Treatment.If the woman has been so unfortunate as to get caught out in a heavy rain so that her clothes have been wet through, or if in the cold weather she should come into the house thoroughly chilled, the best thing to do is to take off her wet things as quickly as possible, be well rubbed down with hot, rough towels, drink a cup of hot tea, go to bed at once and place a hot-water bag over the abdomen. She should remain in bed until the next morning, to the end that the circulation may regain its equilibrium as quickly as possible by the immediate relief of the pelvic congestion. If this exposure should have caused the sudden cessation of the flow, a hot mustard foot-bath should be taken. One tablespoonful of mustard is used to a gallon of water as hot as can be borne; the pail should be made as full as can be without running over, and a blanket wrapped around the pail and woman, so as to cause a profuse perspiration; this should be kept up for ten minutes; if the water cools off, hot water may be added.
"Defer not till to-morrow to be wise,To-morrow's sun on thee may never rise." CONGREVE
"Defer not till to-morrow to be wise,To-morrow's sun on thee may never rise."
CONGREVE
Menorrhagia and Metrorrhagia. By menorrhagia is meant an excessive or too profuse menstrual flow; by metrorrhagia, a flow of blood between the menstrual periods. Neither one constitutes a disease by itself, but is a symptom of some pathologic condition.
It has already been stated that the excretory organs, by constantly eliminating from the system the worn-out material, keep the machine healthy and in good working order. Kept within natural limits, this elimination is the source of strength and health; beyond these limits, the menstrual flow becomes an actual hemorrhage that, by draining away the life, becomes the source of weakness and disease.
No physician would dare to bleed a man or woman once a month, year in and year out for thirty years; but, through ignorance or folly, this is what many girls do for themselves.
This excessive flow, aside from actual local disease, is brought about by excessive muscular exercise during menstruation; by the use of all stimulants, whether alcoholic beverages or quinin; as well as by the thinness of the blood.
When the flow is excessive, it must be considered a pathologic condition, which needs the physician's attention. Rest in the recumbent position is the first essential; the diet must be plain and unstimulating, and attention must be paid to the condition of the blood.
The general diseases which generally cause this condition are anemia, Bright's disease, malaria, the early stages of tuberculosis, and heart disease.
The local causes may be reflex, as powerful emotions; or due to local disease of the uterus and its appendages, as the various inflammations and displacements of the uterus, fibroid tumors, polypi, and cancer.
Dysmenorrheais painful menstruation. The most frequent forms are due to uterine congestion; to mechanical causes, as a narrowing of the cervical canal, particularly at its internal opening, or to a constriction caused by the bending over of the uterus at the junction of the body and the neck; or to ovarian irritation.
The pain varies in intensity from slight discomfort to the most intense uterine colic, which is experienced in the lower part of the abdomen. In severe cases the general health becomes undermined, the nervous system gives way, and hysteria and other disorders of the nervous system result.
The congestive variety usually occurs in patients who have previously menstruated painlessly. The pain comes on suddenly with the flow and ceases when the flow stops; it is very severe and is generally accompanied by a diminution or a cessation of the flow. There is severe headache, marked diminution in the secretion of the kidneys, and general restlessness. The patient frequently experiences pain in walking, is easily fatigued, has leucorrhea and an irritable bladder.
In ovarian dysmenorrhea the pain precedes the flow for several days and ceases when a free flow is established. The pain is of a dull aching character, and may be felt on one or both sides of the abdomen, according as one or both ovaries are involved.
Amenorrhea. In amenorrhea the menstrual flow may not appear for some years after it is normally due; or the flow may cease after some months or years of continuance; or the flow may be abnormally scanty or even absent.
The menstrual flow is much later in appearing in some families than in others, so that this may be considered as a family idiosyncrasy; and if the girl's health is good, it need cause no anxiety. If, on the contrary, the girl has severe headaches, or suffers in any way, the physician should be summoned at once, as the absence of menstruation may be indicative of some serious pathologic condition,
A scanty flow is often indicative of thinness of the blood; on the other hand, serious anemias often lead to profuse menorrhagias or metrorrhagias, as has already been stated. The cause of the profound anemia itself may be insufficient nutrition, overwork, or lack of exercise.
Scanty menstruation is often seen to occur in fevers, in the later stages of consumption, in advanced Bright's disease, in malaria, or in any other very serious disease. In these cases it seems to be a conservative process on the part of nature in the run-down state of the system. As consumption progresses menstruation generally ceases absolutely, never to return again; and in this case nothing should be done to try to induce a return of the flow.
Great shock sometimes causes a sudden cessation of the flow; and sometimes a sea-voyage, followed by the change of habitat, will cause an obstinate form of amenorrhea.
But it cannot be too well understood that, after the menstrual flow has been regularly established, it continues with the greatest regularity throughout the child-bearing period, unless the exposure to wet or cold has been sufficiently severe to cause great indisposition on the part of the woman. In this case it is possible that, if the exposure took place just previous to the time of the expected flow, one period may remain out. But except in case of serious illness, as for example, typhoid fever, two or more periods do not fail to appear except in the case of pregnancy.
Leucorrhea. Leuchorrhea, or "whites," is a mucous or mucopurulent discharge from the vagina; it may be a symptom of uterine or vaginal disease.
Immediately after the menstrual flow there is a well-marked vaginal secretion which is whitish in appearance; it may be transparent or of a milky color, and is sometimes very acrid. This secretion may also precede the flow, and there is nothing abnormal in this. But any discharge occurring between the periods sufficient to stain the clothing the so-called whites or leucorrhea is abnormal, and is caused by an inflammation of the vagina or the neighboring parts. In addition to the discharge there is heat and swelling of the parts, more or less local distress, and generally intense nervousness.
If the disease is not cured, it may become chronic. The pain, heat, and scalding disappear, but a copious discharge continues, and in this stage the disease may be very obstinate and greatly reduces the strength. The constant drain breaks down the system, producing pallor, debility, pain in the back, palpitation, indigestion, and so forth.
The character of the discharge in leucorrhea varies considerably, from a whitish or mucous secretion, to a yellowish or mucopurulent secretion, and is debilitating in proportion as it is profuse. It is to be remembered that this is not in itself a disease, but indicates a disease of some of the pelvic organs; and that all such inflammations left to themselves incline to grow worse.
A severe leucorrhea is generally attended with frequent and finally painful micturition; pain in walking in the lower part of the abdomen, which may become so severe as to compel the patient to go to bed.
Pruritus Vulva. This is an intense and persistent itching of the vulva, and is a symptom rather than a disease. It is not an infrequent result of leucorrhea, the acrid discharge of the latter leading to an irritation of the parts; this causes rubbing of the parts until a veritable inflammation is produced.
Other causes of pruritus vulvae are: The local congestion, such as occurs at the menstrual period, or in certain cases of pelvic inflammations, or in early pregnancy; constipation; sedentary habits; congestion of the liver; incontinence of urine, and diabetes. When dependent on the latter, the malady is most obstinate in yielding to treatment. Indigestible foods or drinks, the rubbing of the clothes, the friction of walking, and the heat of the bed act as exciting causes in those predisposed to it.
The essential treatment here is to at once ascertain and remove the cause; aids in the treatment are vaginal douches and cooling lotions.
"Well, Brutus, thou art noble; yet, I see,Thy honourable mettle may be wroughtFrom that it is disposed: Therefore, 'tis meetThat noble minds keep ever with their likes.For who so firm that cannot be seduced?" "Julius Caesar."
"Well, Brutus, thou art noble; yet, I see,Thy honourable mettle may be wroughtFrom that it is disposed: Therefore, 'tis meetThat noble minds keep ever with their likes.For who so firm that cannot be seduced?"
"Julius Caesar."
Herbert Spencer's Definition of Love. "Love is habitually spoken of as though it were a simple feeling, whereas it is the most compound, and therefore the most powerful, of all the feelings. Added to the purely physical elements of it, are first to be noticed those highly complex impressions produced by physical beauty; around which are aggregated a variety of pleasurable ideas, not themselves amatory, but which have an organized relation to the amatory feelings. With this there is united the complex sentiment we term affection a sentiment which, as it can exist between those of the same sex, must be regarded as an independent sentiment, but one which is here greatly exalted. Then there is the sentiment of admiration, respect, reverence, in itself one of considerable power, and which in this relation becomes in a high degree active. There comes next the feeling called the love of approbation. To be preferred above all the world, and that by the one admired above all others, is to have the love of approbation gratified in a degree passing every other experience, especially as there is added that indirect gratification of it which results from the preference being witnessed by others. Further, the allied emotion of self-esteem comes into play. To have succeeded in gaining such attachment from and sway over another is a proof of power which cannot fail to agreeably exciteamour propre.Yet again, the proprietary feeling has its share in the general activity. There is the pleasure of possession, the two belonging to each other. Once more, the relation allows of an extended liberty of action. Toward each other a strained behavior is requisite. Around each there is a suitable boundary that may not be crossed; an individuality on which none may trespass. But in this case the barriers are thrown down, and the love of unrestrained activity is gratified. Finally, there is an exaltation of sympathies, egotistic pleasures of all kinds are doubled by another's sympathetic participation, and the pleasures of another are added to the egotistic pleasures. Thus around the physical feeling forming the nucleus of the whole, are gathered the feelings produced by personal beauty that constitutes simple attachments, of self-esteem, of property, of love of freedom, of sympathy. These, all greatly exalted and severally tending to reflect their excitements on one another, unite to form the mental state we call love. And as each of them is comprehensive of multidinous states of consciousness, we may say that this passion fans into immense aggregate most of the elementary excitations of which we are capable; and that hence results its irresistible power."
What Constitutes a Suitable Husband. It is desirable that the husband shall be a few years older than the wife. Man is later in coming to maturity, and also retains his sexual powers considerably longer than woman; so that for these functions to cease about the same time, the wife must be younger than the husband. A difference of from two to five years is best; if the parties are young, it is not essential that the husband should be much the wife's senior, as it is later in life. The husband may be ten years older, but a greater disparity of age than this is rarely compatible with congeniality of tastes and dispositions, so essential to a happy married life. The woman who risks her happiness with a man many years younger than herself violates a precept of nature.
The average stature of the man is about three inches greater than that of the woman, and in the physiologic marriage any great deviation from this should be avoided.
The essentials for a happy marriage may be summed up as follows: that the parties shall be of suitable age; that they shall be physically well mated and in full sympathy with each other's views of life, of the same social position, and of equal education.
The Best Age for Marriage. The reproductive life begins with puberty, but maturity is not reached before the age of twenty-one. It is only then that the standard of development is reached that is most compatible with the successful bearing of the grave responsibilities of wifehood and motherhood. The too early exercise of the reproductive functions leads to increased suffering on the part of the mother, depresses her vitality, and increases her liability to disease. Statistics show that the mortality is very much greater where girls marry under twenty years of age.
The offspring are apt to be small and ill developed, and die in large numbers in early life; only a small percentage live long and robust lives. In France it has been observed that where the fear of conscription has caused many young people to marry the offspring were lacking in vigor. Among the offspring of immature parents there is a larger proportion of idiots, cripples, criminals, scrofulous, insane, and tubercular than among the children of nubile parents.
In our climate women are best fitted to become wives and mothers between the ages of twenty-four and twenty-eight years. Before this age neither their self-knowledge, their knowledge of the world, nor their experience is sufficiently mature to fit them to wisely make the choice of a companion for life, or to become mothers. After forty, most women cannot hope for children. Men had better wait until between the ages of twenty-seven and thirty years, before they undertake the responsibilities of parenthood.
Shall Cousins Marry? They might if both families were perfectly healthy; but as few families are without some lurking predisposition to disease, it is not well, as a rule, to run the risk of developing this by too repeated unions.
Contraindications to Marriage. Young women in whose family there is a distinct history of such hereditary diseases as cancer, tuberculosis, or insanity for two generations back, should not marry at all. Not only is this a fearful legacy to hand down to their children, but pregnancy and child-bearing very decidedly favor the development of these diseases.
Syphilis in either sex is a distinct bar to marriage; first, the party married is sure to contract the disease, even though it may have been supposed to have been cured. Fortunately, the children of such marriages are generally still-born; still, they do sometimes live, and are most pitiable and sickly objects. For any one to marry under these conditions is a crime against society, against the State, and against posterity.
Women who have serious forms of heart disease, tuberculosis, or Bright's disease would, by becoming pregnant, run a serious risk of losing their lives toward the close of the pregnancy or at the time of their confinement. In case of heart disease, the pulmonary congestion that accompanies pregnancy, together with the encroachment of the pregnant uterus on the cavity of the chest, would greatly add to the embarrassment of the heart's action.
In normal pregnancy there is some congestion of the kidneys; where there is actual disease of the kidneys prior to the pregnancy, this congestion is apt to become so severe as to threaten the woman's life. These organic diseases are not to be confounded with functional diseases which are dependent on some other cause; as palpitation of the heart due to indigestion, or heart murmurs dependent on the thin state of the blood, or congestion of the kidneys due to exposure to cold; all of which may be cured by proper treatment.
Should a woman with a fibroid tumor marry, she would run a great risk to her life; she should have the tumor removed, or, if this is not possible, she should give up all thoughts of marriage, since the increased irritation and congestion consequent upon the marital relations would tend to favor its growth. Should pregnancy ensue, delivery might be attended with serious complications, as very difficult labor, postpartum hemorrhage, or, as these tumors have but little vitality, and the pressure to which they are subjected during labor is liable to cause their death, disorganization, sloughing, and, as a result, puerperal septicemia.
Sometimes there is such a lack of development of the genital organs as to prevent the woman from having children.
Two persons with even a slight tendency to the same disease, either inherited or acquired, should not intermarry, even if they are in comparatively good health at the time. Their offspring would be quite sure to inherit their diseased tendencies.
Persons whose constitutions have been somewhat injured, but who are not tainted with actual disease, may rear children much healthier than themselves, provided their own lives are wisely regulated. If they are growing better all the time, and are not too much broken in constitution, it may be safe for them to marry.
Among the Jews the physician is frequently consulted before matrimonial alliances are contracted. This custom could not but be of universal benefit; many local or general diseases would be eradicated before marriage, and in this way much suffering and unhappiness would be spared; or, in other cases, the patient would be advised of the inadvisability of marriage.
Do Reformed Profligates Make Good Husbands? The manner of life that has been led by this class of men is such as to undermine their health, if not to have rendered them physical wrecks. There is the overindulgence in alcoholic beverages, and perhaps, added to this, some drug habit. In addition to this, these men early in their career are apt to become infected with some of the venereal diseases, or perhaps with all of them gonorrhea, syphilis, and so forth; and these diseases have the horrible characteristics of becoming latent. A man who contracts this kind of a disease can never be really sure that he is cured. All venereal diseases are highly contagious.
It is now a well-established fact that gonnorrheal infection is not only one of the most common causes of pelvic inflammations in women, but that these same inflammations are of the most virulent types, unless they are recognized and treated in the early stages. It is also a well-known fact that a large percentage of married women suffer from this disease. Sterility almost always results.
In the case of a syphilitic parent, one or two children may be born, but the offspring is generally sickly and diseased. Inebriety as well as sexual excesses are both well recognized as distinct forms of disease accompanied by degeneracy of brain tissue. It is nothing less than criminal for such men to have children, since these children would at least inherit the tendency to the same diseases, if they did not actually have them; there is also a strong probability of such children being born idiots or imbeciles.
It is therefore self-evident that, instead of a reformed profligate making a good husband, he must make a very diseased one. It has therefore been suggested that the parents of the prospective bride should demand from the intended groom a certificate of freedom from all venereal diseases by a physician of their own selection. Also that there should be legislation upon the subject, and that before a man is granted a license of marriage, he should have a certificate from the health officer of freedom from syphilis, gonorrhea, and tuberculosis.
The Proper Length of Time for the Engagement. A period not shorter than three months, nor longer than one year, should elapse between the engagement and the marriage.
There are strong physiologic reasons against long engagements: they keep the affections and the passions in an excited and unnatural condition, which after a time tends to weaken the nervous system and undermine the health. These evil consequences are common to both sexes. It is far better that the subject of marriage should not be entertained at all unless the circumstances are such that the union might with propriety be effected at once.
The Right Time of the Year to Marry. When woman marries she enters upon a new life, and a very trying one. Extreme heat and extreme cold are both very taxing to the human economy. Midsummer and midwinter are therefore both objectionable, but especially the former.
The Selection of the Wedding-day. This is by common consent left to the bride. She should select a time about ten or fifteen days after the end of one of her menstrual periods, as this is the time of comparative sterility, and it is most desirable that the first sexual relations should be fruitless.
"If it is possible to perfect mankind, the means of doing so will be found in the medical sciences." DESCARTES.
"If it is possible to perfect mankind, the means of doing so will be found in the medical sciences." DESCARTES.
The Wedding-journey. The wedding-journey, which was formerly the cause of so much discomfort to both husband and wife, has fortunately gone out of vogue; and in its place has come the retirement to a quiet country or seaside spot, away from the prying eyes of friends. Thus the nervous strain incident to sight-seeing and travel is avoided.
The Ethics of Married Life. It has been said that God set men and women in pairs in order that they might perfect each other and complete each other's happiness. The secret of all true happiness in life lies in the spirit of altruism; one must be able to wholly forget herself and to find her happiness in the welfare of others.
The woman who exhausts herself physically and financially on the preparation of her trousseau and her wedding does her husband a wrong by bringing him a wife who is on the verge of nervous prostration.
The secret of a happy married life depends to no small extent on the very beginning: the relation is so entirely new, and much lies hidden in the character of each that was never suspected by the other.
Between husband and wife there must always be mutual concessions, forbearance, and sympathy; a mutual helpfulness to attain all that is best. This, of course, implies that the life of each is an open book for the other to read; that there is an unreserved exchange of thought; and that no privilege is claimed by the one that would not willingly be accorded to the other.
"How many men," says Balzac, "proceed with women as the monkey of Cassan with the violin; they have broken the heart without knowing it, as they have tarnished and disdained the jewel whose secret they never understood. Almost all men are married in ignorance of women and of love. They have commenced by forcing open the doors of a strange house and have wished to be well received in its salon. But the most ordinary artist knows that there exists between him and his instrument his instrument which is made of wood or ivory a sort of indefinable friendship. He knows by experience that it has taken years to establish this mysterious rapport between an inert material and himself. He could not have divined at the first stroke all its resources and caprices, its faults and its virtues. His instrument only became a soul for him and a source of melody after long study; he only came to understand it as two friends after the most learned interrogation.
"So the world is full of young women who grow pale and feeble, sick and suffering. The ones are a prey to inflammations more or less severe; the others remain under the dominion of nervous attacks more or less violent. All these husbands have caused their own unhappiness and ruin. Never begin married life with a rape. To demand of a young girl whom one has seen forty times in fifteen days to love you because of the law, the king, and justice is an absurdity.
"Love is the union of necessity and of sentiment. Happiness in marriage is the result of perfect understanding between the spirits of husband and wife. From this it happens that in order to be happy, a man is obliged to bind himself to certain rules of delicacy and honor. After taking advantage of the social laws which consecrate the necessity, it is necessary to obey the secret laws of nature, in order to make the sentiments flourish. If a man places his happiness on being loved, it is necessary that he should love sincerely; nothing resists a veritable passion."
Shall Husband and Wife Occupy the Same Bed? Among civilized nations custom differs in this regard; in Germany, for instance, the husband and wife occupy separate beds in the same room; formerly in this country it was almost the universal custom for husband and wife to occupy the same bed. The current of opinion has changed in this respect, and it is now considered in the highest interests of both that they shall occupy not only separate beds, but separate rooms; these rooms communicating through a door which connects their respective dressing-rooms. This is unquestionably the best arrangement from the hygienic as well as from the ethical point of view. Health requires that one-third of the time shall be spent in sleep; the bed was made for sleep; and the most refreshing sleep can only be obtained by occupying the bed alone. If two persons occupy the same bed and one is restless, the sleep of the other is necessarily disturbed. Again, two persons occupying the same bed necessitates the same hour for rising and retiring, which is not always convenient or agreeable. Balzac writes on this subject: "To put the system of separate bed-rooms into practice is to attain to the highest degree of intellectual power and of virility. By what syllogism man arrived at establishing as a custom that of man and wife sleeping together, a practice so fatal to happiness, to health, to pleasure, and even to self-love, would be curious to seek out." If for financial reasons it is not possible to have separate bed-rooms, the German custom of having separate beds should be adopted.
The Consummation of Marriage. The consummation of marriage is often attended with difficulty owing to the rigidity of the hymen; this, if present, must usually be ruptured before connection takes place. Great gentleness and care must be exercised by the husband if it does not readily yield, the use of hot vaginal injections should be kept up for several weeks before the trial is repeated. These usually relax the parts very considerably; but if coitus is still found impossible, it is better to consult a physician at once, when a simple operation will generally remove the trouble and the woman is spared much suffering. In no case is any violence on the part of the husband allowable, as it might produce irreparable injuries.
There is always more or less suffering on the part of the wife at first, partly due to the rupture of the hymen, and partly to the forcible dilatation of the vagina and she should be allowed a sufficient time for nature to repair these injuries. By so doing, the constitutional disturbances and the nervous disorders which are so very prevalent may be prevented. Too frequent indulgence at this period is a prolific source of inflammatory diseases, and often occasions sterility and ill-health.
The first nuptial relations should be fruitless, in order that any indisposition arising therefrom should have had time to disappear before the woman becomes pregnant.
The Marital Relation. It is most important for the interest of both parties that there should be chastity in the marriage relation as well as out of it. Many young couples have had their lives ruined by excessive sexual indulgence. The effect is usually most severe upon the husband, yet the wife becomes weak, nervous, and excitable. Sexual excess is also the grave of domestic affection. The general rule given is that coitus should never take place oftener than every seven or ten days. When coitus is succeeded by langour, depression, or malaise, it has been indulged in too frequently.
Among civilized people there are three widely diferent views as to the proper course to be pursued:
First, those who maintain that sexual intercourse should not take place except for the propagation of the species.
Second, those who believe that the act is a love relation, mutually demanded and enjoyed by both sexes, and serving other purposes besides that of procreation.
Third, those who hold that sexual intercourse is a physical necessity for the man, but not for the woman.
The first theory, "that the sexual relations should never be sustained save for the purpose of procreation," has many advocates. They teach that there are other uses for the procreative element than the generation of offspring, and far better uses than its waste in pleasures. They claim that a life of total chastity increases the physical and mental vigor; and there will result a procreation on the mental and spiritual planes, instead of on the physical ones.
They also claim that to woman belongs the creative power; that she must choose when a new life shall be evolved; and that only by adhering to this law can she be protected in the highest function of her being the function of maternity.
The adherents of the second theory, "that the act is a love relation, mutually demanded and enjoyed by both sexes, and that it serves other purposes besides that of procreation," claim that the female sexual life indicates that the healthy woman is neither indifferent nor passive in the generative act. It has much the same effect as in man a powerful increase in her sensations, whole groups of muscles are set in motion, and the uterus as well as the entire nervous system are in an excited condition and activity. And that it is the province of the mother to decide when a new life should begin.
The third theory, "that sexual intercourse is a physical necessity for the man, but not for the woman," is by far the most widely accepted. We will consider, first, the practical results of this last theory; and, second, the scientific basis on which it rests.
It is generally acknowledged that this practice has done more to cause domestic misery, sickness, and death than that dreadful scourge of the human race, tuberculosis.
This man, accustomed all his life to gratify his sexual passions promisculously, marries a virtuous young girl. In her menstrual periods she has had to do only with the secondary phenomena; with the expulsion of the ova not at all. She has had no instruction in the corresponding physiologic life of the man, and is astonished at the male sexual indications, and is led to believe in their physiologic necessities. The result is that she not only suffers physically, but feels outraged and disgraced. She is liable to the chance of maternity at any time; and such offspring will probably be sickly.
Passion is presented to the young wife in so hideous a guise that it will take the utmost consideration of her husband afterward to enable her to completely overcome her repugnance. If she be worn and weary of excesses in the early days of her married life, the husband will have only himself to blame if he is bound all his life to an apathetic and irresponsive wife. Husbands place great strains upon the affections of their wives, and lower themselves almost past reinstatement in their respect and esteem.
Lastly, on what scientific basis does this "physilogic necessity" for sexual gratification on the part of the male rest? Analogy with the lower animals does not bear it out. Among animals, except in rare instances under domestication, the female admits the male in sexual embrace only for procreation. Among many savage tribes this same rule has but few exceptions. The analogies between the male and the female sexual organs; between seminal emissions and menstruation; between the sexual life of the male and of the female, only go to accentuate the fact that this so-called physiologic necessity on the part of the male has arisen chiefly through the difference of education; so that it has come to be that the woman is chaste and the man is degraded; that the woman is too sentimental and the man too passionate. From a purely medical standpoint, the most eminent physicians and physiologists of the day all unite in advocating a chaste and continent life, simply for the sake of the man's own health, independently of all other considerations.
Times when Marital Relations Should be Suspended. The marital relations should always be suspended during the menstrual period. During pregnancy intercourse should never, or at least very rarely, be indulged in. At this time the mother needs to conserve all her strength and energies for herself and child; and any sexual relations during this time increase the sufferings of the mother and impair the vitality of the child. It has been even suggested that much of the pain during parturition would be avoided by entire continence during pregnancy. Intercourse during the early months of pregnancy is a frequent cause of abortion. Women who have supposed that they have never been pregnant have in reality been having abortions every second or third month.
A woman should never be subjected to coitus until three months after delivery. During lactation intercourse should never, or at least very rarely, be indulged in; as the function of lactation makes a heavy drain on the strength of the mother, and anything which would further weaken her would tend to impoverish the quality of the milk and thus the child would suffer.
"Virtue, the strength and beauty of the soul,Is the best gift of heaven." ARMSTRONG.
"Virtue, the strength and beauty of the soul,Is the best gift of heaven."
ARMSTRONG.
Sexual Instinct in Women. After careful observation of the sexes in the married state, it is found that the sexual appetence is less in women than it is in men. Much of this difference in sexual appetence is doubtless due to the chastity of their lives, coupled with and resulting from the difference of education. The girl is taught repression, and the boy expression; that girls must be chaste; that chastity for boys is impossible.
According to the intensity of the sexual instinct women have been divided into three classes: A larger number than is supposed have little or no sexual feeling. Second, those who are subject to strong passion; this class is larger than the first, but small as compared with the whole of their sex. Third, those in whom the sexual appetite is moderate; this class comprises the vast majority of women.
And, even granting to woman more pleasure in sexual indulgence than usually comes to her by largest allowance, it is safe to say that in nine cases out of ten maternity, with its early pains and later cares, greatly lessens her power of enjoyment; and that for the larger part of her married life she is either positively distressed by the apparently necessary demands of her husband upon her, and irresponsive to them, or kept to a cheerful response by a self-abnegation and regard for his comfort, not to say fear of his moral aberration, which is a positive drain upon her health and strength.
Excessive Coitus. Those who are most frequently found to suffer from venereal excesses are the newly married; especially if they have weak constitutions and excitable temperaments. A great deal of mischief is done by two persons of unequal constitutions being matched together; the husband may exhaust the wife or vice versa, the weaker party being constantly tempted to exceed their strength. In all sexual matters there must be a consideration for others. It is not so much from selfishness as from ignorance that such a mistake is made. The ignorance comes from a lamentable morbid delicacy which prevails on all sexual matters, and which prevents all open and rational conversation on them, even between those who have the most intimate knowledge of each other.
When the conjugal act is repeated too often, the man will become gradually conscious of diminished strength, diminished nerve force, and diminished mental powers. Excess weakens a man's energies, and enervates and effeminates him. Moreover, it renders him liable to an infinity of diseases and a readier victim to death.
Not only is the strength of the constitution lowered by the excessive expenditure of force and matter requisite for the perpetuation of the species, but this lowered standard of vitality is transmitted to children. There can be but little doubt that this is one of the reasons why so many healthy parents beget sickly children, who die early. They have exhausted themselves of the material from which a new life is created, and so it is not properly started at the beginning and never reaches its highest development. To the truth of this statement attests the mental imbecility, the pallid and attenuated forms, of the children who are the earlier products of marriage. The effect of excessive coitus in women is seen by the confirmed ill health of so many women after marriage and repeated child-bearing. A large number of these cases are dependent upon alteration and diseases of the genitalia; but a considerable number are unconnected with local disease, and in many other cases the health is never regained after all local phenomena have disappeared.
Sexual excitement in the woman causes certain congestion of the genital organs; and at the time of the orgasm there is a reflex movement which corresponds to erection, and which consists of a peristaltic movement of the tubes and uterus; to the uterus also is ascribed an act of suction by which the spermatozoa are drawn up into its interior. Even when pregnancy does not follow, the too frequent excitation and activity of the uterus in weak constitutions causes illness, first of the genital organs and then of the nervous system.
Local diseases caused in women by excessive coitus are: vaginal catarrh, acute catarrh of the vulva, acute inflammation of the lining membrane of the uterus as well as of the uterus itself, inflammation of the ovaries, and even peritonitis. It is also known to be an important factor in the origin of blood-tumors and of cancer of the uterus. Especially is coitus at a time of great physical fatigue liable to be provocative of uterine inflammations. Aside from ethical considerations, coitus during the menstrual period may be the cause of rupture of the impaired blood-vessels, thus causing blood-tumors. Excessive coitus is a well-known cause of chronic inflammation of the uterus; that is, a habitual congestion of the uterus is induced by excessive sexual intercourse. This has been frequently mentioned by authors as leading to enlargement of the uterus in the non-pregnant condition; and it is a still more potent factor in the recently impregnated organ, whose tissues are succulent and the vessels enlarged, a condition inviting congestion and enhancing the susceptibility to engorgement.
The general manifestations of impaired health in women due to excessive coitus are: chronic anemia, with malnutrition; impaired and altered functions in all the organs, especially those of the nervous system. Menorrhagia is apt to be induced by overstimulation of the ovaries, together with exhaustion and sexual apathy.
The source of so much misery is the increasing physical weakness of the female and the increasing nervous weakness of the male, with an increasing sexual excitability, two factors of tragic effect for the wife. Here is seen the unfortunate result of teaching two kinds of morals, one for men and another for women.
Causes of Sexual Excitability. Too frequent genital irritation, onanism, too frequent intercourse, alcohol, too rich and too highly seasoned foods, lack of exercise.
Treatment of Sexual Excitability.Avoid alcohol and precocious puberty. Strictest attention must be paid to the diet; everything is to be avoided which is difficult of digestion or which retards it. The following articles of diet must all be avoided: cheese, foods seasoned with pepper and curry, highly salted and acid foods, and all rich foods; and meat must be eaten only in moderate quantities. Constipation irritates the genitalia directly and increases the inflammation. The close relation of Venus and Bacchus is known not only in mythology. Carbonated waters are to be especially avoided, such as soda, seltzers, Preblauer, Geisshubler, and acid waters; also champagne and beer, heavy Italian, Spanish, and English wines. All alcoholic drinks must be forbidden.
As heavy gymnastics as the strength of the individual will admit, and plenty of exercise out-of-doors must be taken. There must also be constant mental and physical employment. In women sexual excitability is often caused by local diseases, and passes off with their cure; if not, she must use her will-power, and take the various forms of cold baths. Sexual intercourse not oftener than once in two or three weeks, and avoid all intimate approaches; if this is not sufficient, she will have to leave her husband for a few months.
"Never let yourselves do evil that good may come. If you do, you hinder the coming of the real, the perfect good in its due time." PHILLIPS BROOKS.
"Never let yourselves do evil that good may come. If you do, you hinder the coming of the real, the perfect good in its due time."
PHILLIPS BROOKS.
Sterility. Conception is least apt to take place from the tenth day after one period until the third day before the next; but there is practically no time during a woman's sexual life when she may not be impregnated; in this connection it must be remembered that the spermatozoa stay alive in her for more than a week.
During lactation women are generally sterile, especially in the first months which follow the accouchement, because the vital forces are then concentrated on the secretion of milk.
The age of the wife at the time of marriage has much to do with the expectation of children. As the age increases over twenty-five years the interval between the marriage and the birth of the first child is lengthened. For it has been ascertained that not only are women most fecund between twenty and twenty-five years, but that they begin their career of child-bearing sooner after marriage than either their younger or older sisters.
A wife who has had children and ceases to conceive for three years will probably bear no more.
When marriages are fruitless, the wife is almost always blamed; but it is by no means the wife that is always at fault; many husbands are absolutely sterile. Every man is not prolific who enjoys good health and is vigorous. Gross states that in one case out of six the sterility was due to the male. Kehrer, after a series of carefully conducted experiments, has arrived at the conclusion that in at least a third of the cases of sterile marriages the husband was the party at fault, and that gonorrhea was the cause of the barrenness.
Venereal diseases have their share of influence, and the gonorrheal infection is a potent cause of sterility. It is by no means proved that syphilis has any unfavorable influence on conception, though abortions due to this are frequent.
Gonorrhea often prevents conception by the inflammation traveling up the womb, and along the Fallopian tubes to the ovaries, whose covering is rendered thick and dense, so that the ovum cannot escape, or if it does, the fimbriated end of the tube is so agglutinated that it cannot grasp the ovum.
Alcoholism is considered a cause of sterility. It evidently does diminish the sexual potency in the male, and for this the female is often blamed.
It does not follow because a woman has not given birth to a child that she has not conceived. The life of an infant for a long time after birth is a frail one, and before birth its existence is extremely precarious; it often perishes a few days after conception. A period coming on a few days late, and at the same time one which is unusually profuse, is the only evidence which the young wife may have of an abortion. Among prostitutes, the frequent delay of menstruation, then abundant hemorrhage, is in many cases only habitual abortion, and leads to changes in the generative organs which must result in sterility. A tendency to miscarriage may therefore be all that stands in the way of having a family; this can frequently be remedied.
Sexual incompatibility is well known to exist; prominent examples being Augustus and Livia; Napoleon and Josephine. It is also a well-known fact that frigidity is a cause of barrenness. A short separation of husband and wife is often salutary in its influence upon fertility.
It is a well-established fact that the time immediately before the period, but still more that immediately following the period, are the most favorable times for conception to take place; the remaining quiet in bed of the woman after the generative act is also favorable to conception.
The most frequent causes of sterility in women are inflammation of the lining membrane of the uterus, or of the neck of the uterus, or of both. The source of this condition in women who have had children is most frequently due to parturition or abortion. In the newly married it may be due to a previously existing slight uterine catarrh in a displaced uterus, or it may be a manifestation of a run-down state of the system. In a majority of the newly married, however, the inflammation of the endometrium is probably due to the first efforts at conjugal approach. Many young women as the result of the preparation of the trosseau, augmented by a round of gaities at the time of marriage, enter the married state in a condition bordering on physical and nervous exhaustion; and then begin engorgements and inflammations which lead to future suffering and to sterility. Displacements and flexions of the uterus also cause sterility. Such displacements of the neck of the uterus may occur that, instead of lying in a pool of semen, as it should, it is above, in front of, or away from it, and this may prevent conception.
Vulvar and vaginal hyperesthesia, inflammations of the vulva, undue shortness of the vagina, unless great care is exercised by the husband, will induce painful coitus, and may bring about sterility by favoring the formation of a copulation sac outside of the axis of the uterine canal, and consequently misdirection of the semen.
Scrofula, probably by its effects on the general condition, leading to deficient development of the whole body, the genital organs included, may be productive of sterility.
The female being less passionate than the male, the orgasm comes on later with her, or the male orgasm occurs so soon that she may not reach that stage at all. If both were simultaneous, it is reasonable to suppose that conception would be more likely to occur.
Ovulation is doubtless more frequently performed in some women than in others. Some women conceive with more or less regularity every fifteen or eighteen months, and others at intervals of several years.
The effect of repeated coition, provided that impregnation does not take place at once, is to engorge the uterine vessels, to alter the nature of the glandular secretions, to cause profound reflex disturbances, and thus to produce such changes in the endometrium as to lead to local inflammation and to general nervous exhaustion. Backache, leucorrhea, and irritable bladder are the first symptoms of this disorder; but frequently there are added to these, headache, indigestion, rectal tenesmus, painful and profuse menstruation. In many cases the disease continues in a mild catarrhal form, giving the woman little inconvenience besides the slight leucorrheal discharge which stains her clothing; but often this is indicative of such a change of the lining membrane of the uterus as to render it unfit for the fixation and development of the ovum, even should impregnation take place.
Under normal conditions, during the intermenstrual period, a plug of clear viscid mucus, which is secreted by the glands of the cervical canal, blocks up that passage, but is washed away each month by the menstrual discharge. Under ordinary conditions this obstruction must seriously interfere with the entrance of the spermatozoa into the cavity of the uterus, and renders the former theory, recently revived by Bossi, quite tenable, that impregnation is most likely to occur just after the menstrual epoch.
The vaginal secretion under certain pathologic conditions may become so acid that it induces sterility. Women who suffer m severe vaginal catarrh are frequently sterile, the spermatozoa being found dead in the vagina some hours after copulation, although an examination a shorter time afterward revealed them still alive. In cases where conception takes place in spite of a very acid condition of the vaginal secretion, it is probable that some of the spermatozoa enter the uterus before the secretion has had time to act on them, or possibly the spermatozoa being injected in a mass, the acid secretion is unable to penetrate and kill them all.
The reaction of the normal vaginal mucus is always acid, that of the cervix alkaline; but as the result of the inflammatory condition, the reaction of each is often intensified, especially that of the vagina, which has an exceedingly sour and penetrating odor. This acid discharge, bathing the neck of the uterus, penetrates more or less into the cervical plug and causes coagulation of the alkaline mucus.
The chief constituent of the semen is albumin; agents which affect albuminous substances influence the functional activity of the spermatozoa heat, concentrated acids, and probably concentrated alkalies. In normal conditions the alkalinity of the seminal fiuid seems to be sufficient to neutralize the acidity of the vaginal secretions, so that the spermatozoa may remain seventeen days or more (Bossi) within the vaginal canal, even during a menstrual period, without having their vitality destroyed.
When hyperacidity of the vaginal secretion is present, it is probable that the fertilizing element is at once rendered inert; but should some of the spermatozoa succeed in reaching the interior of the cervical canal, the increased alkalinity of the secretion there would in all probability put an end to all further progress.
The conditions, then, which appear to prevent fecundation are: First, the absence of the proper nidus for the ovum; second, the obstruction of the cervical canal by a mucus plug; third, increased alkalinity of the cervical secretion, often accompanied by the increased acidity of the vaginal secretion. Three conditions must, then, be determined: First, are there spermatozoa in the semen? Second, do they get into the uterocervical canal? Third, do the secretions in the canal poison the spermatozoa?
"For those who are very anxious for offspring," wrote Marion Sims, "I usually order sexual intercourse on the third, fifth, and seventh days after the flow has ceased; and on the fifth and third days before its return. For the most obvious reasons this would always be before going to bed at night, instead of just before rising in the morning. The horizontal position favors the retention of semen; the erect its expulsion. I am satisfied that too frequent sexual indulgence is fraught with mischief to both parties. It weakens the semen; in other words, that this is not so rich in spermatozoa after too frequent indulgence; and when carried to the extent of a debauch, the fiuid ejaculated may be wholly destitute of spermatozoa. Thus it will be seen that it will be much better to husband the resources of both man and wife."
The Prevention of Conception and the Limitation of Offspring. Some of the contraindications to procreation are when either parent suffers from a disease which is transmissible, and such diseases frequently manifest themselves only after marriage; when the pregnancy would endanger the mother's life, or even where the pregnancy is a nine months' torture to her; where either parent is suffering from ill health; or where for economical reasons no more children are desired.
If there exists no condition in either parent or in their circumstances why they should not have children, the next consideration due to their children, is how the same may be procreated under the most favorable conditions possible; this condition can only be secured by making the circumtsances such that the mother shall be able to choose the time for their conception when both parents are in the best physical condition. That children should be brought into the world haphazard, as the result of accident, is to degrade the human race below that of the lower animals, where the female admits the male only at the time of the rut, which in the majority of cases occurs only once a year.
Another requisite to bearing healthy children is that the pregnancies shall not follow each other too rapidly. Aside from the consideration for the health of the mother herself, she must be in good physical condition to bear the healthiest children she is capable of giving birth to; and for this there must be from two and a half to three years between the successive pregnancies. The results of overproduction on the children are frequently, that they are sickly, short-lived, or suffer from rickets, cerebral paralysis, idiocy, or imbecility.
And last, but certainly not least, many women become chronic invalids, or are hastened to premature graves, by having children as fast as they possibly can.
The most natural and moral way for the artificial prevention of conception, when on account of ill health or for economic reasons no more children are desired, is to abstain from sexual intercourse. But in the majority of cases the husband will not agree to this, and so the greatest number of methods have come to be used to prevent conception.
Perhaps the most frequent method use to prevent conception is withdrawal before the ejaculation of semen. While this is most injurious to the husband debility, nervous prostration, and even paralysis are said to ensue the health of the wife also suffers. If, this interrupted sexual congress is continued for years, there develop gradual nervous disturbances on both sides, and a serious disease of the uterus makes itself felt. The generative organs become engorged with blood, but are not permitted to enjoy relaxation consequent upon the full completion of the act. This engorgement may lead to undue local nutrition, and diffuse growth and proliferation of the connective tissue may take place. Hence the uterine walls become dense and thickened and the nerves compressed. Of course, pain and tenderness and a sense of bearing down will be the result. Flexions and versions may be consequent upon the engorgement. The nerves become shattered, and the woman will be fortunate if she contracts no serious womb trouble.
"It is strange," says John Stuart Mill, "that intemperance in drink or any other appetite, should be condemned so readily, but that incontinence in this respect should always meet not only with indulgence, but with praise. Little improvement can be expected in morality until the producing of too large families is regarded with the same feeling as drunkenness, or any other physical excess."
Sismondi writes: "When our true duties toward those whom we give life are not obscured in the name of a sacred authority, no man will have more children than he can properly bring up. If a woman has a right to decide any question it is how many children she should bear. Whenever it becomes unwise that the family should be increased, justice and humanity require that the husband should impose on himself the same restraint which is submitted to by the unmarried."
In the opinion of Dr. Edward Reich, it is very much to be wished that the function of conception should be placed under the domain of the will. But the strongest appeal has been made for the sake of morality itself; namely, to prevent the crime of abortion. Dr. Raciborski, of Paris, took the position that the prevention of offspring to a certain extent is not only legitimate, but it is to be recommended as a means of public good.
Continence, self-control, and a willingness to deny himself that is what is required of the husband. But suffering women assure us that this will not suffice; that men refuse to restrain themselves; that it leads to loss of domestic happiness, to illegitimate amours; or that it is injurious physically and mentally; that, in short, such advice is useless because it is impracticable.
Dr. Napheys writes: "Is it amiss to hope that science will find resources, simple and certain, which will enable a woman to let reason and sound judgment, not blind passions, control the increase of her family?"
The Crime of Abortion. From the moment of conception a new life begins, a new individual exists; another child is added to the family. The mother who deliberately sets about to destroy this life by want of care, or by taking drugs, or by the use of instruments, commits a great crime, and is just as guilty as if she strangled her new-born infant. The crime she commits is child-murder. Women in their frenzy at finding themselves in this condition, and with no slightest idea of the sin that they are committing, are constantly guilty of committing abortions on themselves, or going to professional abortionists to have this crime of child-murder committed. This is another of the sins due to the ignorance of the sex in all matters pertaining to reproduction; and it is a fearfully prevalent one.
Infidelity in Women. "We have now reached the last infernal circle of the divine comedy of marriage; we are at the depths of the inferno. There is something, I do not know what, terrible in the situation in which a married woman finds herself when an illegitimate love has ruined her for the duties of a wife and mother. As has been so well and strongly expressed by Diderot, infidelity in woman is like incredulity in a priest; it is the last step in human forfeitures; it is for her the great social crime, for it implies all the others.
"Weigh the sufferings of the future, the agonies of years by the ecstasy of half an hour. If this conservative sentiment of the creature, the fear of death, does not stop her, what could be expected of laws? Oh, sublime infamy!" (Balzac).
"Happy heWith such a mother, faith in womankindBeats with his bood, and trust in all things highComes easy to him, and though he trip and fall,He shall not bind his soul with clay." TENNYSON.
"Happy heWith such a mother, faith in womankindBeats with his bood, and trust in all things highComes easy to him, and though he trip and fall,He shall not bind his soul with clay."
TENNYSON.
Nature of Conception. Conception, or impregnation, is the union of the germ and the sperm cell, the result of which is a new being. On coition, the semen being received into the female organs, which are at that time in a state of turgescence, the spermatozoa, by means of their own vibratile activity, find their way into the Fallopian tubes, and here come in contact with the ovule.
The ovule is a minute cell with a transparent membrane, within which is the yolk containing the germinal vesicle. The spermatozoon penetrates into the ovule and becomes fused with it. The processes of development begin at once to occur. There is congestion of the uterine mucous membrane out of proportion to the rest of the uterus; the ovum finds lodging here, and becomes surrounded by a membrane which incloses it in a separate sac.
Pregnancy Defined. Pregnancy begins with conception and ends with parturition; it provides for the nutrition and the expulsion of the embryo and for its nutrition for a short time after birth.
The average duration of pregnancy is ten lunar months, or two hundred and eighty days. The date of the confinement is calculated by reckoning from the date of the last menstrual flow; count backward three months from the date of the first appearance of the last menses; to this add twelve months and seven days, five days being for the average menstrual duration and two days for the possibility of fecundation.
Duration of Pregnancy. Many difficulties are experienced in determining the date of the expected confinement. As most pregnancies occur in married women, we cannot base any calculations on a single act of coitus. And even if there was but one, all physiologists agree that there is a variable period in different women, and in the same woman at different times, between insemination and the fertilization of the ovum. It is the moment of fecundation, or the union of the germ and sperm cells, which marks the beginning of pregnancy. The uncertainty becomes still greater owing to our inadequate knowledge as to the length of time during which the sexual elements, the ova and the spermatozoa, retain their vitality after liberation from their respective sources. While it is not certainly known, it is probable that the ovum is capable of impregnation any time during its sojourn within the oviduct and before reaching the uterus, or probably for a period of about one week from the time of its escape from the Graafian follicle. The remarkable vitality of the spermatozoa even under less favorable circumstances direct observation shows that these elements retain their movements for over nine days outside of the body renders it almost certain that their powers of fertilization are maintained for a long time after they are deposited within the healthy female genital tract; it is believed that the spermatozoa are capable of fertilization after a sojourn of three or more weeks within the oviduct.
Consideration of these facts renders apparent the impossibility of fixing with certainty the date of the beginning of pregnancy, since conception may result from the union of the ovum liberated at the beginning of the period with the spermatozoon introduced at the end of that time; or it may result from the meeting of the male elements already within the oviduct with an ovum discharged a day or two before the occurrence of the menstrual period.
The Signs of Pregnancy. The cessation of the menstrual period is the sign of the greatest value in women who have been regular; but it must always be remembered that there may be an irregularity of menstruation for the first few months after marriage. The appetite is capricious; morning sickness or nausea in the morning on first getting up is a very common symptom in the early months of pregnancy; enlargement of the abdomen; in the first two months of pregnancy the abdomen is flattened and the umbilicus is depressed; after this the abdomen begins to enlarge. There is also an increase in the size of the breasts, with a deepened color of their areolae and later a watery secretion. The external genitals become swollen and of a bluish color. Feeling of the fetal movements that is, the movements of the small parts of the child in the womb by the mother is not always reliable, since gas in the intestines has sometimes been mistaken for this. These signs are more valuable when several exist together.
The nausea and vomiting of pregnancy, the so-called morning sickness, consists of nausea accompanied often by vomiting or retching of a glairy fiuid, showing itself most frequently on rising in the morning, but sometimes appearing after breakfast. It is aggravated by the assumption of the erect position. It may begin within a few days, but as a rule it does not show itself until the fourth week of pregnancy; and it generally ceases about the fourth month, rarely persisting throughout the entire time. In the majority of cases it does not sensibly impair the health. It is a sympathetic disorder reflected from the uterus; it is aggravated by indigestible food, by sexual excitement, and by emotional disturbances; it is most marked in first pregnancies and in women of highly emotional natures. It is not infrequently due to some inflammation of the uterus or erosion about the external orifice, and disappears on the removal of the cause.
Mammary Changes.During pregnancy the mammary glands are in immediate sympathy with the growing reproductive organs of the pelvis; consequently a genuine physiologic enlargement commences in these organs from the beginning of gestation. Their glandular structure becomes larger, fuller, and firmer; a sensation of weight or pricking is felt by the patient; the veins become more prominent. The nipples also become enlarged, more elongated, and somewhat erect. Surrounding the nipple is the areola; this becomes darker in color.
In most women a drop of watery fiuid, the so-called colostrum, may be squeezed out from the nipple at the end of the third month of pregnancy.
The signs of pregnancy are divided into the presumptive, the probable, and the positive. The presumptive signs are: menstrual suppression, morning sickness, irritable bladder, mental and emotional phenomena. The probable signs are: mammary changes, abdominal enlargement, changes in the neck of the womb, and certain changes which are felt on bimanual examination. The positive signs are: feeling the various parts of the fetus, active movements of the fetus, and hearing the fetal heart sounds.
Functional disturbances of the bladder are quite often noticeable in the early part of the pregnancy. In the first part of the pregnancy the bladder is dragged upon, and later it is pressed upon by the enlarged uterus so that the bladder capacity is lessened and frequency of urination is the result. In the fourth month, when the uterus ascends into the abdominal cavity, these bladder symptoms subside, until the very close of the pregnancy, when by the descent of the now greatly enlarged uterus there may be even incontinence of urine.
Changes in the Abdomen.During the first two months of the pregnancy there is a flattening of the abdominal surface, due to the descent of the uterus into the pelvic cavity, thus slightly dragging the bladder downward and drawing the umbilicus inward. In the latter part of the fourth month there is noticeable a slight abdominal enlargement, and the umbilicus is no longer sunken. By the end of the fourth month the base of the uterus has risen two inches above the symphysis, and at the end of the thirty-eighth week it touches the lower extremity of the breast-bone; the umbilicus has been for many weeks protruding; during the last two weeks of pregnancy the uterus again descends and the woman feels more comfortable.
On the inspection of the abdomen of a pregnant woman there will be noticed a brown line which extends from the umbilicus to the pubes, and all over the surface the presence of striae, or long purple grooves, due to the distention of the abdomen; on the sides of the abdomen and down the thighs, red, blue, or white markings, like cicatrices, may be seen.
Quickening. Quickening is the sensation experienced by the mother as the result of the active fetal movements of the child in the womb. These movements are first felt between the eighteenth and the twentieth week; the common rule is that quickening occurs at the middle of pregnancy; that is, at four and a half months. As pregnancy advances these active motions increase in frequency and become more marked. When felt or seen by the physician, as can be done in the sixth month, fetal movements constitute a positive sign of pregnancy.
The Determination of Sex at Will. Although this has always been a question of great interest, and the subject of much experimentation, no rule can as yet be given by which the parents can know in advance of the birth of the child what the sex will be. Dr. Schenck's theory is that the ruling factor in determining the sex is the food partaken of by the mother.
Furst believes that the differentiation may occur before, during, and a little while after the impregnation; that the chances of the development of one or another sex in one and the same woman may vary before final differentiation occurs. It is impossible to determine the sex of the embryo before the tenth week of fetal life. The cause of the differentiation, he believes, lies largely in the good or bad state of the health of the parents; in the first instance there being an excess of females, and in the latter an excess of males, relatively speaking. He believes that there is an excess of male children when conception takes place during the post-menstrual anemia. He has investigated one hundred and ninety-three cases carefully in regard to the probable date of conception after menstruation, and there is a notable increase of male births over female in the cases where conception occurred in the first five days after menstruation; that is to say, where the woman is not so well nourished as later.
Dr. J. Griffith Davis gives as the result of her experiments in this direction, that when conception takes place three days before the menstrual period or within forty-eight hours afterward, the child will be a girl; when conception takes place ten days after the period, the child will be a boy.
Although there are a greater number of the female than the male sex in all parts of the world where reliable statistics have been taken, in all civilized countries the proportion of male births is greater than that of females. There is a greater tendency of the male offspring to die earlier, and this is seen even before birth, in the proportion of three to two. For this reason the stronger sex as applied to men has been regarded by some authors as a misnomer. They are physically weaker in early life and succumb more readily to noxious influences.
The relative age of the parents is said to be another factor in determining the sex of the children. Seniority on the father's side gives an excess of male children; equality in the age of the parents gives a slight preponderance of females; seniority on the mother's side gives an excess of females. Men, and especially scholars, who pass a sedentary life and who exhaust their nervous force to a great extent, beget more girls than boys; so, also, a very advanced age on the part of the man diminishes the number of male offspring.
The Influence of the Male Sexual Element on the Female Organism. Dr. Alexander Harvey, of Aberdeen, has adopted the theory of fetal inoculation. He believes that the effect is first due to the influence of the male element upon the ovum, which, in consequence of the subsequent close attachment and freely inter-communicating blood-vessels between the modified embryo and the mother, inoculates the condition of the mother with the qualities of the male; and so, on the subsequent impregnation by another male, the offspring resembles the first male and not its real parent. He even goes further, and says that it is conceivable, by successive impregnations effected by him, that the influence may be increased, and if so the younger children begotten by him, rather than the elder, might be expected,ceteris paribus,to bear their father's image. And as regards the mother, he suggests the question, whether there is not something in the popular notion that in the course of years the wife comes to resemble the husband; and that not merely in respect of temper, disposition, or habits of thought, but in bodily appearance, which may be referable to this influence exerted by the husband on her constitution, through the medium of the fetusesin utero.
"Yet it shall be; thou shalt lower to his level day by day,What is fine within thee growing coarse to sympathize with clay.As the husband is the wife is; thou art mated with a clown,And the grossness of his nature will have weight to drag thee down.He will hold thee, when his passion shall have spent its novel force,Something better than his dog, a little dearer than his horse."
"Yet it shall be; thou shalt lower to his level day by day,What is fine within thee growing coarse to sympathize with clay.As the husband is the wife is; thou art mated with a clown,And the grossness of his nature will have weight to drag thee down.He will hold thee, when his passion shall have spent its novel force,Something better than his dog, a little dearer than his horse."