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—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.
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, whosesleep 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 thedaughter 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 takedouches 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 anyobstruction 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 hasbeen 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 overworkand 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 bethe 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 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-fouryears. 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.
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 placewhile 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.
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.
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 firstcaused 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,asnearly 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 compulsoryfor 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 awoman 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.
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 atany 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 ofblood, 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 theutensils 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 necessityfor 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.
Courtesy of New York World At Work with the CalipersCourtesy 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.
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.
What to Prepare for the Coming Baby—Care of the Newly-born Baby—The First Bath—Dressing the Cord—Treatment After the Cord Falls off—A Pouting Navel—Bathing Baby—Clothing the Baby—Baby's Night Clothes—Care of the Eyes—Care of the Mouth and First Teeth—Care of the Skin—Care of the Genital Organs—Amusing Baby—Temperature in Children—The Teeth—The Permanent Teeth—Care of the Teeth—Dentition—Treatment of Teething—How to Weigh the Baby—Average Weight of a Male Baby—Average Weight of a Female Baby—Average Height of a Male Child—The Rate of Growth of a Child—Pulse Rate in Children—Infant Records, Why They Should be Kept—"Growing Pains."
What to Prepare for the Coming Baby—Care of the Newly-born Baby—The First Bath—Dressing the Cord—Treatment After the Cord Falls off—A Pouting Navel—Bathing Baby—Clothing the Baby—Baby's Night Clothes—Care of the Eyes—Care of the Mouth and First Teeth—Care of the Skin—Care of the Genital Organs—Amusing Baby—Temperature in Children—The Teeth—The Permanent Teeth—Care of the Teeth—Dentition—Treatment of Teething—How to Weigh the Baby—Average Weight of a Male Baby—Average Weight of a Female Baby—Average Height of a Male Child—The Rate of Growth of a Child—Pulse Rate in Children—Infant Records, Why They Should be Kept—"Growing Pains."
What to Prepare For the Coming Baby.—The physician should instruct the young wife just what to provide for the coming baby. The following list will be found useful as a general guide.
An ordinary clothes basket, padded and lined, is quite sufficient for the first month; or, a baby crib, which may be cheap or expensive as the individual taste dictates. The Taylor crib is probably the handiest and best one on the market.Pin cushion;Puff-box and puff;Soap box containing pure castile soap;Hair brush and fine comb;Two wash cloths;Four ounces of crystal boracic acid, a saturated solution of which is used for cleansing baby's eyes and mouth;One pound of good absorbent cotton;A flexible tube of white vaseline;A bath thermometer;A package of sterile gauze;A half dozen baby towels, good quality;A soft, white, good blanket,—one and one-half yards square;One pair small blunt pointed scissors;A package of the best safety pins;Three or four dozen bird's-eye cotton diapers. First size, eighteen inches square. Second size, twenty-five inches square;One yard of soft white flannel for belly bands; each band should be five inches wide, by twenty-four inches long.Two silk and wool shirts;Three flannel shirts (all shirts should be high necked, long sleeved, and open down the front);Three Eiderdown wrappers;Three Cashmere sacques;Three pads for crib;Six dresses;Six petticoats (they should be thirty-three inches long from neck to hem; they should be turned up at the bottom for about four inches and should button there to keep the feet warm; if it is desired to use pinning blankets for the first two months in place of the petticoats, they should be made of soft white flannel with cotton bands);Six night slips;Six pair socks;Two cloaks;Two hoods;One dozen bibs.
An ordinary clothes basket, padded and lined, is quite sufficient for the first month; or, a baby crib, which may be cheap or expensive as the individual taste dictates. The Taylor crib is probably the handiest and best one on the market.
Pin cushion;
Puff-box and puff;
Soap box containing pure castile soap;
Hair brush and fine comb;
Two wash cloths;
Four ounces of crystal boracic acid, a saturated solution of which is used for cleansing baby's eyes and mouth;
One pound of good absorbent cotton;
A flexible tube of white vaseline;
A bath thermometer;
A package of sterile gauze;
A half dozen baby towels, good quality;
A soft, white, good blanket,—one and one-half yards square;
One pair small blunt pointed scissors;
A package of the best safety pins;
Three or four dozen bird's-eye cotton diapers. First size, eighteen inches square. Second size, twenty-five inches square;
One yard of soft white flannel for belly bands; each band should be five inches wide, by twenty-four inches long.
Two silk and wool shirts;
Three flannel shirts (all shirts should be high necked, long sleeved, and open down the front);
Three Eiderdown wrappers;
Three Cashmere sacques;
Three pads for crib;
Six dresses;
Six petticoats (they should be thirty-three inches long from neck to hem; they should be turned up at the bottom for about four inches and should button there to keep the feet warm; if it is desired to use pinning blankets for the first two months in place of the petticoats, they should be made of soft white flannel with cotton bands);
Six night slips;
Six pair socks;
Two cloaks;
Two hoods;
One dozen bibs.
Simplicity, warmth, and freedom are the essentials in latter-day baby clothes. It is cheaper to make the clothes than to buy them. Excellent and accurate paper patterns can be obtained, giving the quantity of material necessary and suggesting the kind and quality best suited for the purpose. These patterns may be obtained from the Butterick Publishing Company in New York City.
Care of the Newly-Born Baby.—After the nurse has completed her duties with the mother after the confinement, she will prepare to give baby its first bath.
The bath should be given in a warm room. This is a matter that should receive more consideration than has been given it. Nurses do not as a rule attach much importance to this duty, while in reality it is a most important one. I have seen trained nurses make ready to give baby its first bath in rooms, during the night, that were not heated adequately. I am convinced that many babies have been victims of this careless habit to the extent of grafting on them the tendency to catarrhal colds and bronchitis because of undue exposure at this critical period. If one will remember that a baby has just beenremoved from an environment where the temperature was suitable and constant, to one in which it needs a large degree of artificial heat until such time as it may become accustomed to the change, one may appreciate the risk taken in exposing the child for even a short time. The mother should therefore warn the nurse not to undertake the baby's first bath until the temperature and other conditions are favorable. Many nurses and other individuals have the impression, without knowing why, that the baby should be cleansed and bathed immediately after birth. This is not at all necessary. If the conditions are not favorable, it would be far better to wrap the baby snugly in a warm blanket—first having put a diaper on—and place it in its crib with a hot water bottle near it and defer the bathing until the following forenoon. By that time the baby will be adapted to its new surroundings; its lungs will have become accustomed to the air which it is breathing for the first time; the mother will have been rendered comfortable; in other words, the conditions and the environment will be favorable for the baby and for a better performance of the duty.
The next important feature of the first bath is that it should be done in the quickest time consistent with efficient service. Only the necessary exposure should be indulged in. It is not necessary that the baby should be exposed to the admiring inspection of every member of the household—there will be plenty of time for that without risking the health of the child. A pan of water at a temperature of 100° F. should be placed on a stool in front of the nurse. The nurse should have on a rubber apron, and on top of this, an ordinary apron and a warm bath towel laid over her knees. The child should be gently rubbed with warm sweet oil to remove thevernix caseosa(the greasy substance which is on all babies when born to a lesser or greater extent). Particular attention is to be given to all folds of the skin, as under the arms, in the fold of the neck, in the groin, behind the ears, etc., because in these parts the substance is thickest and if not carefully removed it will cake, and cause painful eruptions and sores, which may bleed and render the infant extremely uncomfortable. It is not necessary toexpose the whole body at one time while applying the oil. The lower half may be covered with a warm soft towel while the nurse is oiling the upper part, and vice versa. After the body has been thoroughly oiled it should be cleansed with water at the proper temperature, in which pure castile soap has been dissolved. Absorbent cotton only should be used to wash the baby. All the washing is done with the baby on the nurse's knee; it is not put into the water.
The baby should be mopped dry with sterile gauze, or with a soft sterile towel, the cord dressed and the flannel band adjusted. It should then be completely dressed and put to the nipple and later to sleep.
Dressing the Cord.—The cord should be covered with powder and sterile gauze. The powder to use should be plain subnitrate of bismuth. If there is any reason to use another powder the physician will write a prescription for it according to indications. The subnitrate of bismuth will be found much better than any ordinary talcum or toilet powder, many of which do not make good dressing powders.
Very few nurses know how to dress the cord. It seems to be impossible to impress them with the need of frequent attention to the cord. Fresh powder should be put on every time the diaper is removed, every time the infant urinates, and at other times during the day. The cord should be kept absolutely dry. Putting on powder twice daily will not keep the cord dry and many nurses are too lazy to bother to do it oftener. You cannot make a mistake in putting on too much powder, you can make a serious mistake by not putting on enough. Every time the cord is powdered it should be lifted up, away from the skin of the abdomen, and the powder put below it. The cord should be slightly drawn out and the powder applied round its base where it meets the skin. Many nurses are afraid to touch or handle the cord—they find it easier to neglect it. The mother should see that the nurse dresses the cord at least five times every day.
Applying the Sterile Gauze to the Cord.—A piece of gauze, six inches square is taken, a hole is cut the size of a ten-cent piece out of the center, the cord is drawnthrough the hole, the gauze folded lengthwise over the cord and then sidewise, and this is held in place by the binder. This piece of gauze will adhere to the cord and will most likely be removed with the cord on the fifth day. If it should fall off, another piece may be put on in the same way.
If the cord does not fall off until very late it is because it has not been attended to rightly or because it was a very thick cord.
Treatment After the Cord Falls Off.—The stump of the cord should be powdered with the same powder used on the cord; a pad two inches square of sterile gauze and quite thick should be held over the stump for a number of days by the abdominal binder. This is used to prevent a possible rupture. After a week the size of the pad may be reduced, but a small pad should be used over the stump of the cord for a month or more.
A Pouting Navel.—If the stump of the cord should protrude, a piece of strong pasteboard, the size of a fifty-cent piece, should be wrapped in soft gauze and placed over the navel, over this a gauze pad, and if necessary this should be held in place by a strip of adhesive plaster, though the binder is usually sufficient if it is put on carefully. If this pad is held properly and worn for a month the tendency to protrusion or rupture will have passed away. These pads may of course, be removed when the baby is being bathed and put back again before the binder is applied.
Bathing Baby.—A baby should not be put into water for a bath until after the cord has been off for forty-eight hours.
During the first few months the temperature of the water should be 98° F. The temperature of the water should be taken with a bath thermometer; it should not be guessed at. A bath thermometer is an inexpensive commodity and it will be in daily use in many ways in a home where there is a baby—it should therefore be procured wherever possible. The room should be warm; there should be no draughts. The mother or nurse should cultivate the habit of bathing baby quickly and with system. Everything should be ready and at hand. A littlesalt in the water will tend to strengthen the skin; it will also relieve any superficial rashes or excoriations which may be on the skin. Four tablespoonfuls to a gallon of water will be sufficient. The sea salt sold in the stores may be used in lesser quantities.
By the end of the fifth month the temperature of the water may be reduced to 95° F., and by the end of the first year to 90° F. After the first year the mother should accustom the child to a quick sponge with cool water on the chest and spine immediately after the bath. This simple means, if kept up, will often prevent the development of colds and bronchial troubles so common to children in temperate latitudes.
The best time to give the warm bath is at night. In the morning a cold sponge bath is desirable. This should be given as described in the chapter on cold sponge or shower baths.
In certain children bathing seems to depress their entire system. They do not react well even to a warm bath. They remain blue or pale around the mouth and eyes; bathing should therefore be carefully undertaken with these children until such time as they acquire strength.
Clothing of Baby.—The baby should wear a woolen shirt, with a high neck and long sleeves. The abdominal binder may be worn for the first three months. It is not necessary after that time. If worn longer the habit is acquired and chronic indigestion may ensue when it is ultimately taken off. If the baby is very thin it may be wise to leave it on, simply for its warming effect, for a few months longer. If the child is normal and healthy the binder should be left off permanently after three months. The band for the first four weeks should be made of plain flannel; after this period a knitted band with shoulder straps is the better article. All petticoats and skirts should be supported from the shoulders. Stockinet is a good material for diapers; it is soft, warm, and pliable.
Baby's feet should be warm always. Cold feet are frequently responsible for colic and gastro-intestinal troubles. A hot water bottle should be placed in the carriage if the weather is cold, but care should be takento see that it does not touch the feet, otherwise it may burn them. The same measure may be adopted in the baby's crib if the feet are cold.
During the summer the outer clothing should be made of the thinnest quality of material possible, and the underclothing of the finest flannel or gauze. Body heat may be maintained during changes of temperature by extra outer wraps—not by dressing the baby in clothes that keep it too hot and uncomfortable all the time.
The main object to be attained in clothing the baby is to ensure a sufficient protection, but the clothing must be light, warm, loose, and non-irritating. Don't bundle up the arms and legs so that they cannot be moved; don't pin them so tight that the child cannot breathe properly and don't put the band on so that the child is in torture all the time from inability to move the abdomen.
Baby's Night Clothes.—The night clothing should be the same as that worn during the day, but it should be loose and of the lightest flannel material. For older children a thin woolen shirt (not the one worn during the day) and a suit of union clothing with feet is best.
The mistake must not be made to cover children too warmly at night. They can do with relatively less than adults. Too much covering will render the sleep restless, will encourage nightmare, and in older children will engender bad habits. Delicate children especially must not be over-covered at night.
For the first few months children should sleep in a darkened room.
Care of the Eyes.—The eyes should be cleansed for the first few days with a saturated solution of boracic acid. They should be protected from the direct light for two or three weeks after birth.
Care of the Mouth and First Teeth.—Boiled cooled water should be used to cleanse the mouth every morning after the bath. A soft piece of sterile gauze should used for this purpose. The mother must guard against using too much force in cleaning the mouth of an infant.
The milk teeth should receive attention. If they are allowed to become dirty they will become carious andcause bad breath and neuralgia. Teeth of this character are a menace to health because they harbor germs and in this way infect the mouth and cause stomach troubles. Teeth that are carious should be filled or removed.
Care of the Skin.—The skin of a baby, because of its delicate character, is susceptible to the slightest changes in the weather or to the condition of the digestive organs. Babies are frequently subject to rashes, intertrigo, excoriations, eczema, and other skin affections. It is much easier to prevent these conditions than to cure them. Cleanliness, not only in giving a daily efficient bath, but in every other respect, is essential. Castile soap only should be used, and no rubbing indulged in, simply mopping the parts with gauze well saturated with soapy water. All napkins should be removed as soon as soiled. If the skin is easily chafed the child should be bathed in salt water or water in which bran is mixed as explained in the chapter on bran baths.
The baby should be well powdered with a good quality of toilet powder. Ordinary starch, or talcum, or the stearate of zinc is suitable. Fat infants should be powdered in all the skin folds; otherwise they are sure to chafe.
Care of the Genital Organs.—The mother should make it a habit to remove any dirt from the genitals of the baby during the morning bath. Fecal matter sometimes gets into the folds of the female baby; this should be removed promptly. In older female children, dirt and dust get into the genitals which often has to be removed carefully with a soft piece of cloth. An exceedingly chronic form of inflammation is often seen in poor children because of neglect of these parts.
In male babies the mother must daily push back the foreskin and clean under it. If this is not done the natural secretion will gather there and cause much trouble. If the foreskin is long, the child should be circumcised; if it is not long it must be pushed back daily for a number of weeks; otherwise it will contract and it may be necessary to operate on it at a later date. If this is not faithfully attended to the prepuce will become adherent, the child becomes nervous and irritable, and itmay become addicted to self-abuse at a very early date—simply because the mother is derelict in the performance of her duty. If you are afraid to do your duty, don't neglect it, ask the doctor to show you just what has to be done and just how it should be done. You will find it to be a simple matter when you know how, as most things are.
Amusing Baby.—Mothers should understand that it is not necessary to amuse a baby under one year of age. Their nervous systems are not ready for any such sport. To excite a baby to laughter is to subject it to a shock which may injure it. The healthy development of the brain of a child demands quiet and restful surroundings. It should sleep, eat, and be allowed to amuse itself in a natural way.
Temperature in Children.—The normal temperature in a child varies more than it does in an adult. The rectal range may be between 98° and 99.5° F. and may be normal to that particular child. A rectal temperature of 97.5° F. or of 100.5° F. is of no importance unless it continues.
The best place to take the temperature in a child is the rectum and the next best place is in the groin. The temperature will always be from a half to a full degree higher in the rectum than in the groin. The thermometer should be left in the rectum for two minutes, and in the groin for five minutes.
The temperature in a child is a very fair guide as to the severity of the disease. It must be remembered, however, that a child will develop a temperature of two or three degrees from a very slight cause. It is not the height of the fever that is significant, but rather the duration of the fever that is important. A fever of 102° F. in a child may only mean a slight indigestion which will wholly disappear after a laxative is given, while the same degree of temperature in an adult usually means something much more serious. The degree of the temperature therefore should not occasion unnecessary worry; if, however, it continues and if the child shows other signs of illness, it may be regarded as indicating an abnormal condition which should be immediately found out. A temperatureof 100° F. to 102° F. usually means a mild illness, and one of 104° F. or over, a serious sickness.
It is not advisable that the ordinary mother should possess a clinical thermometer. There are many occasions when a child will have a fever which should not cause any worry; if the mother gets the thermometer habit, she will many times occasion unnecessary calls of the physician only to learn that they are false fears.
The Teeth.—There is no definite time at which the first teeth appear. They usually come between the sixth and eighth months. They may not, however, come until much later; or they may come earlier than the sixth month; and yet the child may be perfectly healthy. They come as a rule in the following order: