PREPARING FOR MOTHERHOOD
Menstruation--Irregular Menstruation--Changes in the Quantity
of the Flow--How the Womb is Held in Place--Symptoms of
Menstruation--Menstruation Should Not be Accompanied with
Pain--Don't Give Your Daughters Patent Medicines or "Female
Regulators"--Take Your Daughter to the Doctor--Leucorrhea in
Girls--Bathing when Menstruating--Constipation and Displaced
Wombs--Dress and Menstruation--Absence of Menstruation, or
Amenorrhea--Treatment of Amenorrhea--Painful Menstruation, or
Dysmenorrhea--Causes of Dysmenorrhea--Treatment of
Dysmenorrhea--Sterility in the Female--Conditions Which Affect
the Fertility of Women--Climate--Station in Life--Season of the
Year--Age--The Tendency to Miscarry--Causes of Sterility in the
Female--Displacement of Womb--Diseases of Womb, Ovaries, or
Tubes--Malformations--Lacerations--Tumors--Leucorrhea--Physical
Debility--Obesity--Special Poisons--"Knack of
Miscarrying"--Miscarriage--Cause of Miscarriage--The Course and
Symptoms of Miscarriage--What to do when a Miscarriage is
Threatened--Treatment of Threatened Miscarriage--Treatment of
Inevitable Miscarriage--After Treatment of Miscarriage--The
Tendency to Miscarriage.
MENSTRUATION
We have explained in the previous chapter what menstruation is, its
frequency, its significance and its origin. There are a number of its
common characteristics with which the mother and daughter should be
acquainted.
IRREGULAR MENSTRUATION.--Menstruation may occur once (the first time)
and fail to recur the following month or for a number of months. This
need cause no alarm as long as the general health remains good. It will
come again in its own time. Nervousness may cause a suspension of
menstruation. This is quite common in school girls who are driven too
hard at school, whose sleep is interfered with, whose appetite is poor
and who are allowed too many social indiscretions, as parties, dances,
etc., where late hours are observed, all of which should be put aside
until school life is over. Sometimes menstruation will temporarily stop
if the girl goes away from home on a visit.
Sometimes the quantity will be greater than at other times, and a very
scant flow, after it has been free and regular may cause apprehension.
Various causes may be responsible for a decrease, catching cold, sitting
on cold steps or cold ground, wearing damp clothes, nervousness, mental
worry, physical exhaustion, insufficient food and exercise, and anemia,
may cause it. For these reasons a girl should be exceedingly careful of
her health, she should guard against catching cold. Do not change the
underwear until certain that the weather is far enough advanced in
season to justify such a change. She should not become exhausted or
worry. In all cases of suppression, or of increased flow, a physician
should be consulted at once, and girls should be instructed to tell
their mothers of any change in the character of the "periods," as soon
as it occurs. Mothers should instruct their daughters to rest the first
day of their monthly flow, and all during the menstruation they should
refrain from any unusual activity. Even play should be moderated and
abstained from entirely if there is any pain. In order that the girl
fully appreciates why these rules are laid down, it is advisable to
explain just how the womb is held in place in her body.
This appears to the writer as being a particular important point. A girl
must not be expected to give these matters the serious consideration
they merit unless she thoroughly understands the reasons why. An
explanation, in the form of even an intelligent talk, will soon be
forgotten. If, however, a definite, concrete picture, is impressed upon
her; if she actually sees in her mind the process that is going on, she
will understand why it is necessary to do as she is told. If the mother
will therefore assure herself that the daughter actually knows what is
being accomplished in her womb at the menstrual period, she will carry
out the instructions more faithfully.
HOW THE WOMB IS HELD IN PLACE.--The human uterus, or womb, is held in
its proper place in much the same way as a clothes pin sits on a clothes
line. The heavier part is the upper part, and that part is held in place
partly by resting on the rectum behind, and the bladder in front. When
menstruation occurs, the body of the womb becomes much heavier because
of the increased amount of blood in its interior. This added weight
increases its liability to tip over, and if any extra strain or effort
is made at this time it will become tipped, or as the physician calls
it, displaced. If a womb becomes displaced, every menstruation afterward
will be painful and prolonged,--sometimes excessively so. A displaced
womb becomes congested and unhealthy. It causes leucorrhea or a chronic
discharge, makes a nervous wreck of the woman, results in sterility and
frequently in a dangerous operation. There are, therefore, ample reasons
for watchfulness and care on the part of the growing girl.
SYMPTOMS OF MENSTRUATION.--After menstruation is established there
should be no actual pain at each period. There are, however, certain
undefined feelings,--premonitory symptoms,--which may be explained in
the following terms:--A day or two before the date on which the
menstruation is expected, the girl will appreciate that "her sickness"
is coming. She will not, or should not, complain of pain, but will state
that she has a bearing down feeling, is a little more nervous than
usual, has no desire to go into company, and wants to be more or less
her own entertainer. The "sick" period usually lasts four or five days.
The second day is the most important.
MENSTRUATION SHOULD NOT BE ACCOMPANIED WITH PAIN.--If any actual pain
accompanies menstruation, either before or after it is established, the
mother should at once take the daughter to the family physician.
Menstruation is a natural, physiological act and should not be
accompanied with actual distress or pain. It is astonishing how many
mothers will allow their daughters to suffer needlessly, for months and
years, because of the mistaken idea that "since the pain is there, it
must be," or because she--the mother--suffered, so also must the
daughter suffer. There is no more unfortunate mistake, and many a girl's
health and happiness has been blasted because of this misbelief. The
cause of the pain is, in a vast majority of the cases, a very simple
one, and can be removed in a very brief time.
Should the menstrual period last too long, be too frequent, or be in any
way not what it should be, consult your physician. If you are not sure
of "what it should be," or if you have any doubt, ask your doctor. Don't
let any false pride or feeling of modesty on your part, or on the part
of your daughter, dictate your policy under such circumstances. Don't
take the advice of your friends or neighbors in a matter so vital. It is
too important, and they are not qualified to "guess" any more than you
are. Don't, if you have any respect for yourself, or love for your
child, begin dosing her with the advertised patent medicines and "Female
Regulators" for which so much is claimed, and which seem to "just suit"
your daughter's case at this particular time. Take her to the doctor,
whose advice you value (or you should not have him as a family
physician), who has no interest at stake except to help you and your
child, and whose fee is no more than the price of one of these bottles
of advertised poison. He is the only one qualified to speak with
authority on such a momentous subject, and you will never spend a dollar
to better advantage. Warn your daughter not to speak about "her
sickness" to other girls.
Especial attention should be paid to cleanliness during this period. The
mistaken idea that bathing of any kind at this time may have disastrous
consequences is responsible for much of this neglect. If proper care is
taken warm sponge baths, in a warm room, will not cause any trouble.
Unpleasant odors can be avoided by sponging the parts with a warm
solution, into which a mild antiseptic is put, upon changing the cloths.
LEUCORRHEA IN GIRLS.--It has been stated above that a displaced womb may
cause leucorrhea or a discharge. It must be remembered that leucorrhea,
or "whites," may occur in girls as well as in married women. It can also
result from catching cold during the menstrual period. Another mistaken
idea is that girls should not take douches for fear of injuring the
hymen. This is erroneous, and while they are entirely unnecessary in a
vast majority of cases it is sometimes absolutely essential to douche in
order to cure leucorrhea. When they are given, it is advisable to use
the small nozzle that comes with every douche bag set.
CONSTIPATION AND DISPLACED WOMBS.--When the picture is fresh in the mind
of the girl, of how the womb is held upright in her body, the mother
should speak to her about the serious results that may occur from
constipation. If the rectum is full of hardened feces the womb will be
pushed out of place, and if under these circumstances straining is
necessary to empty the bowel, and if this condition is habitual,
constipation may be the actual cause of displacement of the womb.
DRESS AND MENSTRUATION.--It is also an opportune time to demonstrate to
what extent serious results may follow mistakes in dressing. The habit
of permitting growing girls to constrict the waist, to bind and pull the
abdomen by too tight garters, or too tight corset, is wrong, and no
mother should permit it. In another part of the book, this matter is
taken up more fully, but if it is explained to the girl while she is
considering the subject of menstruation, she may more quickly and more
fully appreciate its significance.
ABSENCE OF MENSTRUATION--AMENORRHEA.--The absence of menstruation after
it has been established, does not, as a rule, indicate any disease of
the womb or female sexual organs. It is to be regarded merely as a
symptom and can be, as previously stated, safely ignored if the general
health is good. If the general condition is poor, and the quantity and
quality of the blood deficient, it is a provision of nature to suppress
menstruation in the interest of the general health. For this reason it
is safe to disregard the amenorrhea and build up the bodily strength.
This explains why some girls pass the usual age of puberty and show no
signs of menstruating. They are poorly developed sexually, through
deficiency of blood. If, on the other hand, a girl should have all the
symptoms of menstruation every month, but no flow, she should be
examined by a physician to determine if there is any obstruction to the
escape of blood. Total absence of any symptoms of menstruation extending
into adult life, may indicate an absence of the sexual organs. During
the first year after puberty it is quite natural for menstruation to be
irregular; after the function is thoroughly established there are many
causes that may be responsible for its temporary absence.
CAUSES OF AMENORRHEA.--Any condition or circumstance which reduces the
general health or impoverishes the quality or quantity of the blood and
weakens the nervous system, will result in a stoppage of the monthly
periods. Among these are insufficient food and exercise, overwork,
overstudy, exposure to cold, sitting on cold steps or gold ground,
wearing damp clothes, bathing in cold water at the beginning of
menstruation, powerful emotions, as great fright, anger, anxiety; acute
diseases, such as typhoid fever, cholera, the infectious skin diseases;
chronic diseases such as Bright's disease, heart disease, consumption;
anemia and chlorosis are very common causes. Obesity or an overfat
condition will cause an early suppression of the menses which may result
in a fruitless marriage. Displacement of the womb and other local
disorders frequently result in scanty or delayed menstruation. Anxiety
lest pregnancy may occur in the newly married may cause a delay in the
periods. A radical change of climate or sometimes a visit to the
country, or changed circumstances may stop the flow for the time being.
TREATMENT.--The treatment of amenorrhea, or absence of menstruation,
will depend on the underlying cause. A careful investigation should be
made into the mode of life and the hygienic surroundings of the patient.
Her general health and her mental condition should be inquired into. If
the patient is not in good health, or is not obtaining exercise in the
open air, or if she is a victim of mental worry or of domestic
unhappiness, or if any sufficient cause exists for the amenorrhea it
must be removed before any treatment may be expected to relieve the
condition. If the patient is a married woman the possibility of
pregnancy should always be borne in mind, and no radical treatment
instituted until this has been excluded. If the absence of menstruation
is dependent upon defective development of the sexual organs we cannot
expect much from any treatment. The amenorrhea from exhaustive diseases
will usually correct itself with, or soon after, the establishment of
convalescence. In diseases which tend to death, as in consumption, heart
disease, etc., the function is never reestablished. A very common habit
of most people is to regard the absence of the monthly periods as the
cause of their ill health. It is not, it is the result of the ill
health. Get rid of the bad health and the menses will take care of
themselves. That form of amenorrhea which is the result of change of
climate or surroundings will regulate itself as soon as the victim
becomes acclimated or reconciled to the change, or returns home if the
visit is of brief duration.
As a general routine treatment, good wholesome food, regular hours,
fresh air, sunlight, and judicious exercise, with such other measures as
may be suggested by the condition of the blood and nervous system, are
the indications in the way of treatment. Anemia and chlorosis (poor
blood) should be treated by the administration of iron in some form.
Obesity should be reduced by diet, exercise, and such other treatment as
may be found efficient and not detrimental to health. Overwork, mental
and physical, should be stopped, and sedentary habits changed to a more
active out-door life. The acute suppression from exposure to cold,
wearing of damp clothes, sitting on cold stones or cold or damp ground,
sea bathing in very cold water, is very often associated with an acute
inflammation of the womb itself and calls for rest in bed, laxatives to
open the bowel, hot application to the lower part of the abdomen and a
teaspoonful of Hayden's Viburnum in a glass of hot water every four
hours until relieved. The use of the sitz bath is frequently successful
if taken at night followed by a laxative and a hot drink.
PAINFUL MENSTRUATION--DYSMENORRHEA.--Most, if not all, victims of
painful menstruation are of a nervous temperament. Dysmenorrhea is
simply one symptom of the general nervous condition. The nervousness may
be acquired or it may be the result of heredity. In girls it has been
found to be an accompaniment of the overwork and worry of school and
student life. Girls who suffer greatly from it while in school are
entirely free during vacation from school.
There is a type of painful menstruation known as neuralgic dysmenorrhea.
This is simply a local expression of a general neuralgic tendency. It
comes under conditions which favor neuralgias in other parts of the
body. Girls and women affected with this type of dysmenorrhea are often
anemic, hysterical, and not infrequently the victims of malaria,
rheumatism, or other diseases which tend to impoverish the blood and
reduce nerve vitality. The pain resembles neuralgia elsewhere. It comes
and goes, it may last a brief time or a long time, it may be very mild
or very severe. The pain bears no fixed relation to the flow, it may
proceed, accompany or follow it.
Mechanical dysmenorrhea is that form in which a mechanical impediment
exists to the escape of the menstrual fluid. The internal canal may be
too small, displacement, growths, either inside or out of the womb,
faulty development, or frequently simple congestion will act as an
obstruction and cause pain from tension. The pain accompanying
mechanical dysmenorrhea is very different from the neuralgic type. It
comes on gradually, increases slowly until it is very severe and stops
suddenly. A gush of blood from the womb announces the fact that the
obstruction has been overcome and the womb has emptied itself; as soon
as this occurs the pain ceases.
In the mechanical variety there are frequently clots in the menstrual
flow. Inasmuch as this type may be caused by imperfect development of
the womb, it is common to find that pain has characterized the monthly
periods from the time of the first menstruation. It may, however, as
stated above, be caused by growths which had their beginning at a later
period.
TREATMENT.--For the neuralgic variety the treatment should be general.
The whole object is to build up the general health. Fresh air, sunlight,
out-door exercise, plain, substantial food, regular hours, pleasant
surroundings, and such medication as may be indicated, should be the
course to follow. The bowels should be kept regular and digestion aided
in every way possible, if necessary by rest from school, or work, or by
a change of air and scene. If the patient is inclined to malaria she
must take quinine and live in a locality free from that tendency. If
rheumatic she should take the remedies advised in that disease and avoid
colds, wet clothes, or sitting in cold, badly ventilated rooms, churches
or theatres. If there are no distinct evidences of special tendencies,
general tonics may be given to advantage. These should consist chiefly
of iron, arsenic, phosphous, nux vomica, cod liver oil, etc.
The treatment of mechanical dysmenorrhea of course implies removal of
the cause. As this necessitates operative procedure, or at least an
examination by a physician, it is best left in his hands.
STERILITY
Sterility means the inability to become a parent. A woman who is sterile
cannot become a mother. She is for some reason unable to have a baby.
A childless union is frequently the cause of much unhappiness. There is
something lacking in the expression "a childless home." It seems a
paradox, as home is inherently associated with children and happiness.
It has been stated that one out of every eight marriages is barren. The
average time which elapses after marriage and the birth of the first
child is seventeen months. Physicians agree that if a woman goes over
three years after marriage without having a baby her chances of having
one are small. If children are desired, and they usually are by
childless parents, every effort should be made within the first three
years to ascertain the cause of the sterility, and if it can be
rectified. The barrenness may be dependent upon some physical defect
which will quickly respond to the proper medical treatment. It is well
to remember, however, that the defect is not always the woman's. In
every six childless marriages about one is due to sterility in the
husband. The age of the greatest fertility in women is between twenty
and twenty-four years. It is rare to find a barren woman between these
years. Nature evidently intended that the duties of maternity should be
assumed between the twenty and twenty-fourth year. If married before the
age of twenty the statistics prove that barrenness exists in one woman
in every twelve. If married after the twenty-fourth year the chances of
having children decreases with the age of the woman.
If a mother goes for three consecutive years without becoming pregnant
the chances are that she will have no more children. Consequently if
other children are desired it is unsafe to rest upon the assumption that
a woman will again be a mother simply because she has been one in the
past. Many conditions could, and may, have occurred since the last
pregnancy (and may be as a result of that pregnancy) to change her
natural fertility into a condition of temporary sterility. An
examination should therefore be made before too long an interval elapses
and the facts learned. It will usually be found in such cases that a
displacement or laceration, or at most, some cause easily remedied is
immediately responsible for the apparent barrenness.
CONDITIONS WHICH AFFECT THE FERTILITY OF WOMEN
CLIMATE.--It is a well-known fact that more children are born in
southern regions than in northern countries. It may be asserted,
therefore, that climate affects the fertility of the race.
STATION IN LIFE.--Children are more numerous among the poor than among
those who are wealthy and enjoy the luxury of riches. This condition
cannot, however, be construed as a true expression of fertile
efficiency. It is more a comparison of ethics, and when we express it
thus we are giving it its most charitable name.
SEASON OF THE YEAR.--The spring of the year, being more favorable to
fecundity, exerts an influence over the increase of population. Nursing
mothers are as a rule sterile until after weaning time. This is not
always so however, and the possibility of pregnancy taking place while
nursing a baby, and before menstruation is reestablished must be
reckoned with as it occurs quite frequently.
AGE.--Age may be said to affect the fertility of women inasmuch as
sterility is the natural and proper condition before menstruation is
established and after menstruation ceases.
THE TENDENCY TO MISCARRY.--Because a woman has never given birth to a
living child is no proof that she is sterile. Many women have the
ability to conceive but for some reason they have acquired the
misfortune, or the "knack," of miscarrying. This is a condition of the
gravest significance and will be considered at length in its proper
place.
The influence of a temporary separation has had excellent results in a
great many historical cases. Where the married couple seem to be lacking
in some one or other of the emotional or temperamental qualifications,
it is advisable to suggest a temporary separation. When this period has
expired and they resume marital relationship the element of novelty,
acting as a stimulus, quite frequently reestablishes a fertility that
was seemingly suspended, or awakens it if conception has never
previously taken place.
There are a great many cases on record where, conditions having remained
the same, women have become fertile after years of seeming barrenness.
It is impossible to explain, or to satisfactorily understand these
cases. It is quite common to note cases in which women have never become
pregnant until a number of years after marriage, even when the desire to
have children existed. There is one case on record of a woman married at
eighteen, but although both herself and her husband enjoyed habitual
good health, conception did not take place until she was forty-eight
years of age when she bore a healthy child. Women should not, therefore,
become easily discouraged in the hope of having a baby, especially when
they have a clean history, and a healthy body. The conditions may change
and may become favorable when hope is about to die.
CAUSES OF STERILITY IN WOMEN
Inasmuch as it is necessary to consult a competent physician in all
cases of sterility, it is not necessary to go into detail regarding each
possible cause, other than to explain how each may produce barrenness.
It will be observed that a competent physician is specified and advised
in these cases. This is very important because many advertising, or
"quack" doctors, particularly solicit these kind of cases. They are not
competent to be trusted with such cases and will likely effect more harm
than good. A woman should not hesitate to consult the best available
medical authority if she is a victim of sterility. There is nothing to
be ashamed of. It is a perfectly proper medical situation and should
receive the best medical advice and investigation. The following are the
more frequent causes of absolute sterility.
(A) Displacement of womb.
(B) Diseases of womb, ovaries or fallopian tubes.
(C) Malformations.
(D) Lacerations or tears of mouth of womb.
(E) Tumor.
(F) Leucorrhea.
(G) Physical debility.
(H) Special blood poisons.
(I) Great obesity.
(J) Anemia.
(K) Self-abuse.
(L) Habitual alcoholism.
(M) Lack of moderation in the marital relations.
(N) Certain diseases may be associated with barrenness: cancer,
diabetes, consumption, Bright's disease, etc.
(O) Certain temperamental conditions may be associated with barrenness:
lack of affinity, frigidity.
THE KNACK OF MISCARRYING
DISPLACEMENT OF WOMB.--In many instances the primary cause of the
displaced womb was some energetic, muscular effort, made while the
victim was yet a girl,--probably before menstruation began. Whatever act
first caused a slight tilting of the womb, must necessarily have been
an unusual physical effort, and as girls are getting more and more
strenuous we may look for more trouble in this direction in the future.
Inasmuch as a slight tilting of the womb gradually gets worse it is a
reasonable expectation to believe that sterility is a natural sequence
to displacement. The girl may have been the victim of painful
menstruation which was neglected, because not quite painful enough to
compel medical relief, which is sought for only as a last resource
unfortunately under the circumstances. Intercourse may also have been
more or less painful,--a condition which again is mistakenly and
imprudently borne in silence and left to take care of itself. But when
persistent sterility faces her, the woman seeks medical assistance and
her trouble is discovered. As the displacement is found to be the cause
of her sterility, its correction, which is a comparatively easy medical
problem, not only cures the barrenness but happily relieves her of the
menstrual distress and all other pain.
The treatment for displacement consist of placing medicated pieces of
wool or cotton, called tampons, in the vagina in such a position as to
hold the womb, _as_ nearly in its proper place as is possible. After a
time nature will so strengthen the ligaments that they will hold the
womb and a cure is, therefore, affected. The length of time necessary to
cure depends upon the length of time the displacement has existed. It
may take, from two to four months. When the displacement is of long
standing and is accompanied with more or less inflammation, adhesions
sometimes grow between the womb and the adjacent organs. It is necessary
to resort to surgery in such cases, but the result is always good and
the danger practically nothing.
DISEASE OF THE WOMB, OVARIES OR FALLOPIAN TUBES.--Disease of the womb,
ovaries, and fallopian tubes, which renders the victim sterile, is as a
rule the direct result of infection. Such infection is conveyed by the
husband to the wife. This is quite a common condition. The simple fact
that such conditions exist leads us to hope that the time is not far
distant when it will be compulsory for all participants in the marriage
ceremony to submit to a thorough physical examination. By this means,
and by this means only, will the innocent be protected. No one can
conceive, unless he has been identified, as a physician, with one of the
large metropolitan hospital clinics, of the extent of this class of
disease, and of the frightful suffering caused, and innocent lives
ruined, by infection conveyed in this way. It is a tragic corollary to
the marriage vow "for better or for worse."
If a woman is fortunate enough to fall into the hands of an honorable
physician, who will tactfully explain to her the serious significance of
her condition and obtain her consent to treat her until she is cured,
which in all probability will include a surgical operation, and will do
so with diligence, without regard to the size of the bill, she will
indeed be a lucky woman. It is from women who are suffering with such
diseases,--most of them without the slightest idea of what ails
them,--that the venders of advertised nostrums reap their fortunes, and
it is from the same victims that most of the advertised medical "quacks"
look for their blood-money. The great difficulty, however, lies in the
failure of the woman to appreciate the seriousness of her condition, and
as a consequence she fails to understands why it should take so long to
cure her. She loses confidence in her physician, she buys certain
"cures" recommended to her by Mrs. Busybody and later tries other
physicians and ends by losing faith in herself. Meantime she grows worse
and worse. There are thousands such. It may be here stated without fear
of contradiction that if the public in general would repose more
confidence in the medical profession, there would be much less
suffering, much less sorrow, fewer regrets, fewer irresponsible "isms,"
and cults, because there would be fewer disappointed individuals to
support them. If the medical profession would condescend to employ the
tactics and devices of those questionable, fashionable agencies that
claim the power to cure human suffering, it could quickly reap the
profit and the laudation that it now escapes because it keeps the faith.
The way to be cured of any disease, if it is curable, is to engage a
reputable physician and follow his instructions implicitly. Let him
understand you expect him to see you through your trouble and let him
know you have confidence in him. There isn't one physician in a thousand
who will cheat you under these circumstances.
MALFORMATION.--Under this heading are all those cases of sterility
resulting from imperfect generative organs. These are products of a
failure on the part of nature to furnish or develop the structures
participating in the propagation of the species. The entire generative
organs are sometimes wanting. The womb may have failed for some reason
to grow with the rest of the body, it remains (as it is known) as an
"infantile womb." Occasionally the womb grows together, that is, it is
solid instead of being a hollow organ. The mouth of the womb may be too
small, representing what is called "a pin head opening." The natural
opening is large enough to admit a lead pencil, a "pin head opening"
would not be larger than the lead in the pencil. The latter condition is
quite a common cause of sterility and is readily amenable to treatment.
Most of the malformations which produce sterility are impossible to
cure.
LACERATIONS OR TEARS IN MOUTH OF WOMB.--This subject is fully discussed
on another page of this volume.
TUMOR.--A tumor may be so situated as to prevent conception, or it may
involve the body of the womb constituting a reason in itself for
sterility.
LEUCORRHEA.--Leucorrhea or "the whites" may be of such an acid character
as to kill the spermatozoa in the vagina, or it may be of such volume as
to render impregnation impossible. The treatment of this condition is
discussed elsewhere.
PHYSICAL DEBILITY.--When the general health is bad, no matter from what
cause, sterility usually exists. This lack of vitality may be due to
chronic disease, or it may have been caused by a very severe acute
illness, such as typhoid fever. One's mode of living, if unhygienic, may
be responsible for continued bad health and a consequent sterility.
OBESITY.--Very fat women are usually barren. If a woman rapidly
accumulates fat after marriage she as a rule does not have more than one
or two children. Women often become stout immediately after the child
bearing age ceases.
SPECIAL POISONS.--Certain special poisons in the blood cause sterility
by producing miscarriage.
MISCARRIAGE
By the term "miscarriage" we mean that for some reason the progress of
pregnancy has been interrupted and the fetus is expelled from the womb.
A miscarriage or abortion (both terms meaning the same--the difference
between the two terms is a technical one and need not concern us here)
can occur any time after conception up to approximately the seventh
month, when, if labor takes place, the child may be born alive. The
condition would then be termed a premature labor. A miscarriage or
abortion is an immature labor and implies an immature or dead child.
The condition is a serious one no matter whether it is attended with
grave symptoms or apparently no symptoms. If it occurs shortly after
conception, during the first few months of married life it is serious,
if not in its physical consequences, it is in its significance, because
it establishes the tendency to miscarry,--a tendency that may result in
great mental distress because of the worry and fear it engenders, and of
sorrow and heartache because it may blast the hope of parentage. Such a
miscarriage may take place at once after conception. If so, the
following menstruation may be delayed for a week or so and is then a
little more profuse than is customary. This will be the only indication
that a life has been sacrificed that the young wife may have, and
frequently the significance of such an occurrence is never understood,
yet the tendency to miscarry is nevertheless established, and a seeming
sterility is apparently the fate of the woman. It is, therefore, of the
greatest importance that extreme care should be taken to bring the first
pregnancy to a successful consummation. A young wife should realize that
she is apt to become pregnant at any time. Her conduct therefore should
be such at least as not to harm the life principle with which she has
been entrusted. To this end any excessive sexual activity should be
strictly avoided.
CAUSES OF MISCARRIAGE.--Any strenuous physical effort must be guarded
against. Included in such efforts may be the following: dancing,
running, jumping, surf-bathing, sewing on a machine, sweeping, washing,
house-cleaning, moving furniture, etc. Sometimes the primary cause of a
miscarriage is to be found in some hygienic act, such as a hot bath, too
prolonged or too many hot douches near the menstrual periods. A blow or
a fall, even a fright or shock may cause a miscarriage. Anything that
violently shakes or agitates the womb, which may at this time be
irritable because of its condition, will be sufficient to excite it to
contract and miscarry. Hence violent coughing or vomiting should be
avoided if possible; horseback riding, jolting in a carriage,
convulsions, hysterical crying, may also be the causative factors.
Displacement of the womb by limiting its tendency to grow when pregnant,
may cause it to miscarry. Very severe general diseases such as
small-pox, pneumonia, etc., will cause the womb to empty itself. Disease
of the fetus or the presence of syphilis in either of the parents will
also have the same result.
THE COURSE AND SYMPTOMS OF MISCARRIAGE.--The cause of a miscarriage or
abortion is much the same as an ordinary labor at term. Whatever
interrupts the pregnancy causes the death of the fetus. The dead fetus
acts as a foreign body and excites the womb to contract as it does
during an ordinary confinement. The contractions open up the mouth of
the womb and the fetus is expelled together with its membranes and
after-birth. The significant and the most important symptom of a
miscarriage or abortion is hemorrhage or bleeding from the privates. The
flow of blood may not amount to much or it may be excessive and
alarming; it may not be constant, it may come from time to time in the
form of clots.
The next significant and important symptom of miscarriage or abortion is
pain. The pain, like the flow of blood, may be only slight or it may be
very severe, sometimes it is absent in very early miscarriage. As a rule
the pain is severe when the miscarriage occurs after pregnancy has
lasted for a number of months.
A miscarriage or abortion is said to be "complete" when the fetus with
its membranes and after-birth is expelled clean and whole, or in other
words when the womb empties itself completely. A miscarriage or abortion
is said to be "incomplete" when some part of the embryo is left in the
womb.
WHAT TO DO WHEN A MISCARRIAGE IS THREATENED.--When a woman, who is
pregnant, begins to flow she should at once go to bed and keep perfectly
quiet and send for a physician. A miscarriage is a treacherous condition
and is so regarded by all medical men. It may not amount to much or it
may, on the other hand, develop into a serious situation. The immediate
danger is from hemorrhage; the ultimate or remote danger is sepsis or
blood poisoning. The condition is one that can only be taken in charge
by a qualified physician in whose hands we can safely leave the conduct
of the case.
As a general rule it is quite safe to assert that a woman will not bleed
enough at the beginning of a miscarriage to do any permanent harm.
Consequently there is no occasion for unnecessary alarm. She must,
however, as stated above, heed the warning and go to bed, keep perfectly
quiet and send for a physician. If she fails to follow this advice it is
quite possible that she may have a hemorrhage during the course of the
miscarriage of a sufficiently serious character to endanger her life or
from the effects of which she may suffer for the remainder of her life.
There is practically no danger during the course of or after a
"complete" miscarriage. The danger which may ensue from an "incomplete"
miscarriage is hemorrhage and a form of poisoning caused by the
absorption into the system of putrifying products of the part of the
dead embryo left in the womb.
There are a large number of cases of criminal abortion in which septic
poisoning occurs caused by the utensils or instruments used in inducing
the abortion. All of these cases are operative cases which must be
attended to promptly to save life.
TREATMENT OF THREATENED MISCARRIAGE.--Not all of the cases of beginning
miscarriage end in miscarriage. If the physician is sent for in time he
can very frequently give directions that will, if carried out
faithfully, avert the disaster. Success is more likely to attend those
cases in which the trouble has been caused by some accidental injury, as
a fall, or blow, or extra exertion. This is more especially the case if
the woman has previously borne children, is healthy and in good
condition and whose womb is known not to be diseased. In these cases
there is a partial separation of the fetus from the wall of the womb,
which causes the bleeding. The physician will direct that the woman be
put to bed, in a quiet, darkened room. He will instruct the nurse to
sterilize the external genital region: a sterile gauze dressing is then
left in place. Some form of prescription will be given to diminish the
patient's nervous fear and to allay any tendency on the part of the womb
to contract. It is always essential and very important to save
everything that passes from the womb during the course of a threatened
miscarriage in order that the physician may know exactly just what the
condition is. Each cloth, each clot of blood will have to be examined
before the proper treatment can be pursued in safety.
When the miscarriage cannot be prevented it is called an "Inevitable
miscarriage."
TREATMENT OF AN INEVITABLE MISCARRIAGE.--In these cases every precaution
is taken, just as in a normal confinement, to avert blood poisoning. The
hands, instruments, dressings, etc., are carefully rendered sterile and
the whole field must be surgically clean. The physician will conduct the
case as conditions justify and as the situation develops.
AFTER TREATMENT OF A MISCARRIAGE.--It is one of the many thankless tasks
of a physician's life to insist on each patient staying in bed at least
ten days after a miscarriage. The average woman and frequently the
intelligent woman fails to appreciate the absolute necessity for this
procedure. It is necessary and it is the physician's duty to insist on
it being done in the interest of the woman. Many of the multitude of
diseases of women are caused by disregarding advice on such occasions.
THE TENDENCY TO MISCARRY.--If a woman, for any reason, has had a
miscarriage, her womb will tend to miscarry at the same period during a
subsequent pregnancy. If the miscarriage should occur during her first
pregnancy the tendency to miscarry will be greater than if acquired
after she has had a baby.
This is one of the reasons why young wives often fail to have children.
They "get rid" of the first one or two, because they are not ready to
have children, or because they want some enjoyment themselves before
they are tied down with a family. Having established the habit their
womb has been educated to abort, and it will keep this habit up, much to
their astonishment and chagrin.
Young wives should therefore faithfully follow out all the rules of the
Hygiene of Pregnancy laid down by their physician, and which are given
in detail in this book.
[Illustration: _Courtesy of New York World_
AT WORK WITH THE CALIPERS
Watching carefully the physical development of the child month by month
is one of those many little things which may result in disaster if
neglected.
Abnormal development, or lack of development, should be promptly
reported to the physician, as it may be a warning of serious trouble.
For the table of standards, mental and physical, adopted by the American
Medical Society see page 271.]
THE BABY