needed. But in the ovum that has been impregnated, and which is now
called an embryo, a feverish activity commences. First of all it looks
for a fixed place of abode. If the ovum happened to be in the uterus
when the spermatozoön met and entered it, it remains there. It becomes
attached to some spot in the lining of the womb and there it grows and
develops, until at the end of nine months it has reached its full
growth, and the womb opens and it comes out into the outside world. If
the ovum is in the Fallopian tube when the spermatozoön meets it, as
is usually the case, it travels down to the uterus, and fixes itself
there.
=Extra-Uterine Pregnancy.= The tube is a bad place for the ovum to
grow and develop, because the tube cannot stretch to such an extent as
the uterus can, nor can it furnish the embryo such good nourishment as
the uterus can. Occasionally, however, it happens that the impregnated
ovum remains in the tube and develops there; we then have a case of
what we call _extra-uterine_ (outside-of-the-uterus) or _tubal_
pregnancy. Extra-uterine pregnancy is also called _ectopic_ pregnancy,
or ectopic gestation. Unless diagnosed early and operated upon, the
woman may be in great danger, for after a few weeks or months the tube
generally ruptures.
From the moment the spermatozoön has entered the ovum, a process of
_division_ or _segmentation_ commences. The ovum, which consists of
one cell, divides into two, the two into four, the four into eight,
the eight into sixteen, these into thirty-two, these into sixty-four,
128, 256, 512, 1,024, until they can no longer be counted. This
mulberry mass of cells arranges itself into two layers, with a cavity
in between. And from these layers of cells there develop gradually all
organs and tissues, until a fully formed and perfect child is the
result. If two ova are impregnated at the same time by two
spermatozoa, the result is twins.[5]
I might mention here that the moment the ovum is impregnated, i.e.,
joined by a spermatozoön, it is called technically a zygote; it is
also called embryo, and this name is applied to it until the age of
five or six weeks. Some use the term embryo up to two or three months.
After that, until it is born, it is called fetus.
A study of the development of the embryo and the formation of the
various organs from one single cell, the ovum, vitalized or fecundated
by another single cell, the spermatozoön, is the most wonderful and
most fascinating of all studies. But that belongs to the domain of
Embryology, which is a separate science.
What we see in the process of fecundation is a foreshadowing of the
future man and woman. The ovum has no motion of its own, it is moved
along by the wave-like motions of the lining cells of the Fallopian
tube, and throughout the entire act it remains passive. The
spermatozoön, on the other hand, is in a state of continuous activity
from the moment it has been ejaculated by the male until it has
reached its goal--the ovum. And as the spermatozoa carry in them the
entire impress of the man, and the ova of the woman, they foretell us
the fates of the future boy and girl. The woman's rôle throughout life
is a passive and the man's an active one. And in choosing a mate the
man will always be the active factor or pursuer. So biology seems to
tell us. Whether education--using the word in its broadest sense--will
effect a radical change in the relation of man and woman remains to be
seen. A change putting the man and the woman on a footing of
_equality_ would be desirable; but whether biological differences
having their roots in the remotest antiquity can be obliterated, is a
question the answer of which lies in the distant future. As Geddes and
Thomson so well said: The differences [between the sexes] may be
exaggerated or lessened, but to obliterate them it would be necessary
to have all the evolution over again on a new basis. What was decided
among the prehistoric Protozoa cannot be annulled by act of
Parliament.
FOOTNOTES:
[4] Hair-like appendages.
[5] Each ovum has one germinal vesicle; occasionally one ovum may
contain two germinal vesicles; and from the impregnation of such an
ovum a twin pregnancy may result.
CHAPTER TEN
PREGNANCY
Period of Pregnancy in Human Female--Physiologic Process of
Pregnancy--Growth of Embryo from Moment of Conception--Pregnant
Woman Provides Nourishment for Two--Her Excreting Organs Must
Work for Two.
From the moment the ovum has been fertilized or fecundated by the
spermatozoön, the woman is said to be pregnant (or in French
_enceinte_. This term was used very frequently and is still used by
prudes, who seem to consider the word pregnant vulgar and
disgraceful). Pregnancy, or the period of gestation, lasts from the
moment of conception to the moment that the fetus or child is expelled
from the uterus. The period of pregnancy differs very widely in
different animals,[6] but in the human female it lasts nine calendar
months or ten lunar months--from about 274 to 280 days. We usually
count 280 days from the _first_ day of the _last_ menstruation. A
pregnant woman generally wants to know the day of the expected
confinement--for this purpose a table is appended to this chapter. If
you know the first day of your last menstruation, you will see at a
glance when the confinement may be expected. There may be a difference
of a few days--either before or after the expected date--but for
practical approximate purposes the tables serve very well.
A simple way is to count back three months and add seven days. For
instance, a woman's last menstruation occurred on April 4th; counting
back three months gives you January 4th; add seven days and you get
January 11th, the probable date of delivery. The first day of the last
menstruation was December 30th; counting back three months gives you
September 30th; add seven days and you get October 6th, the probable
date of delivery. The presence of a short month like February may be
disregarded, as the calculation is not absolutely, but only
approximately correct.
The period at which the child's movements begin to be felt by the
mother is termed Quickening. It usually occurs at the middle of the
pregnancy, between the 16th and 18th week.
Pregnancy is a normal physiological process; but every active
physiological process is apt to be accompanied by disturbances, and
there is certainly no process in the animal body in which greater
activity, greater changes, go on than during the process of pregnancy.
Just see what occurs in nine months. The uterus, at first the size of
a small pear, reaches a size larger than that of the head of a big
man; it does not merely stretch, as some think, but it actually grows
enormously in size, the muscular walls of a pregnant uterus being many
times thicker than those of a non-pregnant one. They have to be or
they would not have the strength to expel the child, when the proper
time comes. It is to be borne in mind that the child does not slip out
by itself; it is the powerful muscular contractions of the uterus that
push it out. If the uterus should refuse to work, if its walls were
too thin or too weak, the child could not come out, but would have to
be taken out with forceps. Still greater changes than in the uterus
take place in the child itself. At the moment of conception it is the
size of _the head of a pin_; at the moment of birth it weighs from
seven to ten pounds; at the moment of conception it is a minute,
undifferentiated mass of protoplasm, just a single fertilized cell; at
the moment of birth it consists of millions and millions of cells,
which have become differentiated into numerous harmoniously working
organs, and different tissues, such as brain and nerve tissue,
muscular tissue, connective tissue, bone, cartilage, etc., etc. A
truly wonderful process. And in the meantime this child, which is
biologically a parasite (though it is not a nice name to call it by)
draws its sustenance from the mother's blood, and the mother has to
provide nourishment for two. And, besides providing nourishment, her
excreting organs, her kidneys, must work for two, because her system
has also to get rid of the child's excretions. No wonder that the
pregnant woman, particularly under an artificial unhealthy mode of
living, is subject to many troubles and disturbances.
DR. ELY'S TABLE FOR CALCULATING THE DATE OF CONFINEMENT
---------+-----------------------------------------------
January | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OCTOBER | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 |NOV.
----------------------------------------------+-----
---------+-----------------------------------------------
February | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NOVEMBER | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 |
24 25 26 27 28 29 30 1 2 3 4 5 |DEC.
----------------------------------------------+-----
---------+-----------------------------------------------
March | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
DECEMBER | 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 |JAN.
----------------------------------------------+-----
---------+-----------------------------------------------
April | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
JANUARY | 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
22 23 24 25 26 27 28 29 30 31 1 2 3 4 |FEB.
----------------------------------------------+-----
---------+-----------------------------------------------
May | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
FEBRUARY | 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 |MAR.
----------------------------------------------+-----
---------+-----------------------------------------------
June | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
MARCH | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
24 25 26 27 28 29 30 31 1 2 3 4 5 6 |APRIL
----------------------------------------------+-----
---------+-----------------------------------------------
July | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
APRIL | 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 |MAY
----------------------------------------------+-----
---------+-----------------------------------------------
August | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
MAY | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 |JUN.
----------------------------------------------+-----
---------+-----------------------------------------------
September| 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
JUNE | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
24 25 26 27 28 29 30 1 2 3 4 5 6 7 |JULY
----------------------------------------------+-----
---------+-----------------------------------------------
October | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
JULY | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 |AUG.
----------------------------------------------+-----
---------+-----------------------------------------------
November | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
AUGUST | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
24 25 26 27 28 29 30 31 1 2 3 4 5 6 |SEPT.
----------------------------------------------+-----
---------+-----------------------------------------------
December | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
SEPTEMBER| 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 |OCT.
----------------------------------------------+-----
EXPLANATION.--Find in top line the date of menstruation, the figure
below will indicate the date when confinement may be expected, _i.e._,
if date of menstruation is June 1st, confinement may be expected on
March 8th, or one day earlier if leap year.
FOOTNOTES:
[6] For instance, in rabbits one month, in dogs two months, in sheep
five months, in cows nine months, in horses eleven months.
CHAPTER ELEVEN
THE DISORDERS OF PREGNANCY
Smooth Course of Pregnancy in Some Women--Pregnancy and
Parturition May be Made Normal Processes Through Education in
True Hygiene--Morning Sickness and Its Treatment--Necessity for
Medical Advice in Pernicious Vomiting--Anorexia--Bulimia--Aversion
Towards Certain Foods--Peculiar Cravings--Tendency to Constipation
Aggravated by Pregnancy--Dietary Measures in Constipation--Rectal
Injections in Constipation--Laxatives--Cause of Frequent Desire to
Urinate During First Two or Three and Last Months of Pregnancy--
Treatment of Frequent Urination--Cause of Piles During Pregnancy
and Their Treatment--Cause of Itching of External Genitals During
Pregnancy and Treatment--Cause of Varicose Veins and Treatment--
Liver Spots.
We saw that in some women menstruation runs a perfectly smooth course,
free from any disagreeable symptoms. The same is true of pregnancy. It
is remarkable how smooth and easy the entire course is with some
women. Many women know that they are pregnant only because of the
non-appearance of the monthly periods; and even in the later months
they feel no discomfort, attending to all their work and pleasures as
usual; and even childbirth is a trifling matter with them.
Unfortunately the number of such women is not very large, and,
because of our confined, unnatural, often exhausting way of living,
is becoming smaller and smaller. There is no question that the
civilized, refined woman has a harder ordeal in pregnancy and
childbirth than has her primitive sister. We confidently hope that
this will not be so in the future; we expect the time to come when
true hygiene will be an integral part of the education and the life of
every girl, and then pregnancy and parturition may become even easier
processes than they are in the primitive races. But the time is not
yet; and in the meantime our young women have a good deal to go
through.
=Morning Sickness.= One of the commonest disorders of pregnancy is the
so-called morning sickness. This consists in a feeling of nausea and
vomiting, which comes on soon after getting up. The morning sickness
makes its first appearance in the third, fourth or fifth week of
pregnancy and lasts usually until the end of the third or fourth
month. In some women, however, the morning sickness comes on in a few
days after impregnation has taken place, and those women diagnose
their condition unmistakably by the feeling of slight nausea which
they experience on getting up. Medicines are as a rule of little use
in treating morning sickness. The "disease" can be relieved but not
cured. The patient should stay in bed later than usual, should have
her breakfast in bed, and then not get up for about half an hour
afterward. If the patient is anemic, a good iron preparation may prove
useful.
=Pernicious Vomiting.= The vomiting of pregnancy sometimes becomes so
severe and uncontrollable that it has been given the name pernicious.
The patient is unable to retain any kind of food, not even liquids,
vomits almost incessantly, and may become very much run down and
exhausted. The vomited matter may contain blood. For this condition a
competent physician must be consulted, for in some cases the patient's
life may be in danger and an abortion has to be performed.
=Capricious Appetite.= A capricious appetite is very common in
pregnancy. The capriciousness may express itself in four different
directions: (1) The patient may lose her appetite, almost altogether,
partaking only of very little food, and that with effort. This
condition of loss of appetite is called anorexia. (2) The patient may
develop an enormous appetite--what we call bulimia--eating several
times as much as she does ordinarily. (3) She may develop an aversion
towards certain articles of food. Thus many women develop an aversion
towards meat, the mere sight of or talk about meat causing in them a
sensation of nausea. (4) She may show a craving for the most peculiar
articles of food and for articles which are not food at all. The
craving for sour pickles or sour cabbage is well-known; but some women
will eat chalk, sand, and even more peculiar things (for the chalk
there may be a reason: the system needs an extra amount of lime and
chalk is carbonate of lime).
=Constipation.= Constipation is very common among women in the
non-pregnant condition; but in the pregnant it is much more common and
much more aggravated. Constipation must be guarded against, but the
measures must be of a mild nature. If we can relieve the constipation
by dietary measures alone, so much the better. The dietary measures
should consist in eating plenty of fruit--prunes, apples, figs, dates,
etc., and coarse bread and bran. Constipating articles, such as cheese
or coffee, should be eliminated. Where dietary measures alone are
insufficient, the patient should take an enema--a rectal
injection--twice or three times a week. The enema should consist of
about 8 ounces (half a pint) of cold or lukewarm water containing a
pinch of salt, and should be retained about ten minutes. Instead of
water, we may advise an occasional enema of two to four drams of
glycerin. Or instead of a glycerin enema, a glycerin suppository may
be used. If internal laxatives are to be used, only the mildest and
non-griping preparations should be employed The best are: a good
mineral oil--one or two tablespoonfuls on going to bed, or fluid
extract of cascara sagrada, one-half to one teaspoonful on going to
bed. It is very important, whatever we use, _not_ to use the same
thing for a long time. If the same drug or measure is used without any
change, the bowels get used to it and cease to respond and we have to
use larger and larger doses. In fighting constipation we must
therefore constantly change our weapons: one night we use mineral oil,
the next night cascara sagrada, the third night an enema, the fourth
night a glycerin injection or suppository, the fifth night perhaps
nothing at all, the sixth night a blue mass pill, the seventh morning
a Seidlitz powder, then a rest for a day or two, then a repetition of
the same measures. But always remember: first try to get along without
any drugs at all. Many cases can get relieved of their constipation by
a proper change in diet alone. And where this is impossible, then use
mild laxatives and use them interchangeably.
=Toothache= is not uncommon in pregnancy, and a pregnant woman should
have her teeth put in first-class condition.
=Difficulty in Urination.= Pregnant women often suffer with frequency
and urgency of urination. Some have to urinate, while they are on
their feet, every few minutes. This is due to the fact that during
the first two or three months of pregnancy the uterus is not only
enlarged but is also _anteverted_, that is _turned forward_ and
_presses down_ upon the bladder. When the woman is lying down the
pressure on the bladder is relieved, and she does not have to urinate
frequently. This pressure lasts only the first two or three months,
because after that the growing womb lifts itself out of the pelvis,
rising into the abdominal cavity; it is no longer anteverted and the
pressure on the bladder is relieved. During the last months of the
pregnancy there is again frequent urination, because then the heavy
uterus sinks again into the pelvic cavity and presses upon the
bladder. The treatment for this frequent urination consists in wearing
a well fitting abdominal belt or corset, which raises the uterus and
prevents pressure on the bladder. Sometimes a pessary which prevents
the anteversion is efficient. In all cases lying down and resting is
useful. In short, keeping off one's feet is the most efficient remedy
for the treatment of frequent urination in pregnant women.
=Hemorrhoids= (Piles). On account of the pressure of the womb on the
rectum, and also on account of the constipation which is so frequent
during pregnancy, hemorrhoids or piles are quite frequent among
pregnant women. The treatment of hemorrhoids consists in removing the
cause: wearing a well-fitting abdominal belt, and relieving the
constipation. Injecting into the rectum about half a pint of cold
water three times a day is very useful. For the intolerable itching
sometimes present in hemorrhoids the following ointment will be found
very grateful: menthol, 5 grains; calomel, 10 grains; bismuth
subnitrate, 30 grains; resorcin, 10 grains; oil of cade, 15 grains;
cold cream, one ounce. The piles (the hemorrhoids) are to be well
cleansed with hot water, and this ointment is to be well smeared over;
a little is pushed into the rectum, and a piece of cotton is put over
the anus. This protects the clothes from soiling and keeps the
medicine in place for a longer time. Instead of ointment a cocoa
butter suppository may be used. A suppository of the following
composition is good: powdered nutgalls, 3 grains; oil of cade, 3
drops; resorcin, 1 grain; bismuth subnitrate, 5 grains; cocoa butter,
20 grains. One such suppository to be inserted three times a day. The
ointment and the suppository given above, if used in conjunction with
the proper regulation of the bowels, will not only relieve but will
cure most cases of hemorrhoids caused by pregnancy.
=Itching of the Vulva. Pruritus Vulvæ.= Itching of the external
genitals during pregnancy is not uncommon. This may be due to the
fact that the vulva is generally congested and swollen during
pregnancy or it may be caused by an increased leucorrheal discharge.
The itching is sometimes very severe, and if the patient scratches
with her nails and produces bleeding, she may cause an infection of
the parts. The patient should be cautioned against scratching; she
should try simple measures to relieve the itching. A small towel or
gauze compress wrung out of boiling water and applied to the vulva
several times a day, followed by a free application of stearate of
zinc powder is often efficient. If it is not, the following salve may
be tried: carbolic acid, 10 grains; menthol, 5 grains; resorcin, 15
grains; zinc oxide, 1 dram; and white vaseline, one ounce. In very
severe cases the vulva should be painted with a solution of silver
nitrate, 25 grains to 1 ounce of distilled water.