,,the ,,four ,,epochs ,,of ,,woman',s ,,life ,a ,study in ,hygiene ,,by ,,anna ,m4 ,,galbraith1 ,m4,d4 ,author of ,hygiene and ,physical ,culture for ,women2 ,fellow of the ,new ,york ,academy of ,medicine 2 ,ex-,president of the ,alumnae ,association1 ,woman's ,medical ,college of ,pennsylvania2 ,attending ,physician1 ,neorological ,department1 ,new ,york ,orthopedic ,hospstal and ,dispensary4 ,,with ,,an ,,introductory ,,note by ,,john ,h4 ,,musser1 ,m4,d4 ,late ,professor of ,clinical ,medicine1 ,university of ,pennsylvania4 ,as in a building ,stone rests on stone1 and wanting the foundation ,all would be wanting1 so in human life ,each action rests on the foregoing event ,that made it possible1 but is forgotten ,and buried in the earth4 -- ,,longfellow4 ,,introductory ,,note ,,it has been well said that the bulwarks of a nation are the mothers4 ,any contribution to the physical1 and hence the mental1 perfection of woman should be welcomed alike by her own sex1 by the thoughtful citizen1 by the political economist1 and by the hygienist4 ,observation of the truths1 expressed in a modest1 pleasing1 and conclusive manner1 in the essay of ,dr4 ,galbraith contribute to this end4 ,these truths should be known by every woman1 and ,i gladly commend the essay to their thoughtful consideration4 ,,john ,h4 ,,musser1 ,m4,d41 ,late ,professer of ,clinical ,medicine in the ,university of ,pennsylvania4 ,,preface ,,to ,,the ,,second ,,edition4 ,,the author takes this opportunity to thank the medical profession and the laity for the very cordial reception which has been tendered the first edition of this small volume4 ,the necessity for the use of technical expressions in a book written expressly for the laity must always be a matter of regret4 ,and only those who have attempted to write a similar work can fully appreciate the truth of ,herbert ,spencer's remark1 that ,nothing is so difficult as to write an elementary book on scientific subjects4 ,the author has added to this edition a section on ,the ,hygiene of ,puberty1 one on ,hemorrhage at the ,menopause a ,significant ,symptom of ,cancer1 and one on ,the ,hygiene of the ,menopause4 ,,anna ,m4 ,,galbraith4 #ae ,,west ,,ninety-,,first ,,street1 ,,new ,,york4 ,,preface4 ,ignorance is the curse of ,god2 ,knowledge1 the wings wherewith we fly to heaven4 -- ,henry ,,vi4 ,,perfect health is essential to perfect happiness4 ,the greater the knowledge of the laws of nature1 and the more closely these laws are lived up to1 so much nearer ideal will be the health and happiness of the individual4 ,hence the necessity that these same laws should be as familiar to the adult man and woman as the alphabet4 ,further1 with our present knowledge of the certain suffering1 disease1 and death that are bred by ignorance of all these subjects1 it is little less than criminal to allow girls to reach the age of puberty without the slightest knowledge of the menstrual function2 young women to be married in total ignorance of the ethics of married life2 women to become mothers without any conception of the duties of motherhood2 other women1 as the time approaches1 to live in dread apprehension of the change of life2 and many women unnecessarily to succumb to disease at this time4 ,the masses of women have at last awakened to a sense of the awful penalties which they have paid for their ignorance of all those laws of nature which govern their physical being1 and to feel keenly the necessity for instruction at least in the fundamental principles which underlie the various epochs of their lives2 and it is in response to a widespread demand that this small volume has been written4 ,this is preeminently the day of preventive medicine2 and the physician who can prevent the origin of disease is a greater benefactor than the one who can lessen the mortality or suffering after the disease has occurred4 ,,anna ,m4 ,,galbraith4 #ae ,,west ,,ninety-,,first ,,street1 ,,new ,,york4 ,,contents ,,introduction ,,education ,,as ,,the ,,controlling ,,factor ,,in ,,the ,,physical ,,life ,,of ,,woman ,huxley's ,definition of ,education2 the ,correlation of ,mind and ,body2 the ,emotional ,nature2 ,age for ,going to ,school2 the ,effect of the ,study of the ,scientific ,branches2 ,industrial ,education ,,part ,i4-- ,,maidenhood ,,chapter ,i4 ,,puberty ,sexual ,development2 ,age of ,puberty2 ,physical ,changes at ,puberty2 ,first ,onset of ,menstruation2 ,psychic ,changes at ,puberty ,,chapter ,,ii4 ,,hygiene ,,of ,,puberty ,home ,life2 ,corsets2 ,shoes2 ,underwear2 ,nutrition2 ,diet2 ,water2 ,constipation2 ,school ,life2 ,spinal ,curvature2 ,exercise2 ,walking2 ,running ,,chapter ,,iii4 ,,anatomy ,,of ,,the ,,female ,,generative ,,organs ,the ,vulva2 the ,hymen2 ,condition of the ,hymen as a ,proof of ,virginity2 the ,bladder2 ,vagina2 ,uterus2 ,respiratory ,movements of the ,uterus2 ,fallopian ,tubes2 ,ovaries ,,chapter ,,iv4 ,,physiology ,,of ,,the ,,female ,,generative ,,organs ,ovulation2 ,etiology of ,menstruation2 ,uterine ,nerve-supply2 the ,function of the ,uterus2 ,stages of the ,menstrual ,cycle2 ,average ,duration of the ,menstrual ,flow2 ,character of the ,flow2 ,relation of ,ovulation to ,menstruation2 the ,menstrual ,wave2 ,definition of ,menstruation2 ,premonitory ,symptoms of the ,flow2 ,hygiene of ,menstruation ,,chapter ,v4 ,,the ,,anomalies ,,of ,,menstruation ,menorrhagia and ,metrorrhagia2 ,dysmenorrhea2 ,amenorrhea2 ,leucorrhea2 ,pruritus ,vulva ,,chapter ,,vi4 ,,the ,,marriage ,,question ,herbert ,spencer's ,definition of ,love2 ,what ,constitutes a ,suitable ,husband2 ,best ,age for ,marriage2 ,shall ,cousins ,marry8 ,contraindications to ,marriage2 ,do ,reformed ,profligates ,make ,good ,husbands8 the ,proper ,length of ,time for the ,engagement2 the ,right ,time of the ,year to ,marry2 the ,selection of the ,wedding ,day ,,part ,,ii4-- ,,marriage ,,chapter ,,vii4 ,,the ,,ethics ,,of ,,married ,,life ,the ,wedding ,journey2 the ,ethics of ,married ,life2 ,shall ,husband and ,wife ,occupy the ,same ,bed8 the ,consummation of ,marriage2 the ,marital ,relation2 ,times when ,marital ,relations ,should be ,suspended ,,chapter ,,viii4 ,,sexual ,,instinct ,,in ,,women ,sexual ,instinct in ,women2 ,excessive ,coitus2 ,causes of ,sexual ,excitability ,,chapter ,,ix4 ,,sterility ,sterility2 the ,prevention of ,conception and the ,limitation of ,offspring2 the ,crime of ,abortion2 ,infidelity in ,women ,,part ,,iii4-- ,,maternity ,,chapter ,x4 ,,pregnancy ,nature of ,conception2 ,pregnancy ,defined2 ,duration of ,pregnancy2 the ,signs of ,pregnancy2 ,quickening2 the ,determination of ,sex at ,will2 the ,influence of the ,male ,sexual ,element on the ,fernale ,organism2 ,heredity2 ,hygiene of ,pregnancy2 ,causes of ,miscarriage ,,chapter ,,xi4 ,,the ,,confinment ,preparation for the ,confinement2 ,signs of ,approaching ,labor2 ,symptoms of ,actual ,labor2 ,the ,confinement-bed2 the ,process of ,labor ,,chapter ,,xii4 ,,the ,,lying-,,in ,management of the ,lying-in2 ,lactation2 ,nursing ,,chapter ,,xiii4 ,,the ,,new-,,born ,,infant ,the ,infant's ,toilet2 the ,crib2 ,feeding of ,infants2 the ,wet-nurse2 ,artificial ,feeding2 ,characteristics of ,healthy ,infants2 the ,stools2 ,constipation2 ,urination2 ,teething ,,part ,,iv4-- ,,the ,,menopause ,,chapter ,,xiv4 ,,the ,,menopause ,average ,duration of the ,menstrual ,function2 ,duration of ,menopause2 the ,menopause2 ,general ,phenomena of the ,menopause2 ,prominent ,symptoms of ,menopause2 ,pathologic ,conditions of ,menopause2 ,hemorrhage at the ,menopause a ,significant ,symptom of ,cancer2 ,causes of ,suffering at ,menopause ,,chapter ,,xv4 ,,hygiene ,,of ,,the ,,menopause ,diet2 ,constipation2 ,stimulants2 the ,kidneys2 ,skin2 ,turkish ,baths2 ,massage2 ,exercise2 ,profuse ,menstruation2 ,hemorrhage2 ,mental ,therapeutics ,,chapter ,,xvi4 ,,hints ,,for ,,home ,,treatment ,indigestion2 ,constipation2 ,enemas2 ,diarrhea2 ,vaginal ,douch1 ,baths2 ,headache2 ,fainting2 ,hemorrhage ,,glossary ,,the ,,four ,,epochs ,,of ,,woman',s ,,life ,,introduction4 ,,education ,,as ,,the ,,controlling ,,factor ,,in ,,the ,,physical ,,life ,,of ,,woman4 ,huxley's ,definition of ,education2 the ,correlation of ,mind and ,body2 the ,emotional ,nature2 ,age for ,going to ,school2 the ,effect of the ,study of tuse ,scientific ,branches2 ,industrial ,education4 ,what is man1 ,if his chief good1 and market of his time1 ,be but to sleep and feed8 ,a beast2 no more4 ,sure1 ,he that made us with such large discourse1 ,looking before and after1 gave us not ,that capability and godlike reason ,to fust in us unused4 -- ,hamlet4 ,,the word education is here used in its broadest sense1 and is meant to include the physical1 mental1 intellectual1 and industrial4 ,huxley's definition is as follows3 ,education is the instruction of the intellect in the laws of nature1 under which ,i include not only things and their forces1 but men and their ways2 and the fashioning of their affections and of the will into an earnest and living desire to move in harmony with these laws4 ,that man1 ,i think1 has had a liberal education who has been so trained in his youth that his body is the ready servant of his will1 and does with ease and pleasure all the work that1 as a mechanism1 it is capable of2 whose intellect is a clear1 cold1 logic engine1 to be turned to any kind of work1 to spin the gossamers as well as to forge the anchors of the mind2 whose mind is stored with the great and fundamental truths of nature and the laws of her operations2 one whose passions are trained to come to heel by a vigorous will1 the servant of a tender conscience2 one who has learned to love all beauty1 whether of nature or of art1 to hate all vileness1 and to respect others as himself4 ,the ,correlation of ,mind and ,body4-- ,it is of the utmost importance that the mutual reaction of mind and body upon each other should be thoroughly understood4 ,this reaction is so constant1 so intricate1 and so complex that it is at times difficult to say which is cause and which effect4 ,does the depressed state of the mind cause the indigestion1 or is a torpid liver the real seat of the melancholia8 ,the brain is the most delicately constructed organ in the entire body4 ,in the lower animals the brain is simply the great nerve-center which1 with its prolongation the spinal cord1 presides over all the functions of life which differentiate the animal from the vegetable4 ,in the human being the brain is much more highly developed and complicated2 and is1 in addition1 the seat of the mind1 the intellect1 and the affections4 ,like all the other tissues of the body1 the brain receives its nourishment from the blood-vessels which pass through it1 and its healthy maintenance is in a direct ratio to the condition of its blood-supply4 ,a most interesting psychologic study is found in the case of cerebral paralysis of young children1 where there is mental defect amounting to stupidity or imbecility1 accompanied by extensive paralysis of the body1 so that the child is not able to sit up4 ,with the gradual improvement of the physical condition1 so that the muscles become firm and the child can sit1 stand1 and even walk1 there is a corresponding mental development2 from being stupid and dull1 the expression of the face brightens and becomes intelligent2 the child talks quite as well as other children of its age1 and sometimes becomes really intellectually precocious4 ,here we see the development of the brain as a direct result of the improved physical condition4 ,in certain cases of insanity1 on the contrary1 we find that the wasting away of the body results from the disease of the brain1 i4 e41 the disease of the brain has wrought the wreck of the body4 ,from these pathologic studies1 or studies of how the diseased state of the brain and body may be overcome by physical development1 on the one hand1 and1 on the other hand1 how the healthy body may be wrecked by disease of the brain1 we will turn to a consideration of the effect of the development of the mind and intellect upon the physical health4 ,on a girl's entering ,vassar ,college an exact and detailed physical examination is made by the resident physician1 a health record is kept during her stay there1 and at the time of her graduation a final physical examination is made4 ,as a result of these statistics ,dr4 ,thelberg says3 ,these statistics1 now covering a number of years1 show that not only can girls profitably take a college education1 that is accomplished2 but will prove that grave physical imperfections can be corrected in the period between eighteen and twenty-two years of age1 coincidently with the development of the mind along the lines of college work2 the college work1 if not excessive in amount1 being a real and most important factor in the physical development4 ,but a still more striking proof can be cited of the beneficial result of mental and intellectual occupation upon the bodily health4 ,at ,vassar a great deal of attention is very properly paid to general hygiene and the physical development1 in addition to the natural advantages of outdoor life in the country4 ,take1 for example1 a woman's medical college located in the city3 the four years' course places the greatest strain on both mind and body2 practically no time is left for recreation1 and very much too little time is spent in sleep2 the amount of exercise taken is the minimum4 ,yet in spite of all these disadvantages under which the young women labor1 a great many of them who enter far below par in health1 or1 indeed1 on the fair road to become chronic invalids1 graduate very greatly improved in health4 ,the ,emotional ,nature4-- ,formerly much more than now1 owing to the defective methods of her education and mode of life1 the emotional nature of woman was allowed to run riot4 ,the child was coddled2 the girl was allowed to grow up without any of the discipline which young men receive in their college and business life1 and little or no attention was paid to her physical development4 ,the woman naturally became a bundle of nerves1 highly irritable1 unreasonable1 and hysterical4 ,all this reacted in the most detrimental manner upon her physical health4 ,the seed for much of this emotional hyperesthesia is sown in childhood4 ,from birth until the end of the eighth year should be one grand holiday4 ,during this time the child develops very rapidly1 especially during the first two years of life4 ,and at the end of the eighth year the brain has attained to within a few ounces of its full weight4 ,the muscular system has been developed together with the coordination of motion4 ,the child has learned to use a language fairly well2 she has developed an excellent memory and is most inquisitive and acquisitive4 ,another method for undermining the healthy tone of the nervous system is the intricate dances taught very young children and then placing them on public exhibition1 where they are wrought up to the highest pitch4 ,from a purely medical standpoint1 children under eight years of age should not be allowed to take dancing lessons4 ,after this age a moderate amount of dancing in a well-ventilated room is good exercise4 ,children's parties belong in the same category1 and1 on account of the injurious effects on the nervous system1 should be tabooed4 ,they are too exciting1 and cause an overstimulation of the nervous system and a precocious childhood and puberty4 ,instead of rearing an oversensitive hot - house plant that must be fragile in the extreme1 strive to rear a sturdy plant that can hold its own amid the storms4 ,the child should spend as much of its life as possible in the open air1 and in the warm months live out-of-doors4 ,city children should be taken to the seashore or country to spend several months every summer4 ,together with outdoor sports1 gymnastics adapted to the age of the child should be begun early and continued throughout life4 ,good muscular development is attended with good digestion and a well-balanced nervous system4 ,until after the twelfth year there should be absolutely no difference between the physical1 mental1 or industrial education of girls and boys4 ,and1 still further1 they should be encouraged to have their sports together2 this will improve the girls physically and broaden them mentally1 and will do a great deal to take the rough edges off the boys4 ,after this age it will be wise to allow slight barriers to grow up1 without calling the attention of any one to the fact1 that will cause the companionship to be less free and unrestrained4 ,age for ,going to ,school4-- ,although the child may be allowed to go to kindergarten long before this time1 it should not be allowed to enter the school-room before eight years of age4 ,and from eight to twelve years1 not more than four hours a day should be spent in study4 ,after this time it may be put down more closely to intellectual work2 but no more mental work should be required than will enable the girl to enter college at eighteen4 ,and eighteen years of age is as young as any girl should be allowed to go to college2 after this age the mind is more matured and acquires knowledge more easily than before1 while the development of the body is less rapid4 ,the physical system has become more stable4 ,the literature indulged in by girls under eighteen years of age should be most carefully selected4 ,the ,effect of the ,study of the ,scientific ,branches4-- ,a knowledge of the laws of nature is essential to health2 hence the necessity for the study of the natural sciences-- anatomy1 physiology1 chemistry1 physics1 and zoology4 ,aside from the intrinsic value of this knowledge1 it is almost universally conceded that these studies develop the judgment2 and no one will have the temerity to deny that a lack of judgment must undermine the health as well as the success and happiness of the individual4 ,industrial ,education4-- ,when it is considered how intimate are the relations between the physical and the psychic states1 and how often the psychic condition leads to actual disease1 and that often of the most incurable type1 it needs no demonstration that a mental occupation which will take the woman out of herself is a physical necessity4 ,therefore when the girl has reached the subjective limit of her intellectual education1-- that is1 when she has reached the limit of her capacity or taste1-- it is essential to her physical well-being that she should turn her attention to some industrial occupation4 ,this may be housekeeping or any other occupation for which she has taste or talent4 ,a healthy mental occupation is an absolute necessity to prevent the individual from becoming self-centered4 ,and to become self-centered is the first step on the certain road to chronic invalidism4 ,a most important part of an education is the knowledge of how to procure the most perfect development of the body possible1 and how to maintain the health4 ,this has not been touched upon here1 since the outlines for the general physical education have already been given in ,hygiene and ,physical ,culture for ,women199 and the present volume concerns itself only with the four critical epochs of woman's life4 99 ,by ,anna ,m4 ,galbraith1 ,m4 ,d42 published by ,dodd1 ,mead ,co4 ,with this broad view of an education1 as a means to procure the best physique possible2 a mind disciplined to meet to the greatest advantage all the vicissitudes of life2 an intellect developed along the lines of its greatest possibilities2 and an occupation chosen in accordance with the tastes and talents of the individual2 it becomes an incontrovertible fact that the education is the controlling factor in the physical life of every woman4 ,be not simply good2 be good for something4 ,,thoreau4 ,,part ,i4-- ,,maidenhood4 ,,chapter ,i4 ,,puberty4 ,sexual ,development2 ,age of ,puberty2 ,physical ,changes at ,puberty2 ,first ,onset of ,menstruation2 ,psychic ,changes at ,puberty4 ,self-reverence1 self-knowledge1 self-control1 ,these three alone lead life to sovereign power4 -- ,o,enone4 ,sexual ,development4-- ,sexual development goes on during all the years of childhood1 but is not complete in the female sex until between the twenty-second and the twenty-fifth year4 ,if the child has no inherited taint1 and has been properly educated morally1 physically1 and intellectually1 it must follow that the structural development of the pelvic organs has been normal2 and normal organs always perform their functions perfectly4 ,the commencement of the ovarian function does not cause any more profound change in the system and habits than does dentition4 ,the various epochs of life are generally spoken of as if they were paroxysmal-- as though they were separated by some tremendous chasm1 which had to be leapt over or fallen into4 ,nature makes no such egregious blunders2 preparations for every change in life have been going on for a very long time before the evidences of such change become manifest4 ,in a healthy girl the psychic and physical changes incident to puberty occur so gradually as to escape the girl's own notice4 ,the first and1 if the girl has not been properly prepared for it1 always startling change is the appearance of the menstrual flow4 ,the mother who has not told her daughter of this coming change in her life before it is due has committed a serious error2 it is no uncommon occurrence for girls who know nothing of this function to get into a tub of cold water to stop the flow2 and if they stay in long enough1 it generally does stop1 and the girl's health may be ruined for life4 ,the opinion of ,dr4 ,ely van de ,warker is that if healthy ovulation is the outcome of healthy childhood1 the function will obey the law of periodicity year by year1 and all this time the young woman will be able to sustain uninterrupted physical and intellectual work as well as the young man4 ,not that the laws of health may be violated with impunity at puberty or any other time of a woman's life2 but a law of health is no more binding upon a young woman than it is upon a young man2 and there really is no such thing as one law for women and another for men4 ,age of ,puberty4-- ,in the temperate regions the age of puberty is reached between the ages of twelve and fourteen years4 ,the girl is then said to be nubile2 that is1 as soon as menstruation appears it is possible for her to bear children2 but she is by no means sufficiently developed to do so1 as she herself will not be completely developed physically or mentally before the age of twenty-two or twenty-five years4 ,physical ,changes at ,puberty4-- ,the physical changes that gradually take place1 beginning at the time of puberty1 are3 the breasts1 pelvis1 and neck enlarge2 hair develops over the pubis and in the arm-pits2 the voice alters4 ,as a rule1 women continue to grow in stature until the twenty-fifth year4 ,it is said that brunettes develop sooner than blondes1 and that large women develop more slowly than women of small stature2 city girls develop younger than girls brought up in the country4 ,whatever stimulates the emotions causes a premature development of the sexual organs2 as children's parties1 late hours1 sensational novels1 loose stories1 the drama and the ball-room1 talk of beaux1 of love and marriage1 and children being surrounded with the atmosphere of riper years4 ,it is generally believed that early stimulation of the sexual instincts leads to the premature establishment of puberty1 as do also spiced foods and alcoholic beverages4 ,first ,onset of ,menstruation4-- ,sometimes the first menstrual discharge appears suddenly1 lasts for a few days1 and then stops2 it may appear after an interval of two or three weeks1 or not for several months4 ,if for several months the flow appears at the regular time1 and the quantity is about the same as the first1 the menstrual habit may be said to be established4 ,the mode of onset varies considerably within the limits of health4 ,so long as the general health remains good1 no anxiety need be felt in regard to the establishment of the menstrual function4 ,in other cases there may be a discharge of blood at the first period1 and none afterward for several months2 in other words1 menstruation may be established suddenly1 intermittently1 or gradually4 ,it must be remembered that certain pathologic conditions cause many disturbances connected with the onset of puberty4 ,psychic ,changes at ,puberty4-- ,the angular1 gawky feeling gradually disappears2 the girl becomes self-conscious2 new impulses arise1 and she gives up many of the hoydenish ways of childhood4 ,the girl's imagination is more lively1 and just at this time mathematics form an excellent subject for mental occupation4 ,the girl now begins to question the whys and wherefores1 and demands reasons for the course that is laid out for her1 and is full of ideas of her own2 so that while as a child she had accepted almost unquestioningly the commands of her parents1 she can be managed now only through the power of reason4 ,and this is just as it should be1 for the girl has reached the years of discretion1 and now is the time when her reason and judgment are capable of rapid cultivation4 ,,chapter ,,ii4 ,,hygiene ,,of ,,puberty4 ,home ,life2 ,corsets2 ,shoes2 ,underwear2 ,nutrition2 ,diet2 ,water2 ,constipation2 ,school ,life2 ,spinal ,curvature2 ,exercise2 ,walking2 ,running4 ,every man is the architect of his own fortune4 ,,pseudo-,,sallust4 ,home ,life4-- ,with beginning menstruation the equilibrium of the body is very easily disturbed1 so that even in the case of the healthy girl some precautions should be taken and a rational regime should be adhered to2 while in the case of the delicate girl a still more careful attention will have to be directed toward her weak points1 in order that she may develop into a healthy woman4 ,for every girl at this time of life home is preeminently the place2 so that she may not only have the benefit of a mother's watchful care1 but also lead a life as free from conventionalities and as much in the open air as possible4 ,no girl should be sent away to school at this period of rapid growth and development2 nor should girls of the working classes1 when it can possibly be avoided1 be sent out to fill positions as clerks in illy ventilated stores1 in factories1 or as domestics4 ,if a girl can be kept at home until she is eighteen years old1 she will be a much stronger1 healthier woman than would otherwise be possible4 ,corsets4-- ,at this period of life it is particularly necessary that the clothing should be warm and at the same time sufficiently loose to prevent the constriction of any part of the body4 ,and whatever the adult woman may elect to do in the matter of wearing corsets herself1 she does her young daughter an irreparable injury by constricting and moulding her growing body in these corset-splints4 ,corsets placed on the young girl interfere with the functions of circulation1 respiration1 digestion1 and of the pelvic organs1 also with muscular development4 ,in addition to all this1 the girl is handicapped in taking all outdoor exercises and athletic sports4 ,the lungs1 heart1 and great blood-vessels are placed in and completely fill an air-tight1 distensiblecage1 which is most distensible at its base4 ,the least chest girth of the adult woman-- that is1 the under-arm girth around the chest-- that is consistent with health is twenty-eight inches2 and this girth must be enlarged three inches in forced inspiration4 ,in ordinary respiration the waist expansion should be one-half to one inch1 while during great muscular activity it should be from one and a half to three or four inches4 ,one-third of the lungs lie below the point of beginning corset pressure1 so that with tight corsets this amount of lung substance must be more or less useless4 ,it is self-evident that any restriction placed about the waist1 by preventing the full expansion of the ribs and the descent of the diaphragm1 will further embarrass the heart's action by diminishing the amount of room it has to work in1 at the same time that it diminishes the amount of oxygen which is inspired4 ,fresh air is by far the most important part of the daily food4 ,it is in the lungs that the blood throws off its carbonic acid and other impurities2 but it is able to do this only when the lungs are supplied with an abundance of oxygen4 ,every inch which a woman adds to her chest measure adds to the measure of her days4 ,great physical injury has followed women playing lawn-tennis while tightly corseted4 ,and although dancing is a much milder exercise1 since it frequently takes place in an overheated and poorly ventilated room1 fatal results occasionally occur from the same cause4 ,standing erect calls into action almost all the muscles of the trunk1 neck1 and lower extremities4 ,so long as the line of gravity falls within the area of the feet1 the muscular effort required is so slight that it is little more than the tonicity contained in all living muscle4 ,the greater the displacement of the line of gravity1 the greater the muscular effort required to maintain the equilibrium of the body4 ,up to a certain extent1 exercising the muscle develops the strength and size of the muscle4 ,on the other hand1 when a muscle within the body is unused1 it wastes2 when used within certain limits1 it grows4 ,but when the corset splint is applied to the body of the young girl1 it supplants the functions of the abdominal and back muscles1 which is to hold the trunk erect1 and these muscles gradually grow weak and waste4 ,and so the liability to the various spinal curvatures is increased4 ,the original object of the corset was to give greater prominence to the hips and abdomen4 ,but fashions change6 ,in the ,french figure or straight-front corset now in vogue the pelvis is tilted forward1 producing a sinking in of the abdomen and a marked prominence of the hips and sacrum1 necessitating a compensatory curve of the spine which increases the curvature forward at the small of the back-- a deformity which1 a few years ago1 women were going to orthopedic surgeons to have corrected4 ,in this attitude the line passing through the centre of gravity strikes the heels1 the knees are hyper-extended1 and the muscles of the calves and thighs are rendered tense4 ,by interfering with the muscular development and digestion1 the girl is very apt to become angular1 flat-chested1 anemic1 and to have a muddy complexion4 ,and so the corset really defeats the object for which it was put on-- that of giving the girl a good figure and enhancing her beauty4 ,there is no objection to girls wearing any of the various forms of hygienic waists now on the market4 ,shoes4-- ,the feet are the part of the body to come in contact with the greatest degree of cold1 whether on the floor of the house or the pavement of the street4 ,hence it is a matter of prime importance to the entire body that the feet should be properly clad4 ,the thick-soled1 flat-heeled shoes which became popular with bicycling and golf are most hygienic1 and it is highly desirable that this style of shoe should be adhered to for outdoor exercise4 ,underwear4-- ,in our cold and changeable climate the most suitable undergarment is the combination woolen undersuit1 which reaches from neck to ankles and has long sleeves4 ,much greater warmth is afforded when the undersuit is moderately tight fitting4 ,such a suit should be worn the entire year1 the grade of weight being adapted to the season4 ,nutrition4-- ,the nutrition of the body is dependent on the food supply1 digestion and excretion4 ,the growing girl should eat more than the adult woman1 because of her more active life and of the fact that the food which she takes must not only replace the worn-out material of the body1 but also provide new material needed for growth4 ,insufficient food and food of defective quality and composition work proportionately for more harm during the growing age4 ,the full adult weight is not attained before the twenty-fifth year4 ,when the final growth of the body and development of the vital organs is completed1 the function of food is simply to replace waste with new material and to furnish material for the development of force4 ,diet4-- ,the diet should be a mixed one1 consisting of the various kinds of fresh meats1 fish1 milk1 eggs1 poultry1 vegetables1 fruit1 and fat in the shape of cream1 butter1 and the fat of beef and mutton4 ,animal food improves the condition of the muscles1 which are made firmer than they would be through a vegetable diet4 ,meat in general has a more stimulating effect upon the system and is more strengthening than vegetable food1 and it gives rise to a sensation of energy and activity4 ,the common estimate is that meat should occupy one-fourth and vegetable food three-fourths of a mixed diet4 ,common salt in moderate quantity is essential1 but all highly spiced or seasoned foods should be avoided1 also pickles and vinegar4 ,all sweets are harmful1 because they destroy the appetite for other things and upset the digestion4 ,tea and coffee should be tabooed1 as well as all alcoholic beverages4 ,good digestion depends for the most part on serving the meals at the same hour every day1 eating leisurely1 and masticating the food well4 ,there is a great tendency on the part of the school girl to sleep late in the morning1 then bolt her breakfast in order to get to school in time4 ,nothing could be more pernicious to the digestion1 unless it is the eternal nibbling of candy4 ,a healthy girl needs nothing between meals4 ,a delicate girl will be the better for a glass of milk in the middle of the morning and at bed-time2 or pure beef juice may be given instead4 ,water4-- ,water is needed to keep the kidneys properly flushed4 ,the amount of urine secreted during the twenty-four hours should be three pints4 ,of course it will be less than this if the quantity of water is insufficient4 ,in addition to the urine about ten ounces of water are lost from the surface of the lungs1 and eighteen ounces from the skin1 making a total of about five pints2 and this quantity of water must be taken daily in order to maintain the equilibrium of the body4 ,the solid food of a mixed diet contains from fifty to sixty per cent4 of water1 so that about twenty-five ounces of water are taken into the system daily as an integral part of the food4 ,in addition1 three pints more should be taken as plain water4 ,the bladder acts as a reservoir for the urine1 and should be emptied at least three or four times a day4 ,constipation4-- ,in order to keep the digestive system in good condition1 the refuse matter which collects in the lower bowel must be evacuated every day4 ,and in order to secure this regular bowel movement1 regularity in the time of going to the toilet is a prime necessity4 ,and now is the time when the habits of a lifetime are being formed4 ,if a tendency to constipation exists1 it can almost always be overcome by increasing the amount of fruit and vegetables eaten1 also by eating cracked wheat1 oatmeal1 corn and graham bread2 all of which increase the peristaltic action of the intestines4 ,the small amount of water taken by girls and women is another fertile source of constipation4 ,school ,life4-- ,when it is considered that fully one-half of the girl's waking hours are spent in school or in study preparing for school1 it becomes evident that the girl's attitude at her desk should be the correct one4 ,the malpositions at the desk are the most frequent cause of lateral curvatures1 round shoulders1 and flat chests4 ,and these deformities are more common in girls than they are in boys4 ,the common faults of the desk and seat leading to these malpositions are unsuitable shape of the back of the seat1 too great a distance between the seat and the desk1 and the incorrect slope of the desk4 ,the edge of the desk should slightly project over the edge of the chair4 ,the top of the desk should incline downward about ten degrees toward the student1 and be low enough to allow the forearm to rest on it without raising the shoulder4 ,the seat should be sufficiently deep to support almost the entire thigh1 and close enough to the floor to allow the soles of the feet to rest firmly on it4 ,the back of the chair should be arched so as to support the hollow of the back1 and should reach just above the lower part of the shoulder-blades1 and so make it easy and comfortable for even a weakly child to sit upright4 ,if the seat is too high1 the feet do not rest on the floor1 and so the girl does not get the proper aid from the legs and feet to maintain an erect position4 ,if the desk is too high1 the elbow can rest on it only by curving the spine and raising the shoulder4 ,the work is brought too close to the eyes and causes extra strain4 ,if the desk is too low1 the child stoops over it and becomes round-shouldered1 and there is a tendency to become short-sighted4 ,the pupil should sit erect with the weight equally borne by both buttocks2 the legs should be straight before the trunk1 and the feet firmly resting on the floor4 ,the book should be held about twelve inches from the eyes4 ,spinal ,curvatures4-- ,it should be distinctly borne in mind that lateral curvature of the spine is a distortion of growth4 ,the deformity appears and is developed during the growing years4 ,it is more common in girls than in boys1 for two reasons3 that at the age when lateral curvature is first seen1 girls grow more rapidly than boys2 and their muscular system is less well developed4 ,in most early cases the faulty attitudes are clearly the result of muscular weakness4 ,the growth in size has not been accompanied by a corresponding development of the muscles4 ,this condition is most frequently met with in rapidly growing girls1 and it is one of the most common causes of lateral curvature4 ,in these cases proper gymnastics are indicated1 but they should be prescribed and carried out with much care4 ,it is upon the erectness1 suppleness1 and strength of the spinal column that most of the power and grace of the body depend4 ,lack of ventilation is a fertile cause of headache1 anemia 7or an impoverished condition of the blood in iron and oxygen71 and dyspepsia4 ,all these are rare before but common after twelve years of age4 ,exercise4-- ,in physical culture the object aimed at should be the symmetrical development of all the muscles of the body4 ,hence the necessity for bringing every individual muscle into play1 at first for its development1 and later for its maintenance4 ,the tendency of almost all forms of exercise is to develop some portion of the body at the expense of the rest4 ,the most perfect form of exercise is therefore that one which will most nearly call into play all the muscles of the body4 ,walking4-- ,walking is the only form of exercise which may be said to be universal4 ,in walking the muscles of the chest get little exercise1 and those of the spine and abdomen even less4 ,in walking the arms should swing easily at the sides1 both from a physiological and an esthetic point of view4 ,if the girl is weak or is unaccustomed to take any exercise1 the guide for the amount of exercise taken at any one time must be this3 ,at the first sense of fatigue1 stop at once and rest1 otherwise positive harm instead of good may be accomplished4 ,the girl who depends on walking for her outdoor exercise should walk at least three miles every day1 and walk at the rate of three miles an hour4 ,after acquiring as great a walking speed as is consistent with a graceful and easy carriage1 the running exercise should be begun1 gradually increasing the distance1 but not the rate of speed4 ,in exercising1 all tight clothing about the neck1 chest1 and waist must be removed4 ,pure air and full breathing are required during and after exercise4 ,full breathing not only promotes the change of air in the lungs1 but also quickens the functions of the circulation and digestion4 ,eating must be avoided shortly before or shortly after any considerable exercise1 as it impairs digestion4 ,running4-- ,running is the best exercise for developing the breathing capacity4 ,while brisk walking is allowable1 fast running is not4 ,the rule for running is to begin slowly1 run moderately for perhaps fifty feet1 then increase the speed gradually2 but in running for exercise1 never speed to the utmost4 ,a five-mile gait is quite sufficient4 ,the run should be closed with the same moderation with which it was begun1 and the girl should never stop short1 as this sudden arrest of action gives a most undesirable shock to the heart4 ,in beginning to take any form of exercise the intensity and duration of the movements practiced must be increased very gradually1 or positive harm instead of good will be done4 ,as soon as fatigue is appreciable1 the exercise should be discontinued and at once be followed by complete rest4 ,rapid respiration1 palpitation or dizziness1 headache1 the face becoming pale or pinched or flushing suddenly1 a feeling of great heat or excessive perspiration1 are all danger signals showing that the exercise has already been carried too far and should cease at once4 ,continued over-exertion carried to a point of exhaustion leads to an obstinate irritability of the heart as well as to organic lesions4 ,mountain-climbing1 rowing1 and bicycling call into play almost all the muscles of the body4 ,of all the outdoor exercises for girls1 swimming is one of the most perfect4 ,it not only calls into vigorous action most of the muscles of the body1 but spares many of those muscles that are so commonly overworked1 the most of the work being performed by muscles that are so little used as to have become flabby and weak4 ,swimming and sea-bathing must be avoided by girls who have weak hearts and in whom the reaction after a plunge into cold water is never established2 also by girls with heart disease or kidney disease4 ,the principal outdoor games are croquet1 archery1 golf1 tennis1 cricket1 foot-ball1 and base-ball4 ,of these1 croquet is the mildest1 and is for that reason a good beginning exercise4 ,croquet1 archery1 golf1 and tennis are all defective in that they cause a greater development of the right than of the left side of the body4 ,as the greater majority of these outdoor exercises can only be indulged in for seven months of the year1 they should be supplemented by exercises in the gymnasium for the remaining five winter months4 ,there should be the greatest variety possible in the kinds of exercise taken1 not only to develop the body symmetrically1 so as to obtain strength1 vigor1 grace1 celerity1 and accuracy of movement1 but also because there is no such potent cause of fatigue as monotonous repetition of the same act1 whether physical or mental4 ,it has been repeatedly proven that physical deterioration can be overcome by exercise1 and that by so doing the mental capacity is greatly increased4 ,,chapter ,,iii4 ,,anatomy ,,of ,,the ,,generative ,,organs4 ,the ,vulva2 the ,hymen2 ,condition1 of the ,hymen as a ,proof of ,virginity2 the ,bladder2 ,vagina2 ,uterus2 ,respiratory ,movements of the ,uterus2 ,fallopian ,tubes2 ,ovaries4 ,he that respects himself is safe from others2 ,he wears a coat of mail that none can pierce4 -- ,,longfellow4 ,the ,vulva4-- ,the female generative organs consist of three groups-- the external1 the intermediate1 and the internal4 ,the vulva1 or external generative organs1 comprises all those organs which are external to the body4 ,the vulva is pierced by two openings1 the smallest and most anterior of which is the external opening of the urethra1 or excretory duct of the bladder4 ,this opening is surrounded by a slight eminence and has a somewhat puckered aspect4 ,the larger opening is the vaginal orifice4 ,in the virgin this is partially closed by the hymen4 ,about one inch back of this is the anus1 or the external orifice of the large bowel4 ,this part of the bowel is known as the rectum4 ,the ,hymen4-- ,the hymen consists of a thin duplicature of mucous membrane strengthened by fibrous tissue1 and is stretched across the posterior part of the vaginal orifice1 which it partly occludes4 ,rupture of the hymen usually1 but not always1 occurs during the first sexual intercourse4 ,in rare cases it is found intact at the time of the birth of the first child4 ,in women who have borne children the vaginal orifice is surrounded by small irregular elevations2 these are the remains of the ruptured hymen1 but are usually present only after labor has taken place1 since the torn hymen is converted into eminences as the result of the pressure incident to child-bearing1 and not to coitus4 ,the ,condition of the ,hymen as a ,proof of ,virginity4-- ,formerly much stress was laid on the condition of the hymen as a proof of virginity4 ,the hymen tightly closed1 barely admitting the tip of a small index-finger1 is positive evidence of virginity4 ,but the hymen may lose its tone by a local catarrhal condition or by a general muscular relaxation2 it may then become so relaxed that the only positive evidence rendered by the intact hymen is that the woman has not borne a child4 ,in a paper on the preservation of the hymen1 ,dr4 ,hannah ,m4 ,thompson writes3 ,further1 if the hymen was intended as a guarantee of moral character1 and for moral protection1 either of man or woman1 would we not have some reason for reflecting on the wisdom and righteousness of a ,creator who has failed to make equal provision1 and to give a like guarantee of an uncorrupted manhood8 ,as physicians1 we know too well that where one woman enters the marriage relation tainted in body there are thousands of men reeking with disease2 and there is no demonstrable test to distinguish these1 no proof for the young woman of the virginity or virtue of the young man4 ,the ,bladder4-- ,the female bladder is relatively broad and capacious1 and is also highly distensible4 ,when the bladder is allowed to become overdistended1 it is carried backward and tends to cause a backward displacement of the uterus4 ,the urethra1 or excretory duct of the bladder1 is about an inch and a half long1 and lies firmly imbedded in the anterior vaginal wall4 ,the ,vagina4-- ,the intermediate organ is the vagina4 ,this is a musculo-membranous canal which connects the external with the internal organs of generation4 ,the vagina lies in relation with the bladder and the urethra in front1 and with the rectum behind4 ,the vagina is sufficiently distensible to allow of the passage of so large a body as the child4 ,the ,uterus4-- ,the internal organs of generation are the uterus1 the ovaries1 and the ,fallopian tubes4 ,of these1 the ovaries and the uterus are the essential female organs of generation4 ,the virgin uterus is a small1 hollow1 muscular organ1 somewhat pear-shaped1 whose cavity is about one and a half inches deep4 ,the uterus is divided by a natural constriction into a body and a neck4 ,the neck1 or cervix1 is somewhat spindle-shaped1 and has a canal running through its center which opens by a small aperture-- the so-called external orifice1-- into the vagina4 ,in the virgin uterus the apposition of the anterior and posterior walls reduces the cavity to little more than a longitudinal cleft4 ,with the advent of old age the whole organ suffers marked atrophy4 ,the uterus is situated in the middle of the pelvic cavity1 between the bladder and the lower bowel4 ,it is held in place by broad elastic bands which go to different sides of the pelvis2 it is also in part supported by the structures below and above it4 ,but so loosely is the uterus held that it is easily pushed about-- as1 for instance1 by a full bladder or a packed bowel4 ,and persistently allowing the bladder to become overfull1 and failure to have a daily evacuation of the bowels1 are prolific sources of displacements of the womb4 ,respiratory ,movements of the ,uterus4-- ,when no constrictions are placed about the waist1 the uterus moves freely up and down with every respiration4 ,so distinctly and with such regularity do these movements take place that an operator by watching the movements of the uterus can tell the effect that the anesthetic is having on the patient's breathing4 ,these so-called respiratory movements play a very important role in the circulation of the uterus1 and in the return of the venous blood to the heart4 ,anything which interferes with these movements1 as the use of corsets1 or of tight bands around the waist1 prevents the free return of the venous blood4 ,the uterus becomes congested1 and through the constant abnormal weight of the organ itself1 as well as the pressing down upon it from above of the superincumbent organs1 the uterus is pushed down below its normal position1 the ligaments whose duty it is to hold it up become relaxed1 and the unhappy woman suffers all the agonies that are attendant on the falling of the womb4 ,for this reason the disorder is frequently met with in women who have never borne children as well as in those who have4 ,the ,fallopian ,tubes4-- ,the ,fallopian tubes extend from the upper1 rounded angles of the uterus1 within and along the free margin of the broad ligaments1 for a distance of about two inches1 to the vicinity of the ovaries1 where each one terminates in a funnel-shaped orifice surrounded by a series of fringed processes4 ,the lumen of the tube is narrowest at its inner end1 where it opens into the cavity of the uterus by a minute orifice which scarcely admits a bristle2 the diameter of the canal gradually increases until it reaches its ovarian extremity4 ,the mucous lining of the tube is clothed by a single layer of hair-like epithelium1 whose current sweeps from the ovarian toward the uterine end of the tube2 and it is these movements which propel the ovum from the ovary to the uterus4 ,the ,ovaries4-- ,the ovaries are two small bodies of an almond shape1 and lie on either side of the uterus4 ,the bulk of the entire organ consists of connective tissue1 in which lie imbedded the ,graafian follicles or ovisacs1 in which the ova are contained4 ,these follicles or ovisacs are minute cells which are packed immediately beneath the surface1 where they occur in all stages of development4 ,with the increase in size which accompanies their development the follicles pass toward the surface1 where they form a distinct projection1 and at this point will occur the final rupture of the sac and the escape of the ovum4 ,it is supposed that the ovum is grasped by the fringe-like extremity of the ,fallopian tube and is carried through it by the movements of the ciliary epithelium to the uterus4 ,the formation of new follicles continues only for a short time after birth1 when the ,graafian follicles are the most numerous2 the entire number contained within the ovaries of the child being estimated at over #gj1jjj4 ,in view of the unquestionably large number of follicles in very young ovaries1 and the relatively small number of ova which reach maturity1 the degeneration of many follicles after reaching a certain degree of development seems certain4 ,,chapter ,,iv4 ,,physiology ,,of ,,the ,,female ,,generative ,,organs4 ,ovulation2 ,etiology of ,menstruation2 ,uterine ,nerve-supply2 the ,function of the ,uterus2 ,stages of the ,menstrual ,cycle2 ,average ,duration of the ,menstrual ,flow2 ,character of tahe ,flow2 ,relation of ,ovulation to ,menstruation2 the ,menstrual ,wave2 ,definition of ,menstruation2 ,premomitory ,symptoms of the ,flow2 ,hygiene of ,menstruution4 ,toil and grow strong2 by toil the flaccid nerves ,grow firm1 and gain a more compacted tone4 -- ,,armstrong4 ,ovulation4-- ,at birth the formation of the ova is nearly completed2 the production of' new cells probably ceases after the second year4 ,the ovaries of the child of two years contain1 therefore1 the full quota of ova1 although the vast majority of these cells always remain immature and undeveloped4 ,while it is probable that a variable number of the immature ova undergo partial development before puberty1 yet the advent of sexual maturity at that time marks the establishment of the regular development of the ,graafian follicles and their contained ova1 accompanied by the attendant phenomena of menstruation4 ,during the entire child-bearing period1 or from about the age of fifteen to forty-five years1 the development of the ,graafian follicles and the discharge of the ova are continually taking place4 ,the liberation of the ova usually takes place at definite times1 which in general coincide with the menstrual epochs1 one or more ova being set free at each period2 but this is by no means invariable4 ,the ripe human ovum or germ cell is a spheric cell1 about #j4b mm4 in diameter1 consisting of granular protoplasm1 in which lies a nucleus which contains the germinal spot4 ,the proper cell-wall is a structure of great delicacy1 outside of which is a secondary envelope4 ,menstruation4-- ,the etiology of menstruation has been variously explained at different epochs4 ,the chief theories have been that of plethora1 and the ovulation1 the tubal1 and the nerve theories4 ,first1 the ,theory of ,plethora4-- ,from the time of ,hippocrates to #ahce the theory prevailed that in the female body the formation of blood is sufficiently rich to provide every four weeks for an overflow of the same1 the evacuation of which becomes a necessity4 ,it was believed that this excess of blood depended on an excess of formative power in the woman4 ,second1 the ,ovulation ,theory4-- ,this was distinctly formulated about #ahde4 ,it construed the menstrual hemorrhage as a subsidiary phenomenon1 entirely dependent on the periodic dehiscence of ovules4 ,the changes supposed to take place in the ,graafian follicles at each menstrual period were believed to involve a peculiar expenditure of nerve force1 which was so much dead loss to the individual life of the woman4 ,the growth of the ,graafian vesicle and its contained ovum was supposed to cause an irritation of the nerves of the ovary1 which was reflected to the entire nervous system4 ,the gradual accumulation of this irritation finally caused a reflex action which determined an afflux of blood to the uterus and ovaries1 which constitutes the catamenial flow4 ,the ovulation theory was refuted by the following facts3 ,ovulation may and does occur without menstruation2 women who have never menstruated may conceive2 conception may occur during lactation1 without the menses having returned since the last parturition2 children at birth have many ovules contained within the ovaries2 ovulation may persist for a time after the menopause1 and even pregnancy has occurred1 although very rarely after this time2 the menses may continue regularly after the removal of the ovaries and ,fallopian tubes2 this is exceptional1 and1 as a rule1 the periods only continue for two or three years at longest4 ,third1 the ,tubal ,theory4-- ,lawson ,tait thought that thorough removal of the tubes was far more essential in determining the menopause1 and that cases of periodically recurring hemorrhage after the removal of the ovaries were to be explained by the fact that the tubes had not been sufficiently removed4 ,as an anatomic and surgical fact1 the tubes can never be wholly excised unless the upper part of the uterus is also amputated4 ,fourth1 the ,nerve ,theory of ,menstruation4-- ,this is based upon the following views3 #a4 ,that menstruation is a process directly controlled by a nerve-center situated in the lumbar region of the spinal cord4 #b4 ,that the menstrual impulses reach the uterus through two sets of nerves4 #c4 ,that menstruation is the result of nerve irritation1 vascular congestion1 and the subsequent relief of these by hemorrhagic discharges4 #d4 ,that hemorrhage from the uterus is the result either of a local uterine condition1 or of influences outside of the uterus acting directly on the center4 #e4 ,that the removal of the appendages arrests menstruation by preventing the propagation of uterine influences to the center4 ,uterine ,nerve ,supply4-- ,one set of nerves causes contraction of the muscular fibers of the uterus1 while the other set transmits impulses which bring about its vascular engorgement2 and they are probably concerned in bringing about the determination of blood to the uterus and its appendages1 which is so marked a feature of the menstrual process4 ,as the result of long-continued investigation1 ,johnstone has come to the conclusion that the lining membrane of the uterus belongs to that class of organs whose function it is to replace organic waste4 ,menstruation is a periodic wasting away of those corpuscles that are too old to make a placenta4 ,he has further found that1 as compared with the uteri of very many of the lower animals1 the human uterus is very scantily supplied with lymphatics1 and the only way to rid the uterus of the overripe1 and therefore consequently useless1 tissue is to wash it out through the vagina by a blood-stream4 ,the tough wall of the human uterus and the increased blood-pressure caused by the erect position cause the difference between menstruation in the human female and rut in the lower animals4 ,the strong light of recent investigations has necessitated the laying aside of many time-honored theories2 and as the close of the nineteenth century has seen the emancipation of the uterus from the thralldom of the ovary1 so we may believe that the twentieth century will find women of such fine physique as to prove the error of the popular fallacy that the cause of woman's weakness lies in the performance of her functions4 ,the ,function of the ,uterus4-- ,the function of the uterus is to provide a favorable place for the reception of the product of conception1 where it may be protected and nourished during the period of its development4 ,the purpose of menstruation is to keep the uterus in suitable condition for the reception of this product of conception at any time4 ,it is now known that the menstrual flow is not the whole of menstruation1 and that the changes going on in the uterus are almost as continuous as the process of digestion4 ,the whole of the reproductive life of woman has been divided into cycles of twenty-eight days each2 these cycles have been divided into four stages4 ,stages of the ,menstrual ,cycle4-- ,the first or constructive stage is one of preparation for the reception of the ovum4 ,during this stage the preparing of a decidua takes place1 or building a nest for the expected egg2 there is a swelling of the mucous membrane1 an enlargement of the uterine glands1 and an increase in the connective tissue4 ,it is thought that this stage lasts for one week2 when pregnancy does not occur1 it is followed by degenerative changes4 ,the second or destructive stage is marked by destructive changes which give rise to the usual phenomena of the menstrual period2 there is a discharge of blood1 mucus1 and disintegrated mucous membrane4 ,the actively growing cells of the uterine lining membrane undergo rapid destructive changes1 the fabric of the half-formed decidua tumbles to pieces1 the turgid capillaries burst and pour out the menstrual flow1 which sweeps away all the useless debris4 ,the irritation sets up reflex uterine contractions1 and so the blood is squeezed out of the distended capillaries and washes away the degenerated cells4 ,the third or reparative stage1 as its name indicates1 is one of repair1 in which by constructive changes the epithelial lining which was thrown off is replaced by new1 which is formed in from three to four days4 ,the fourth or quiescent stage includes the remaining twelve or fourteen days of the menstrual cycle1 and represents the quiescent period prior to the initiative changes which mark the beginning of the next period4 ,average ,duration of the ,menstrual ,flow4-- ,the average duration of the menstrual flow is five days1 although the variations are considerable in healthy women4 ,a flow lasting any place from two to six days is perfectly consistent with health2 but a flow continuing less than two or more than six days generally indicates local or general disease4 ,character of the ,menstrual ,flow4-- ,for the first few hours1 or perhaps for the first day1 the flow is usually slight in quantity and light in color2 on the second and third days the flow reaches its height1 and is profuse and dark1 but it should never be clotted2 after this it gradually ceases4 ,the amount of the flow varies from five to ten ounces4 ,if less than five or six or more than eighteen napkins are pretty well saturated through1 the amount may be considered abnormal4 ,relation of ,ovulation to ,menstruation4-- ,it has not yet been decided just in what relation the processes of ovulation and menstruation stand to each other4 ,it is supposed that the transit of the ovum to the uterus occupies at least one week4 ,it has been thought that the decidua of a particular menstrual period is related1 not to the ovum discharged at that period1 but to the ovum discharged at the preceding period4 ,the menstrual wave1 or the wave of supplementary nutrition199 upon which the menstrual process ultimately depends1 was first established by ,dr4 ,mary ,putnam ,jacobi in the ,boylston prize essay for #ahgf2 showing that menstrual life is associated with a wave of well-marked vital energy1 which manifests itself in a monthly fluctuation of the tempera ture of the body1 in the daily amount of the excretion of urea and of carbonic acid1 and of the rate and tension of the pulse4 ,the wave attains its maximum during the week preceding menstruation1 and slowly falls to its minimum1 which is reached the week after menstruation4 99 ,dr4 ,goodman and ,dr4 ,stephenson have since written on this subject1 and the wave is often known as the ,stephenson wave4 ,this wave indicates a periodic variation in the bodily metabolism1 and is probably directly influenced by the rhythmic activity of the menstrual center4 ,this observation would seem to be nullified by the fact that the phenomena referred to have been found to occur in men as well as in women2 and that the lower animals also seem to show the same periodic variations4 ,it is therefore evident that the phenomena belong not to the function of menstruation1 but to a general law of vital energy4 ,definition of ,menstruation4-- ,menstruation may1 then1 be defined as the periodic discharge of blood from the uterus1 accompanied by the shedding of the epithelium of the body1 as well as that of the uterine glands near their orifices4 ,the sanguineous discharge is due partly to the oozing of blood from the surfaces denuded of epithelium1 and partly to active congestion4 ,the discharge from the uterus is largely augmented by mucus secreted in increased quantity at this period from the enlarged uterine glands4 ,the tubes take some part in the process of menstruation2 their mucous membrane is swollen1 the epithelium is shed in places1 and they are filled with a thin bloody fiuid1 containing blood-corpuscles and cast-off epithelium cells4 ,the menstrual wave continues from puberty to the menopause2 it is a nervous phenomenon4 ,ovulation is a progressive1 non-periodic process2 it begins before birth and continues till the ovarian tissue is atrophied or worn out4 ,premonitory ,symptoms of the ,flow4-- ,the premonitory symptoms of the monthly flow should not be so marked as to cause the individual any discomfort4 ,the first indication of the return of the period should be the appearance of the flow4 ,there is generally a feeling of abdominal fulness with some lassitude1 and sometimes slight headache4 ,the temperature is lower and the pulse is slower than at other times4 ,this lowered tone of the system is an additional reason for increased care against exposure in wet or cold weather4 ,hygiene of ,menstruation4-- ,during the menstrual periods all cold baths must be strictly prohibited1 whether tub-baths or cold sponges4 ,the reason of this is that the application of cold to the surface causes a driving in of the blood from the exterior of the body to the internal organs2 and at the menstrual periods there is already a congested condition of the pelvic organs1 and it must be remembered that congestion is the first stage of inflammation4 ,hot or warm sponge-baths may be taken throughout the period2 and the vulva should be bathed with warm water twice a day through the entire period of the flow1 as this not only removes the clotted blood before it decomposes and becomes the source of irritation1 but also removes other irritating matters1 and prevents the nervousness that is caused by a local irritation4 ,it is strange how women who are scrupulously neat in all other respects will allow the smegma to collect in and about the vulva2 as a matter of fact1 for the purpose of cleanliness it is much more necessary that the external genitals should be washed twice a day with soap and water all through life than that the face should be washed that often4 ,another question which is still sub judice is the necessity for and the frequency with which vaginal douches should be taken2 all physicians are agreed that a vaginal douche taken immediately after the menstrual period is beneficial1 as it removes all the debris of the flow1 which is sometimes very irritating4 ,exercise4-- ,a moderate amount of exercise should be taken every day2 this is needed now quite as much as at any other time1 and only good can result from it4 ,and no harm comes of a woman going out in the rain or in cold weather2 as has been shown1 the menstrual process is going on for a large part of the time1 and the flow is only the external appearance1 but during the time of the flow the woman must be unusually careful not to get her feet wet or to sit down with damp clothing on4 ,violent exercise of all kinds is to be prohibited at this time1 as dancing1 rides on the bicycle1 gymnastics1 and walks of over three miles4 ,the reason for this is very obvious2 the uterus has now reached the height of its turgescence1 and is heavier than at any other time1 hence the danger that displacements or a very profuse flow would be caused by any kind of violent exercise4 ,treatment4-- ,if the woman has been so unfortunate as to get caught out in a heavy rain so that her clothes have been wet through1 or if in the cold weather she should come into the house thoroughly chilled1 the best thing to do is to take off her wet things as quickly as possible1 be well rubbed down with hot1 rough towels1 drink a cup of hot tea1 go to bed at once and place a hot-water bag over the abdomen4 ,she should remain in bed until the next morning1 to the end that the circulation may regain its equilibrium as quickly as possible by the immediate relief of the pelvic congestion4 ,if this exposure should have caused the sudden cessation of the flow1 a hot mustard foot-bath should be taken4 ,one tablespoonful of mustard is used to a gallon of water as hot as can be borne2 the pail should be made as full as can be without running over1 and a blanket wrapped around the pail and woman1 so as to cause a profuse perspiration2 this should be kept up for ten minutes2 if the water cools off1 hot water may be added4 ,,chapter ,v4 ,,the ,,anomalies ,,of ,,menstruation4 ,menorrhagia and ,metrorrhagia2 ,dysmenorrhea2 ,amenorrhea2 ,leuchorrhea2 ,pruritus ,vulvae4 ,defer not till to-morrow to be wise1 ,to-morrow's sun on thee may never rise4 -- ,,congreve ,menorrhagia and ,metrorrhagia4-- ,by menorrhagia is meant an excessive or too profuse menstrual flow2 by metrorrhagia1 a flow of blood between the menstrual periods4 ,neither one constitutes a disease by itself1 but is a symptom of some pathologic condition4 ,it has already been stated that the excretory organs1 by constantly eliminating from the system the worn-out material1 keep the machine healthy and in good working order4 ,kept within natural limits1 this elimination is the source of strength and health2 beyond these limits1 the menstrual flow becomes an actual hemorrhage that1 by draining away the life1 becomes the source of weakness and disease4 ,no physician would dare to bleed a man or woman once a month1 year in and year out for thirty years2 but1 through ignorance or folly1 this is what many girls do for themselves4 ,this excessive flow1 aside from actual local disease1 is brought about by excessive muscular exercise during menstruation2 by the use of all stimulants1 whether alcoholic beverages or quinin2 as well as by the thinness of the blood4 ,when the flow is excessive1 it must be considered a pathologic condition1 which needs the physician's attention4 ,rest in the recumbent position is the first essential2 the diet must be plain and unstimulating1 and attention must be paid to the condition of the blood4 ,the general diseases which generally cause this condition are anemia1 ,bright's disease1 malaria1 the early stages of tuberculosis1 and heart disease4 ,the local causes may be reflex1 as powerful emotions2 or due to local disease of the uterus and its appendages1 as the various inflammations and displacements of the uterus1 fibroid tumors1 polypi1 and cancer4 ,dysmenorrhea is painful menstruation4 ,the most frequent forms are due to uterine congestion2 to mechanical causes1 as a narrowing of the cervical canal1 particularly at its internal opening1 or to a constriction caused by the bending over of the uterus at the junction of the body and the neck2 or to ovarian irritation4 ,the pain varies in intensity from slight discomfort to the most intense uterine colic1 which is experienced in the lower part of the abdomen4 ,in severe cases the general health becomes undermined1 the nervous system gives way1 and hysteria and other disorders of the nervous system result4 ,the congestive variety usually occurs in patients who have previously menstruated painlessly4 ,the pain comes on suddenly with the flow and ceases when the flow stops2 it is very severe and is generally accompanied by a diminution or a cessation of the flow4 ,there is severe headache1 marked diminution in the secretion of the kidneys1 and general restlessness4 ,the patient frequently experiences pain in walking1 is easily fatigued1 has leucorrhea and an irritable bladder4 ,in ovarian dysmenorrhea the pain precedes the flow for several days and ceases when a free flow is established4 ,the pain is of a dull aching character1 and may be felt on one or both sides of the abdomen1 according as one or both ovaries are involved4 ,amenorrhea4-- ,in amenorrhea the menstrual flow may not appear for some years after it is normally due2 or the flow may cease after some months or years of continuance2 or the flow may be abnormally scanty or even absent4 ,the menstrual flow is much later in appearing in some families than in others1 so that this may be considered as a family idiosyncrasy2 and if the girl's health is good1 it need cause no anxiety4 ,if1 on the contrary1 the girl has severe headaches1 or suffers in any way1 the physician should be summoned at once1 as the absence of menstruation may be indicative of some serious pathologic condition1 ,a scanty flow is often indicative of thinness of the blood2 on the other hand1 serious anemias often lead to profuse menorrhagias or metrorrhagias1 as has already been stated4 ,the cause of the profound anemia itself may be insufficient nutrition1 overwork1 or lack of exercise4 ,scanty menstruation is often seen to occur in fevers1 in the later stages of consumption1 in advanced ,bright's disease1 in malaria1 or in any other very serious disease4 ,in these cases it seems to be a conservative process on the part of nature in the run-down state of the system4 ,as consumption progresses menstruation generally ceases absolutely1 never to return again2 and in this case nothing should be done to try to induce a return of the flow4 ,great shock sometimes causes a sudden cessation of the flow2 and sometimes a sea-voyage1 followed by the change of habitat1 will cause an obstinate form of amenorrhea4 ,but it cannot be too well understood that1 after the menstrual flow has been regularly established1 it continues with the greatest regularity throughout the child-bearing period1 unless the exposure to wet or cold has been sufficiently severe to cause great indisposition on the part of the woman4 ,in this case it is possible that1 if the exposure took place just previous to the time of the expected flow1 one period may remain out4 ,but except in case of serious illness1-- as for example1 typhoid fever1-- two or more periods do not fail to appear except in the case of pregnancy4 ,leucorrhea4-- ,leuchorrhea1 or whites1 is a mucous or mucopurulent discharge from the vagina2 it may be a symptom of uterine or vaginal disease4 ,immediately after the menstrual flow there is a well-marked vaginal secretion which is whitish in appearance2 it may be transparent or of a milky color1 and is sometimes very acrid4 ,this secretion may also precede the flow1 and there is nothing abnormal in this4 ,but any discharge occurring between the periods sufficient to stain the clothing-- the so-called whites or leucorrhea-- is abnormal1 and is caused by an inflammation of the vagina or the neighboring parts4 ,in addition to the discharge there is heat and swelling of the parts1 more or less local distress1 and generally intense nervousness4 ,if the disease is not cured1 it may become chronic4 ,the pain1 heat1 and scalding disappear1 but a copious discharge continues1 and in this stage the disease may be very obstinate and greatly reduces the strength4 ,the constant drain breaks down the system1 producing pallor1 debility1 pain in the back1 palpitation1 indigestion1 and so forth4 ,the character of the discharge in leucorrhea varies considerably1 from a whitish or mucous secretion1 to a yellowish or mucopurulent secretion1 and is debilitating in proportion as it is profuse4 ,it is to be remembered that this is not in itself a disease1 but indicates a disease of some of the pelvic organs2 and that all such inflammations left to themselves incline to grow worse4 ,a severe leucorrhea is generally attended with frequent and finally painful micturition2 pain in walking in the lower part of the abdomen1 which may become so severe as to compel the patient to go to bed4 ,pruritus ,vulva4-- ,this is an intense and persistent itching of the vulva1 and is a symptom rather than a disease4 ,it is not an infrequent result of leucorrhea1 the acrid discharge of the latter leading to an irritation of the parts2 this causes rubbing of the parts until a veritable inflammation is produced4 ,other causes of pruritus vulvae are3 ,the local congestion1 such as occurs at the menstrual period1 or in certain cases of pelvic inflammations1 or in early pregnancy2 constipation2 sedentary habits2 congestion of the liver2 incontinence of urine1 and diabetes4 ,when dependent on the latter1 the malady is most obstinate in yielding to treatment4 ,indigestible foods or drinks1 the rubbing of the clothes1 the friction of walking1 and the heat of the bed act as exciting causes in those predisposed to it4 ,the essential treatment here is to at once ascertain and remove the cause2 aids in the treatment are vaginal douches and cooling lotions4 ,,chapter ,,vi4 ,,the ,,marriage ,,question4 ,herbert ,spencer's ,definition of ,love2 ,what ,constitutes a ,suitable ,husband2 ,best ,age for ,marriage2 ,shall ,cousins ,marry8 ,contraindications to ,marriage2 ,do ,reformed ,profligates ,make ,good ,husbands8 the ,proper ,length of ,time for the ,engagement2 the ,right ,time of the ,year to ,marry2 the ,selection of the ,wedding ,day4 ,well1 ,brutus1 thou art noble2 yet1 ,i see1 ,thy honourable mettle may be wrought ,from that it is disposed3 ,therefore1 'tis meet ,that noble minds keep ever with their likes4 ,for who so firm that cannot be seduced8 -- ,julius ,caesar4 ,herbert ,spencer's ,definition of ,love4-- ,love is habitually spoken of as though it were a simple feeling1 whereas it is the most compound1 and therefore the most powerful1 of all the feelings4 ,added to the purely physical elements of it1 are first to be noticed those highly complex impressions produced by physical beauty2 around which are aggregated a variety of pleasurable ideas1 not themselves amatory1 but which have an organized relation to the amatory feelings4 ,with this there is united the complex sentiment we term affection-- a sentiment which1 as it can exist between those of the same sex1 must be regarded as an independent sentiment1 but one which is here greatly exalted4 ,then there is the sentiment of admiration1 respect1 reverence1 in itself one of considerable power1 and which in this relation becomes in a high degree active4 ,there comes next the feeling called the love of approbation4 ,to be preferred above all the world1 and that by the one admired above all others1 is to have the love of approbation gratified in a degree passing every other experience1 especially as there is added that indirect gratification of it which results from the preference being witnessed by others4 ,further1 the allied emotion of self-esteem comes into play4 ,to have succeeded in gaining such attachment from and sway over another is a proof of power which cannot fail to agreeably excite amour propre4 ,yet again1 the proprietary feeling has its share in the general activity4 ,there is the pleasure of possession1 the two belonging to each other4 ,once more1 the relation allows of an extended liberty of action4 ,toward each other a strained behavior is requisite4 ,around each there is a suitable boundary that may not be crossed2 an individuality on which none may trespass4 ,but in this case the barriers are thrown down1 and the love of unrestrained activity is gratified4 ,finally1 there is an exaltation of sympathies1 egotistic pleasures of all kinds are doubled by another's sympathetic participation1 and the pleasures of another are added to the egotistic pleasures4 ,thus around the physical feeling forming the nucleus of the whole1 are gathered the feelings produced by personal beauty that constitutes simple attachments1 of self-esteem1 of property1 of love of freedom1 of sympathy4 ,these1 all greatly exalted and severally tending to reflect their excitements on one another1 unite to form the mental state we call love4 ,and as each of them is comprehensive of multidinous states of consciousness1 we may say that this passion fans into immense aggregate most of the elementary excitations of which we are capable2 and that hence results its irresistible power4 ,what ,constitutes a ,suitable ,husband4-- ,it is desirable that the husband shall be a few years older than the wife4 ,man is later in coming to maturity1 and also retains his sexual powers considerably longer than woman2 so that for these functions to cease about the same time1 the wife must be younger than the husband4 ,a difference of from two to five years is best2 if the parties are young1 it is not essential that the husband should be much the wife's senior1 as it is later in life4 ,the husband may be ten years older1 but a greater disparity of age than this is rarely compatible with congeniality of tastes and dispositions1 so essential to a happy married life4 ,the woman who risks her happiness with a man many years younger than herself violates a precept of nature4 ,the average stature of the man is about three inches greater than that of the woman1 and in the physiologic marriage any great deviation from this should be avoided4 ,the essentials for a happy marriage may be summed up as follows3 that the parties shall be of suitable age2 that they shall be physically well mated and in full sympathy with each other's views of life1 of the same social position1 and of equal education4 ,the ,best ,age for ,marriage4-- ,the reproductive life begins with puberty1 but maturity is not reached before the age of twenty-one4 ,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 motherhood4 ,the too early exercise of the reproductive functions leads to increased suffering on the part of the mother1 depresses her vitality1 and increases her liability to disease4 ,statistics show that the mortality is very much greater where girls marry under twenty years of age4 ,the offspring are apt to be small and ill developed1 and die in large numbers in early life2 only a small percentage live long and robust lives4 ,in ,france it has been observed that where the fear of conscription has caused many young people to marry the offspring were lacking in vigor4 ,among the offspring of immature parents there is a larger proportion of idiots1 cripples1 criminals1 scrofulous1 insane1 and tubercular than among the children of nubile parents4 ,in our climate women are best fitted to become wives and mothers between the ages of twenty-four and twenty-eight years4 ,before this age neither their self-knowledge1 their knowledge of the world1 nor their experience is sufficiently mature to fit them to wisely make the choice of a companion for life1 or to become mothers4 ,after forty1 most women cannot hope for children4 ,men had better wait until between the ages of twenty-seven and thirty years1 before they undertake the responsibilities of parenthood4 ,shall ,cousins ,marry8-- ,they might if both families were perfectly healthy2 but as few families are without some lurking predisposition to disease1 it is not well1 as a rule1 to run the risk of developing this by too repeated unions4 ,contraindications to ,marriage4-- ,young women in whose family there is a distinct history of such hereditary diseases as cancer1 tuberculosis1 or insanity for two generations back1 should not marry at all4 ,not only is this a fearful legacy to hand down to their children1 but pregnancy and child-bearing very decidedly favor the development of these diseases4 ,syphilis in either sex is a distinct bar to marriage2 first1 the party married is sure to contract the disease1 even though it may have been supposed to have been cured4 ,fortunately1 the children of such marriages are generally still-born2 still1 they do sometimes live1 and are most pitiable and sickly objects4 ,for any one to marry under these conditions is a crime against society1 against the ,state1 and against posterity4 ,women who have serious forms of heart disease1 tuberculosis1 or ,bright's disease would1 by becoming pregnant1 run a serious risk of losing their lives toward the close of the pregnancy or at the time of their confinement4 ,in case of heart disease1 the pulmonary congestion that accompanies pregnancy1 together with the encroachment of the pregnant uterus on the cavity of the chest1 would greatly add to the embarrassment of the heart's action4 ,in normal pregnancy there is some congestion of the kidneys2 where there is actual disease of the kidneys prior to the pregnancy1 this congestion is apt to become so severe as to threaten the woman's life4 ,these organic diseases are not to be confounded with functional diseases which are dependent on some other cause2 as palpitation of the heart due to indigestion1 or heart murmurs dependent on the thin state of the blood1 or congestion of the kidneys due to exposure to cold2-- all of which may be cured by proper treatment4 ,should a woman with a fibroid tumor marry1 she would run a great risk to her life2 she should have the tumor removed1 or1 if this is not possible1 she should give up all thoughts of marriage1 since the increased irritation and congestion consequent upon the marital relations would tend to favor its growth4 ,should pregnancy ensue1 delivery might be attended with serious complications1 as very difficult labor1 postpartum hemorrhage1 or1 as these tumors have but little vitality1 and the pressure to which they are subjected during labor is liable to cause their death1 disorganization1 sloughing1 and1 as a result1 puerperal septicemia4 ,sometimes there is such a lack of development of the genital organs as to prevent the woman from having children4 ,two persons with even a slight tendency to the same disease1 either inherited or acquired1 should not intermarry1 even if they are in comparatively good health at the time4 ,their offspring would be quite sure to inherit their diseased tendencies4 ,persons whose constitutions have been somewhat injured1 but who are not tainted with actual disease1 may rear children much healthier than themselves1 provided their own lives are wisely regulated4 ,if they are growing better all the time1 and are not too much broken in constitution1 it may be safe for them to marry4 ,among the ,jews the physician is frequently consulted before matrimonial alliances are contracted4 ,this custom could not but be of universal benefit2 many local or general diseases would be eradicated before marriage1 and in this way much suffering and unhappiness would be spared2 or1 in other cases1 the patient would be advised of the inadvisability of marriage4 ,do ,reformed ,profligates ,make ,good ,husbands8-- ,the manner of life that has been led by this class of men is such as to undermine their health1 if not to have rendered them physical wrecks4 ,there is the overindulgence in alcoholic beverages1 and perhaps1 added to this1 some drug habit4 ,in addition to this1 these men early in their career are apt to become infected with some of the venereal diseases1 or perhaps with all of them-- gonorrhea1 syphilis1 and so forth2 and these diseases have the horrible characteristics of becoming latent4 ,a man who contracts this kind of a disease can never be really sure that he is cured4 ,all venereal diseases are highly contagious4 ,it is now a well-established fact that gonnorrheal infection is not only one of the most common causes of pelvic inflammations in women1 but that these same inflammations are of the most virulent types1 unless they are recognized and treated in the early stages4 ,it is also a well-known fact that a large percentage of married women suffer from this disease4 ,sterility almost always results4 ,in the case of a syphilitic parent1 one or two children may be born1 but the offspring is generally sickly and diseased4 ,inebriety as well as sexual excesses are both well recognized as distinct forms of disease accompanied by degeneracy of brain tissue4 ,it is nothing less than criminal for such men to have children1 since these children would at least inherit the tendency to the same diseases1 if they did not actually have them2 there is also a strong probability of such children being born idiots or imbeciles4 ,it is therefore self-evident that1 instead of a reformed profligate making a good husband1 he must make a very diseased one4 ,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 selection4 ,also that there should be legislation upon the subject1 and that before a man is granted a license of marriage1 he should have a certificate from the health officer of freedom from syphilis1 gonorrhea1 and tuberculosis4 ,the ,proper ,length of ,time for the ,engagement4-- ,a period not shorter than three months1 nor longer than one year1 should elapse between the engagement and the marriage4 ,there are strong physiologic reasons against long engagements3 they keep the affections and the passions in an excited and unnatural condition1 which after a time tends to weaken the nervous system and undermine the health4 ,these evil consequences are common to both sexes4 ,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 once4 ,the ,right ,time of the ,year to ,marry4-- ,when woman marries she enters upon a new life1 and a very trying one4 ,extreme heat and extreme cold are both very taxing to the human economy4 ,midsummer and midwinter are therefore both objectionable1 but especially the former4 ,the ,selection of the ,wedding-day4-- ,this is by common consent left to the bride4 ,she should select a time about ten or fifteen days after the end of one of her menstrual periods1 as this is the time of comparative sterility1 and it is most desirable that the first sexual relations should be fruitless4 ,,part ,,ii4-- ,,marriage4 ,,chapter ,,vii4 ,,the ,,ethics ,,of ,,married ,,life4 ,the ,wedding ,journey2 the ,ethics of ,married ,life2 ,shall ,husband and ,wife ,occupy the ,same ,bed8 the ,comsummation of ,marriage2 the ,marital ,relation2 ,times when ,marital ,relations ,should be ,suspended4 ,if it is possible to perfect mankind1 the means of doing so will be found in the medical sciences4-- ,,descartes4 ,the ,wedding-journey4-- ,the wedding-journey1 which was formerly the cause of so much discomfort to both husband and wife1 has fortunately gone out of vogue2 and in its place has come the retirement to a quiet country or seaside spot1 away from the prying eyes of friends4 ,thus the nervous strain incident to sight-seeing and travel is avoided4 ,the ,ethics of ,married ,life4-- ,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 happiness4 ,the secret of all true happiness in life lies in the spirit of altruism2 one must be able to wholly forget herself and to find her happiness in the welfare of others4 ,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 prostration4 ,the secret of a happy married life depends to no small extent on the very beginning3 the relation is so entirely new1 and much lies hidden in the character of each that was never suspected by the other4 ,between husband and wife there must always be mutual concessions1 forbearance1 and sympathy2 a mutual helpfulness to attain all that is best4 ,this1 of course1 implies that the life of each is an open book for the other to read2 that there is an unreserved exchange of thought2 and that no privilege is claimed by the one that would not willingly be accorded to the other4 ,how many men1 says ,balzac1 proceed with women as the monkey of ,cassan with the violin2 they have broken the heart without knowing it1 as they have tarnished and disdained the jewel whose secret they never understood4 ,almost all men are married in ignorance of women and of love4 ,they have commenced by forcing open the doors of a strange house and have wished to be well received in its salon4 ,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 friendship4 ,he knows by experience that it has taken years to establish this mysterious rapport between an inert material and himself4 ,he could not have divined at the first stroke all its resources and caprices1 its faults and its virtues4 ,his instrument only became a soul for him and a source of melody after long study2 he only came to understand it as two friends after the most learned interrogation4 ,so the world is full of young women who grow pale and feeble1 sick and suffering4 ,the ones are a prey to inflammations more or less severe2 the others remain under the dominion of nervous attacks more or less violent4 ,all these husbands have caused their own unhappiness and ruin4 ,never begin married life with a rape4 ,to demand of a young girl whom one has seen forty times in fifteen days to love you because of the law1 the king1 and justice is an absurdity4 ,love is the union of necessity and of sentiment4 ,happiness in marriage is the result of perfect understanding between the spirits of husband and wife4 ,from this it happens that in order to be happy1 a man is obliged to bind himself to certain rules of delicacy and honor4 ,after taking advantage of the social laws which consecrate the necessity1 it is necessary to obey the secret laws of nature1 in order to make the sentiments flourish4 ,if a man places his happiness on being loved1 it is necessary that he should love sincerely2 nothing resists a veritable passion4 ,shall ,husband and ,wife ,occupy the ,same ,bed8-- ,among civilized nations custom differs in this regard2 in ,germany1 for instance1 the husband and wife occupy separate beds in the same room2 formerly in this country it was almost the universal custom for husband and wife to occupy the same bed4 ,the current of opinion has changed in this respect1 and it is now considered in the highest interests of both that they shall occupy not only separate beds1 but separate rooms2 these rooms communicating through a door which connects their respective dressing-rooms4 ,this is unquestionably the best arrangement from the hygienic as well as from the ethical point of view4 ,health requires that one-third of the time shall be spent in sleep2 the bed was made for sleep2 and the most refreshing sleep can only be obtained by occupying the bed alone4 ,if two persons occupy the same bed and one is restless1 the sleep of the other is necessarily disturbed4 ,again1 two persons occupying the same bed necessitates the same hour for rising and retiring1 which is not always convenient or agreeable4 ,balzac writes on this subject3 ,to put the system of separate bed-rooms into practice is to attain to the highest degree of intellectual power and of virility4 ,by what syllogism man arrived at establishing as a custom that of man and wife sleeping together1 a practice so fatal to happiness1 to health1 to pleasure1 and even to self-love1 would be curious to seek out4 ,if for financial reasons it is not possible to have separate bed-rooms1 the ,german custom of having separate beds should be adopted4 ,the ,consummation of ,marriage4-- ,the consummation of marriage is often attended with difficulty owing to the rigidity of the hymen2 this1 if present1 must usually be ruptured before connection takes place4 ,great gentleness and care must be exercised by the husband if it does not readily yield1 the use of hot vaginal injections should be kept up for several weeks before the trial is repeated4 ,these usually relax the parts very considerably2 but if coitus is still found impossible1 it is better to consult a physician at once1 when a simple operation will generally remove the trouble and the woman is spared much suffering4 ,in no case is any violence on the part of the husband allowable1 as it might produce irreparable injuries4 ,there is always more or less suffering on the part of the wife at first1 partly due to the rupture of the hymen1 and partly to the forcible dilatation of the vagina and she should be allowed a sufficient time for nature to repair these injuries4 ,by so doing1 the constitutional disturbances and the nervous disorders which are so very prevalent may be prevented4 ,too frequent indulgence at this period is a prolific source of inflammatory diseases1 and often occasions sterility and ill-health4 ,the first nuptial relations should be fruitless1 in order that any indisposition arising therefrom should have had time to disappear before the woman becomes pregnant4 ,the ,marital ,relation4-- ,it is most important for the interest of both parties that there should be chastity in the marriage relation as well as out of it4 ,many young couples have had their lives ruined by excessive sexual indulgence4 ,the effect is usually most severe upon the husband1 yet the wife becomes weak1 nervous1 and excitable4 ,sexual excess is also the grave of domestic affection4 ,the general rule given is that coitus should never take place oftener than every seven or ten days4 ,when coitus is succeeded by langour1 depression1 or malaise1 it has been indulged in too frequently4 ,among civilized people there are three widely diferent views as to the proper course to be pursued3 ,first1 those who maintain that sexual intercourse should not take place except for the propagation of the species4 ,second1 those who believe that the act is a love relation1 mutually demanded and enjoyed by both sexes1 and serving other purposes besides that of procreation4 ,third1 those who hold that sexual intercourse is a physical necessity for the man1 but not for the woman4 ,the first theory1 that the sexual relations should never be sustained save for the purpose of procreation1 has many advocates4 ,they teach that there are other uses for the procreative element than the generation of offspring1 and far better uses than its waste in pleasures4 ,they claim that a life of total chastity increases the physical and mental vigor2 and there will result a procreation on the mental and spiritual planes1 instead of on the physical ones4 ,they also claim that to woman belongs the creative power2 that she must choose when a new life shall be evolved2 and that only by adhering to this law can she be protected in the highest function of her being-- the function of maternity4 ,the adherents of the second theory1 that the act is a love relation1 mutually demanded and enjoyed by both sexes1 and that it serves other purposes besides that of procreation1 claim that the female sexual life indicates that the healthy woman is neither indifferent nor passive in the generative act4 ,it has much the same effect as in man-- a powerful increase in her sensations1 whole groups of muscles are set in motion1 and the uterus as well as the entire nervous system are in an excited condition and activity4 ,and that it is the province of the mother to decide when a new life should begin4 ,the third theory1 that sexual intercourse is a physical necessity for the man1 but not for the woman1 is by far the most widely accepted4 ,we will consider1 first1 the practical results of this last theory2 and1 second1 the scientific basis on which it rests4 ,it is generally acknowledged that this practice has done more to cause domestic misery1 sickness1 and death than that dreadful scourge of the human race1 tuberculosis4 ,this man1 accustomed all his life to gratify his sexual passions promisculously1 marries a virtuous young girl4 ,in her menstrual periods she has had to do only with the secondary phenomena2 with the expulsion of the ova not at all4 ,she has had no instruction in the corresponding physiologic life of the man1 and is astonished at the male sexual indications1 and is led to believe in their physiologic necessities4 ,the result is that she not only suffers physically1 but feels outraged and disgraced4 ,she is liable to the chance of maternity at any time2 and such offspring will probably be sickly4 ,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 repugnance4 ,if she be worn and weary of excesses in the early days of her married life1 the husband will have only himself to blame if he is bound all his life to an apathetic and irresponsive wife4 ,husbands place great strains upon the affections of their wives1 and lower themselves almost past reinstatement in their respect and esteem4 ,lastly1 on what scientific basis does this physilogic necessity for sexual gratification on the part of the male rest8 ,analogy with the lower animals does not bear it out4 ,among animals1 except in rare instances under domestication1 the female admits the male in sexual embrace only for procreation4 ,among many savage tribes this same rule has but few exceptions4 ,the analogies between the male and the female sexual organs2 between seminal emissions and menstruation2 between the sexual life of the male and of the female1 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 education2 so that it has come to be that the woman is chaste and the man is degraded2 that the woman is too sentimental and the man too passionate4 ,from a purely medical standpoint1 the most eminent physicians and physiologists of the day all unite in advocating a chaste and continent life1 simply for the sake of the man's own health1 independently of all other considerations4 ,times when ,marital ,relations ,should be ,suspended4-- ,the marital relations should always be suspended during the menstrual period4 ,during pregnancy intercourse should never1 or at least very rarely1 be indulged in4 ,at this time the mother needs to conserve all her strength and energies for herself and child2 and any sexual relations during this time increase the sufferings of the mother and impair the vitality of the child4 ,it has been even suggested that much of the pain during parturition would be avoided by entire continence during pregnancy4 ,intercourse during the early months of pregnancy is a frequent cause of abortion4 ,women who have supposed that they have never been pregnant have in reality been having abortions every second or third month4 ,a woman should never be subjected to coitus until three months after delivery4 ,during lactation intercourse should never1 or at least very rarely1 be indulged in2 as the function of lactation makes a heavy drain on the strength of the mother1 and anything which would further weaken her would tend to impoverish the quality of the milk and thus the child would suffer4 ,,chapter ,,viii4 ,,sexual ,,insinct ,,in ,,women4 ,sexual ,instinct in ,women2 ,excessive ,coitus2 ,causes of ,sexual ,excitability4 ,virtue1 the strength and beauty of the soul1 ,is the best gift of heaven4 -- ,,armstrong4 ,sexual ,instinct in ,women4-- ,after careful observation of the sexes in the married state1 it is found that the sexual appetence is less in women than it is in men4 ,much of this difference in sexual appetence is doubtless due to the chastity of their lives1 coupled with and resulting from the difference of education4 ,the girl is taught repression1 and the boy expression2 that girls must be chaste2 that chastity for boys is impossible4 ,according to the intensity of the sexual instinct women have been divided into three classes3 ,a larger number than is supposed have little or no sexual feeling4 ,second1 those who are subject to strong passion2 this class is larger than the first1 but small as compared with the whole of their sex4 ,third1 those in whom the sexual appetite is moderate2 this class comprises the vast majority of women4 ,and1 even granting to woman more pleasure in sexual indulgence than usually comes to her by largest allowance1 it is safe to say that in nine cases out of ten maternity1 with its early pains and later cares1 greatly lessens her power of enjoyment2 and that for the larger part of her married life she is either positively distressed by the apparently necessary demands of her husband upon her1 and irresponsive to them1 or kept to a cheerful response by a self-abnegation and regard for his comfort1 not to say fear of his moral aberration1 which is a positive drain upon her health and strength4 ,excessive ,coitus4-- ,those who are most frequently found to suffer from venereal excesses are the newly married2 especially if they have weak constitutions and excitable temperaments4 ,a great deal of mischief is done by two persons of unequal constitutions being matched together2 the husband may exhaust the wife or vice versa1 the weaker party being constantly tempted to exceed their strength4 ,in all sexual matters there must be a consideration for others4 ,it is not so much from selfishness as from ignorance that such a mistake is made4 ,the ignorance comes from a lamentable morbid delicacy which prevails on all sexual matters1 and which prevents all open and rational conversation on them1 even between those who have the most intimate knowledge of each other4 ,when the conjugal act is repeated too often1 the man will become gradually conscious of diminished strength1 diminished nerve force1 and diminished mental powers4 ,excess weakens a man's energies1 and enervates and effeminates him4 ,moreover1 it renders him liable to an infinity of diseases and a readier victim to death4 ,not only is the strength of the constitution lowered by the excessive expenditure of force and matter requisite for the perpetuation of the species1 but this lowered standard of vitality is transmitted to children4 ,there can be but little doubt that this is one of the reasons why so many healthy parents beget sickly children1 who die early4 ,they have exhausted themselves of the material from which a new life is created1 and so it is not properly started at the beginning and never reaches its highest development4 ,to the truth of this statement attests the mental imbecility1 the pallid and attenuated forms1 of the children who are the earlier products of marriage4 ,the effect of excessive coitus in women is seen by the confirmed ill health of so many women after marriage and repeated child-bearing4 ,a large number of these cases are dependent upon alteration and diseases of the genitalia2 but a considerable number are unconnected with local disease1 and in many other cases the health is never regained after all local phenomena have disappeared4 ,sexual excitement in the woman causes certain congestion of the genital organs2 and at the time of the orgasm there is a reflex movement which corresponds to erection1 and which consists of a peristaltic movement of the tubes and uterus2 to the uterus also is ascribed an act of suction by which the spermatozoa are drawn up into its interior4 ,even when pregnancy does not follow1 the too frequent excitation and activity of the uterus in weak constitutions causes illness1 first of the genital organs and then of the nervous system4 ,local diseases caused in women by excessive coitus are3 vaginal catarrh1 acute catarrh of the vulva1 acute inflammation of the lining membrane of the uterus as well as of the uterus itself1 inflammation of the ovaries1 and even peritonitis4 ,it is also known to be an important factor in the origin of blood-tumors and of cancer of the uterus4 ,especially is coitus at a time of great physical fatigue liable to be provocative of uterine inflammations4 ,aside from ethical considerations1 coitus during the menstrual period may be the cause of rupture of the impaired blood-vessels1 thus causing blood-tumors4 ,excessive coitus is a well-known cause of chronic inflammation of the uterus2 that is1 a habitual congestion of the uterus is induced by excessive sexual intercourse4 ,this has been frequently mentioned by authors as leading to enlargement of the uterus in the non-pregnant condition2 and it is a still more potent factor in the recently impregnated organ1 whose tissues are succulent and the vessels enlarged1 a condition inviting congestion and enhancing the susceptibility to engorgement4 ,the general manifestations of impaired health in women due to excessive coitus are3 chronic anemia1 with malnutrition2 impaired and altered functions in all the organs1 especially those of the nervous system4 ,menorrhagia is apt to be induced by overstimulation of the ovaries1 together with exhaustion and sexual apathy4 ,the source of so much misery is the increasing physical weakness of the female and the increasing nervous weakness of the male1 with an increasing sexual excitability1 two factors of tragic effect for the wife4 ,here is seen the unfortunate result of teaching two kinds of morals1 one for men and another for women4 ,causes of ,sexual ,excitability4-- ,too frequent genital irritation1 onanism1 too frequent intercourse1 alcohol1 too rich and too highly seasoned foods1 lack of exercise4 ,treatment of ,sexual ,excitability4-- ,avoid alcohol and precocious puberty4 ,strictest attention must be paid to the diet2 everything is to be avoided which is difficult of digestion or which retards it4 ,the following articles of diet must all be avoided3 cheese1 foods seasoned with pepper and curry1 highly salted and acid foods1 and all rich foods2 and meat must be eaten only in moderate quantities4 ,constipation irritates the genitalia directly and increases the inflammation4 ,the close relation of ,venus and ,bacchus is known not only in mythology4 ,carbonated waters are to be especially avoided1 such as soda1 seltzers1 ,preblauer1 ,geisshubler1 and acid waters2 also champagne and beer1 heavy ,italian1 ,spanish1 and ,english wines4 ,all alcoholic drinks must be forbidden4 ,as heavy gymnastics as the strength of the individual will admit1 and plenty of exercise out-of-doors must be taken4 ,there must also be constant mental and physical employment4 ,in women sexual excitability is often caused by local diseases1 and passes off with their cure2 if not1 she must use her will-power1 and take the various forms of cold baths4 ,sexual intercourse not oftener than once in two or three weeks1 and avoid all intimate approaches2 if this is not sufficient1 she will have to leave her husband for a few months4 ,,chapter ,,ix4 ,,sterility4 ,sterility2 the ,prevention of ,conception and the ,limitation of ,offspring2 the ,crime of ,abortion2 ,infidelity in ,women4 ,never let yourselves do evil that good may come4 ,if you do1 you hinder the coming of the real1 the perfect good in its due time4 -- ,,phillips ,,brooks4 ,sterility4-- ,conception is least apt to take place from the tenth day after one period until the third day before the next2 but there is practically no time during a woman's sexual life when she may not be impregnated2 in this connection it must be remembered that the spermatozoa stay alive in her for more than a week4 ,during lactation women are generally sterile1 especially in the first months which follow the accouchement1 because the vital forces are then concentrated on the secretion of milk4 ,the age of the wife at the time of marriage has much to do with the expectation of children4 ,as the age increases over twenty-five years the interval between the marriage and the birth of the first child is lengthened4 ,for it has been ascertained that not only are women most fecund between twenty and twenty-five years1 but that they begin their career of child-bearing sooner after marriage than either their younger or older sisters4 ,a wife who has had children and ceases to conceive for three years will probably bear no more4 ,when marriages are fruitless1 the wife is almost always blamed2 but it is by no means the wife that is always at fault2 many husbands are absolutely sterile4 ,every man is not prolific who enjoys good health and is vigorous4 ,gross states that in one case out of six the sterility was due to the male4 ,kehrer1 after a series of carefully conducted experiments1 has arrived at the conclusion that in at least a third of the cases of sterile marriages the husband was the party at fault1 and that gonorrhea was the cause of the barrenness4 ,venereal diseases have their share of influence1 and the gonorrheal infection is a potent cause of sterility4 ,it is by no means proved that syphilis has any unfavorable influence on conception1 though abortions due to this are frequent4 ,gonorrhea often prevents conception by the inflammation traveling up the womb1 and along the ,fallopian tubes to the ovaries1 whose covering is rendered thick and dense1 so that the ovum cannot escape1 or if it does1 the fimbriated end of the tube is so agglutinated that it cannot grasp the ovum4 ,alcoholism is considered a cause of sterility4 ,it evidently does diminish the sexual potency in the male1 and for this the female is often blamed4 ,it does not follow because a woman has not given birth to a child that she has not conceived4 ,the life of an infant for a long time after birth is a frail one1 and before birth its existence is extremely precarious2 it often perishes a few days after conception4 ,a period coming on a few days late1 and at the same time one which is unusually profuse1 is the only evidence which the young wife may have of an abortion4 ,among prostitutes1 the frequent delay of menstruation1 then abundant hemorrhage1 is in many cases only habitual abortion1 and leads to changes in the generative organs which must result in sterility4 ,a tendency to miscarriage may therefore be all that stands in the way of having a family2 this can frequently be remedied4 ,sexual incompatibility is well known to exist2 prominent examples being ,augustus and ,livia2 ,napoleon and ,josephine4 ,it is also a well-known fact that frigidity is a cause of barrenness4 ,a short separation of husband and wife is often salutary in its influence upon fertility4 ,it is a well-established fact that the time immediately before the period1 but still more that immediately following the period1 are the most favorable times for conception to take place2 the remaining quiet in bed of the woman after the generative act is also favorable to conception4 ,the most frequent causes of sterility in women are inflammation of the lining membrane of the uterus1 or of the neck of the uterus1 or of both4 ,the source of this condition in women who have had children is most frequently due to parturition or abortion4 ,in the newly married it may be due to a previously existing slight uterine catarrh in a displaced uterus1 or it may be a manifestation of a run-down state of the system4 ,in a majority of the newly married1 however1 the inflammation of the endometrium is probably due to the first efforts at conjugal approach4 ,many young women as the result of the preparation of the trosseau1 augmented by a round of gaities at the time of marriage1 enter the married state in a condition bordering on physical and nervous exhaustion2 and then begin engorgements and inflammations which lead to future suffering and to sterility4 ,displacements and flexions of the uterus also cause sterility4 ,such displacements of the neck of the uterus may occur that1 instead of lying in a pool of semen1 as it should1 it is above1 in front of1 or away from it1 and this may prevent conception4 ,vulvar and vaginal hyperesthesia1 inflammations of the vulva1 undue shortness of the vagina1 unless great care is exercised by the husband1 will induce painful coitus1 and may bring about sterility by favoring the formation of a copulation sac outside of the axis of the uterine canal1 and consequently misdirection of the semen4 ,scrofula1 probably by its effects on the general condition1 leading to deficient development of the whole body1 the genital organs included1 may be productive of sterility4 ,the female being less passionate than the male1 the orgasm comes on later with her1 or the male orgasm occurs so soon that she may not reach that stage at all4 ,if both were simultaneous1 it is reasonable to suppose that conception would be more likely to occur4 ,ovulation is doubtless more frequently performed in some women than in others4 ,some women conceive with more or less regularity every fifteen or eighteen months1 and others at intervals of several years4 ,the effect of repeated coition1 provided that impregnation does not take place at once1 is to engorge the uterine vessels1 to alter the nature of the glandular secretions1 to cause profound reflex disturbances1 and thus to produce such changes in the endometrium as to lead to local inflammation and to general nervous exhaustion4 ,backache1 leucorrhea1 and irritable bladder are the first symptoms of this disorder2 but frequently there are added to these1 headache1 indigestion1 rectal tenesmus1 painful and profuse menstruation4 ,in many cases the disease continues in a mild catarrhal form1 giving the woman little inconvenience besides the slight leucorrheal discharge which stains her clothing2 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 ovum1 even should impregnation take place4 ,under normal conditions1 during the intermenstrual period1 a plug of clear viscid mucus1 which is secreted by the glands of the cervical canal1 blocks up that passage1 but is washed away each month by the menstrual discharge4 ,under ordinary conditions this obstruction must seriously interfere with the entrance of the spermatozoa into the cavity of the uterus1 and renders the former theory1 recently revived by ,bossi1 quite tenable1 that impregnation is most likely to occur just after the menstrual epoch4 ,the vaginal secretion under certain pathologic conditions may become so acid that it induces sterility4 ,women who suffer m severe vaginal catarrh are frequently sterile1 the spermatozoa being found dead in the vagina some hours after copulation1 although an examination a shorter time afterward revealed them still alive4 ,in cases where conception takes place in spite of a very acid condition of the vaginal secretion1 it is probable that some of the spermatozoa enter the uterus before the secretion has had time to act on them1 or possibly the spermatozoa being injected in a mass1 the acid secretion is unable to penetrate and kill them all4 ,the reaction of the normal vaginal mucus is always acid1 that of the cervix alkaline2 but as the result of the inflammatory condition1 the reaction of each is often intensified1 especially that of the vagina1 which has an exceedingly sour and penetrating odor4 ,this acid discharge1 bathing the neck of the uterus1 penetrates more or less into the cervical plug and causes coagulation of the alkaline mucus4 ,the chief constituent of the semen is albumin2 agents which affect albuminous substances influence the functional activity of the spermatozoa-- heat1 concentrated acids1 and probably concentrated alkalies4 ,in normal conditions the alkalinity of the seminal fiuid seems to be sufficient to neutralize the acidity of the vaginal secretions1 so that the spermatozoa may remain seventeen days or more 7,bossi7 within the vaginal canal1 even during a menstrual period1 without having their vitality destroyed4 ,when hyperacidity of the vaginal secretion is present1 it is probable that the fertilizing element is at once rendered inert2 but should some of the spermatozoa succeed in reaching the interior of the cervical canal1 the increased alkalinity of the secretion there would in all probability put an end to all further progress4 ,the conditions1 then1 which appear to prevent fecundation are3 ,first1 the absence of the proper nidus for the ovum2 second1 the obstruction of the cervical canal by a mucus plug2 third1 increased alkalinity of the cervical secretion1 often accompanied by the increased acidity of the vaginal secretion4 ,three conditions must1 then1 be determined3 ,first1 are there spermatozoa in the semen8 ,second1 do they get into the uterocervical canal8 ,third1 do the secretions in the canal poison the spermatozoa8 ,for those who are very anxious for offspring1 wrote ,marion ,sims1 ,i usually order sexual intercourse on the third1 fifth1 and seventh days after the flow has ceased2 and on the fifth and third days before its return4 ,for the most obvious reasons this would always be before going to bed at night1 instead of just before rising in the morning4 ,the horizontal position favors the retention of semen2 the erect its expulsion4 ,i am satisfied that too frequent sexual indulgence is fraught with mischief to both parties4 ,it weakens the semen2 in other words1 that this is not so rich in spermatozoa after too frequent indulgence2 and when carried to the extent of a debauch1 the fiuid ejaculated may be wholly destitute of spermatozoa4 ,thus it will be seen that it will be much better to husband the resources of both man and wife4 ,the ,prevention of ,conception and the ,limitation of ,offspring4-- ,some of the contraindications to procreation are when either parent suffers from a disease which is transmissible1 and such diseases frequently manifest themselves only after marriage2 when the pregnancy would endanger the mother's life1 or even where the pregnancy is a nine months' torture to her2 where either parent is suffering from ill health2 or where for economical reasons no more children are desired4 ,if there exists no condition in either parent or in their circumstances why they should not have children1 the next consideration due to their children1 is how the same may be procreated under the most favorable conditions possible2 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 condition4 ,that children should be brought into the world haphazard1 as the result of accident1 is to degrade the human race below that of the lower animals1 where the female admits the male only at the time of the rut1 which in the majority of cases occurs only once a year4 ,another requisite to bearing healthy children is that the pregnancies shall not follow each other too rapidly4 ,aside from the consideration for the health of the mother herself1 she must be in good physical condition to bear the healthiest children she is capable of giving birth to2 and for this there must be from two and a half to three years between the successive pregnancies4 ,the results of overproduction on the children are frequently1 that they are sickly1 short-lived1 or suffer from rickets1 cerebral paralysis1 idiocy1 or imbecility4 ,and last1 but certainly not least1 many women become chronic invalids1 or are hastened to premature graves1 by having children as fast as they possibly can4 ,the most natural and moral way for the artificial prevention of conception1 when on account of ill health or for economic reasons no more children are desired1 is to abstain from sexual intercourse4 ,but in the majority of cases the husband will not agree to this1 and so the greatest number of methods have come to be used to prevent conception4 ,perhaps the most frequent method use to prevent conception is withdrawal before the ejaculation of semen4 ,while this is most injurious to the husband-- debility1 nervous prostration1 and even paralysis are said to ensue-- the health of the wife also suffers4 ,if1 this interrupted sexual congress is continued for years1 there develop gradual nervous disturbances on both sides1 and a serious disease of the uterus makes itself felt4 ,the generative organs become engorged with blood1 but are not permitted to enjoy relaxation consequent upon the full completion of the act4 ,this engorgement may lead to undue local nutrition1 and diffuse growth and proliferation of the connective tissue may take place4 ,hence the uterine walls become dense and thickened and the nerves compressed4 ,of course1 pain and tenderness and a sense of bearing down will be the result4 ,flexions and versions may be consequent upon the engorgement4 ,the nerves become shattered1 and the woman will be fortunate if she contracts no serious womb trouble4 ,it is strange1 says ,john ,stuart ,mill1 that intemperance in drink or any other appetite1 should be condemned so readily1 but that incontinence in this respect should always meet not only with indulgence1 but with praise4 ,little improvement can be expected in morality until the producing of too large families is regarded with the same feeling as drunkenness1 or any other physical excess4 ,sismondi writes3 ,when our true duties toward those whom we give life are not obscured in the name of a sacred authority1 no man will have more children than he can properly bring up4 ,if a woman has a right to decide any question it is how many children she should bear4 ,whenever it becomes unwise that the family should be increased1 justice and humanity require that the husband should impose on himself the same restraint which is submitted to by the unmarried4 ,in the opinion of ,dr4 ,edward ,reich1 it is very much to be wished that the function of conception should be placed under the domain of the will4 ,but the strongest appeal has been made for the sake of morality itself2 namely1 to prevent the crime of abortion4 ,dr4 ,raciborski1 of ,paris1 took the position that the prevention of offspring to a certain extent is not only legitimate1 but it is to be recommended as a means of public good4 ,continence1 self-control1 and a willingness to deny himself-- that is what is required of the husband4 ,but suffering women assure us that this will not suffice2 that men refuse to restrain themselves2 that it leads to loss of domestic happiness1 to illegitimate amours2 or that it is injurious physically and mentally2 that1 in short1 such advice is useless because it is impracticable4 ,dr4 ,napheys writes3 ,is it amiss to hope that science will find resources1 simple and certain1 which will enable a woman to let reason and sound judgment1 not blind passions1 control the increase of her family8 ,the ,crime of ,abortion4-- ,from the moment of conception a new life begins1 a new individual exists2 another child is added to the family4 ,the mother who deliberately sets about to destroy this life by want of care1 or by taking drugs1 or by the use of instruments1 commits a great crime1 and is just as guilty as if she strangled her new-born infant4 ,the crime she commits is child-murder4 ,women in their frenzy at finding themselves in this condition1 and with no slightest idea of the sin that they are committing1 are constantly guilty of committing abortions on themselves1 or going to professional abortionists to have this crime of child-murder committed4 ,this is another of the sins due to the ignorance of the sex in all matters pertaining to reproduction2 and it is a fearfully prevalent one4 ,infidelity in ,women4-- ,we have now reached the last infernal circle of the divine comedy of marriage2 we are at the depths of the inferno4 ,there is something1 ,i do not know what1 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 mother4 ,as has been so well and strongly expressed by ,diderot1 infidelity in woman is like incredulity in a priest2 it is the last step in human forfeitures2 it is for her the great social crime1 for it implies all the others4 ,weigh the sufferings of the future1 the agonies of years by the ecstasy of half an hour4 ,if this conservative sentiment of the creature1 the fear of death1 does not stop her1 what could be expected of laws8 ,oh1 sublime infamy6-- 7,balzac74 ,,part ,,iii4-- ,,maternity4 ,,chapter ,x4 ,,pregnancy4 ,nature of ,conception2 ,pregnancy ,defined2 ,duration of ,pregnancy2 the ,signs of ,pregnancy2 ,quickening2 the ,determination of ,sex at ,will2 the ,influence of the ,male ,sexual ,element on the ,female ,organism2 ,heredity2 ,hygiene of ,pregnancy2 ,causes of ,miscarriage4 ,happy he ,with such a mother1 faith in womankind ,beats with his bood1 and trust in all things high ,comes easy to him1 and though he trip and fall1 ,he shall not bind his soul with clay4 -- ,,tennyson4 ,nature of ,conception4-- ,conception1 or impregnation1 is the union of the germ and the sperm cell1 the result of which is a new being4 ,on coition1 the semen being received into the female organs1 which are at that time in a state of turgescence1 the spermatozoa1 by means of their own vibratile activity1 find their way into the ,fallopian tubes1 and here come in contact with the ovule4 ,the ovule is a minute cell with a transparent membrane1 within which is the yolk containing the germinal vesicle4 ,the spermatozoon penetrates into the ovule and becomes fused with it4 ,the processes of development begin at once to occur4 ,there is congestion of the uterine mucous membrane out of proportion to the rest of the uterus2 the ovum finds lodging here1 and becomes surrounded by a membrane which incloses it in a separate sac4 ,pregnancy ,defined4-- ,pregnancy begins with conception and ends with parturition2 it provides for the nutrition and the expulsion of the embryo and for its nutrition for a short time after birth4 ,the average duration of pregnancy is ten lunar months1 or two hundred and eighty days4 ,the date of the confinement is calculated by reckoning from the date of the last menstrual flow2 count backward three months from the date of the first appearance of the last menses2 to this add twelve months and seven days1 five days being for the average menstrual duration and two days for the possibility of fecundation4 ,duration of ,pregnancy4-- ,many difficulties are experienced in determining the date of the expected confinement4 ,as most pregnancies occur in married women1 we cannot base any calculations on a single act of coitus4 ,and even if there was but one1 all physiologists agree that there is a variable period in different women1 and in the same woman at different times1 between insemination and the fertilization of the ovum4 ,it is the moment of fecundation1 or the union of the germ and sperm cells1 which marks the beginning of pregnancy4 ,the uncertainty becomes still greater owing to our inadequate knowledge as to the length of time during which the sexual elements1 the ova and the spermatozoa1 retain their vitality after liberation from their respective sources4 ,while it is not certainly known1 it is probable that the ovum is capable of impregnation any time during its sojourn within the oviduct and before reaching the uterus1 or probably for a period of about one week from the time of its escape from the ,graafian follicle4 ,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 tract2 it is believed that the spermatozoa are capable of fertilization after a sojourn of three or more weeks within the oviduct4 ,consideration of these facts renders apparent the impossibility of fixing with certainty the date of the beginning of pregnancy1 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 time2 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 period4 ,the ,signs of ,pregnancy4-- ,the cessation of the menstrual period is the sign of the greatest value in women who have been regular2 but it must always be remembered that there may be an irregularity of menstruation for the first few months after marriage4 ,the appetite is capricious2 morning sickness or nausea in the morning on first getting up is a very common symptom in the early months of pregnancy2 enlargement of the abdomen2 in the first two months of pregnancy the abdomen is flattened and the umbilicus is depressed2 after this the abdomen begins to enlarge4 ,there is also an increase in the size of the breasts1 with a deepened color of their areolae and later a watery secretion4 ,the external genitals become swollen and of a bluish color4 ,feeling of the fetal movements-- that is1 the movements of the small parts of the child in the womb-- by the mother is not always reliable1 since gas in the intestines has sometimes been mistaken for this4 ,these signs are more valuable when several exist together4 ,the nausea and vomiting of pregnancy1 the so-called morning sickness1 consists of nausea accompanied often by vomiting or retching of a glairy fiuid1 showing itself most frequently on rising in the morning1 but sometimes appearing after breakfast4 ,it is aggravated by the assumption of the erect position4 ,it may begin within a few days1 but as a rule it does not show itself until the fourth week of pregnancy2 and it generally ceases about the fourth month1 rarely persisting throughout the entire time4 ,in the majority of cases it does not sensibly impair the health4 ,it is a sympathetic disorder reflected from the uterus2 it is aggravated by indigestible food1 by sexual excitement1 and by emotional disturbances2 it is most marked in first pregnancies and in women of highly emotional natures4 ,it is not infrequently due to some inflammation of the uterus or erosion about the external orifice1 and disappears on the removal of the cause4 ,mammary ,changes4-- ,during pregnancy the mammary glands are in immediate sympathy with the growing reproductive organs of the pelvis2 consequently a genuine physiologic enlargement commences in these organs from the beginning of gestation4 ,their glandular structure becomes larger1 fuller1 and firmer2 a sensation of weight or pricking is felt by the patient2 the veins become more prominent4 ,the nipples also become enlarged1 more elongated1 and somewhat erect4 ,surrounding the nipple is the areola2 this becomes darker in color4 ,in most women a drop of watery fiuid1 the so-called colostrum1 may be squeezed out from the nipple at the end of the third month of pregnancy4 ,the signs of pregnancy are divided into the presumptive1 the probable1 and the positive4 ,the presumptive signs are3 menstrual suppression1 morning sickness1 irritable bladder1 mental and emotional phenomena4 ,the probable signs are3 mammary changes1 abdominal enlargement1 changes in the neck of the womb1 and certain changes which are felt on bimanual examination4 ,the positive signs are3 feeling the various parts of the fetus1 active movements of the fetus1 and hearing the fetal heart sounds4 ,functional disturbances of the bladder are quite often noticeable in the early part of the pregnancy4 ,in the first part of the pregnancy the bladder is dragged upon1 and later it is pressed upon by the enlarged uterus so that the bladder capacity is lessened and frequency of urination is the result4 ,in the fourth month1 when the uterus ascends into the abdominal cavity1 these bladder symptoms subside1 until the very close of the pregnancy1 when by the descent of the now greatly enlarged uterus there may be even incontinence of urine4 ,changes in the ,abdomen4-- ,during the first two months of the pregnancy there is a flattening of the abdominal surface1 due to the descent of the uterus into the pelvic cavity1 thus slightly dragging the bladder downward and drawing the umbilicus inward4 ,in the latter part of the fourth month there is noticeable a slight abdominal enlargement1 and the umbilicus is no longer sunken4 ,by the end of the fourth month the base of the uterus has risen two inches above the symphysis1 and at the end of the thirty-eighth week it touches the lower extremity of the breast-bone2 the umbilicus has been for many weeks protruding2 during the last two weeks of pregnancy the uterus again descends and the woman feels more comfortable4 ,on the inspection of the abdomen of a pregnant woman there will be noticed a brown line which extends from the umbilicus to the pubes1 and all over the surface the presence of striae1 or long purple grooves1 due to the distention of the abdomen2 on the sides of the abdomen and down the thighs1 red1 blue1 or white markings1 like cicatrices1 may be seen4 ,quickening4-- ,quickening is the sensation experienced by the mother as the result of the active fetal movements of the child in the womb4 ,these movements are first felt between the eighteenth and the twentieth week2 the common rule is that quickening occurs at the middle of pregnancy2 that is1 at four and a half months4 ,as pregnancy advances these active motions increase in frequency and become more marked4 ,when felt or seen by the physician1 as can be done in the sixth month1 fetal movements constitute a positive sign of pregnancy4 ,the ,determination of ,sex at ,will4-- ,although this has always been a question of great interest1 and the subject of much experimentation1 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 be4 ,dr4 ,schenck's theory is that the ruling factor in determining the sex is the food partaken of by the mother4 ,furst believes that the differentiation may occur before1 during1 and a little while after the impregnation2 that the chances of the development of one or another sex in one and the same woman may vary before final differentiation occurs4 ,it is impossible to determine the sex of the embryo before the tenth week of fetal life4 ,the cause of the differentiation1 he believes1 lies largely in the good or bad state of the health of the parents2 in the first instance there being an excess of females1 and in the latter an excess of males1 relatively speaking4 ,he believes that there is an excess of male children when conception takes place during the post-menstrual anemia4 ,he has investigated one hundred and ninety-three cases carefully in regard to the probable date of conception after menstruation1 and there is a notable increase of male births over female in the cases where conception occurred in the first five days after menstruation2 that is to say1 where the woman is not so well nourished as later4 ,dr4 ,j4 ,griffith ,davis gives as the result of her experiments in this direction1 that when conception takes place three days before the menstrual period or within forty-eight hours afterward1 the child will be a girl2 when conception takes place ten days after the period1 the child will be a boy4 ,although there are a greater number of the female than the male sex in all parts of the world where reliable statistics have been taken1 in all civilized countries the proportion of male births is greater than that of females4 ,there is a greater tendency of the male offspring to die earlier1 and this is seen even before birth1 in the proportion of three to two4 ,for this reason the stronger sex as applied to men has been regarded by some authors as a misnomer4 ,they are physically weaker in early life and succumb more readily to noxious influences4 ,the relative age of the parents is said to be another factor in determining the sex of the children4 ,seniority on the father's side gives an excess of male children2 equality in the age of the parents gives a slight preponderance of females2 seniority on the mother's side gives an excess of females4 ,men1 and especially scholars1 who pass a sedentary life and who exhaust their nervous force to a great extent1 beget more girls than boys2 so1 also1 a very advanced age on the part of the man diminishes the number of male offspring4 ,the ,influence of the ,male ,sexual ,element on the ,female ,organism4-- ,dr4 ,alexander ,harvey1 of ,aberdeen1 has adopted the theory of fetal inoculation4 ,he believes that the effect is first due to the influence of the male element upon the ovum1 which1 in consequence of the subsequent close attachment and freely inter-communicating blood-vessels between the modified embryo and the mother1 inoculates the condition of the mother with the qualities of the male2 and so1 on the subsequent impregnation by another male1 the offspring resembles the first male and not its real parent4 ,he even goes further1 and says that it is conceivable1 by successive impregnations effected by him1 that the influence may be increased1 and if so the younger children begotten by him1 rather than the elder1 might be expected1 ceteris paribus1 to bear their father's image4 ,and as regards the mother1 he suggests the question1 whether there is not something in the popular notion that in the course of years the wife comes to resemble the husband2 and that not merely in respect of temper1 disposition1 or habits of thought1 but in bodily appearance1 which may be referable to this influence exerted by the husband on her constitution1 through the medium of the fetuses in utero4 ,yet it shall be2 thou shalt lower to his level day by day1 ,what is fine within thee growing coarse to sympathize with clay4 ,as the husband is the wife is2 thou art mated with a clown1 ,and the grossness of his nature will have weight to drag thee down4 ,he will hold thee1 when his passion shall have spent its novel force1 ,something better than his dog1 a little dearer than his horse4 ,darwin1 on the other hand1 considers it a most improbable hypothesis that the mere blood of one individual should affect the reproductive organs of another individual in such a manner as to affect the subsequent offspring4 ,the analogy1 he says1 from the direct action of the foreign pollen on the ovaries and seed coats of the mother plant strongly supports the belief that the male element acts directly on the reproductive organs of the female1 and not through the intervention of the crossed embryo4 ,dr4 ,john ,brown1 in reviewing the subject1 says it must be conceded that the male element has an influence on the female1 over and above its fertilizing influence upon the ovum4 ,the limit of this influence is at present unknown4 ,heredity4-- ,girls are more apt to resemble their fathers in mental traits1 disposition1 and constitution2 while boys take after their mothers4 ,boys procreated by intelligent mothers will be intelligent2 while it does not always follow that the sons of intelligent fathers are intelligent4 ,the poets ,burns1 ,ben ,johnson1 ,goethe1 ,walter ,scott1 ,byron1 and ,lamartine were all born of women remarkable for vivacity and brilliance of language4 ,hygiene of ,pregnancy4-- ,the health and perfection of the child depend largely upon the health and perfection of the parents at the time of its conception1 as well as upon the condition of the mother during the pregnancy4 ,even when both parents possess a strong constitution1 but one or both of them is suffering from a temporary exhaustion or malaise1 the child will be born below the standard of health it ought to possess4 ,children born during the first year of married life seldom equal in health the children born of the same parents later2 they are not only apt to be sickly1 but the liability to premature death is greatly increased4 ,for this reason it is better that the first year of married life should be allowed to pass without conception taking place4 ,a child begotten in an intoxicated or depraved condition of a parent may be depraved itself in the same way1 and is apt to be feeble-minded or idiotic4 ,it must be borne in mind that prenatal culture of some sort begins at the time of conception2 and that on the mental as well as on the physical state of the mother1 the health as well as the disposition of the child will depend to no slight extent4 ,the prospective mother who constantly gives way to her feelings does a wrong to her unborn child4 ,the mother is at this time more impressionable1 more nervous1 and more irritable than is natural to her2 and while her family should make a certain allowance for her condition1 she1 on her part1 should not allow herself to give way to her morbid feelings4 ,the prospective mother should not lead a life of self-indulgence1 on the one hand1 or1 on the other1 should not be weighed down with cares2 she should interest herself in her usual duties1 and be relieved of all anxiety possible4 ,dress4-- ,the clothing must be loose1 and all compression about the waist and abdomen must be especially avoided4 ,if the woman wears corsets1 she must take them off at once1 and substitute a ,ferris or some similar hygienic waist4 ,the corset prevents the proper development of the abdominal muscles1 which play so important a role in the expulsion of the child from the womb1 as well as in the proper growth and development of the fetus itself4 ,if the woman has already borne children1 and toward the end of the pregnancy the abdomen becomes pendulous1 she will very materially add to her comfort by swearing a muslin abdominal bandage4 ,a woolen undersuit1 or undervest and drawers1 with high neck and long sleeves1 must be worn winter and summer2 the grade of the wool to be adapted to the season of the year4 ,the especial necessity for wearing wool next the skin during the pregnancy is because of the intimate relation between the skin and the kidneys4 ,any chilling of the body at this time is apt to lead to the congestion of the kidneys4 ,if there is already any congestion of the kidneys present1 or any abdominal pain1 in addition to the undersuit an abdominal bandage should be worn4 ,these bandages come woven in ribbed woolen1 and fit the body snugly4 ,this bandage is to be constantly worn1 and1 of course1 changed at night4 ,during the cold weather the stockings should also be of wool4 ,under no circumstances are garters allowed to be worn1 as they form a constriction around the leg and interfere with the return of the venous blood to the heart1 and so increase the tendency to the formation of the varicose veins4 ,it is better not to use any means to hold the stockings up2 they will be kept sufficiently well in place by the under-drawers4 ,low shoes should never be worn except in the hottest weather4 ,it is of the greatest importance that the woman should be impressed with the necessity of the avoidance of taking cold1 since any lung or kidney trouble is a serious complication of pregnancy4 ,diet4-- ,the diet is the same as that at any other time1 only it is more necessary to guard against anything which is likely to cause indigestion4 ,in other words1 the diet should be plain1 simple1 and easy of digestion2 nutritious and partaken of at regular intervals4 ,in the latter part of pregnancy owing to the pressure of the enlarged uterus on the stomach1 the food may have to be partaken of in smaller quantities and at shorter intervals4 ,at this time also the appetite is abnormally large4 ,where it does not disagree with the patient1 milk is the best adjuvant possible to the diet4 ,constipation4-- ,constipation is the rule of pregnancy4 ,this is due to the great pressure that the enlarged uterus makes on the bowel2 and as important as it is at all times to keep the bowels regular1 it is at this time more necessary than ever that the woman should have the bowels well evacuated every day4 ,a retention of fecal matter in the body causes the reabsorption into the blood of the toxic matters1 with the resulting headaches1 dizziness1 loss of appetite1 and intense nervousness4 ,to obviate this tendency to constipation1 plenty of fruit and vegetables should be eaten1 as well as cereals if the woman is taking a good deal of outdoor exercise1 otherwise the latter had better be omitted4 ,the woman should drink plenty of water-- at least three pints a day2 this acts as a laxative as well as to flush out the kidneys4 ,if1 in spite of all these measures1 constipation still persists1 as it probably will1 a seidlitz powder can be taken the first thing on rising in the morning2 or from one teaspoonful to one tablespoonful of the effervescing granules of the phosphate of soda in a glass of water1 also to be taken on rising in the morning2 or one-half grain of the solid extract of cascara sagrada night and morning4 ,the object of these is to keep the bowels open1 but purgation must always be avoided4 ,bladder ,symptoms4-- ,if there is any irritability of the bladder1 any scalding on urination1 or a very great frequency of emptying the bladder in the early months of pregnancy1 a physician should be consulted at once2 in the last months of pregnancy there is a desire to evacuate the bladder frequently1 and sometimes at the last there is an incontinence of urine1 which is due to the descent of the uterus and the great pressure on the bladder2 this condition disappears with the confinement4 ,leucorrhea4-- ,if this is present to any marked degree1 the vaginal douche should be continued throughout the pregnancy2 the temperature of the douche should be from #aaj to #aab ,f42 it must never be taken very hot or very cold4 ,the fountain syringe should be used1 and the bag should not be hung more than three feet above the bed1 so that there shall not be too much force to the stream of water4 ,baths4-- ,warm tub-baths may be taken throughout the pregnancy1 but never oftener than twice a week1 and the woman should never stay in the tub longer than is absolutely necessary for the bath1 as otherwise the bath is too enervating4 ,a daily sponge-bath of cool or cold salt water at a temperature of from #hj to #gj ,f41 and in the proportion of a pint of rock or sea salt to a gallon of water is most invigorating1 and counteracts many of the nervous symptoms and promotes sleep and good digestion4 ,the temperature of the room in which this bath is taken should be #gb ,f4 ,shower-baths cause too great a shock to the nervous system1 and they as well as foot-baths must be prohibited4 ,sitz-baths at a temperature from #aaj to #ij ,f4 may be taken just before retiring throughout the pregnancy4 ,the frequency and duration of the bath as well as the temperature should be regulated by the attending physician4 ,in cases of intense nervousness and insomnia these baths have an excellent sedative effect4 ,a pregnant woman must never under any circumstances take ocean baths1 since there is always great danger that the shock of the waves will cause an abortion4 ,sea-voyages should be avoided because of the severe nausea and vomiting1 as well as the danger that the lurching of the vessel may cause miscarriage4 ,the sewing-machine is a tabooed thing for the pregnant woman1 because of the jarring of the pelvis which it produces4 ,sweeping of heavy carpets is also injurious4 ,there must be no lifting of heavy pieces of furniture1 and especially no lifting from the floor1 as it interferes with the circulation in the uterus and is apt to produce miscarriage4 ,driving in an easy carriage over smooth roads is permissible2 dogcarts1 or any conveyance which produces much jolting1 must be avoided2 and while driving is good1 the woman should not do her own driving1 on account of the danger of the jars that would be caused by the sudden pulling of the horse upon the lines4 ,horseback-riding and bicycling are1 of course1 forbidden1 as are also golf1 tennis1 and dancing4 ,exercise4-- ,exercise in the open air should be taken every day1 when the weather is suitable1 and walking is the best form of exercise4 ,the amount will be regulated to some extent by what the woman has been accustomed to taking1 and it should always stop short of fatigue4 ,the woman should live as much as possible in the open air1 and she should attend to her ordinary duties about the house4 ,long railway journeys are always objectionable4 ,hemorrhoids or piles are very often troublesome toward the close of the pregnancy4 ,to overcome this1 the patient should lie down immediately after the bowel movement1 and remain in the recumbent position for ten or fifteen minutes4 ,in addition1 care should be taken to secure a loose movement of the bowels4 ,should the piles come down1 applications of cloths wrung out of hot water1 and held well pressed against the bowel1 should be made2 the piles should then be pressed back until the finger feels that the mass has been pushed above the second constriction of the bowel1 which is felt to exist at about two inches above the sphincter ani muscle4 ,should these means not suffice1 the physician must be consulted at once4 ,swelling and pain of the external genitals and of the lower limbs are best relieved by the recumbent position4 ,should the veins of the legs be much enlarged or the feet swollen1 the patient should have compression made by the wearing of elastic stockings4 ,or in some cases a bandage is sufficient2 in this case the bandage may be made of muslin2 it should be three inches wide1 and1 beginning at the toes1 should extend up as high as the enlargement of the veins continues4 ,this bandage should be freshly applied every morning before rising4 ,pain caused by the stretching of the skin may be relieved by the inunction of the skin with cottonseed or cocoanut oil4 ,for severe pain in the small of the back1 rubbing with soap liniment or alcohol will be found useful4 ,mental ,occupation4-- ,important as this always is1 it is doubly so now4 ,the mind should be constantly and pleasantly occupied1 but no severe study should be indulged in4 ,the emotional susceptibility is generally somewhat increased4 ,the pregnant woman1 quite excitable and irritable1 readily responds to influences by which in the non-gravid condition she could not be affected4 ,sometimes she feels unusually well1 is intellectually brightened and more active1 and says she is positively happier4 ,at other times she is despondent and morose4 ,physiologists admit and observation proves that maternal emotions do affect the development and the exterior of the fetus2 likewise the mental organization of the fetus may be affected4 ,all unpleasant news1 frights1 and physical shocks1 also scenes of suffering and distress1 must be avoided1 as the mind is particularly impressionable at this time4 ,around the patient should be thrown a gentle and protective care1 and she should be treated with the considerate kindness which her condition demands4 ,theatres and all places where there will be a large assemblage of people should be avoided1 as the close air and general bad ventilation are apt to produce vertigo and sometimes attacks of fainting4 ,sleep4-- ,during pregnancy a large amount of sleep is required2 there should be eight hours spent in sleep at night1 and one hour every afternoon4 ,pregnant women should never do any night watching4 ,there is unusual necessity for good ventilation during sleep at this time4 ,the ,marital ,relation4-- ,coitus is1 as a rule1 distasteful to pregnant women4 ,it is for the best interest of the wife as well as for that of the child that all marital relation should be suspended at this time4 ,even uncivilized nations have condemned the privilege of sexual intercourse during pregnancy1 and have visited punishment on the offender4 ,if these relations are not wholly suspended1 they must at least be at those periods which correspond to the time at which the woman would have been unwell had she not been pregnant4 ,to the continuance of these relations throughout the pregnancy is due much of the suffering of the wife1 not only then1 but at the time of the labor as well2 and the nourishment of the child is interfered with4 ,causes of ,miscarriage4-- ,hemorrhoids2 straining at stool2 excessive intercourse in the newly married2 nursing2 ocean-bathing2 overexertion2 overexcitement2 a fall2 any violent emotion2 anger2 sudden or excessive joy2 a fright2 running2 dancing2 horseback-riding2 riding in a heavily built carriage over rough roads2 great fatigue2 lifting heavy weights2 the abuse of purgative medicines2 disease or displacements of the womb2 and a general condition of ill health4 ,the danger of miscarriage is greatest during the first three months of pregnancy4 ,miscarriage is a fruitful source of disease and often of danger to wives2 it is said that thirty-seven out of every hundred pregnant women miscarry4 ,miscarriage is most apt to occur during the first pregnancy2 and great care should be taken to prevent this1 as the habit is easily established1 and after one miscarriage has occurred1 another is likely to follow1 so that it is sometimes with the greatest difficulty that the woman can be made to carry the fetus to full term4 ,artificially produced abortions are not an infrequent cause of sterility2 the young wife becomes pregnant1 and has an abortion produced because she is not yet ready to give up all her pleasures2 and eventually when she does become very anxious to have a child such an extent of uterine disease has been produced by the abortions that she cannot conceive4 ,to ,prevent ,miscarriage4-- ,the life must be free from all excitement1 and must be as quiet as possible without becoming monotonous2 especial care must be exercised at the return of the dates for the menstrual periods4 ,the symptoms of miscarriage are a show of blood1 more or less profuse1 with intense abdominal pain2 on the slightest show of blood the patient should go to bed at once and the physician should be sent for4 ,,chapter ,,xi4 ,,the ,,confinement4 ,preparation for the ,confinement2 ,signs of ,approaching ,labor2 ,symptoms of ,actual ,labor2 the ,confinement-bed2 the ,process of ,labor4 ,to my conception one generation of educated mothers would do more for the regeneration of the race than all other human agencies combined2 and it is an instruction of the head they need1 and not of the heart4 ,the doctrine of responsibility has been ground into ,christian mothers above what they are able to bear4 -- ,,isabelle ,,beecher ,,hooker4 ,preparations for the ,confinement4-- ,the right time to engage the physician who is to take charge of the woman at her confinement is just so soon as the woman knows that she is pregnant4 ,it used to be argued that1 since giving birth to children was a physiologic process1 there was no necessity for the woman to consult the physician until he was sent for when the labor pains began4 ,take the case of the woman who is for the first time pregnant2 she is absolutely at sea2 she has not the least idea how she ought to feel1 what she ought to do or to leave undone2 the result is that she often has a miscarriage which is the source of the greatest disappointment to her husband and herself1 or she suffers very unnecessarily throughout the entire pregnancy1 has a difficult labor1 and perhaps gives birth to a sickly child4 ,the educated physician will explain to her what symptoms are normal and what are pathologic1 and often he will be able to entirely cure the latter4 ,it is now a well-established fact that the most serious complications of the pregnancy1 and of the labor itself are caused by severe congestion or disease of the kidneys4 ,the condition of the kidneys can only be determined by frequent examinations of the urine2 during the early months of pregnancy these examinations are made once a month1 and during the last month they are made every week4 ,the amount of urine passed in the normal condition is three pints a day4 ,nowhere1 perhaps1 is the constant vigilance of the physician so well rewarded as in the careful oversight of the pregnant woman4 ,she goes through her entire pregnancy feeling well1 and often the greatest discomfort that she suffers is due to her size2 her labor and her lying-in are normal1 and she gives birth to a healthy child4 ,engagement of the ,nurse4-- ,this is generally left to the physician in charge of the case1 since he is responsible for the safe delivery of the woman2 but if the patient has any decided choice in the matter1 it is acceded to unless there should be some very valid objections1 and the physician always sends the nurse in view for that case to see the patient in order to ascertain if she is personally agreeable to the patient4 ,choice of ,room for the ,confinement and ,lying-in4-- ,the room should be light1 sunny1 and well ventilated2 it should not be too near a water-closet4 ,in the city as quiet a room as possible should be selected1 and one that is well removed from the rest of the house1 so that if necessary perfect quiet can be maintained4 ,the room should be as cheery as possible4 ,the dress of the mother during the lying-in consists of a merino undervest1 with high neck and long sleeves1 and a nightgown1 which shall be open all the way down the front4 ,the gowns should be made of light muslin or of cambric2 and there should be a sufficient number so that they may be changed every day4 ,six abdominal bandages should be provided4 ,these are made of light muslin1 and they should be eighteen inches wide and long enough to go once and a third around the patient's hips at the sixth month of pregnancy1 or about one yard and a quarter long2 they may be made straight or to fit the patient at the sixth month4 ,this bandage is fastened down the front2 it is applied directly after the labor1 and adds greatly to the patient's comfort during the lying-in4 ,the vulvar pads used during the lying-in are the antiseptic absorbent pads which can be obtained at any place where surgical dressings are sold2 they are made of absorbent cotton1 covered with cheesecloth1 and sterilized4 ,there must be a sufficiently generous supply of sheets so that they can be changed every day1 and the drawsheet as often as may be required4 ,nothing is so important to a good lying-in as to have a clean1 well-ventilated room1 and plenty of fresh bed-linen4 ,cleanliness is the first requisite to antisepsis1 and this is the secret of avoiding puerperal fever4 ,articles to be provided for the confinement are3 #a4 ,an oblong douche-pan of agate-ware4 #b4 ,an agate bed-pan4 #c4 ,a bath thermometer4 #d4 ,two pieces of rubber sheeting2 one1 one yard square1 and the other two yards square4 #e4 ,two sterilized bed-pads1 #cj inches square by #c to #d inches thick4 #f4 ,three dozen antiseptic absorbent pads4 #g4 ,one pound of sterilized absorbent cotton2 twelve yards of cheese-cloth4 #h4 ,six abdominal bandages1 eighteen inches wide1 preferably made to fit the figure at the sixth month of gestation4 #i4 ,two hand-scrubs4 #aj4 ,four ounces of the tincture of green soap4 #aa4 ,bottle of corrosive sublimate tablets4 #ab4 ,four ounces of powdered boric acid4 #ac4 ,half a pint of good whisky4 #ad4 ,two ounces of aromatic spirits of ammonia4 #ae4 ,two ounces of aqua ammonia4 #af4 ,one pint of alcohol4 #ag4 ,two tubes sterilized white vaselin4 #ah4 ,plenty of large and small safety-pins4 #ai4 ,hot-water bag4 #bj4 ,new fountain syringe1 to hold four quarts2 with glass nozle4 #ba4 ,one small basin for vomited matter4 #bb4 ,two very large agate basins or wash-bowls for washing doctor's hands and for antiseptic solutions4 #bc4 ,vessel for after-birth4 #bd4 ,three large pitchers2 one for boiling water1 one for cold boiled water1 and one for antiseptic solution4 #be4 ,tumbler for boric acid solution for washing baby's eyes1 with fine old linen sterilized4 #bf4 ,one dozen freshly laundered sheets1 and two dozen towels4 #bg4 ,stocking-drawers1 muslin4 #bh4 ,change of night-clothing warmed for the mother4 #bi4 ,a warm blanket to receive the baby4 #cj4 ,an infant bath-tub4 #ca4 ,a large piece of oil-cloth to protect the floor499 99 ,van ,horn ,co41 ,park ,avenue and #dast ,street1 ,new ,york1 keep an obstetric outfit1 containing many of the above articles1 cleansed1 sterilized1 and packed in a box ready for use1 so that they remain intact until needed4 ,the price of this outfit is #af4ej4 ,baby's ,outfit4-- ,four flannel bandages1 to be made of fine1 soft flannel1 four inches wide1 to go once and a third around the body4 ,the edges may be pinked or whipped1 but should never be hemmed2 a tape is sewed on double1 the ends passing around the body1 and so the bandage is fastened without pinning4 ,six merino shirts1 with high neck and long sleeves1 made to button down the front4 ,cotton diaper napkins1 not too large2 old soft ones are preferable4 ,long merino stockings which can be pinned to the napkin4 ,flannel petticoats1 not too long2 these may be made on muslin bands1 which are held up on the shoulders by means of straps4 ,the essential in all the clothing is that it should be sufficiently loose4 ,dress-slips should not be so elaborate that they cannot be washed and changed with sufficient frequency2 and not so long that the baby's feet will be hampered in their movements by them4 ,all of baby's clothes but the dress should be fastened by safety-pins4 ,baby's basket should contain3 #a4 ,one outfit of clothes4 #b4 ,one tube of sterilized tape4 #c4 ,a pair of blunt-pointed scissors4 #d4 ,large and small safety-pins4 #e4 ,pieces of fine old linen2 old handkerchiefs are the best4 #f4 ,a soft hair-brush4 #g4 ,a powder box and puff1 with talcum powder4 #h4 ,two tubes of sterilized white vaselin4 #i4 ,two soft towels4 #aj4 ,castile soap4 #aa4 ,single-bulb syringe2 so-called eye and ear syringe4 #ab4 ,a woolen shawl or wrap4 ,if there is no nurse available before the labor sets in1 and it is necessary for the patient to see to the sterilizing of the above articles1 she should first scrub off all pitchers1 basins1 and other utensils1 as well as the douche-pan1 fountain syringe1 and rubber sheeting1 with a brush and hot soap-suds2 the hand-scrubs are to be well washed2 then each article should be pinned separately in coarse towels1 and put to boil for half an hour in an ordinary wash-boiler4 ,the articles so boiled are then dried without removing the towels1 put away1 and not opened till the time of the labor4 ,the abdominal bandages must be laundried and pinned up in separate towels until they are needed4 ,the cheese-cloth must be laundried and then sterilized4 ,the vulvar pads should be pinned in an old napkin1 in packages of half a dozen each2 and one package is sterilized at a time by placing it in the oven until the outer covering is scorched4 ,the linen for the baby's eyes and the cheese-cloth are treated in the same way2 they are to be cut up into small pieces and sterilized as needed4 ,signs of ,approaching ,labor4-- ,about two weeks before labor there is a sinking of the womb4 ,at the beginning of the ninth lunar month this was at the end of the breast-bone2 it now descends to a point midway between this and the navel2 the abdomen becomes smaller1 the pressure on the lungs is relieved1 and the woman breathes more freely4 ,but at the same time that the woman is relieved of the pressure on the chest1 she experiences increase of the troubles in the lower extremities4 ,there is an increase of the bladder symptoms1 with a desire for frequent unrination4 ,constipation becomes more troublesome1 and there may be hemorrhoids2 the veins of the lower extremities may become greatly enlarged4 ,there is an increased fullness of the external genitals and a greatly augmented amount of mucous discharge4 ,there is a feeling of anxiety and nervousness1 with depression of spirits4 ,during the last two weeks of pregnancy patients are apt to have cramp-like pains in the lower part of the abdomen4 ,these are often mistaken for labor pains4 ,true labor pains are characterized by starting in the back1 extending around the abdomen and toward the pubes and down the thighs2 they come at more or less regular intervals of half to three-quarters of an hour1 and increase in intensity with a decrease in the intervals4 ,a strong pain is apt to be followed by two weaker ones4 ,the so-called false pains are irregular in their occurrence4 ,symptoms of ,actual ,labor4-- ,first is generally the show2 this is a discharge of mucous tinged with blood2 at the same time the true labor pains set in4 ,when the patient or nurse is in any doubt as to the character of the pains1 or when the show appears1 the physician should be summoned at once4 ,other symptoms are frequent desire to empty the bladder and bowels1 and a sensation of shivering4 ,the ,confinement-,bed4-- ,a single bed is much more convenient1 but it is rarely found in a private house4 ,the double bed is arranged as follows3 ,the hair mattress is covered with a large rubber sheet1 which is pinned with safety-pins at the corners and tucked well under the mattress2 the rubber sheet must not be drawn too tightly for fear of tearing4 ,over this comes the sheet1 and over the upper half of the bed1 the draw-sheet2 this is a sheet folded four double1 which goes across the bed so as to come under the hips of the patient1 and is tucked under the mattress at both sides4 ,the object of this is so that it may be frequently and easily changed without disturbing the patient4 ,the sheet1 blanket1 and spread which are to serve as a covering after delivery are folded back and placed on the left side of the bed4 ,the lower right-hand corner of the bed-- the right side of the bed is that side which is toward the right hand as one stands facing the foot-board-- is arranged for the confinement2 on this is fastened the smaller rubber sheet1 and over this the sheet is folded1 and both are fastened down with safety-pins4 ,the pillow for the patient should be placed at the upper and inner corner of the square4 ,after the delivery the patient is lifted to the upper part of the bed and the temporary dressing is removed4 ,a sheet and blanket are used for a covering during the confinement4 ,before the labor begins it is well to fasten up the vest and gown1 so that they will not be soiled1 as it is important that the patient shall be moved as little as possible after the labor1 as all movements tend to increase the bleeding4 ,the floor oilcloth must be spread at the side of the bed which is made up for the confinement1 and should extend slightly under the bed4 ,a bureau in the room should contain the mother's and baby's clothing1 bed-linen1 towels1 and any other articles which will be needed1 all properly arranged4 ,the clothing for the mother and baby will be placed where it will keep warm1 and the infant bathtub will be in readiness in case of sudden need for it4 ,all water used about the confinement must have been carefully sterilized in advance4 ,the best way to sterilize the water is by boiling it in a large wash-boiler2 whatever vessel is used must be scrupulously clean1 and ought to be new4 ,the vessel is covered over1 and the water is allowed to boil for half an hour2 it is then1 still covered1 set aside to cool4 ,there should be three gallons each of sterilized hot and cold water2 since in case of an emergency there must be plenty of water ready for use4 ,the various articles ordered in the confinement outfit will be at hand ready for use4 ,it is the duty of the nurse to have everything ready for the doctor before his arrival4 ,the patient should have a full warm tub-bath1 fresh night-clothes put on1 and an enema should be at once given to unload the bowels1 and this even though there may have been a bowel movement only a few hours previously4 ,the patient should remain in bed until the arrival of the doctor4 ,after an examination has assured the latter that all is right1 she may be allowed to go around the room1 with a wrapper thrown on over the night-gown4 ,conveniently near the bed should be a small table1 covered with one or two freshly laundried towels4 ,this table should have on it a wash-basin1 a hand-brush1 soap and hot water1 an antiseptic solution1 scissors1 a ligature for the navel1 and a suitable aseptic lubricant for the hands4 ,the ,process of ,labor4-- ,the process of labor is divided into three stages4 ,the first stage is that of dilatation2 by which is meant the stretching of the mouth of the womb so that the child may pass through4 ,at the first confinement this stage lasts about fifteen hours2 at subsequent labors the length of this stage is much shorter1 the average time being eight hours4 ,the pains during this stage are sharp and cutting1 and they are accompanied by a slight show of blood4 ,the patient is fretful and nervous ,the second stage of labor is called that of expulsion1 because in this stage the uterus contracts down together with the abdominal muscles to expel the child from the womb and the vagina into the world4 ,the duration of this stage in the first confinement is about an hour and a half4 ,the third stage of labor includes the time from the expulsion of the child till the coming away of the after-birth2 the average length of this stage is from twenty minutes to half an hour4 ,the average length of time for the first labor is seventeen hours2 and for subsequent labors from eight to eleven hours4 ,the bag of waters is the sac of membranes in which the child is inclosed4 ,it contains a liquid in which the child floats2 the object of the water is to protect the child from sudden shocks or any kind of injury during pregnancy4 ,during labor this membrane with its contained water serves as a dilating wedge to assist in the opening of the womb1 and it also protects the child from the direct contraction of the uterus upon it4 ,when the waters break prematurely1 the labor is much longer and more tedious2 normally this should not occur before the mouth of the womb is fully dilated4 ,the pains of the second stage of labor are of a bearing down character1 and constantly increase in force and frequency2 the climax being reached as the head passes through the vulvar orifice4 ,a child usually lies in the womb with the head downward2 the reason of this is that there is more room in the upper part of the uterus1 and as the small parts of the child as it is folded upon itself take up the most space1 they occupy this position1 while the head lies just above the pubes4 ,the normal position of the child is3 the head is flexed on the chest1 the legs on the thighs and the thighs on the abdomen1 and the hands are folded across the chest4 ,and so the child is usually born head first4 ,during the stage of expulsion the head of the child is forced down slightly during each pain1 to recede a little during the intervals between the pains2 in this way the vagina and its external orifice are gradually stretched so that the head of the child may pass through without tearing the parts4 ,if the head is allowed to pass through suddenly1 or where the labors are rapid1 as in the case of women who have given birth to several children1 much mischief may be done by tearing the soft parts4 ,after the birth of the head there is a short interval of rest1 when the shoulders are born2 the rest of the body easily slips out2 and with the expulsion of the after-birth the labor is over4 ,at the very beginning of labor the patient should be given a full warm tub-bath1 and make an entire change of linen4 ,she will usually prefer to be dressed in her night-clothing1 over which during the first stage she may wear a loose wrapper2 a sterilized napkin should be worn over the vulva during this stage4 ,during the first stage1 as a rule1 the patient should not be confined to bed until the dilatation is well advanced2 she is generally more comfortable if she is allowed to move around the room1 and the pains are thereby advanced4 ,the only way in which the physician can determine whether labor has begun is by making an internal examination2 and this will enable him to decide as to whether it is necessary to remain or not4 ,the nurse should always wear a wash dress in the confinement and lying-in room4 ,if the labor is long1 nourishment in the form of beef-tea1 broths1 and milk may be given4 ,no stimulants should be given without the direction of the physician4 ,the frequent taking of cold water is permissible4 ,at the beginning of the labor the family and friends must be excluded from the room1 and it must be kept as quiet and as cheerful as possible4 ,toilet of the ,patient4-- ,the newly born child is received in a small blanket1 is well wrapped1 and laid in a warm place4 ,the nurse then turns her attention to the mother2 the external genitals and soiled parts of the body are cleansed with sterilized cheese-cloth wrung out of an antiseptic solution2 if the body-linen has become soiled1 it is also changed1 and all blood-stained articles are removed from the bed4 ,the patient is then carefully lifted up on the permanent bed1 and the vulvar pad and the abdominal bandage are applied2 after which the patient is allowed to rest4 ,,chapter ,,xii4 ,,lying-,,in4 ,management of the ,lying-in2 ,lactation2 ,nursing4 ',tis is ourselves that we are thus or thus4 ,our bodies are our gardens2 to the which1 our wills are gardeners4-- ,othello4 ,management of the ,lying-in4-- ,immediately after the delivery the first essential for the patient is absolute quiet and rest2 the room must be kept quiet and darkened1 and ordinarily the patient is allowed to fall into a light sleep4 ,during the first few hours after labor the best position for the mother is flat on the back1 with only a small pillow under the head4 ,after the first twenty-four hours the patient may be allowed to turn on the side as she prefers4 ,since absolute rest is the first requisite for the patient1 she must be left alone with the nurse1 who must see that she does not fall into too deep a sleep4 ,if the child's cries disturb the mother1 it must be taken into another room4 ,the lying-in room must be kept free from all odors1 all soiled clothing must be at once removed from the room1 and good ventilation must be insured1 being careful to prevent any drafts4 ,while the patient is asleep1 and after the baby has been attended to1 the nurse should place all blood-stained articles in cold water to soak4 ,if in the city1 the after-birth may be burned in the furnace or range2 it should be well covered with coal4 ,in the country the after-birth can be buried in a deep hole4 ,during the first two or three days the vulvar dressings should be changed from every three to six hours1 and at all times as often as they are soiled4 ,each time that the dressing is renewed the external genitals and their immediate surroundings are to be carefully cleansed with sterilized water1 and finally washed with a solution of boric acid1 in the proportion of one tablespoonful of boric acid to one quart of water4 ,it is convenient to keep this solution mixed and on hand1 as it takes some little time to prepare it2 it should be kept in a strength double that which is desired1 so that it may be diluted with warm water to give the desired temperature4 ,this solution may be poured over the parts from a small pitcher1 the douche-pan having been placed under the patient before the washing began4 ,after labor the vulva is very sensitive1 so that while the greatest care must be used to remove all clots of blood and the discharge1 there must be no brisk rubbing of the parts4 ,no blood-stained linen should be permitted to remain about the patient or the bed4 ,since the lying-in woman perspires freely1 her skin ought to be frequently cleansed by sponging with a weak solution of alcohol in tepid water2 this should be followed by friction with a towel until the skin is in a glow4 ,cleanliness of the bed is promoted by the use of a draw-sheet1 which is a sheet folded to four thicknesses and placed beneath the patient's hips in such a way that the upper edge of the sheet shall come under the lower part of the pillows4 ,air and light must be freely admitted at all times in order that the room may be bright and cheerful4 ,for the first few weeks the eyes of the new-born infant should be shielded from all strong light4 ,visitors4-- ,for the first week after the confinement the patient should see no visitors4 ,even the husband or mother should not remain in the room long at a time4 ,nothing of a disagreeable nature should be told to the patient2 and whoever goes into the sick-room should always carry the most cheerful manner1 as it is highly necessary that the patient should be kept mentally as well as physically quiet at this time4 ,diet4-- ,for the first twenty-four hours the diet must be restricted to liquids1 and in most cases nothing is given until the patient has had a few hours' rest4 ,the first thing that is given to the patient should be a cup of warm milk or tea4 ,milk is the best diet2 this may be varied with beef-tea1 bouillon1 mutton or chicken broth2 any of these broths may be made with rice or barley to vary the flavor1 but these must not be given to the patient4 ,the patient should have six ounces of the liquid every two hours during the day and every three hours during the night4 ,on the second day bread well toasted through may be added to any of the liquids4 ,on the third day stewed or baked apples should be added to the diet4 ,on the fourth day1 and from this on1 the patient will have regular meals1 but the diet must be a plain one4 ,for breakfast1 stale bread1 a soft-boiled egg1 fruit1 and a cup of tea1 not too strong4 ,for dinner1 which should always be given in the middle of the day1 an oyster-stew or clam broth1 a lamb chop1 or a very small piece of beefsteak or chicken2 but with these there must be no gravies or dressings2 a potato baked in the skin2 raw tomatoes1 if in season2 apple sauce or cranberry2 celery2 junket1 plain corn-starch1 lemon jelly1 plain cup-custard4 ,from this list the diet must be arranged so as to give as much variety as possible from day to day4 ,midway between breakfast and dinner1 and again in the middle of the afternoon1 the patient should have a glass of milk4 ,the diet should be generous1 but simple4 ,urination4-- ,the feeble condition of the bladder in the first few hours after delivery frequently leads to the retention of urine4 ,owing to the copious secretion of urine which is so common at this time1 painful and injurious distention of the bladder may result4 ,the patient should therefore endeavor to pass her urine in at least six hours after labor1 whether she feels any inclination to do so or not2 the sound of running water or warm fomentations over the bladder1 warm water in the douche-pan1 and moderate pressure applied by the hand over the suprapubic region1 are often effective in accomplishing the desired result4 ,if all these means fail1 the catheter must be used as the last resort4 ,during the entire lying-in the bladder should be emptied every six hours4 ,evacuation of the ,bowels4-- ,there should be an evacuation of the bowels in from twenty-four to thirty-six hours after the labor4 ,for this purpose a seidlitz powder may be given1 or the liquid citrate of magnesia4 ,if this does not suffice1 an enema of warm water1 to which a little soap or two teaspoonfuls of glycerin have been added1 may be given4 ,two pints of water should be prepared2 the patient will retain as much as she comfortably can1 and as long as she can4 ,the bowels should be opened daily after the first day4 ,after-pains are caused by the same physiologic process that causes labor pains-- namely1 by the contractions of the uterus4 ,after the first confinement the after-pains are1 as a rule1 not severe2 attention to the regular emptying of the bladder and bowels also lessens the severity of the after-pains2 these pains seldom last after the second day4 ,the ,lochia4-- ,the discharges of the mother continue for about two weeks1 and are called lochia4 ,for the first twenty-four hours they are pure blood2 the second and the third day they are of the character of bloody water2 from the fourth to the sixth day they have a1 greenish-yellow color1 and from the tenth to the twelfth day they become pure white4 ,soiled napkins and dressings should never be allowed to remain in the patient's room4 ,duration of the ,lying-in4-- ,this lasts for six weeks4 ,during this time the organs of generation are returning to their normal size and condition4 ,in order that the woman may be in the best condition possible at the end of this time1 it is essential that for the first two weeks she should remain in bed2 and so long as there is any blood in the discharge the woman should not be allowed to sit up4 ,the first sitting up should be in bed1 the patient being supported by a bed-rest4 ,during the second two weeks the patient may be allowed to divide her time between the bed and the couch2 in the latter part of this time she may be allowed to go around her room a very little2 and for two weeks more she should remain on the same floor4 ,the first sitting up should not last more than half an hour4 ,getting up and going around too soon after the confinement1 being too smart1 is one of the most prolific sources of falling of the womb1 and all manner of uterine trouble1 by which the general health of the woman is greatly impaired4 ,lactation4-- ,if it is at all possible1 every mother should nurse her own child2 in the interests of both the mother and the child4 ,so far as the mother is concerned1 the process of lactation is beneficial because it hastens the return of the uterus to its normal size4 ,wet-nurses are known tyrants1 and if the quality of the milk has anything to do with the disposition of the child1 as is believed to be the case1 the idea is distasteful of having a woman who belongs to the lower classes provide nourishment for your child2 and artificial feeding is one unmitigated trouble4 ,a deficiency of the quantity or the quality of the mother's milk can generally be remedied by the diet and attention to the health of the mother2 if the deficiency in quantity persists1 the mother's milk can be supplemented by artificial feeding4 ,there may exist certain conditions of the mother in which nursing her own infant would be inadvisable or even impossible4 ,syphilis contracted late in the pregnancy1 and tuberculosis1 are contraindications1 owing to the danger of the mother infecting the child4 ,inversion of the nipples1 their excoriation1 or persistent sensitiveness may make it impossible4 ,in marked general debility of the mother from any cause whatever1 it would be injurious to the mother and the child4 ,after the mother and the new-born infant have had some hours of rest and sleep1 it is advisable to apply the child to the breast1 to receive by this first effort the small quantity of milk which is an especial provision to act as a natural purge and to start the bowels of the child into a healthy activity2 this also excites the milk glands to secretion4 ,the mother's milk in full supply may be expected in from forty to sixty hours after delivery4 ,nursing4-- ,when the mother's nipples are of the normal size and well formed1 the healthy infant instinctively suckles at once when placed at the breast1 but sometimes it has to be taught2 by squeezing out a few drops of milk to wet the nipple1 the child will usually take hold1 or a little sugar and water may be put on the nipple2 a little patience and tact are all that is necessary to insure success4 ,but the infant must be taught to nurse at once before the breasts become engorged with milk4 ,under ordinary circumstances the child is to be kept at the breast for one year4 ,but if within this time the menstrual period should recur and be profuse1 or should the woman again become pregnant1 the quality of the milk becomes poor1 and necessitates the immediate weaning of the child2 the character of the milk is also altered1 and even its secretion may be checked4 ,nervous agitation may so alter the quality of the milk as to make it poisonous4 ,a fretful temper1 fits of anger1 grief1 and sudden terror not only lessen the quantity of the milk1 but render it thin and unhealthful1 inducing disturbances of the child's bowels1 diarrhea1 and so forth4 ,position of the ,mother ,when ,nursing4-- ,when in bed in the recumbent position1 the mother should lie on that side from which the infant is going to nurse2 when up1 the mother should sit erect4 ,care of the ,nipples4-- ,immediately after each nursing the nipples should be washed off in a saturated solution of boric acid in cold water1 and dried with a soft cloth4 ,if they are disposed to crack1 anoint them with cocoa-butter immediately after each cleansing4 ,if the skin of the nipple is very sensitive1 a nipple-shield should be used for the first few days2 or should the nipple become sore at any time1 the shield can be resorted to4 ,the nipple-shield must fit tightly2 the best ones are made of glass with a rubber tip4 ,in the intervals of nursing the nipple-shield should be kept in cold water after it has been thoroughly cleansed by being brushed on both sides4 ,the breasts are sometimes distended from an over-secretion of milk2 this is relieved by saline cathartics1 by abstinence from liquids1 and by the use of a compression breast bandage4 ,this is made of a straight piece of muslin1 with a shallow notch cut in one edge for the neck1 and1 a deep one for each arm2 the bandage is closely applied over the breasts1 and the ends pinned in front2 it is also pinned over the shoulders4 ,in debilitated women the supply of milk may be insufficient2 the most reliable evidence of this is the fact that the infant ceases to gain in weight4 ,,chapter ,,xiii4 ,,the ,,new-,,born ,,infant4 ,the ,infant's ,toilet2 the ,crib2 ,feeding of ,infants2 ,artificial ,feeding2 the ,wet-nurse2 ,characteristics of ,healthy ,infants2 the ,stools2 ,constipation2 ,urination2 ,dentition4 ,o thou child of many prayers1 ,life hath quicksands2 life hath snares4 -- ,,longfellow4 ,the ,infant's ,toilet4-- ,so soon as the mother has been made comfortable1 the toilet of the infant is attended to4 ,this should be made near the register or stove2 and the lap of the nurse should be covered with a small flannel blanket4 ,the baby's body will be found to be covered over with a white1 greasy1 somewhat cheesy substance2 some sort of grease is needed for its removal2 rendered lard1 sweet oil1 and lanolin are the best2 vaselin is less effective4 ,all of this cheesy substance must be at once removed2 the most difficult parts will be in the folds and creases4 ,the nurse should grease the palms of her hands1 then take the head of the child between them1 and thoroughly grease it2 particular attention must be given to the ears2 then come the neck1 shoulders1 arms1 chest and back1 groins1 external genital organs1 and lower extremities4 ,after the child has been thoroughly gone over1 the grease should be rubbed off with a soft towel4 ,a rectal injection of one tablespoonful of warm water is given at once to unload the bowels of the meconium2 this generally acts before the baby's toilet is completed4 ,the meconium is the first discharge from the infant's bowels after birth1 and that which had collected in the intestines during the pregnancy4 ,the ,baby's ,bath4-- ,the baby's bath-tub is filled about one-third full of water at a temperature of #ajj ,f41 tested by the thermometer4 ,the baby is then gradually immersed in the water1 with the exception of the head2 this is supported on the left wrist of the nurse1 which passes under the infant's neck1 while her hand grasps the left shoulder2 with the right hand the nurse quickly rubs over the child's head and body2 the entire bath should not occupy over five minutes4 ,the infant is then lifted out into the lap of the nurse1 on which is spread a soft1 warm towel1 with which it is carefully dried4 ,one of the important points in giving the infant its bath is to be sure that the groins1 arm-pits1 and genitals are thoroughly well dried2 otherwise excoriation at these parts is sure to occur4 ,after this a daily tub-bath is given in the same way2 soap is rarely needed2 when it is1 castile soap should be used2 its constant use is not necessary and would only irritate the skin4 ,these daily baths strengthen the nervous system and prevent coughs and colds4 ,the bath should be given during the morning1 one hour after feeding1 and should not last more than five minutes4 ,the mother herself1 just as soon as she is able to go around1 should superintend the bath2 in this way she is assured that if properly given1 and will also recognize any incipient affection of the child4 ,these daily baths should be continued till the child is four years old4 ,powder is not essential2 but if it is desired1 a plain talcum powder may be used4 ,the ,dressing of the ,cord4-- ,after the bath the ligature which was tied around the cord at the birth of the child will be found slightly loosened2 this should first be made tight1 and then the cord1 doubled back on itself1 should be tied by the ends of the same ligature4 ,a square of soft sterilized linen or gauze is slit up to its center2 the cord is allowed to pass through this slit1 which looks toward the child's right2 the stump of cord is laid on the left and the ends of gauze are folded over this2 the whole is kept in place by the abdominal bandage4 ,as there is some exudation from the cord1 it is necessary to change these dressings twice a day2 as this exudation is of a somewhat gluey nature1 it will be found that the dressings stick to the cord4 ,in removing the gauze great care must be used not to make any traction on the cord2 when the infant is placed in the bath1 the water loosens the dressing and it falls off in the water2 at other times it must be removed with the greatest care4 ,there should never be any odor about the cord2 it usually drops off about the fifth day4 ,the process of ulceration by which the cord falls off leaves an open surface on the child's body which offers an avenue for septic infection4 ,great care must therefore be taken that the nurse's hands or anything which comes in contact with this surface should be perfectly clean4 ,the dressings used must be thoroughly antiseptic4 ,care should be used not to fasten the abdominal bandage too tightly2 the bath is given on an empty stomach1 and allowance should be made for this2 the binder should be loose enough to allow two or three fingers to easily slip under it4 ,the ,meconium4-- ,the ,first discharge that comes from the bowels is of a dark1 greenish color1 and should come away during the first twenty-four hours2 if it does not1 the baby may suffer a good deal of pain1 and an enema of warm water must be given4 ,as this substance is very difficult to be washed out of napkins1 the first ones used should be old and afterward be burned4 ,cleansing4-- ,every time the napkin needs to be changed1 even if it is only wet1 the baby should be washed with warm water4 ,a napkin should never be used twice without washing2 it chafes the child1 and it is an unsafe as well as a filthy practice2 the napkin must always be removed as soon as it is wet4 ,the ,infant's ,toilet4-- ,after the application of the binder and napkin1 comes the undervest2 the fingers of the nurse are passed up through the sleeve to seize the infant's hand and pull it through2 as soon as it gets a little older the child will grasp a finger laid in its palm1 which greatly facilitates this part of the toilet4 ,the stockings are next put on and pinned with safety-pins to the napkin2 then comes the petticoat1 the band of which is also loosely fastened with safety-pins1 and with the slip the toilet is complete4 ,all the clothing should be changed night and morning4 ,the eyes and mouth should be washed out with separate pieces of gauze or old linen4 ,for the mouth1 a small piece of cloth wet in warm water is wrapped around the little finger of the right hand1 going into the left angle of the baby's mouth and coming out at the right1 going between the gums and cheeks as well as over the tongue4 ,this procedure should be gone through with every time preceding and following the nursing1 and in this way the milk is prevented from souring in the mouth1 and the digestion is kept in good condition4 ,a sore mouth in a baby indicates carelessness on the part of the nurse4 ,a soft hair-brush may be used1 but the scalp is too tender to permit the use of a comb4 ,after the toilet has been completed1 the baby is laid in its crib1 on the right side of the body1 and warmly covered4 ,the weaker the baby1 the more attention must be paid to the external warmth4 ,it may be necessary to place a warm-water bottle in the crib1 but this must never touch the infant4 ,the ,crib4-- ,the infant must have its own crib1 without rockers1 and it must on no account be put to sleep in the same bed with its mother4 ,in its early life it should never be taken out of its crib except to be fed1 to have its clothing changed1 or to be bathed4 ,there should be no holding on the lap1 no dangling1 no carrying or fussing over the new-born infant2 and the more the baby is let alone1 the better and healthier it will be4 ,if baby cries1 look at once to see if it needs a fresh napkin2 if not1 if any pins are sticking into it1 if the clothing is possibly too tight2 if none of these things are wrong1 give it a sup of water and turn it over on the other side4 ,the baby often becomes restless by sleeping for several hours in the same position4 ,but on no account take the infant up out of its crib simply because it cries4 ,cheerfulness and good nature on the part of the infant are dependent on its general good health4 ,a healthy infant should not have colic1 but if such is the case1 there is a peculiar look of distress on the face1 which indicates that the child is in pain2 what is needed is warmth or medication according to the severity of the case1 but never floor walking4 ,begin the latter procedure1 and you may hope to keep it up for several years4 ,ventilation4-- ,the air is sometimes vitiated for children's uses in various ways2 their nervous susceptibilities are greater than those of older people4 ,a very little odor of tobacco may cause nausea and discomfort to an infant in arms4 ,the atmosphere of the room should be sweet and pure and unscented4 ,all scents and perfumes affect the nervous system1 and by constant excitation do it damage4 ,a bouquet of flowers renders the air of a closed room too heavy4 ,feeding of ,infants4-- ,during the day the infant should be put to the breast once every two hours1 and once every three hours during the night4 ,this interval of time between the feeding is necessary in order that there may be sufficient time given for digestion to take place4 ,regurgitation of milk soon after feeding is a sign that the stomach has been overfilled4 ,as the infant usually falls asleep after nursing1 it is necessary to waken it up at the time for the next nursing1 as good digestion depends upon regularity of feeding4 ,for the first nursing the infant may be put to the breast in from two to six hours after the labor if the mother is sufficiently rested2 from ten to twenty minutes is long enough for each nursing4 ,before each nursing the nipples should be carefully washed off with a solution of boric acid4 ,the first secretion of the breasts is laxative2 that is1 it acts on the bowels1 and makes is unnecessary to give the infant anything to take for this purpose4 ,the breasts should be used alternately in feeding the infant1 as this allows a longer time for the accumulation of the milk4 ,for the first few days the infant needs very little food1 and the mother's milk is generally sufficient4 ,the infant should be given a teaspoonful of cool water to drink two or three times a day1 as the milk does not quench the thirst4 ,the water should be sterilized by boiling1 and be kept in an air-tight flask4 ,at the end of the third month the intervals of nursing for the daytime should be three hours1 and the last nursing at night should be at eleven o'clock1 and the first nursing in the morning at five o'clock2 thus allowing the mother an interval of six hours of unbroken sleep4 ,the best evidence of the proper nutrition of the child is a progressive gain in weight4 ,the child should be weighed every week4 ,a loss of a few ounces usually takes place during the first few days after birth1 so that the child does well if at the end of the first week it weighs as much as it did at birth4 ,after the first week the weekly gain should not fall below five ounces4 ,the ,wet-nurse4-- ,when the mother for any reason whatever is not able to nurse her child1 the best substitute is a wet-nurse4 ,before she is employed the wet-nurse should always be carefully examined by a physician to insure her freedom from disease4 ,the best age is between twenty and thirty years1 and the age of the child of the nurse should be at least within a month of that of the child to be nursed4 ,the best sign of the good health of the nurse and of the condition of her milk is furnished by the health of her own child4 ,the breasts should be well formed and the nipple of good shape4 ,it is well1 if possible1 to get a woman who has borne several children1 as she will understand the care of the child better4 ,no woman who is not perfectly healthy is fit to be a wet-nurse2 and even after she has been engaged her health and her habits must be watched over4 ,artificia#a ,feeding4-- ,the first requisite in artificial feeding is that the milk shall be made to correspond as nearly as possible to that of the mother4 ,for this purpose the following formula1 prepared by ,rotch1 of modified cow's milk is considered the best3 ,milk #b ounces ,cream #c ounces ,water #aj drams ,milk-sugar #f #c_/d drams ,lime-water #a ounce ,to make one pint of the mixture for use in the twenty-four hours1 take the milk and cream as soon as it comes in the morning1 and mix as above directed4 ,no less important than the correct proportions of the ingredients1 is freedom from disease germs and bacteria of putrefaction4 ,complete sterilization is possible by prolonged boiling2 but experience has proved that under prolonged exposure to a temperature near the boiling-point certain changes take place in the albuminoids of the milk which greatly impair its digestibility4 ,full sterilization of milk for infant feeding has therefore practically been abandoned4 ,it has been found that milk heated to #afg ,f4 for twenty minutes1 and promptly chilled by placing on ice1 remains practically sterile for twenty-four hours1 and it is spared the injurious changes which take place at a higher temperature4 ,this process is known as ,pasteurization4 ,the ,arnold steam sterilizer affords a convenient method of sterilizing2 if used with the cover removed1 the steam chamber being open1 the temperature of the steam chamber does not exceed #agj ,f4 ,it is claimed that in the ,arnold steam sterilizer1 with the use of a suitable gas stove1 the water begins to boil at the end of two minutes after the gas is lighted4 ,a four-ounce bottle of milk at an initial temperature of #gj ,f4 in the open steam chamber attains a temperature of #agj in just one hour4 ,an exposure of about one hour and twenty minutes in the steam chamber is therefore necessary for the ,pasteurization4 ,the rules for sterilizing are as follows3 ,first1 clean the bottles thoroughly2 then place them in cold water1 which is allowed to come to boil and boiled for ten minutes4 ,second1 fill each with the milk you wish to use2 put in the rubber cork without the glass plug2 this leaves a small opening in the rubber cork2 set the bottle in the basket1 then in the boiler4 ,third1 set in the refrigerator until needed for use4 ,fourth1 when wanted for use1 place a bottle of the milk so prepared in the tin mug which accompanies the sterilizer2 fill the mug with hot water to the height of the milk in the bottle1 heat the milk to the temperature of #ii ,f41 remove the rubber cork and put on the nipple1 when it is ready for use4 ,fifth1 cleanse the bottle immediately after using2 throw away any milk that has not been used4 ,sixth1 if the steaming process is preferred1 place the basket without the bottles in the boiler1 fill the water up to1 but not above1 the bottom of the basket1 place the bottles in the basket1 and proceed as before4 ,it is important that the milk should be sterilized or ,pasteurized as soon as it is served in the morning4 ,each bottle must be thoroughly washed as soon as it is emptied4 ,milk sterilized in this way will keep for days without spoiling1 as it is hermetically sealed and all the unhealthy germs have been removed4 ,the most exact method for the artificial feeding of infants1 and that which most nearly approaches the mother's milk1 is that used by the ,walker-,gordon ,laboratory1 branches of which are to be found in many of the large cities4 ,not only is the greatest care taken that the milk used shall be pure and sterilized ready for use1 but these laboratories are equipped by special machinery which separates the important elements of the milk-- namely1 the fat1 the milk-sugar1 and the proteids4 ,so that the physician can modify the proportions of these various ingredients of the milk to meet the necessity of the age and requirements of the infant4 ,when the milk contains too little sugar1 the infant does not gain as rapidly in weight as it would otherwise do4 ,too much sugar in the milk is indicated by colic1 thin1 green1 or acid stools1 or eructations of gas from the stomach4 ,an excess of fat in the milk is indicated by vomiting2 too little fat causes constipation with dry hard stools4 ,proteids in excess are a prolific cause of colic and also of diarrhea4 ,prescription blanks are furnished the physician1 who fills out the percentages of fat1 milk-sugar1 proteids1 and alkalinity1 to suit the age1 weight1 and general condition of the child4 ,he orders also the amount to be given at each feeding1 and the number of feedings to be given in the twenty-four hours4 ,each bottle contains just the amount to be given at one feeding4 ,all that the mother needs to do is to place the bottle in a receptacle containing warm water1 until the milk has attained a temperature of #ii ,f41 remove the cotton stopper1 and put on the nipple1 when it is ready for use4 ,the ,nursing ,bottle4-- ,this should be of clear glass1 with a rounded bottom1 and of such a shape as is easy to clean2 so that no particles will cling around a corner which cannot be reached4 ,the graduated bottle is the most convenient1 as it enables the quantities of each of the materials used in the preparation of the feeding to be mixed in the bottle1 doing away with the trouble of measuring before putting into the bottle4 ,rubber ,nipples4-- ,two nipples should be kept for alternate use1 and no nipple should be used longer than two weeks4 ,a soft rubber of conical shape is best1 with an opening at the top which is not too large1 so that the milk will not flow through1 as it is desirable that the child should obtain the milk by suction4 ,so soon as the feeding is over1 the nipple should be removed from the bottle1 and brushed on both sides with a stiff brush4 ,it should then be put in cold water1 where it is kept until it is again wanted4 ,the baby should be fed slowly1 from ten to twenty minutes being taken for each feeding4 ,sucking from an empty bottle or with a nipple in the mouth should never be permitted1 as in this way the baby draws air into its stomach1 which will result in colic4 ,each flask should contain only enough for one feeding4 ,in lieu of the regular sterilizing apparatus1 milk may be similarly prepared by placing the milk in an ordinary glass fruit-jar with a screw lid4 ,this is placed in a colander over a pot of boiling water2 the milk should be allowed to boil in the open jar for two minutes2 the jar-lid is then screwed on1 and it should steam for twenty minutes longer4 ,the capacity of the infant stomach at birth is about one ounce1 which is the average quantity of food that should be taken at one meal4 ,the average rate of increase in the amount of food is one and a half drams a week for the first six months2 subsequently somewhat less4 ,the intervals of feeding should be two hours at birth1 and increased to three hours at the end of the third month4 ,the food should be given at a temperature of #ii ,f4 and fed directly from the sterilizing bottle4 ,fresh ,air4-- ,in warm weather the baby is taken out-of-doors in from three to four weeks after birth2 in cold weather not before two to three months4 ,in the latter case it is prepared for the change by being first dressed as for the street1 with wrap and cap2 the windows of the room are then opened1 and the infant is carried about here4 ,in the winter months when the baby is first taken out1 it is better to carry it in the arms1 as it will be kept warmer in this way1 and if it does become chilled it will be more quickly noticed4 ,characteristics of the ,healthy ,infant4-- ,the average weight of an infant at birth is about seven pounds1 and its length is about twenty inches2 the extremes are four pounds or a little less up to eleven pounds4 ,the head and trunk of the child are developed out of proportion to the limbs4 ,the skin of the new-born infant varies from pinkish to red2 about the fourth day the color becomes somewhat yellowish2 this tinge should disappear about the end of the second week1 and at the same time the skin begins to peel off4,this process lasts about two weeks longer1 when the baby's skin takes on its normal color4 ,the shape of the head varies greatly1 much being due to the amount of pressure during labor2 but this disappears in a few days4 ,as a rule1 the large bones of the head are felt to be separated by membranous ridges called sutures2 there is one on the median line on the top of the head1 and at either end of the suture is a large open space1 called a fontanel4 ,the largest one is at the front of the head1 and is called the anterior fontanel2 it is about large enough to be covered by the tips of two fingers1 and is of a lozenge shape2 this opening does not close till the child is about eighteen months old4 ,in a healthy baby this fontanel should be on a level with the bones of the head2 a slight pulsation may be noticed in it1 due to the pulsations of the vessels of the brain4 ,there is a much smaller three-cornered fontanel at the back of the suture1 and one behind either ear2 these soon close up with bone4 ,a new-born baby cannot probably do any more than distinguish light from darkness4 ,up to the sixth week there is an inability at coordination of the ocular muscles2 after this time the eyes begin to move in an orderly manner1 and they will follow a bright object moved slowly in front of them4 ,at about the end of the second month rapid movements are perceived1 as is evinced by the child's closing its eyes quickly on an object suddenly approaching it4 ,at three months the child begins to recognize colors2 the first recognized are yellow1 red1 pure white1 gray1 and black4 ,but the faculty of distinguishing between colors is not perfected till the third year4 ,the mother is recognized about the third month4 ,hearing and a sense of smell develop rapidly after birth2 loud noises in its vicinity will cause a child to start during the first day after birth4 ,by the time the child has reached three months of age it shows signs of having a mind of its own1 and is capable of exercising thought4 ,it grasps for objects1 and indicates its likes and dislikes4 ,at from eight to ten months it can utter several syllables1 and at the age of one year should be able to say mama and papa2 at two years it should be able to frame short sentences4 ,weight of the ,baby4-- ,by the end of the sixth month the child's weight should be double what it was at birth2 that is1 about fourteen pounds2 at the end of the twelfth month be three times as much as at birth1 or about twenty pounds4 ,muscular ,action4-- ,muscular action in the new-born infant is entirely involuntary1 there being no voluntary acts until about the end of the third month4 ,sucking and licking are largely instinctive4 ,the movements of the arms and legs are impulsive acts1 and occur during sleep1 just as they did in the intra-uterine life4 ,the act of raising the head1 which is attempted about the fourth month in healthy children1 is volitional1 requiring not so much added strength of muscle as power of coordination4 ,as volition develops the power of coordination gradually increases1 and the child learns to perform voluntary or purposeful acts4 ,voluntary grasping is done after the fourth month4 ,as the child learns to balance its head1 it attempts to sit up4 ,this act is not successfully accomplished until about the fortieth week2 the child sits firmly alone when ten or eleven months old4 ,before this time it is necessary to support the head and spine of the child with the hand4 ,by the third or fourth month the infant should be able to grasp things4 ,the child begins to creep about the ninth month4 ,the clothing should be so arranged as to allow entire freedom of motion4 ,it should be able to stand up by a chair by the tenth month1 and be able to walk alone at the end of the first year4 ,it is important that parents should know this1 since not knowing what a normal baby ought to be able to do1 cases of birth palsy1 or even an attack of paralysis due to teething1 are not infrequently overlooked1 not only by the mother1 but even by the doctor1 who attributes the inability of the child to do what other children can do at this age simply to weakness1 which the child will outgrow2 and thus the time passes in which the most could be done to cure the child and to prevent the subsequent deformity4 ,a baby should not be forced to stand or walk2 a very stout baby1 on account of its weight1 will stand up and walk much later than a slight one1 the two being equally healthy4 ,or if a baby has been sick1 it will feel no inclination to stand up4 ,naturally1 a child creeps before it walks1 and this develops the muscles of the lower limbs1 so that they will support the weight of the child in standing4 ,by prematurely forcing a child to stand up and walk1 there is danger of causing bow-legs1 as the bones of the legs are still weak2 the child should be discouraged from standing up too much rather than encouraged to stand up more4 ,sleep4-- ,a large proportion of the time of early infancy is spent in sleep2 for the first few weeks the infant only wakens up to be fed4 ,during sleep the eyelids should be tightly closed2 a partial opening of the lids1 showing the whites of the eyes1 is an indication of ill health4 ,up to the age of six1 children require twelve hours of sleep at night1 besides an hour or more in the middle of the day2 the child should be permitted to sleep as long in the morning as it will4 ,respiration4-- ,the healthy infant breathes on an average forty-four times a minute2 the only time the respirations can be satisfactorily counted is during sleep4 ,when the child is awake1 the respirations are hurried by slight movements of the body1 crying1 and so forth4 ,the average pulse of a newborn baby is one hundred and forty2 this is hurried by the same causes that hastens respirations2 the pulse is most easily counted at the anterior fontanel4 ,the average temperature of the infant is #ii ,f4 ,when the tip of the nose and the extremities are cold1 it indicates a lowered vitality4 ,the nature of the child's cry indicates1 variously1 hunger1 temper1 or pain2 the mother will soon learn to distinguish these varieties4 ,if the child cries because it is hungry1 the cry ceases so soon as it is fed4 ,but a child is never to be fed simply because it cries2 it must be fed on the hour by the clock4 ,if this rule is not strictly adhered to1 it will suffer all the forms of indigestion and colic that babies are heir to4 ,if it cries because of colic1 there is a drawn look on the face1 and at the same time the legs are sharply flexed on the thighs and the thighs on the abdomen4 ,if the cries are due to earache1 the head will be rolled about from one side to the other4 ,in either case nothing will stop the cries until the pain is relieved4 ,a baby does not shed tears until the third month4 ,the ,stools4-- ,the stools of a very young baby fed on breast-milk should be of a yellow or orange color4 ,there should be three or four evacuations daily2 they should contain no curds4 ,stools of bottle-fed babies are lighter in color and more offensive4 ,constipation4-- ,constipation is not uncommon in infancy2 it may be overcome by the use of a soap suppository1 or by an injection of warm soap-suds into the bowel1 or by an injection of oil and water1 or by gentle friction over the bowel1 following the course of the large intestine4 ,to make the soap suppository1 take a piece of castile soap about an inch long1 give it the shape of a cone not any larger than the end of the little finger1 and make it perfectly smooth4 ,this is inserted to about half of its length into the rectum and held there until it causes the bowels to move4 ,the bowel injection is best given by means of the single-bulb syringe1 known as the eye and ear syringe2 the bulb holds about two tablespoonfuls of liquid4 ,this may be warm cotton-seed oil1 sweet oil1 or glycerin one teaspoonful to warm water two tablespoonfuls4 ,the nozle should be small1 smooth1 and well oiled4 ,it should be very carefully introduced into the bowel1 being directed a little to the left side1 and the bulb gently squeezed to force the contents into the bowel4 ,the injection is more effective if it is retained for a little while2 this is accomplished by making slight pressure on the anus with a towel4 ,rubbing the abdomen for about ten minutes in the direction of the large bowel is sometimes very effective in overcoming constipation2 begin in the right groin and rub up as far as the border of the ribs1 then across to the left1 then down on the left side4 ,vomiting4-- ,vomiting means often only that the stomach has been overfilled1 and may be relieved by withholding all food for a few hours4 ,urination4-- ,the frequency of urination in a newborn baby will vary greatly with the weather and other conditions2 in cool weather it is not unusual for the napkin to need changing almost every hour4 ,healthy urine should not stain the napkin4 ,the new-born infant secretes very little urine until it begins to take nourishment freely4 ,the bladder is usually emptied during birth1 and very often the bowels also1 so that if the child seems well and there is no malformation of the parts1 the family may be assured that the apparent retention of urine is only temporary4 ,the use of hot fomentations over the kidneys and bladder will often hasten the evacuation of urine if it has been unduly delayed4 ,if the secretion seems highly concentrated1 a drop of sweet spirits of niter in a teaspoonful of water may be given every two hours4 ,teething4-- ,the first tooth generally appears about the end of the fourth month2 in delicate children they come later4 ,as a rule1 the lower front teeth come first1 coming in pairs1 one tooth coming on each side of the mouth2 followed in about a month by the corresponding teeth in the upper jaw4 ,preceding their appearance the gums become swollen1 hot1 and painful1 and the saliva forms in excess and runs from the mouth4 ,the child is irritable1 flushed and restless2 and there usually occurs some disturbance of the bowels1 commonly diarrhea4 ,this all indicates a nervous derangement1 and calls for a judicious diet and general careful oversight4 ,the symptoms subside when the teeth are through4 ,during teething the child manifests a desire to bite on something1 and a soft rubber ring will give it great comfort4 ,the first set of teeth are twenty in number1 and are usually cut in groups1 starting about the fourth month and continuing until between the twentieth and thirtieth month1 when the first dentition should be complete4 ,as a rule there is an interval of rest between the eruption of the various groups4 ,during dentition children are generally more peevish and fretful than usual1 but there should be no general constitutional disturbance4 ,during dentition it is of especial importance to keep the bowels well opened2 it is better to have them too loose than costive2 constipation at this time greatly increases the tendency to convulsions4 ,bottle-fed babies are apt to cut their teeth later than those nursed at the breast4 ,the lack of appearance of any teeth before the end of the first year indicates that the nutrition of the child is below par1 or1 in other words1 that the child has rickets4 ,the permanent teeth begin to appear about the sixth or seventh year4 ,,part ,,iv4-- ,,the ,,menopause4 ,,chapter ,,xiv4 ,,the ,,menopause4 ,average ,duration of the ,menstrual ,function2 ,duration of ,menopause2 the ,menopause2 ,general ,phenomena of the ,menopause2 ,prominent ,symptoms of ,menopause2 ,pathologic ,conditions of the ,menopause2 ,hemorrhage at the ,menopause a ,significant ,symptom of ,cancer2 ,causes of ,suffering at ,menopause4 ,yet ,i doubt not through the ages one increasing purpose runs1 ,and the thoughts of men are widened with the process of the suns4 ,knowledge comes1 but wisdom lingers1 and ,i linger on the shore1 ,and the individual withers1 and the world is more and more4 ,knowledge comes1 but wisdom lingers1 and he bears a laden breast1 ,full of sad experience1 moving toward the stillness of his rest4 -- ,locksley ,hall4 ,average ,duration of ,menstrual ,function4-- ,the average duration of the menstrual function is from thirty to thirty-two years4 ,raciborski estimated the duration of menstrual life at about thirty-one years and nine months4 ,according to him1 the mean age of puberty at ,paris was fourteen years and seven months2 therefore1 the average age of the menopause was forty-six and one-half years4 ,tilt gives the average age of the cessation of menstruation in #ajhb cases as forty-five years and nine months4 ,the average age is between forty-five and fifty years4 ,it has been shown by ,krieger1 ,kisch1 and others1 that the earlier the menses appear1 the later they cease1 and vice versa4 ,however1 when the first period is unusually early or late1 the menopause comes very early4 ,also that the sexual function is usually abolished earlier in the laboring classes1 who are compelled to work hard and who have many cares1 than in the well-to-do and rich4 ,race does unquestionably influence the duration1 but given a sound healthy race1 which is not too much enervated with civilization1 and the menstrual process will1 equally with the total physical vigor and the vitality1 be increased4 ,at the present day there is an increased sexual vitality1 which shows itself in the fact that the duration of menstrual life has been increased three to four years during the past generation4 ,the inference can be fairly deduced that vigorous vitality causes prolongation of the menstrual process and the actual age4 ,duration of ,menopause4-- ,by the menopause or climacteric is understood the whole period from the beginning irregularities in the time of appearance of the menstrual flow until its actual cessation4 ,the average duration of the menopause is from two and a half to three years4 ,the ,menopause4-- ,the menopause is a physiologic and conservative process4 ,it occurs at a time of life when all the tissues are most stable and the nutrition of the body is at its best4 ,other physiologic changes which occur at the same time are decrease in the size of the spleen and lymphatic glands1 the muscular coats of the intestine atrophy1 and lessened peristalsis ensues2 hence the increased tendency to constipation4 ,these are not the degenerations of age1 but the blood-supplying1 blood-making1 and blood-elaborating organs of the body have completed the growth of the organism1 done their work1 and are striking a balance with the needs of the economy4 ,the object of each metamorphic or developmental epoch is a critical readjustment of the organism1 in order to insure the greatest possible amount of health for each subsequent period of life4 ,in the vast majority of cases this object is quietly effected1 but sometimes the constitution only rallies after having been severely shaken for a varying period4 ,general ,phenomena of the ,menopause4-- ,borner states that while many women pass this period without noting any change in their former condition1 and are conscious of the occurrence of the change of life only by reason of the absence of the menstrual flow1 others suffer for years with a host of troubles4 ,one of the most essential changes is that of the woman s psychic condition-- from slight vagaries1 loss of interest in the daily affairs of life1 to melancholia and insanity4 ,two factors are generally taken into account3 first1 the sudden cessation of the menses2 second1 the reflections of the patient caused by her condition1 meditations on the loss of youth and sexual power1 and anxiety in view of the dangers of the climacteric4 ,it cannot be denied that there is some truth in the supposed sad thoughts about the beginning of old age1 and the depression caused by them can scarcely be considered abnormal 7,borner74 ,napier believes that it is extremely rare for the cessation to occur without some physical discomfort or some disturbance of the nervous system1 but adds that3 ,some women1 however1 cease menstruating with very slight inconvenience4 ,as a rule1 the woman misses one1 two1 or more periods1 then a menstruation of almost normal quantity and duration2 and this is again repeated at gradually longer intervals1 and with a diminished flow1 until actual cessation occurs4 ,the periods cease owing to the degeneration and disappearance of the glandular tissues of the uterus1 and secondarily to similar changes in the ovaries and other glands4 ,this is followed by an atrophy of all the structures of the genitalia4 ,an increase in the size of the uterus1 from increase in the amount of blood1 is frequently noticed at the beginning of the menopause2 later it becomes smaller in all its dimensions4 ,the wall becomes thinner2 the cervix becomes shorter and thinner1 sometimes hard1 sometimes flabby as a membrane4 ,but the distinguishing feature of the menopastic uterus is atrophy of its lining membrane4 ,the changes in the uterus and ,fallopian tubes are earlier than those in the ovaries1 so that ovulation1 though lessened in activity1 may persist for a considerable time after menstruation has ceased4 ,ovarian atrophy has been referred to senile rather than menopastic changes4 ,atrophy of the ovaries occurs very gradually4 ,peuch found that in one case the ovaries were of normal size three years after the establishment of the menopause4 ,kiwisch describes the structural change in this gland as consisting1 on the one hand1 of an increase of the connective-tissue stroma2 and1 on the other hand1 the ,graafian vesicles themselves undergo retrograde change4 ,in consequence of these microscopic changes1 which take place very slowly1 the entire organ becomes harder and smaller4 ,napier believes that the ovaries secrete specialized substances which aid in determining menstruation2 and that in a less degree the utricular glands and the glands of the ,fallopian tubes share in this action4 ,he considers that this is probably secondary to the chain of peripheral irritation from the uterine glands1 but that this secretion is none the less an essential feature of the menstrual process4 ,in support of this view he calls attention to the pigmentation of the skin which occurs during pregnancy and chlorosis1 showing that the absence of the catamenia results in the retention in the blood of some substance which would normally be excreted at this time4 ,other atrophic changes in the genitalia are shriveling of the vulva1 with prolapse of the vagina or uterus from relaxation of the ligaments and loss of the natural support afforded by the changed perineal body4 ,uterine catarrh occurs almost invariably1 and only ceases in advanced years4 ,displacements of all kinds are frequent1 but on account of the now greatly diminished weight of the uterus1 these are insignificant4 ,the vagina is at first almost always hyperemic1 but this disappears as the vessels successively atrophy4 ,the vagina gradually becomes narrower and shorter4 ,the mucous membrane loses its rugae and presents a pale1 grayish1 blanched hue4 ,the researches of ,byron ,robinson1 made by the dissection of a number of old women1 show that after the menopause not only is there an atrophy of the genital organs1 but that the hypogastric plexus of the great sympathetic nervous system also shrinks away4 ,it becomes smaller and firmer1 and no doubt some strands disappear4 ,on this fact must he based the pathologic symptoms accompanying the cessation of the menstrual function4 ,the importance of the genital organs is shown by the vast nerve-supply sent to them4 ,when this great nerve-tract becomes atrophic1 so that it can no longer transmit the higher physiologic orders1 all parts of the sympathetic system must be unbalanced1 until a new line1 the next line of least resistance is established4 ,and ,robinson believes that this is the explanation of the many pathologic manifestations of every viscus at the menopause2 that is1 the irritation which arises by trying to pass more nervous impulses over plexuses than normal gives origin to what is unfortunately known as functional disease4 ,it is just as organic as any disease1 only we are unable to detect it4 ,chemical changes in the blood and tissues are constant vital phenomena2 increased oxidation causes increased activity of the circulation1 increase of temperature1 increase of urea and carbonic acid in the economy from retrograde changes1 and1 finally1 during menstrual life the flow of blood from the uterus carried off the effete materials from the highly charged system4 ,the elimination of albuminoids1 as shown by the altered condition of the blood after menstruation1 is greater than can be accounted for by the blood discharged4 ,when the menopause is attained suddenly1 the retention of such albuminoid substances must act toxically4 ,hence the resulting clinical fact that sudden cessation of the menses is1 in the majority of cases1 attended with pronounced symptoms of discomfort1 and it is in these cases that untoward results are most likely4 ,james ,oliver believes that the catamenial flow eliminates from the body substances whose presence in the blood would exert a deleterious influence on the animal economy4 ,the ,prominent ,symptoms of the ,menopause4-- ,christopher ,martin holds that the symptoms of the change of life are produced largely by a condition of instability and increased excitability of certain other cerebrospinal centers directly brought about by failure of the menstrual center1 and adds3 ,it is probable that the ovaries1 like the liver and thyroid gland1 modify the blood circulating through them1 and add to the blood some peculiar product of their metabolism4 ,it may be that some of the climacteric symptoms are due to the loss of this substance from the system4 ,arthur ,johnstone's theory of the symptoms of the menopause is that the lining membrane of the uterus atrophies and becomes old cicatricial tissue1 and sinks into quiet decay4 ,the nervous system begins to readjust itself2 but no longer having free outlet through the soft1 lymphoid tissues of the uterus1 the wave pressure meets with resistance and a choppy sea results4 ,vertigos1 bilious attacks1 and so forth are nothing more than reflex waves4 ,the weakest organ of the individual is the one that generally suffers4 ,and that the kidneys1 which all along have borne the brunt of life1 should now show positive signs of disease is natural4 ,the etiology and pathology of the menopause lie in the sympathetic nervous system4 ,and it is by the breaking up of the harmony of previous processes that nervous disturbances are produced4 ,after the cessation of the flow1 over #h of women suffer from flashes2 this symptom is caused by irritation of the heart and vasomotor centers4 ,the blood-vessels of the head and neck seem to be most affected1 yet the skin of the whole body shares in the disturbance4 ,besides the vasomotor and heat center being disturbed1 the sweat center is irritated4 ,the flushes and flashes are followed by various degrees of sweating1 which varies from a slight moisture to great drops4 ,nervous irritability is a prominent symptom in #h of women at the time of the menopause4 ,most of the pain arises around the stomach2 that is1 the solar plexus4 ,digestive disturbances are very common at this time2 they may be in the shape of fermentation1 diarrhea1 or constipation1 accompanied by congestion of the liver4 ,tilt holds the very plausible view that the too strong reaction of the sexual organs on the central ganglia of the sympathetic nervous system is their principal cause of disease4 ,puberty1 menstruation1 pregnancy1 lactation1 or the menopause almost always entail some derangement of this system which is sometimes sufficiently severe to lead to insanity and suicide4 ,debility underlies all affections of the sympathetic nervous system1 in the same way as nervous irritability underlies all cerebral diseases4 ,sometimes there is an overpowering sense of exhaustion pervading the whole system4 ,forms of climacteric insanity are delirium1 mania1 hypochondriasis1 melancholia1 irresponsible impulses1 and the perversion of moral instincts4 ,if the reproductive apparatus does not act on the brain by the instrumentality of the circulating organs of the blood1 it must do so by means of the nerves4 ,the genital apparatus is richly endowed with nerves from the sympathetic system1 and ,i have shown how frequently evident signs of disturbance in these centers coincided or alternated with headaches1 nervousness1 hysteria1 and epilepsy4 ,what wonder1 then1 if the same powerful influence of the sexual organs1 through the instrumentality of the sympathetic system1 should at times produce a permanent derangement of the mental and moral faculties4 ,i am thus led to look on the sympathetic nervous center as a source of vital power producing reflex morbid phenomena1 in accordance with variable cerebral predisposition 7,tilt74 ,another very frequent symptom of the menopause is distress in the region of the heart1 with palpitation and shortness of breath4 ,it may be caused by the condition of the blood1 whether it be impoverished-- anemia-- or too rich in red globules2 by reflex irritation of the pneumogastric or sympathetic nerves2 by overexertion2 or by alcoholism4 ,it may also be due to general debility2 the woman resists fatigue less easily1 and she experiences a general malaise4 ,to the palpitations are rapidly added faintness and shortness of breath4 ,the sleep is troubled with distress in the region of the heart4 ,it is said that women in whom the menopause occurs early are more liable to tachycardia than those who menstruate later in life2 and that it occurs with especial frequency when the menopause has been prematurely induced by surgical operation or by disease4 ,it is believed that this functional heart trouble is caused by the increased connective-tissue fibers of the sexual organs acting in some unknown way on the terminal fibers of the sympathetic2 and it is not infrequently due to the formation of scar tissue at the seat of a cervical laceration1 and has often been promptly and permanently relieved by removing the cicatricial tissue and suturing the wound4 ,the cause acts by producing a transitory paralysis of the inhibitory fibers of the pneumogastric nerve4 ,pathologic ,conditions of the ,menopause4-- ,perhaps the most alarming symptom of the menopause is hemorrhage4 ,it may be due to general or local causes4 ,among the general causes are diseases of the heart1 lungs1 spleen1 and kidneys4 ,local causes of hemorrhage are3 inflammation of the lining membrane of the uterus1 chronic pelvic inflammations1 faulty uterine positions1 erosions and ulcerations of the mouth of the uterus1 fibroid tumors1 and cancer4 ,all competent observers agree that cancer in women is much commoner from forty to fifty years than at any other age4 ,hemorrhages occupy the foremost place among the pathologic phenomena of the genital tract during the menopause4 ,hemorrhage has been attributed in many instances to the senile rigidity and friability of the uterine vessels1 which are not in a condition to offer sufficient resistance to the blood-pressure which is brought to bear on their walls2 there is also softening and relaxation of the uterine tissue4 ,additional causes are found in the circulatory disturbances in the pelvic organs1 whereby the outflow of blood from the pelvic vessels is hindered a chronic congestion in the uterine vessels is produced4 ,it has also been attributed to early and profuse menstruation1 frequent and difficult labors1 frequent abortions1 and excess in drinking4 ,the third and last variety includes those cases which may be referred to some disease of the pelvic organs themselves4 ,anatomic changes may lead up to pathologic conditions4 ,a chief feature characteristic of uterine disease is malnutrition from atrophy-- a sudden curtailing of the blood-supply from the degeneration of the genital-nerve apparatus and consequent impaired vitality of tissue from defective nourishment4 ,the anatomic changes in the glands and substance of the uterus also favor the irritation1 and the development of new growths1 which may be malignant or benign-- as cancers1 fibroid growths1 and so forth4 ,hemorrhage at the ,menopause a ,significant ,symptom of ,cancer4-- ,not only should any excessive and prolonged bleeding at the time of the menopause be a source of great anxiety to the woman1 but even the irregular appearance of a slight show of blood just sufficient to keep the clothing stained1 or a slight bleeding following coition2 since all of these are symptoms of very great gravity1 and demand an immediate local examination and appropriate treatment4 ,the widespread belief among the laity that hemorrhage at the time of the menopause is a normal condition1 and that if left alone it will stop in the course of a few years1 is most erroneous and fatal4 ,on this altar of ignorance thousands of women sacrifice their lives every year4 ,the case-book of any gynecologist will testify to the truth of this statement4 ,the following three cases will serve to illustrate different types of hemorrhage in cancer patients1 in no one of which did the patient even suspect that she was suffering from anything more serious than the vagaries of the menopause4 ,case ,i4-- ,woman aged seventy years2 came on account of incontinence of urine1 which had been troublesome for two years4 ,the menopause occurred at fifty4 ,she stated that three or four years previous to her visit1 she had had a return of the flow of blood1 perhaps twice in the first year1 and that during the past year there had been a flow every month-- about the same that there used to be4 ,this she took to be a return of the menstrual period4 ,she said1 further1 that there was a constant bleeding-- enough to necessitate the wearing of a napkin-- and an occasional severe hemorrhage2 that she could not take long walks or drives because of the excessive flow which followed4 ,the case was one of cancer of the uterus which had spread to all the pelvic viscera2 and in addition to this1 the patient's general condition was such that any operation was out of the question4 ,yet the patient had never thought of the possibility of any uterine trouble sufficiently serious to make a local examination necessary4 ,it was only the loss of control over the bladder that drove her to seek a physician's advice4 ,case ,,ii4-- ,woman aged fifty-three years came to consult me because of pain1 hemorrhage1 and loss of weight4 ,there had never been any cessation of the menstrual period4 ,she said that she began to have irregular hemorrhages three years previously1 and that they were constantly becoming more frequent and more alarming1 and that1 in addition to this1 there was a constant discharge of blood1 which necessitated her wearing a napkin all the time4 ,she also stated that for the preceding six months the pain had been so severe that she had not had one solid night's sleep1 and that in that time she had lost forty pounds in weight4 ,this patient was in the very last stages of cancer of the uterus1 and all that could be done for her was to make her comfortable4 ,she had given birth to one child which caused a deep tear of the neck of the womb2 and it is probable that this neglected tear was the primary cause of the cancer1 which began in the neck of the womb4 ,case ,,iii4-- ,woman aged forty-five years2 married1 but had never had any children4 ,she said that the periods were normal as to duration and amount1 but that for the past two years they had two days ahead of time1 and that for the past four months she had been having just enough irregular bleeding between the periods to keep her clothing stained4 ,on examination a diagnosis of cancer of the uterus was made4 ,the pathological examination proved this to be a most malignant type of cancer of the neck of the womb4 ,the entire uterus and appendages were at once removed4 ,and although the patient made an excellent recovery from the operation1 she succumbed to the disease one year after the operation was performed4 ,these cases have been cited at length because they are all typical and because of the variety of symptoms and the great difference of age4 ,only in one of the cases was there any very severe pain1 and it was really the pain1 which had become unendurable1 which caused the patient to seek relief4 ,it is the concensus of opinion of the medical profession that cancer of the uterus is one of the common causes of death among women2 that the cancer rate of mortality has increased during the last four decades2 that it is most common near the time of the menopause2 and that there is a direct causal relation between cancer of the neck of the womb and the traumatisms which occur during childbirth4 ,the symptoms of cancer of the uterus are hemorrhage1 a more or less offensive discharge1 and pain4 ,the quantity of blood may vary from a slight amount which occasionally stains the clothing to a profuse hemorrhage4 ,in the married1 bleeding following coition is always a suggestive symptom4 ,during the menopause any irregular or profuse bleeding should excite suspicion4 ,after the cessation of the menopause any bleeding whatsoever1 whether slight or profuse1 should always be regarded as a danger signal which demands an immediate and thorough local examination4 ,the same is true of any offensive vaginal discharge4 ,pain is frequently so late a symptom that to wait for its appearance means that the favorable time to perform an operation has passed by4 ,emaciation is also a symptom of advanced disease4 ,cancer is chiefly a disease of the climacteric2 when there is a diminished power on the part of the tissues to resist adverse influence4 ,it affects the debilitated and overworked1 but it is also found in the well nourished and in the comparatively young4 ,cancer always begins as a local disease1 and when it occurs in the uterus1 it is easily accessible and eradicable in its earliest stages2 that is1 if the disease is discovered in its incipiency1 an operation will remove all the diseased tissue4 ,if1 on the contrary1 the disease is left to nature1 the growth spreads out into the surrounding viscera like the roots of a tree in the earth1 and the cancer may be literally said to eat into the tissues which it invades4 ,at the same time the germs of the disease begin to be carried all through the body1 and the entire constitution is affected4 ,prophylaxis1 or the ,prevention of ,cancer4-- ,all pelvic inflammations should be promptly treated1 and not allowed to become chronic4 ,leucorrhea is a symptom of inflammation1 the true cause of which can be determined only by local examination4 ,women who have given birth to children-- and this is more especially necessary as they near the age of forty years-- should be carefully examined for tears of the neck of the womb4 ,if these tears are extensive they should be repaired1 as it is certain that malignant growths frequently do follow local injuries and traumatisms4 ,any irregular or profuse bleeding demands an immediate investigation by means of a local examination4 ,a stormy1 irregular1 or delayed menopause should excite in the woman a suspicion of some abnormal condition4 ,the importance of women being carefully watched by gynecologists at this period of their lives cannot be too emphatically stated1 for upon the early recognition of cancer depends the only hope of radical cure of the disease4 ,it is estimated that at the present time not less than #ie per cent4 of all cases of cancer of the uterus come under the observation of the profession at a stage of the disease when all prospect of permanent relief is out of the question4 ,it is a deplorable state of affairs that women1 not knowing what a normal climacteric is1 attribute all hemorrhages1 no matter how severe1 to the change of life4 ,therefore1 regarding the hemorrhage as a necessary evil1 they fail to consult a specialist until the favorable time for eradicating the disease by means of an operation has passed4 ,and whatever knowledge science may bring in the future as to the cure of cancer1 at present it is a fact universally agreed upon that early operation1 while the cancer is still local1 is the only radical cure for the disease4 ,pruritus ,vulvae4 ,perhaps one of the most annoying and obstinate symptoms of the menopause is pruritus vulvae4 ,this is sometimes caused by sugar in the urine2 there is a congestion of the liver which results in sugar being thrown into the system and this is eliminated by the kidneys4 ,it is quite possible that this is due to the altered circulatory conditions of the menopause4 ,kidney ,disease4-- ,the last pathologic condition which we will mention is kidney disease4 ,le ,gendre believes that the menopause exerts a deleterious effect on the kidneys1 whether this be a congestion1 followed by a diminution in the quantity of urine1 or a sort of auto-intoxication due to the retention of a poison in the system that has been prevented from leaving by the ordinary path4 ,armstrong says that in almost all cases at the time of the menopause the amount of urine passed is below normal1 the specific gravity is increased1 and that the urine contains urates and almost always uric acid in excess4 ,further1 that the functions of digestion and assimilation and the various metabolic changes are so largely under the control of the nerve-centers that nothing seems more likely than that so great a disturbance of that system as takes place at the menopause should cause secondary derangements of these most important functions4 ,that being so1 the blood becomes loaded with waste products1 and the usual symptoms follow-- gout and so forth4 ,it has been a grave question in the mind of the medical profession whether the dangers that certainly do attend the menopause are natural or acquired2 that is1 could these dangers be averted by any precautions or hygienic measures on the part of women1 or are these dangers a necessary accompaniment of this period of life8 ,tilt has reached the conclusion that3 ,the best way to avoid the dangers of this critical time is to meet its approach with a healthy constitution4 ,a marked want of strength prevents the regular succession of the vital phenomena by which all critical periods are carried on4 ,and as the change of life is marked by debility1 when this is grafted on constitutional weakness1 loss of power will be of long duration4 ,all complaints remain chronic because there is not stamina enough to carry them through their stages4 ,causes of ,suffering at ,menopause4-- ,dusourd1 whose practice lay in an agricultural district in the south of ,france1 as well as ,tilt1 believes that peasant women suffer little at this time4 ,their health is generally good when the menopause comes on and they are little liable to nervous disorders4 ,the poor of large towns suffer much at this epoch-- the necessity of working hard1 the anxieties of poverty and their unhygienic surroundings4 ,but by a fortunate compensation the necessity for working hard prevents or cures the nervous affections which so often assail the rich at this period4 ,tilt's cases showed that women who suffered much at the menopause had previously suffered at puberty and at the menstrual periods4 ,and among thirty-nine cases where there was no suffering at the menopause1 there was the same immunity from suffering at puberty and at the menstrual epochs4 ,tilt's statistics were1 or course1 taken from ,english women4 ,in forty-four cases of my own1 all women past the menopause1 the average age of the first menstruation was fourteen years and four months2 and the average age of the actual cessation of the menstrual flow was forty-eight years and five and two-thirds months4 ,subtracting from this the average age of the first menstruation1 we have as the mean age of menstrual life thirty-four years one and two-thirds months2 that is1 the average duration of the menstrual function was from two to four years longer than that usually given4 ,a further investigation in order to ascertain any possible relation between the age of marriage and the number of pregnancies and the sufferings of the menopause elicited the following statistics4 ,the average age of marriage was twenty-five years and ten months4 ,of the four women who were married after thirty-eight years1 all were sterile2 among the remaining there was an average of slightly above three children each4 ,forty per cent4 of all these cases had one or more miscarriages4 ,nine had habitually suffered from severe dysmenorrhea1 eleven had slight dysmenorrhea1 and twenty-two had never felt the slightest inconvenience4 ,in a list of fifty-two cases1 eight were added to the list already given1 all of whom had passed the menopause4 ,five were perfectly healthy and had never suffered the slightest inconvenience4 ,of these1 one was single and only one had one miscarriage4 ,ten had suffered at the time of the menopause from slight malaise1 but not sufficiently to call in a medical attendant4 ,thirty-seven were more or less seriously ill2 thirty of these needed local as well as constitutional treatment1 and seven constitutional treatment only4 ,the prominent symptoms of the climacteric were as follows3 ,marked debility1 #bd2 intense nervousness1 #ca2 nervous prostration1 #i2 melancholia1 #aj2 headache1 #ad2 neuralgia1 #f2 hysteria1 #g2 irritable heart1 #aa2 tachycardia1 #h2 insomnia1 #ai2 indigestion1 #cb2 constipation1 #bh2 diarrhea1 #c2 leucorrhea1 #ch2 rheumatism1 #ba2 gout1 #a2 ,bright's disease1 #ab2 hemorrhage1 #f2 alcoholism1 #b2 corpulency1 #b4 ,as a result of the study of these cases1 the most striking feature was the relation of miscarriages to the sufferings and ill health at the time of the menopause4 ,of the nineteen women who had miscarriages1 only one did not suffer in some way at the time of the menopause4 ,four suffered only slightly1 and fourteen suffered extremely1 not only during the menopause1 but in the post-climacteric period as well4 ,and the next most striking feature was that the prominent symptoms of the menopause are preeminently reflex or the functional diseases of the nervous system4 ,tilt believes that single women suffer less than other women at the time of the menopause4 ,he further writes3 ,as at puberty1 from the ignorance in which it is still thought right to leave young women1 so at the change of life1 women often suffer from ignorance of what may occur1 or from exaggerated notions of the perils which await them4 ,it would be well if they were made to understand that if in tolerable health1 provided that they will conform to judicious rules1 they have only blessings to expect from the change of life4 ,most unfortunately1 the individual not cognizant of the invisible changes going on in the economy does not adapt the mode of life to the new conditions of the organism1 and the weakened and lessened amount of the digestive fluids is unable to master the large quantities of food4 ,the absorbents refuse to take more than is needed to repair the tissues4 ,the atrophying muscles of the digestive tube1 unable to hurry on the mixed products of indigestion2 fermentation2 and micro-organisms inciting fermentations and elaborating toxic alkaloids1 poison and disorder the functions of life4 ,man's outdoor life enables him to escape many of these evils4 ,woman's enervating mode of life1 the continued introspection1 coupled with the peculiar changes in the nutrition of the body at this time1 render the nervous system peculiarly impressionable and liable to the manifold forms of diseases4 ',the woman is told that she must be calm and patient1 and in time the tomb-builder will alleviate all her sufferings4' ,this critical period may be dangerous to those who are always ailing1 for habitiual sufferers at the menstrual periods1 and for those affected with uterine diseases4 ,if1 on the first indication of the change of life1 women who are in fair health carefully followed a regimen and pursued a line of life in harmony with the physiologic processes on which this change depends1 disease would be prevented4 ,but as the change concerns a natural function1 it is left to nature2 no additional precautions are taken1 and advice is sought only when the mischief is done4 ,it is not wise to marry during this period4 ,on the first appearance of the irregularities of the menopause the amount of food and stimulants to which women have been accustomed should be curtailed rather than augmented4 ,the system requires supporting by medicine and regimen-- as1 baths1 mental and moral hygiene1 and occupation-- rather than stimulating by spirits4 ,we have seen that1 in accordance with the plethric theory1 which prevailed until #ahce1 and with the nerve theory1 which is based on the latest anatomic and physiologic researches1 menstruation is a physiologic process to get rid of effete material1 and is therefore an excretion4 ,at the end of perhaps thirty years1 by a conservative process of nature1 the child-bearing period ceases and the organism is readjusted to the end that the woman's vitality may all be conserved for her own individual life4 ,each metamorphic or developmental period of life-- dentition1 puberty1 and the menopause-- throws a special strain on the nervous system1 and the recent studies of the sympathetic nervous system at the time of the menopause show that very extensive anatomic changes occur at this time4 ,that being the case1 the woman must lead such a life as will insure her having on hand a large reserve force necessary to meet these heavy demands4 ,tilt's observations show that women who have experienced no suffering at puberty or1 at the menstrual periods do not suffer at the menopause4 ,it is therefore evident that the time to begin this preparation is in childhood4 ,that single women suffer less than married women would suggest that excessive coitus and the occurrence of abortions1 frequent child-bearing1 and lesions as the result of pregnancies1 many of which lesions could have been prevented or cured by the timely aid of the physician1 are the combined sources of much of the suffering at the time of the menopause4 ,that the most frequent and serious disturbances are those of the nervous system1 and that from their mode of life and habits of introspection the rich suffer more from these ailments than the poor1 must cause serious consideration of the physiologic necessity for a definite occupation for the daughters as well as for the sons of the rich4 ,the frequency with which ,bright's disease is found at the time of the menopause is dependent not so much on the local physiologic changes which are taking place as on the time of life4 ,loomis says that it was not until life-insurance examinations became so common that the frequency with which kidney disease existed in persons who believed themselves well was even imagined4 ,and as a result of his observations in these cases1 and of a large number of autopsies conducted at the ,bellevue1 he stated that it was his belief that #ij of men and women over forty years of age suffer from some form of ,bright's disease4 ,that being the case1 it would seem that after this period of life at least as much attention should be directed to the kidneys as to the teeth1 and that a semi-annual examination of the urine should be made4 ,although the menopause is a physiologic occurrence1 yet1 owing to the many pathologic changes which are liable to take place at this time1 the woman should be as carefully watched during the menopause by the gynecologist as the pregnant woman now is by the obstetrician4 ,if the same care were taken1 in the majority of cases1 the dangers attending the menopause would be avoided1 and the woman would be prepared to enjoy a healthy and useful post-climacteric period of life4 ,,chapter ,,xv4 ,,hygiene ,,of ,,the ,,menopause4 ,diet2 ,constipation2 ,stimulants2 the ,kidneys2 the ,skin2 ,turkish ,baths2 ,massage2 ,exercise2 ,profuse ,menstruation2 ,hemorrhage2 ,mental ,therapeutics4 ',tis the breathing time of day4 -- ,hamlet4 ,hygiene of the ,menopause4-- ,the changes which occur in all the organs of the body at the time of the menopause are retrograde1 and therefore just the opposite of those which occur at the time of puberty4 ,this fact should be borne in mind in the matter of alimentation4 ,all that is now needed is to make the repair equal to the waste4 ,diet4-- ,unless the woman is taking a great deal of active exercise1 it is better to diminish the amount of meat eaten1 and to increase the vegetable food and take more fluids4 ,unless the effect of the meat eaten is counterbalanced by active outdoor exercise1 it produces an excess of waste matter1 which accumulates and causes biliousness1 and sometimes rheumatism and gout4 ,a vegetable diet is less taxing to the excretory organs than an animal diet4 ,indigestion is at this time of life apt to appear in the form of fermentation1 which may assume the gastric or intestinal type4 ,the chief causes of the formation of gases are the lessened peristaltic action of the intestines1 the increased tendency to congestion of the liver and to obstinate constipation4 ,all dishes rich in sugar1 as cake1 candy1 preserves1 and jelly1 should be indulged in with moderation2 or where there is a tendency to fermentative indigestion1 they should be wholly avoided4 ,all dishes known to be difficult of digestion1 as hot breads1 pastry1 cheese1 fried dishes1 and rich salads1 should be cut off the menu1 since these readily overtax an already weakened digestive system4 ,if there is a hereditary tendency to rheumatism or gout1 the disease is most apt to take on an active form at this time4 ,in either case the manifestation of the disease indicates an excess of uric acid in the system1 and a diet becomes a necessity4 ,pickles1 all highly spiced articles of food1 and vinegar must be omitted from the bill of fare4 ,the vinegar may be replaced in salad-dressings by lemon juice4 ,tomatoes1 rhubarb1 strawberries and grapefruit are contra-indicated2 also all articles of food rich in sugar4 ,in chronic cases animal food cannot1 as a rule1 be excluded from the dietary1 but must be limited in quantity4 ,fish1 eggs1 and fowl may be eaten1 also a moderate amount of lean meat in the form of beef1 lamb1 and mutton4 ,milk may be indulged in freely4 ,the diet should consist principally of easily digested fresh green vegetables4 ,the amount of tea and coffee should be limited4 ,all malt liquors1 sweet wines1 and champagne must be absolutely prohibited4 ,constipation4-- ,a daily free evacuation of the bowels is essential to good health4 ,where constipation exists1 and the woman is full-blooded1 with a tendency to a rush of blood to the head1 saline laxatives are indicated4 ,but if the woman is constipated and anemic1 cascara sagrada is a better laxative2 while cod-liver oil acts as a laxative and at the same time improves the quality of the blood4 ,stimulants4-- ,women resort to alcoholic stimulants as an analgesic to relieve pain1 whether physical or mental2 as a narcotic to produce sleep2 and as a spur to a failing appetite or bodily powers4 ,the majority of women patients say that they first used alcohol in the shape of whisky1 brandy or gin to relieve pain at the time of the menstrual period4 ,the pain that is caused at this time by a chilling of the body would be as effectually relieved by drinking a cup of hot tea2 while if the pain is intense and constant1 recurring every month1 it is doubtless caused by some local inflammation1 and the use of alcohol only veils the real trouble1 and the woman loses valuable time by not consulting a physician at once4 ,as to the use of alcohol to blunt the nervous sensibility due to mental suffering1 it is the testimony of the entire medical profession that this is the greatest cause of inebriety or drunkenness among women of all classes of society4 ,sleeplessness generally arises from some well-defined physical cause-- very frequently from inaction of the liver-- and the proper remedial agents should be used to remove the cause4 ,while at first the use of alcoholic beverages increases the appetite1 as the amount taken is increased1 distaste for food is created1 the system languishes under an insufficient food-supply1 and the original aim of increasing the appetite is defeated4 ,as to taking stimulants to do more work than one could otherwise accomplish1 it is by means of stimulants that woman can accomplish her physiological ruin more quickly than is possible in any other way4 ,and the early symptoms of chronic alcoholism show themselves in the form of neuralgia1 insomnia1 palpitation of the heart1 and muscular tremors4 ,the ,kidneys4-- ,on account of the prevalence of some form of ,bright's disease after forty years of life1 the kidneys should be carefully watched at this time4 ,and in order to keep them in good condition they must be well flushed with water every day4 ,three pints of urine should be excreted daily1 and three pints of water as such must be taken into the system daily4 ,the urine should be examined by the physician every six months4 ,in this way kidney disease is often discovered in its incipiency1 which otherwise might run into a serious form of ,bright's disease4 ,the ,skin4-- ,it must be remembered that the skin is one of the excretory organs of the body1 and the pores should be kept well open by the various forms of baths4 ,the ,turkish bath or some modification of it will often be found to be particularly useful4 ,massage with alcohol after the bath lessens the tendency to take cold4 ,for a woman who is anemic or run down1 it is well to follow the ,turkish with the ,roman bath1 which is an inunction with almond oil or cocoa-butter4 ,a much more thorough massage is given with the ,roman bath than with the alcohol rub4 ,it is often necessary to modify the ,turkish bath by omitting the steam-room and shortening the time spent in the hot dry air4 ,in ordinary cases the time spent in the hot dry-room should be only that necessary for producing a free perspiration4 ,this time varies in different individuals from ten to twenty minutes4 ,no woman should go to a ,turkish bath without first consulting her physician1 since if the woman has a weak heart1 the bath may be the source of positive danger4 ,comparatively few women are strong enough to take the cold plunge4 ,massage4-- ,massage1 well given by a skilful masseuse twice a week1 will greatly tone up the nervous and circulatory systems4 ,women who are very stout and who have sluggish livers with obstinate constipation will find massage particularly beneficial4 ,exercise4-- ,daily exercise in the open air is absolutely essential to every woman's good health4 ,the minimum amount of outdoor exercise compatible with health is an hour's walk1 at the rate of three miles an hour4 ,if the woman has never taken any exercise1 she must begin with a very short walk and stop on the first sign of fatigue4 ,gradually increase the distance and the speed until the three miles is reached4 ,profuse ,menstruation4-- ,if the menstrual flow is unusually profuse or lasts beyond the regular time1 the woman should stay quietly in bed until the flow ceases4 ,all exercise increases the flow4 ,the flow now becomes less in quantity1 and the periods more infrequent than formerly4 ,hemorrhage must always be regarded as a danger-signal the significance of which can scarcely be overestimated4 ,to immediately consult a specialist on the appearance of any irregularities of the flow would1 in the opinion of the most eminent gynecologists of the day1 be the means of saving thousands of women's lives every year4 ,mental ,therapeutics4-- ,it is particularly necessary at this time of life that the mind should be pleasantly occupied4 ,her children have passed the age when they need her constant supervision1 and the mother must take some relaxation from her home cares1 in the form of social diversions1 amusements1 outdoor life1 and change of scene4 ,any mental occupation that will take the woman out of herself is the best possible safeguard against a state of introspection which conjures up a host of evil fantasies1 and which is the first step in the downward road to a fixed and permanent melancholia4 ,hang sorrow1 care will kill a cat2 ,and therefore let 's be merry4 ,,chapter ,,xvi4 ,,hints ,,for ,,home ,,treatment ,indigestion2 ,constipation2 ,diarrhea2 ,enemas2 ,vaginal ,douche2 ,baths2 ,headache2 ,fainting2 ,hemorrhage4 ,woman is woman's natural ally4 -- ,,euripides4 ,indigestion4-- ,the chief causes of indigestion are3 eating rapidly1 eating at irregular hours1 eating indigestible foods1 constipation1 and lack of exercise4 ,no one who values her good health will allow herself to be hurried through a meal1 nor will she allow the perplexities of life to be thrust upon her at the table for solution4 ,the first requisite for the digestion of foods is that they should be well masticated1 so that the digestive fluids may act on the finely divided particles to the greatest possible advantage4 ,and while digestion is going on all mental labor should be held in abeyance1 in order to avoid drawing the blood away from the stomach to the brain4 ,furthermore1 it is a well-known fact that digestion is best performed when the meals are served at regular hours4 ,constipation leads to the formation of gases in the intestines1 to fermentation1 and to the absorption of toxic materials by the blood4 ,through lack of exercise1 the appetite fails1 the liver becomes torpid1 and the muscular and nervous systems lose their tone4 ,the exercise which the housekeeper gets in going around her house is not sufficient4 ,daily exercise in the open air is essential to health2 as this is to supplement the indoor exercise1 the amount taken will vary in proportion to the former4 ,for teachers or those who have a sedentary occupation an hour's active exercise in the open air-- a three-mile walk-- should be supplemented by active gymnastic exercise4 ,for people in good health1 a mixed diet-- that is to say1 a diet consisting of meat1 vegetables1 and fruit-- is the best4 ,if the individual is not well1 then the diet must be adapted to meet the needs of that particular case4 ,hot breads1 all articles of food fried in fats1 salads1 and pastry are difficult to digest4 ,tea is very constipating1 and when taken in excessive quantities renders the individual nervous4 ,an excess of coffee leads to congestion of the liver4 ,where indigestion exists1 the simplest and most sensible remedies are to regulate the diet1 and avoid eating between meals4 ,by drinking a glass of water as hot as it can be sipped one hour before each meal1 the mucus is washed out of the stomach1 the stomach is empty on coming to the table1 and in the best possible condition for the gastric juice to act on the food-stuffs4 ,constipation4-- ,constipation is the rule with the average ,american woman2 the causes are their corsets1 the tight bands of their clothing1 lack of exercise1 and the fact that they drink too little water and too much tea4 ,the most rational means to overcome it is to drink more water2 at least three pints a day should be taken1 in addition to soups1 tea and coffee1 and so forth2 the water must be taken into the system as such4 ,then attention must be given to the diet2 plenty of fruit should be eaten1 vegetables1 and coarse bread4 ,regularity in this1 as in all other habits of life1 is most essential1 and the individual should go to the toilet at the same hour every day1 even if there is no inclination to have a bowel movement1 and thus the habit will be established2 the most convenient time is directly after breakfast4 ,medical ,treatment4-- ,but if all these means have failed1 medicines must be resorted to4 ,cold water is a better laxative than hot2 to a glassful of cold water add from one teaspoonful to one tablespoonful of the effervescing granules of the phosphate of soda1 and take this the first thing on rising in the morning4 ,this preparation of soda is particularly useful because it acts slightly on the liver4 ,other laxatives are3 a seidlitz powder dissolved in a glass of cold water on rising2 a wineglass or more of ,hunyadi ,janos1 also taken on rising4 ,any of these may be taken with safety by pregnant women4 ,for children the simplest laxative is one teaspoonful of ,husband's milk of magnesia1 to be taken in one glass of water on rising4 ,enemas4-- ,perhaps one of the most common methods used by the laity for the relief of constipation is the rectal injection1 or enema4 ,enemas habitually given to unload the bowels are productive of much harm by overdistending the rectum1 so that in time the rectum fails to react to the normal stimulus-- namely1 the presence of the feces-- as it otherwise would4 ,but by some means or other the bowels must be well moved once every twenty-four hours4 ,and it is much better to use an enema than to go to bed without a bowel movement4 ,if the woman is going around1 so that she can give the enema to herself1 the most effective way to take it is in the knee-chest position or an approximation to this4 ,either a fountain or bulb syringe may be used for this purpose2 a quart of water at a temperature of #aaj ,f4 should be prepared by making it into a suds with castile soap1 or one tablespoonful of glycerin may be added to one pint of water4 ,the nozle to be used is the smallest one that comes with the syringe1 the so-called infant's nozle2 this is quite large enough1 and its insertion is not nearly so painful as the larger ones2 the nozle must be well greased with vaselin4 ,when everything is ready1 the patient gets down on her knees with the shoulders near the floor1 having first loosened all of her bands and taken off her corsets2 the nozle is introduced as far as it will go into the rectum1 and if a bulb syringe is used the water must be very gradually squeezed into the rectum1 otherwise it will not retain so much2 or if the fountain syringe is used1 it must not be hung too high4 ,so soon as the patient feels that she has taken all that she can retain1 she should lie down on the left side1 and retain the water as long as possible1 as it is thus rendered more effective4 ,an enema so taken will be very much more effective than one taken in the ordinary manner of sitting on the toilet4 ,in the method just described more water can be used and it will be longer retained2 it can be felt to go up along the course of the large bowel1 and it will often be found very effective when the ordinary enema fails4 ,this enema will often be found to be a very valuable aid in curing an obstinate chronic diarrhea1 which is kept up by particles of feces remaining in the folds of the large intestine4 ,if the patient is confined to bed1 she should lie on the left side1 with a heavy towel folded under her to prevent the bed from becoming wet2 when the nurse withdraws the nozle she should make pressure on the anus with the towel1 to help the patient to retain the water as long as possible4 ,but should the patient have gone so long without a bowel movement that all these means fail1 it will be necessary to precede the water enema with one of oil2 or still more effective is the following combination3 take one teaspoonful of the spirits of turpentine1 the yolk of one egg1 and two tablespoonfuls of olive oil1 and beat well together1 and add to these one pint of water at a temperature of #aaj ,f4 ,constipation1 however1 of so obstinate a character as this demands a physician's attention4 ,diarrhea4-- ,a diarrhea may be acute or chronic2 the treatment is essentially different4 ,for an acute attack accompanied by frequent stools and severe abdominal pain the first thing to do is to go to bed4 ,if there is nausea1 drink a glass of water as hot as can be taken1 at once2 for the diet1 a glass of scalded milk1 not boiled but just allowed to come to the boiling-point1 every two hours2 and nothing else should be taken until the diarrhea is well in check4 ,if the pain is severe1 a spice plaster over the abdomen will be found to be very comforting4 ,it is made as follows3 take of powdered allspice1 cinnamon1 cloves1 and ginger each two tablespoonfuls1 and two teaspoonfuls of cayenne pepper2 mix well together in a bowl2 then quilt in a piece of flannel large enough to cover the abdomen2 when ready for use1 dip in hot whisky and apply as hot as the patient can bear2 cover over with a large napkin1 as the plaster produces a deep stain which does not wash out2 keep on as long as necessary4 ,if the rest in bed and the milk diet kept up for twenty-four hours do not suffice to cure the diarrhea1 it is not wise to take any risks1 but send for your doctor at once4 ,or if there should be any blood in the stools1 do not wait for anything1 but send for the doctor without delay4 ,for a chronic diarrhea an enema given in the knee-chest position1 as already described1 will often be found a most efficient remedy4 ,in diarrheas the use of fruits and vegetables should be avoided2 the best diet after the milk is bread well toasted through1 toast-water1 soft-boiled eggs1 beefsteak1 oyster stew1 and clam broth4 ,vaginal ,douche4-- ,to be of service except for mere cleansing purposes the douche must be taken in the horizontal position1 either on a couch or1 if it is not cold1 on the floor4 ,of course1 this position necessitates the use of a douche-pan4 ,the douche-pan is best of agate-ware1 oblong in shape1 and with a broad strip which comes under the nates4 ,on lying down to take the douche the nates must come down well over the pan and the clothing must be pushed well up to prevent the water from seeping up the back4 ,to make the woman more comfortable there should be a pillow under the head1 and she must have a shawl or some light woolen material to throw over her while taking the douche to prevent chilling2 thus doing more harm than good4 ,there are two forms of syringes on the market3 the bag or fountain syringe1 which is hung up sufficiently high-- about three feet above the patient-- to cause the water to flow2 and the bulb syringe1 in which the bulb has to be constantly squeezed by the hand1 which is tiresome to many women1 but this is a much more convenient form to have in traveling4 ,during pregnancy the fountain syringe only should be used1 and it should be hung as low as will enable the water to flow4 ,for a woman who has never taken douches it is well to begin with a temperature of #aaj ,f41 gradually increasing the temperature to #aah or #abj2 this is as high as the woman should attempt to go1 for a higher temperature would burn her1 leaving the vulva so sensitive that she would only be able to take cool douches for a long time after this2 a bath thermometer should be used in all cases to test the temperature1 so that the woman knows exactly what she is doing4 ,in cases of inflammation of the uterus or its adnexa four quarts of water should be used1 and the douche should be taken in the horizontal position4 ,the water thus acts as a hot poultice about the uterus1 and the woman will find on rising that some water flows out from the vagina4 ,ordinarily plain hot water is all that is necessary to use1 but where the discharge is acrid and scalding1 the plain hot-water douche should be followed by a warm douche containing one teaspoonful of borax to a pint of water4 ,the best time for taking a douche is at night just before retiring2 there is also less danger of taking cold when the douche is taken at this time4 ,the scalding sensations at the vulva may be due to the acidity of the urine1 in which case it will be increased just after urination2 or it may be due to an acrid discharge from the vagina4 ,a little observation on the part of the patient will enable her to distinguish which is the real cause4 ,if there is any trouble with the urine1 it should be carefully examined at once1 as some congestion or inflammation of the kidneys is not infrequently present1 which if attended to might be cured1 and which if allowed to run on unattended to1 may develop into a serious form of ,bright's disease4 ,the genitals should be washed with soap and water night and morning4 ,women who do not suffer from leuchorrhea need not take a vaginal douche more than once a week2 after the menstrual flow the vaginal injection is advised to remove the detritus of the flow4 ,baths4-- ,the most ordinary forms of baths used may be classified under sponge-1 shower-1 sitz-1 and tub-baths4 ,the sponge-bath as ordinarily taken is of service for cleansing purposes1 and if the water be cold it tones up the system to some extent1 and is so a preventive against taking cold4 ,the effect of this bath will be found to be vastly more beneficial if salt is added to the bath in the proportion of a pint of salt to a gallon of water2 either sea-salt may be used or the ordinary coarse salt4 ,it is most advantageously taken sitting in a bath or hat-tub1 so that the entire surface of the body will be wet at the same time1 and the water can be allowed to run down the back and over the chest4 ,it is well to begin these baths at a temperature of #hj ,f4 and to gradually decrease this until the bath is taken at #gj1 which is about the temperature of running water1 and the bath should be kept up at this4 ,for most people the best time to take the bath is just before retiring2 this bath is not only very strengthening1 but also is excellent in cases of insomnia and nervousness4 ,shower-baths4-- ,these may be taken after a hot bath1 or taken alone after violent muscular exercise4 ,the body should be quickly scrubbed off and the shower should be warm at the beginning and gradually allowed to become cold1 stooping over so as to get the full force of the shower on the spine and over the region of the stomach and heart4 ,they will be found to be most refreshing after great muscular fatigue1 and1 when taken after the hot tub-bath1 greatly lessen the susceptibility of the individual to taking cold4 ,sitz-baths4-- ,these are given for their local effect in cases of inflammation2 whether this inflammation be of the kidneys1 bladder1 or of the uterus and its adnexa4 ,a sitz-tub is necessary to properly take this form of bath4 ,the water should be used as hot as is comfortable to the patient1 from #aje to #aaj ,f41 hot water being added as the first cools off2 a pint of salt should be added to the gallon of water1 and the patient should remain in this from five to eight minutes4 ,a blanket should be wrapped about the patient so that she will be thrown into a perspiration2 it is almost needless to say that the only time for taking this bath is just before retiring1 and that this bath does make the woman more susceptible to taking cold1 so that it is necessary to wear an abdominal woolen bandage day and night4 ,tub-baths4-- ,the tub-bath ought not1 as a rule1 be taken more than twice a week1 unless the cold plunge is used1 which may be taken every day4 ,if the tub-bath is taken hot1 the woman should remain in it not much longer than is necessary to scrub off with a flesh-brush2 this bath should be followed either with a cold shower-bath1 or the water in the tub be gradually allowed to cool off until it is down to #gj ,f4 ,headaches4-- ,headaches1 aside from those of acute illness1 may be roughly divided into three classes3 first1 those which are due to indigestion2 second1 neuralgic headaches2 and1 third1 those due to pelvic inflammations4 ,the headaches due to indigestion are usually located over the eyes and all over the forehead2 they are more or less constant and are accompanied by other symptoms of indigestion1 and very often by constipation4 ,the feces are allowed to remain in the bowels overlong1 the toxic matters are taken up by the blood1 and headaches and vertigo result4 ,neuralgic headaches are of an entirely different character2 the pains are here of a lancinating character1 and are not confined to any one region of the head4 ,as a rule1 they are accompanied by neuralgic pains in other parts of the body4 ,neuralgia generally means a rundown state of the system from overwork1 worry1 or malaria1 and tonics and cod-deliver oil are indicated4 ,a constant dull pain on the top of the head or in the back of the neck generally indicates some uterine inflammation1 and can only be cured by removing the cause4 ,in any case it is very evident that taking the various headache powders with which the market is flooded will never cure the woman of her headaches2 and many of these powders are very dangerous1 especially where the heart is weak1 as most of them are heart-depressants4 ,fainting4-- ,fainting may be due to a weak heart1 to heart disease1 or to sudden shock1 as on receiving a bad piece of news2 during pregnancy the close air of a room may cause a woman to faint4 ,the first thing to be done is to lay the woman down on the floor or bed with nothing under her head2 loosen all her clothes about the neck and waist1 and throw the windows open so that she will get plenty of fresh air4 ,if she is able to drink1 give her one teaspoonful of aromatic spirits of ammonia in four tablespoonfuls of cold water4 ,if the feet are cold1 place hot-water bottles to them to improve the circulation4 ,and if at the end of fifteen minutes she does not show signs of decided improvement1 give her two tablespoonfuls of whisky in an equal quantity of hot water4 ,in the meantime the physician will have been summoned4 ,these attacks of fainting often occur in a crowded ball-room1 and are due to tight lacing and the poor ventilation of the room4 ,hemorrhage4-- ,a profuse hemorrhage is the most alarming as well as the most dangerous thing which can befall a woman1 and the very nearest doctor should be summoned until the family physician can be gotten there4 ,the woman should be made to lie down wherever she may happen to be1 her clothes loosened1 the windows thrown open1 so that she will not only have plenty of fresh air1 but that the air shall be cool4 ,if the blood is coming from the mouth1 give her pieces of ice to hold in it2 if she coughs up the blood1 it would be well to put a bag of ice-cold water or cloths wrung out of ice-water on the chest4 ,if the woman is suffering from a uterine hemorrhage1 have her take at once a hot vaginal douche1 from #aah to #abj ,f41 and have the foot of the bed raised4 ,the head should always be kept low4 ,women hold their health in their own hands to a far greater extent than they have ever dreamed of2 and if the majority of women suffer1 it is very often their own fault1 either because they have disregarded nearly every law of health1 or have allowed trivial ailments to go on until they were almost incurable4 ,the broad mountain-top1 with its sunlight and free air1 is possible to all of us1 if we choose to struggle on and reach it4 -- ,phillips ,brooks4 ,,glossary4 ,abortion4 ,the expulsion of the fetus before the end of the third lunar month4 ,afferent ,nerves4 ,those nerves which convey the impressions to the nerve-centers4 ,after-pains4 ,the pains which follow labor and which are caused by the contractions of the uterus4 ,amenorrhea4 ,absence of the menstrual flow4 ,anemia4 ,the so-called thinness of the blood1 due to a deficiency of red blood-corpuscles4 ,antisepsis4 ,the use of chemical substances which have the power of destroying germs4 ,anus4 ,the external circular outlet of the rectum or distal part of the large intestine4 ,appendages1 ,uterine4 ,the ,fallopian tubes1 the ligaments of the uterus1 and the ovaries4 ,atrophy4 ,a progressive diminution in the bulk of an organ or tissue4 ,automatic4 ,involuntary1 mechanical4 ,bulbi ,vestibuli4 ,a plexus of veins on each side of the vestibule4 ,capillaries4 ,the terminal and very finest branches of the blood-vessels4 ,catamenial ,flow4 ,see ,menstruation4 ,cellular ,tissue4 ,a loose1 transparent tissue which surrounds the muscles and organs of the body4 ,cerebrum4 ,the upper and larger portion of the brain4 ,chlorosis4 ,anemia of young women about the time of puberty4 ,climacteric4 ,see ,menopause4 ,clitoris4 ,a small1 elongated1 erectile organ situated at the upper part of the vulva4 ,cohabitation4 ,see ,coitus4 ,coition4 ,see ,coitus4 ,coitus4 ,syn41 coition1 copulation1 cohabitation1 sexual congress1 sexual intercourse4 ,the carnal union of the sexes4 ,colostrum4 ,a thin albuminous fluid which appears in the breasts at the fourth month of pregnancy4 ,conception1 or impregnation1 is the union of the germ and sperm cell which results in a new being4 ,confinement4 ,childbed1 the expulsion of the child from the womb4 ,congestion4 ,the abnormal accumulation of blood in a part4 ,constipation4 ,costiveness2 a state in which there is not a free daily evacuation of the bowels1 or where the evacuations are hard or expelled with difficulty4 ,continence4 ,abstinence from or moderation in sexual indulgence4 ,copulation4 ,see ,coitus4 ,cord1 ,umbilical4 ,the cord which connects the fetus with the mother4 ,through the blood-vessels contained in this cord the child receives nourishment4 ,corpuscle4 ,a very small particle4 ,decidua4 ,a membranous sac formed in the uterus during gestation1 and thrown off after parturition4 ,defecation4 ,the act by which the contents of the bowel are expelled from the body4 ,dehiscence4 ,the splitting open of an organ4 ,dentition4 ,the cutting of the teeth4 ,dysmenorrhea4 ,painful and difficult menstruation4 ,dystocia4 ,a difficult labor4 ,embryo4 ,the name applied to the very earliest stages of the child in utero2 that is1 up to about the time of quickening4 ,endometrium4 ,the lining membrane of the uterus4 ,epithelium4 ,a layer of minute cells which forms the covering of many membranes4 ,erection4 ,the state of a part which1 having been soft1 becomes rigid and elevated by the accumulation of blood within its tissues4 ,fallopian ,tubes4 ,two very small tubes extending from the upper angles of the uterus to the ovaries and serving to convey the ova from the ovaries to the uterus4 ,feces4 ,stools2 the normal discharge from the bowels4 ,fetus4 ,the child in utero from the time of quickening to that of birth4 ,fomentations4 ,the application of cloths which have previously been dipped in hot water4 ,function4 ,an action of an organ which could be performed only by that organ1 and which is necessary to the well-being of the individual4 ,generative ,organs4 ,syn41 genital1 reproductive1 sexual2 those organs in the male and female by means of which a new being is created4 ,genital4 ,see ,generative4 ,gestation4 ,see pregnancy4 ,gonorrhea4 ,a highly contagious venereal disease1 characterized by an inflammatory discharge of mucus from the urethra and prepuce in the male1 and from the urethra and the vagina in the female4 ,graafian ,follicles4 ,minute ovarian vesicles which contain the ova4 ,hemorrhoids4 ,piles or tumors at or within the anus1 and consisting of enlarged veins4 ,hymen4 ,the semilunar fold situated at the outer orifice of the vagina in the virgin4 ,hypertrophy4 ,the increased activity of a part which leads to an increase in its bulk4 ,hypochondriasis4 ,morbid feelings concerning the health and simulating disease4 ,impregnation4 ,see ,conception4 ,infectious4 ,see ,contagious4 ,katabolic ,nerves are those nerves which stimulate the breaking down of tissue4 ,labia ,majora4 ,two thick folds of skin which extend backward from the mons veneris4 ,labia ,minora4 ,nymphae2 two very delicate folds of skin which are inside of and protected by the labia majora4 ,labor4 ,see ,parturition4 ,lactation4 ,the secretion of milk2 nursing1 suckling the child4 ,lactiferous ,ducts4 ,the milk ducts4 ,leucorrhea4 ,whites2 a whitish or yellowish discharge from the vagina4 ,lochia4 ,a discharge which follows labor and which lasts for about two weeks4 ,lying-in4 ,the period which follows childbed4 ,lymphatics4 ,the vessels in which the lymph is carried4 ,mammae4 ,the mammary glands2 the breasts4 ,marital ,relations4 ,see ,coitus4 ,massage4 ,a systematic kneading of the muscles4 ,meatus ,urinarius4 ,the external orifice of the urethra4 ,meconium4 ,the first discharge from the infant's bowel after birth1 and which had collected in the intestines during the pregnancy4 ,medulla4 ,the base of the brain at its junction with the spinal cord4 ,menopause4 ,climacteric1 change of life1 the time of the natural cessation of the monthly sickness4 ,menorrhagia4 ,an excessive menstrual flow4 ,menstruation4 ,menstrual period1 menstrual flow1 menses1 monthly sickness1 the monthly discharge of blood from the uterus1 which1 with certain exceptions1 recurs monthly from about the age of thirteen to forty-six years4 ,metabolism4 ,transformation changes4 ,metamorphoses4 ,changes of shape or structure4 ,metrorrhagia4 ,a flow of blood between the menstrual periods4 ,micturition4 ,the act of passing water4 ,miscarriage4 ,the expulsion of the fetus between the twelfth and twenty-eighth weeks4 ,molecular4 ,belonging to the molecules1 or the minutest portion of anything4 ,mons ,veneris4 ,the uppermost part of the vulva1 which is a fatty cushion covered with hair4 ,nerve-center4 ,a nerve station from which orders are transmitted and where orders are received4 ,nubile4 ,puberty1 that period of life in which young people of both sexes are capable of procreating children4 ,nymphae4 ,see ,labia minora4 ,ovaries4 ,two small ovoid bodies1 one on each side of the uterus1 in which the ova are formed4 ,oviduct4 ,see ,fallopian tobe4 ,ovulation4 ,the formation of the ova in the ovary1 and the discharge of the same4 ,ovule4 ,see ,ovum4 ,ovum4 ,germ cell1 a small1 round vesicle situated in the ovaries1 and which1 when fecundated1 constitutes the rudiments of the embryo4 ,parturition4 ,labor1 delivery1 child-birth1 the expulsion of the child from the womb4 ,pathologic4 ,relating to the diseased condition of tie body4 ,pelvis4 ,the bony cavity situated at the lower end of the spinal column and supported by the thighs4 ,periodicity4 ,the recurrence of physiologic phenomena at regular intervals4 ,periphery4 ,the circumference of an organ4 ,peristaltic ,action4 ,an alternate contraction1 making small1 and enlargement of the bowel2 it is by this means that foods1 etc41 are forced along its passage4 ,peritoneum4 ,a serous membrane which lines the abdominal cavity1 and wholly or in part envelopes the organs contained in it2 it also partly covers the organs contained in the pelvic cavity4 ,phenomena4 ,remarkable appearances4 ,physical4 ,pertaining to the body4 ,placenta4 ,after-birth1 a soft1 spongy1 vascular body adherent to the uterus1 and which is connected with the embryo through the umbilical cord4 ,plethora4 ,a condition marked by a superabundance of blood4 ,postpartum ,hemorrhage4 ,hemorrhage following labor4 ,pregnant4 ,enceinte1 gravid2 the state of a woman who is with child4 ,premature ,labor4 ,the expulsion of the fetus between the end of the twenty-eighth week and the time that labor ought to have occurred4 ,propagation4 ,the spreading or extension of a thing4 ,pruritus ,vulva4 ,an intense itching of the privates1 or vulva4 ,psychic4 ,pertaining or belonging to the mind4 ,puberty4 ,sexual maturity2 nubility2 that period of life in which young people of both sexes are capable of procreating children4 ,pubes or ,pubis4 ,the lowest and middle part of the pelvis in its anterior surface4 ,puerperium4 ,the lying-in after child-birth4 ,quickening4 ,the sensation experienced by the mother as the result of active fetal movements in the womb4 ,rectum4 ,the lower extremity of the large intestine4 ,reflex4 ,the reflection of an impulse from a nerve-center which has been received from elsewhere by that center4 ,reproduction4 ,see ,generative4 ,respiration4 ,breathing4 ,rugs4 ,wrinkles4 ,rut4 ,the copulation of animals4 ,septicemia1 ,puerperal4 ,childbed fever4 ,sexual4 ,that which relates to sex4 ,see ,generative4 ,smegma4 ,a cheesy substance which may collect about the vulva4 ,spermatozoa4 ,the essential male fertilizing elements4 ,sympathetic ,nervous ,system4 ,presides over involuntary acts2 as digestion1 breathing1 etc4 ,syphilis4 ,a venereal disease which is highly contagious by coition1 contact with the lips1 etc4 ,tachycardia4 ,distress in the region of the heart1 with palpitation and shortness of breath4 ,umbilicus4 ,navel4 ,urea4 ,the most important of the solid constituents of the urine4 ,ureters4 ,the ducts leading from the kidneys to the bladder4 ,urethra4 ,the excretory duct from the bladder for the escape of the urine4 ,urination4 ,the act of passing water4 ,uterosacral ,ligaments4 ,ligaments which pass from the uterus to the sacrum1 and assist in holding the uterus in position4 ,uterus4 ,womb2 the hollow1 pear-shaped pelvic organ which is destined to retain the child from the moment of its conception until the time of its expulsion at birth4 ,utricular ,glands4 ,glands of the uterus4 ,vagina4 ,the canal which connects the female internal and external organs of generation4 ,vascular4 ,pertaining to the blood-vessels4 ,vasomotor ,nervous ,system4 ,comprises the brain1 spinal cord1 and the nerves given off from the cord3 this system presides over voluntary acts1 that is1 those acts which are under the control of the will4 ,vestibule4 ,a smooth cavity that exists in the female between the perineum and the nymphae4 ,viscera4 ,the contents of the large cavities of the body4 ,vulva4 ,the external genitals1 private parts1 the female external organs of generation4 ,vulvitis4 ,inflammation of the vulva4