become somewhat enlarged. This is due to the pressure of the womb,
which interferes with the circulation. If the veins become very
prominent, swollen and tortuous, they are called varicose. This
condition should be prevented, because it often and to some degree
always persists permanently even after the pregnancy is over. The best
precautionary measure is for the woman to wear a well-fitting
abdominal belt or maternity corset, which supports the womb and does
not permit it to sink too low into the pelvis. If varicose veins have
been permitted to develop, the woman should wear well-fitting rubber
stockings, or at least have the legs bandaged with woven elastic
bandages. The bandage must be applied by a competent person, uniformly
and not too tightly. Constipation has also a bad effect in making
varicose veins worse; the bowels should therefore also be looked
after. In some severe cases all measures are of little value unless
the patient at the same time stays in bed or on a couch for a few
days, with the legs elevated.
Swelling of the feet should be at once attended to. It may be a
trifling matter due only to pressure of the womb; then again it may be
due to some kidney trouble. The physician will determine the true
cause and prescribe the appropriate treatment.
=Liver Spots. Chloasma.= In some cases irregular brownish patches or
splotches develop on the skin around the breasts, on the sides, or on
the face. These patches are known popularly as liver spots or in
medical language as _chloasma_. Nothing can be done for them, but they
generally disappear after the pregnancy is over. A few patches here
and there may remain permanently.
CHAPTER TWELVE
WHEN TO ENGAGE A PHYSICIAN
Necessity for the Pregnant Woman Immediately Placing Herself Under
Care of Physician and Remaining Under His Care During Entire
Period.
The disorders and disturbances described above are, with the exception
of pernicious vomiting, of a minor nature. They are annoying, may
cause considerable discomfort and suffering, but they do not endanger
the life of the woman or of the child. Occasionally, however,
fortunately not very often, the kidneys become affected, and for this
condition treatment by a physician is absolutely necessary. In fact,
the correct and safe thing for a woman to do is to consult a physician
as soon as she knows she is pregnant, and have him take care of her
during the entire pregnancy. Some women engage a physician during the
eighth or ninth month and this is decidedly wrong, because it may then
be too late to correct certain troubles which if taken at the outset
could have been easily cured; while many troubles in the hands of a
competent physician can be prevented altogether. I must therefore
reiterate: every woman should engage a physician from the beginning
of her pregnancy, or at least during the third or fourth and certainly
not later than the fifth month. He will examine the urine every month
and make sure that the kidneys are in order, he will make sure that
the child is in a normal position, and will prevent a host of other
ills.
[Illustration: POSITION OF THE CHILD IN THE WOMB.]
This is not a special treatise on the management of pregnancy, and
therefore minute details are out of place. Besides, to the details the
physician will attend. But some hints regarding diet and general
hygiene will prove useful.
If everything is satisfactory, if there is no severe vomiting, kidney
trouble, etc., the usual mixed diet may continue. The only changes I
would make are the following: Drink plenty of hot water during entire
course of pregnancy: a glass or two in the morning, two or three
glasses in the afternoon, the same at night. From six to twelve
glasses may be consumed. Also plenty of milk, buttermilk and fermented
milk. Plenty of fruit and vegetables. Meat only once a day. For the
tendency to constipation, whole wheat bread, rye bread, bread baked of
bran or bran with cream.
As to exercise, either extreme must be avoided. Some women think that
as soon as they become pregnant, they must not move a muscle; they are
to be put in a glass case, and kept there to the day of delivery.
Other women, on the other hand, of the ultramodern type, indulge in
strenuous exercise and go out on long fatiguing walks up to the last
day. Either extreme is injurious. The right way is moderate exercise,
and short, non-fatiguing walks.
Bathing may be kept up to the day of delivery. But warm baths,
particularly during the last two or three months, are preferable to
cold baths.
CHAPTER THIRTEEN
THE SIZE OF THE FETUS
Approximately Correct Measurements and Weight of Fetus at End of
Each Month of Pregnancy.
Men and women are always interested to know how large the fetus is and
how far it is developed during the various months of pregnancy.
Absolutely exact measurements cannot be given, but the following
approximate measurements are correct:
[Illustration: 1. EMBRYO BETWEEN ONE AND TWO WEEKS OLD.
2. EMBRYO ABOUT FOUR WEEKS OLD.
3. EMBRYO ABOUT SIX WEEKS OLD.
(Illustrations are double the actual size.)]
At the end of the first month (lunar) it is about the size of a
hazelnut. Weighs about 15 grains.
At the end of the second month it is the size of a small hen's egg.
The internal organs are partially formed, it begins to assume a human
shape, but the sex cannot yet be differentiated. Up to the fifth or
sixth week it does not differ much in appearance from the embryos of
other animals.
At the end of the third month it is the size of a large goose egg; it
is about two to three and a half inches long. Weighs about one ounce.
At the end of the fourth month the fetus is between six and seven
inches long and weighs about five ounces.
At the end of the fifth month the fetus is between seven and eleven
inches long, and weighs eight to ten ounces.
At the end of the sixth month it is eleven to thirteen inches long and
weighs one and one-half to two pounds. If born, is capable of living a
few minutes, and it is reported that some six months' children have
been incubated.
At the end of the seventh month the fetus is from thirteen to fifteen
or sixteen inches long and weighs about three pounds. Is capable of
independent life, but must be brought up with great care, usually in
an incubator.
At the end of the eighth month the length is from fifteen to
seventeen inches, and weight from three to five pounds.
At the end of the ninth month the length of the fetus is from sixteen
to seventeen and one-half inches, and weight from five to seven
pounds.
At the end of the tenth lunar month (at birth) the length of the child
is from seventeen to nineteen inches and the weight from six to twelve
pounds; the average is seven and a quarter, but there are full term
children weighing less than six pounds and more than twelve; but these
are exceptions.
CHAPTER FOURTEEN
THE AFTERBIRTH (PLACENTA) AND CORD
How the Afterbirth Develops--Bag of Waters--Umbilical Cord--The
Navel--Fetus Nourished by Absorption--Fetus Breathes by Aid of
Placenta--No Nervous Connection Between Mother and Child.
Whatever part of the womb the ovum attaches itself to is stimulated to
intense activity, to growth. Numerous bloodvessels begin to grow and
that part of the lining membrane with its numerous bloodvessels
constitute the placenta, or as it is commonly called _afterbirth_,
because it comes out _after_ the _birth_ of the child. From the
placenta there is also reflected a membrane over the ovum, so as to
give it additional protection. That membrane forms a complete bag over
the fetus; this bag becomes filled with liquid, so that the fetus
floats freely in a bag of waters; this bag bursts only during
childbirth. The fetus is not attached close to the placenta, but is,
so to say, suspended from it by a _cord_, which is called the
_umbilical cord_. When the child is born, the umbilical cord is cut,
and the scar or depression in the abdomen where the umbilical cord
was attached constitutes the navel or umbilicus (in slang
language--button or belly button). The umbilical cord consists of two
arteries and one vein embedded in a gelatin like substance and
enveloped by a membrane, and it is through the umbilical cord that the
blood from the placenta is brought to and carried from the fetus. The
blood of the fetus and the blood of the mother do not mix; the
bloodvessels are separated by thin walls, and it is through these thin
walls that the fetal blood receives the ingredients it needs from the
mother's blood. In other words, it receives its nourishment from the
mother by _absorption_ or _osmosis_. The blood from the placenta also
furnishes the fetal blood with oxygen, so that the fetus breathes by
the aid of the placenta, and not through its own lungs.
It is well to remember that there is absolutely no nervous connection
between mother and child. There are no nerves whatever in the
umbilical cord, so that the nervous systems of the fetus and of the
mother are entirely distinct and separate. And this will explain why
certain nervous impressions and shocks received by the mother are not
readily transmitted to the child. It is only through changes in the
mother's blood that the fetus can be influenced. As will be seen in a
later chapter we are skeptical about "maternal impressions."
CHAPTER FIFTEEN
LACTATION OR NURSING
No Perfect Substitute for Mother's Milk--When Nursing is Injurious
to Mother and Child--Modified Milk--Artificial Foods--Care
Essential in Selecting Wet Nurse--Suckling Child Benefits
Mother--Reciprocal Affection Strengthened by Nursing--Sexual
Feelings While Nursing--Alcoholics are Injurious--Attention to
Condition of Nipples During Pregnancy Essential--Treatment of
Sunken Nipples--Treatment of Tender Nipples--Treatment of Cracked
Nipples--How to Stop the Secretion of Milk When Necessary--
Menstruation While Nursing--Pregnancy in the Nursing Woman.
Every mother should nurse her child--if she can. There is no perfect
substitute for mother's milk. There is only one excuse for a mother
not nursing--that is when she has no milk, or when the quality of the
milk is so poor that the child does not thrive on it, or when the
mother is run down, is threatened with or is suffering with
tuberculosis, etc. In such cases the nursing would prove injurious to
both mother and child.
When the mother cannot nurse the child, it should be brought up
artificially on modified cow's milk. Formulas for modified milk have
been worked out for every month of the child's life, and if the
formulas are carefully followed, and the bottle and nipples are
properly sterilized, the child should have no trouble, but should
thrive and grow like on good mother's milk. If the child is sickly or
delicate and does not thrive on modified cow's milk or on the other
artificial foods, such as Horlick's malted milk, or Nestlé's food,
then a wet nurse may become necessary. But before engaging a wet nurse
great care should be taken to make sure that she is healthy, that the
age of her child is approximately the same as the age of the child
which she is about to nurse, and particularly that she is free from
any syphilitic taint. One, two or more Wassermann tests should be made
to settle the question definitely.
Mothers should bear in mind that suckling the child is good not only
for the child, but for the mother as well. Lactation helps the
_involution_ of the uterus: the uterus of a nursing mother returns
more quickly and more perfectly to its normal ante-pregnant condition
than the uterus of the mother who cannot or will not nurse her child.
It is asserted that the reciprocal affection between mother and child
is greater in cases in which the child suckled its mother's breast.
This is quite likely. It is also asserted that the nursing mother
transmits certain traits to its child, which the non-nursing mother
cannot. This is merely a hypothesis without any scientific proof.
On the other hand, the statement that many women experience decidedly
pleasurable sexual feelings while nursing seems to be well
substantiated.
That the mother who nurses her child should partake of sufficient
nourishment goes without saying. But the advice often given to nursing
mothers to partake of beer, ale or wine is a bad one. It is a question
if a mother partaking of considerable quantities of alcoholic
beverages may not transmit the taste for alcohol to her children. No,
alcoholics should be left alone, but milk, eggs, meat, fruit and
vegetables should be partaken of in abundance.
=Preparing the Nipples.= For the infant to be able to nurse properly
the nipples of the breast must be in good condition. If the nipples
are sunken, depressed, it is torture for the child to nurse. It uses
up a lot of energy uselessly, becomes exhausted, and gets very little
milk; while if the nipples be tender or cracked the process of nursing
is a torture for the mother.
It is therefore necessary to attend to the nipples in due time--to
begin at the fifth or sixth month is not too early. If the nipples are
sufficiently prominent, little need be done for them except to wash
them with a little boric acid solution (one teaspoonful of boric acid
to a glass of water) occasionally, and now and then to rub in a little
petrolatum, plain or borated. But if the nipples are sunken so that
they are below the surface of the breast, or if they are only slightly
above the surface of the breast, they must be treated. Gentle traction
must be made on them with the fingers three or four times a day. There
are only a few cases where persistent manipulation will not develop
the nipple and make it stand out prominently.
If the nipple is tender it should be washed two or three times a day
with a mixture of alcohol and water; one part of alcohol to three
parts of water is sufficient. In washing the nipple with this diluted
alcohol it should be dried and a little petrolatum or vaseline rubbed
in. This done two or three times a day during the last month or two of
the pregnancy will generally produce a good healthy nipple.
=The Treatment of Cracked Nipples.= If the care of the nipple has been
neglected, and it develops cracks or fissures so that the nursing of
the child causes the mother severe pain, the nursing should be done
through a nipple shield, and in the meantime between the nursings the
nipple should be rubbed with the following preparation, which is
excellent and which I can fully recommend: thymol iodide, ½ dram;
olive oil, ½ ounce. This should be applied every hour to the nipple
and covered with a little cotton; before each nursing, however, it
must be well washed off with warm water or warm boric acid solution.
When the nipples are cracked, the infant's lips should also before
nursing be carefully wiped out with boric acid solution. For the
baby's mouth contains bacteria which while harmless in themselves may
if they get into the cracks of the nipple set up an inflammation of
the breast or "mastitis" and cause an abscess. If the cracks are
excruciatingly painful, as they sometimes are, it is necessary to give
the one breast a rest for twenty-four hours and have the child nurse
at the other until the cracks have partially healed.
=When It Is Necessary to Dry Up the Breasts.= In case of the death of
the child, or if the mother for some other reason finds herself unable
to nurse, such as in cases where there is absolutely no nipple,
instead of the prominence of the nipple there being a deep depression,
it becomes necessary to stop the secretion of the milk, or as it is
said in common parlance, "to dry up the breasts." In former days, not
so very long ago, and the practice is still common enough to call
attention to it and to condemn it, the breasts used to be tightly
bandaged, or they used to be pumped every few hours. The first causes
unnecessary pain and trouble, while the second procedure, the pumping,
does exactly the reverse to what it is intended to do. Instead of
drying up the breasts it keeps up the secretion. The best thing to do
in a case like that is to leave the breasts alone, not to pump them,
but just gently support them with a bandage and then in three or four
days the secretion of the milk will gradually disappear. There is some
discomfort the first twenty-four or forty-eight hours, but if left
alone the discomfort is less than if the breasts are manipulated,
bandaged or pumped.
=Menstruation or Pregnancy While Nursing.= Many women do not
menstruate and do not become pregnant while they are nursing. Some
women will not conceive, no matter how long they may nurse the
child--a year or two or longer. And some women take advantage of this
fact, and in order to avoid another child they will keep up the
nursing as long as possible. In Egypt and other Oriental countries
where our means for the prevention of conception are unknown, it is no
rare sight to see a child three or four years old interrupting his
work or his play and running up to suckle his mother's breast. But not
all women have this good luck. Some women (about fifty per cent.)
begin to menstruate in the sixth month of lactation, while some become
pregnant even before they begin to menstruate. It only too often
happens that a woman considering lactation her safeguard omits to use
any precautions and finds herself, to her great discomfiture, in a
pregnant condition.
When a nursing woman discovers that she is pregnant she should give up
nursing at once. The milk is apt to become of poor quality, but even
where this is not the case, it is too much for a woman to feed one
child in the uterus and one at the breast.
CHAPTER SIXTEEN
ABORTION AND MISCARRIAGE
Definition of Word Abortion--Definition of Word Miscarriage--
Spontaneous Abortion--Induced Abortion--Therapeutic Abortion--
Criminal Abortion--Missed Abortion--Habitual Abortion--Syphilis
as Cause of Abortion and Miscarriage--Dangers of Abortion--
Abortion an Evil.
The word abortion, used somewhat loosely, signifies the premature
expulsion of the fetus; the expulsion of the fetus from the womb
before it is viable, i.e., before it is capable of living
independently. Used in a stricter sense, the word abortion is applied
to the expulsion of the fetus up to the end of the 16th week; to the
expulsion of the fetus between the 16th and the 28th week the term
miscarriage is applied; and when the expulsion of the fetus takes
place after the 28th week, but before full term, we use the term
premature labor. The laity does not like the term abortion, as it is
under the impression that the term always signifies criminal abortion;
it therefore prefers to use the term miscarriage ("miss"), regardless
of the time at which the expulsion of the fetus takes place.
When an abortion (or miscarriage) takes place by itself, without any
outside aid, we call it _spontaneous abortion_. When it is brought on
by artificial means, whether by the woman herself or by somebody else,
we call it _induced_ abortion. When an abortion is induced for the
purpose of saving the woman's life, we call it _therapeutic_ abortion;
this is considered perfectly legal and proper. But where an abortion
is induced merely to save an unmarried mother's reputation, or because
the married mother is too poor or too weak to have any more children,
or is reluctant to have any (or any more) for any other reason, it is
called _criminal_ or _illegal_ abortion, and, if discovered, subjects
the mother and the person who produced the abortion to severe
punishment.
When the fetus for some reason dies in its mother's womb, it is
generally expelled within a few hours or days. Sometimes this is not
the case, and the dead fetus is retained for several weeks, or months
or even years; to such a phenomenon we apply the term _missed_
abortion. Some women suffer from what might be called the abortion
habit; they can hardly ever carry a child to full term, but lose it in
the same month or even in the same week of gestation during each
pregnancy; we call this habitual abortion. And this habitual abortion
may be independent of disease, such, for instance, as syphilis. The
terms _threatened_, _imminent_ and _inevitable_ abortion require no
further explanation.
=The Causes of Abortion.= Outside of the abortion habit, which may be
due partly to heredity or be caused by a diseased condition of the
lining membrane of the uterus, the principal cause of abortion and
miscarriage is syphilis. And when a woman has had two or three or four
or more miscarriages in succession we generally assume the cause to be
syphilis, and in most cases the assumption will be correct.
When an abortion is performed by an experienced physician, with the
observance of the utmost cleanliness (asepsis and antisepsis), then
the abortion is accompanied with very little or no danger; but when
performed carelessly, by incompetent, non-conscientious physicians and
midwives, the operation is fraught with great danger to the patient's
health or to her very life. And abortion is a great cause of premature
death and chronic invalidism among women. And as long as the people
will remain ignorant of the proper means of regulating their
offspring, so long will abortion thrive.
While I recognize that there are cases in which the performance of an
abortion is perfectly justifiable from a moral standpoint, for
instance in cases of rape or where the mother is unmarried,
nevertheless abortion must be recognized as an evil, a necessary evil
now and then, but an evil, nevertheless. It is never to be undertaken
lightly, or to be considered in a frivolous spirit; and it is the duty
of all serious-minded and humanitarian men and women to do everything
in their power to remove those conditions which make abortion
necessary and unavoidable.
CHAPTER SEVENTEEN
PRENATAL CARE
Meaning of the Term--Misleading Information by Quasi-Scientists--
Exaggerated Ideas Regarding Prenatal Care--Nervous Connection
Between Mother and Child--Cases Under Author's Observation--Effects
on Offspring--Advice to Pregnant Women--Germ-plasm of Chronic
Alcoholic--A Glass of Wine and the Spermatozoa--False Statements--
Cases of Violence and Accidents During Pregnancy.
By prenatal care we understand the care taken during pregnancy before
the child is born. Used in a wider sense the term includes the care
which both parents should take of themselves even before the child is
conceived.
Of course the father and the mother should be in the best possible
physical and mental condition during the time of conception and even
before conception, and the mother should take the very best care of
herself--she should be in good health and as calm a spirit as possible
during the entire period of gestation. For the general health and
condition of the mother does influence the child.
And still I feel impelled to say something which may meet with violent
opposition in some quarters. The trouble is, there are too many
half-baked scientists in our midst. They spread misleading information
and the public at large is too apt to take every statement that has a
quasi-scientific seal for something absolute, for something positive,
for something that admits of no exceptions.
I have seen so much misery caused by wrong prenatal care teaching and
by the foolish, exaggerated ideas on the subject, that I consider it
my duty to say something in order to counteract those erroneous
notions. I consider it my special mission to destroy error, mysticism
and superstition. And the prenatal care teaching as imparted by some
unfortunately partakes of all three of the above.
Of course, I repeat, the mother should try to be in the best possible
condition while she is carrying the child. Nevertheless, it is foolish
to imagine if the mother is not quite well, or is worried about
something, or has a fit of anger, that it is invariably going to be
reflected on the child. The child, as we know, has no nervous
connection whatever with the mother, and it is only very violent or
prolonged shocks that are apt to have an injurious influence.