopian tubes, the ligaments of the uterus,

and the ovaries.

Atrophy. A progressive diminution in the bulk of an organ or tissue.

Automatic. Involuntary, mechanical.

Bulbi Vestibuli. A plexus of veins on each side of the vestibule.

Capillaries. The terminal and very finest branches of the

blood-vessels.

Catamenial Flow. See Menstruation.

Cellular Tissue. A loose, transparent tissue which surrounds the

muscles and organs of the body.

Cerebrum. The upper and larger portion of the brain.

Chlorosis. Anemia of young women about the time of puberty.

Climacteric. See Menopause.

Clitoris. A small, elongated, erectile organ situated at the upper

part of the vulva.

Cohabitation. See Coitus.

Coition. See Coitus.

Coitus. Syn., coition, copulation, cohabitation, sexual congress,

sexual intercourse. The carnal union of the sexes.

Colostrum. A thin albuminous fluid which appears in the breasts at the

fourth month of pregnancy.

Conception, or impregnation, is the union of the germ and sperm cell

which results in a new being.

Confinement. Childbed, the expulsion of the child from the womb.

Congestion. The abnormal accumulation of blood in a part.

Constipation. Costiveness; a state in which there is not a free daily

evacuation of the bowels, or where the evacuations are hard or

expelled with difficulty.

Continence. Abstinence from or moderation in sexual indulgence.

Copulation. See Coitus.

Cord, Umbilical. The cord which connects the fetus with the mother.

Through the blood-vessels contained in this cord the child receives

nourishment.

Corpuscle. A very small particle.

Decidua. A membranous sac formed in the uterus during gestation, and

thrown off after parturition.

Defecation. The act by which the contents of the bowel are expelled

from the body.

Dehiscence. The splitting open of an organ.

Dentition. The cutting of the teeth.

Dysmenorrhea. Painful and difficult menstruation.

Dystocia. A difficult labor.

Embryo. The name applied to the very earliest stages of the child in

utero; that is, up to about the time of quickening.

Endometrium. The lining membrane of the uterus.

Epithelium. A layer of minute cells which forms the covering of many

membranes.

Erection. The state of a part which, having been soft, becomes rigid

and elevated by the accumulation of blood within its tissues.

Fallopian Tubes. Two very small tubes extending from the upper angles

of the uterus to the ovaries and serving to convey the ova from the

ovaries to the uterus.

Feces. Stools; the normal discharge from the bowels.

Fetus. The child in utero from the time of quickening to that of

birth.

Fomentations. The application of cloths which have previously been

dipped in hot water.

Function. An action of an organ which could be performed only by that

organ, and which is necessary to the well-being of the individual.

Generative Organs. Syn., genital, reproductive, sexual; those organs

in the male and female by means of which a new being is created.

Genital. See Generative.

Gestation. See pregnancy.

Gonorrhea. A highly contagious venereal disease, characterized by an

inflammatory discharge of mucus from the urethra and prepuce in the

male, and from the urethra and the vagina in the female.

Graafian Follicles. Minute ovarian vesicles which contain the ova.

Hemorrhoids. Piles or tumors at or within the anus, and consisting of

enlarged veins.

Hymen. The semilunar fold situated at the outer orifice of the vagina

in the virgin.

Hypertrophy. The increased activity of a part which leads to an

increase in its bulk.

Hypochondriasis. Morbid feelings concerning the health and simulating

disease.

Impregnation. See Conception.

Infectious. See Contagious.

Katabolic Nerves are those nerves which stimulate the breaking down of

tissue.

Labia Majora. Two thick folds of skin which extend backward from the

mons veneris.

Labia Minora. Nymphae; two very delicate folds of skin which are

inside of and protected by the labia majora.

Labor. See Parturition.

Lactation. The secretion of milk; nursing, suckling the child.

Lactiferous Ducts. The milk ducts.

Leucorrhea. Whites; a whitish or yellowish discharge from the vagina.

Lochia. A discharge which follows labor and which lasts for about two

weeks.

Lying-in. The period which follows childbed.

Lymphatics. The vessels in which the lymph is carried.

Mammae. The mammary glands; the breasts.

Marital Relations. See Coitus.

Massage. A systematic kneading of the muscles.

Meatus Urinarius. The external orifice of the urethra.

Meconium. The first discharge from the infant's bowel after birth, and

which had collected in the intestines during the pregnancy.

Medulla. The base of the brain at its junction with the spinal cord.

Menopause. Climacteric, change of life, the time of the natural

cessation of the monthly sickness.

Menorrhagia. An excessive menstrual flow.

Menstruation. Menstrual period, menstrual flow, menses, monthly

sickness, the monthly discharge of blood from the uterus, which, with

certain exceptions, recurs monthly from about the age of thirteen to

forty-six years.

Metabolism. Transformation changes.

Metamorphoses. Changes of shape or structure.

Metrorrhagia. A flow of blood between the menstrual periods.

Micturition. The act of passing water.

Miscarriage. The expulsion of the fetus between the twelfth and

twenty-eighth weeks.

Molecular. Belonging to the molecules, or the minutest portion of

anything.

Mons Veneris. The uppermost part of the vulva, which is a fatty

cushion covered with hair.

Nerve-center. A nerve station from which orders are transmitted and

where orders are received.

Nubile. Puberty, that period of life in which young people of both

sexes are capable of procreating children.

Nymphae. See Labia minora.

Ovaries. Two small ovoid bodies, one on each side of the uterus, in

which the ova are formed.

Oviduct. See Fallopian tobe.

Ovulation. The formation of the ova in the ovary, and the discharge of

the same.

Ovule. See Ovum.

Ovum. Germ cell, a small, round vesicle situated in the ovaries, and

which, when fecundated, constitutes the rudiments of the embryo.

Parturition. Labor, delivery, child-birth, the expulsion of the child

from the womb.

Pathologic. Relating to the diseased condition of tie body.

Pelvis. The bony cavity situated at the lower end of the spinal column

and supported by the thighs.

Periodicity. The recurrence of physiologic phenomena at regular

intervals.

Periphery. The circumference of an organ.

Peristaltic Action. An alternate contraction, making small, and

enlargement of the bowel; it is by this means that foods, etc., are

forced along its passage.

Peritoneum. A serous membrane which lines the abdominal cavity, and

wholly or in part envelopes the organs contained in it; it also partly

covers the organs contained in the pelvic cavity.

Phenomena. Remarkable appearances.

Physical. Pertaining to the body.

Placenta. After-birth, a soft, spongy, vascular body adherent to the

uterus, and which is connected with the embryo through the umbilical

cord.

Plethora. A condition marked by a superabundance of blood.

Postpartum Hemorrhage. Hemorrhage following labor.

Pregnant. Enceinte, gravid; the state of a woman who is with child.

Premature Labor. The expulsion of the fetus between the end of the

twenty-eighth week and the time that labor ought to have occurred.

Propagation. The spreading or extension of a thing.

Pruritus Vulva. An intense itching of the privates, or vulva.

Psychic. Pertaining or belonging to the mind.

Puberty. Sexual maturity; nubility; that period of life in which young

people of both sexes are capable of procreating children.

Pubes or Pubis. The lowest and middle part of the pelvis in its

anterior surface.

Puerperium. The lying-in after child-birth.

Quickening. The sensation experienced by the mother as the result of

active fetal movements in the womb.

Rectum. The lower extremity of the large intestine.

Reflex. The reflection of an impulse from a nerve-center which has

been received from elsewhere by that center.

Reproduction. See Generative.

Respiration. Breathing.

Rugs. Wrinkles.

Rut. The copulation of animals.

Septicemia, Puerperal. Childbed fever.

Sexual. That which relates to sex. See Generative.

Smegma. A cheesy substance which may collect about the vulva.

Spermatozoa. The essential male fertilizing elements.

Sympathetic Nervous System. Presides over involuntary acts; as

digestion, breathing, etc.

Syphilis. A venereal disease which is highly contagious by coition,

contact with the lips, etc.

Tachycardia. Distress in the region of the heart, with palpitation and

shortness of breath.

Umbilicus. Navel.

Urea. The most important of the solid constituents of the urine.

Ureters. The ducts leading from the kidneys to the bladder.

Urethra. The excretory duct from the bladder for the escape of the

urine.

Urination. The act of passing water.

Uterosacral Ligaments. Ligaments which pass from the uterus to the

sacrum, and assist in holding the uterus in position.

Uterus. Womb; the hollow, pear-shaped pelvic organ which is destined

to retain the child from the moment of its conception until the time

of its expulsion at birth.

Utricular Glands. Glands of the uterus.

Vagina. The canal which connects the female internal and external

organs of generation.

Vascular. Pertaining to the blood-vessels.

Vasomotor Nervous System. Comprises the brain, spinal cord, and the

nerves given off from the cord: this system presides over voluntary

acts, that is, those acts which are under the control of the will.

Vestibule. A smooth cavity that exists in the female between the

perineum and the nymphae.

Viscera. The contents of the large cavities of the body.

Vulva. The external genitals, private parts, the female external

organs of generation.

Vulvitis. Inflammation of the vulva.