Qass_ Book_ COPYRIGHT DEPOSIT iiy special permission of Owen Zimmerman, Photograj THE MOTHER AND HER FIRST-BORN. What is so attractive as a young and beautiful mother with her babe t "A mother is a mother still, ike }coliest thing alive. :} HYGIENE TOCOLOGY PEDIATRICS LIFE KNOWLEDGE ■OR WOMAN'S RESPONSIBILITIES AND DUTIES AT ALL PERIODS OF LIFE — A GUIDE IN THE MAINTENANCE OF HER OWN HEALTH AND THAT OF HER CHILDREN — BY— MYER SOLIS-COHEN, A.B., M.D. Instructor in Physical Diagnosis, University of Pennsylvania; Visiting Physi- cian to the Hospital for Diseases of the Lungs, Chestnut Hill; Assistant Physican to the Philadelphia General Hospital; Physican to the Children's Dispensary of the Jewish Hospital, Philadelphia. PROFUSELY ILLUSTRATED WITH COLOR PLATES SCIENTIFIC DRAWINGS AND HALF-TONE ENGRAVINGS MANIKIN CHART Printed in Colors, with an Index UPLIFT PUBLISHING COMPANY PHILADELPHIA ' Copys'igtit, 1909 By W. E. Scuii Entered according to act of Congress in the year 1906 by W. E. SCULL, in the office of the Librarian of Congress, at Washington, D. C. Woman: In Girlhood, Wifehood, and Motherhood. All Rights Reserved LIBRARY of CONGRESS Two Codes Received APR 16 180$ Copy meat tntry CEASS «_ KXC, No, "2-3> Q, § 53 CCr- :■ PREFACE AND INTRODUCTION I |T is remarkable in this age of higher education for women that instruction concerning so many im- ggBa ) portant things in a woman's life should be practically neglected, and, as a rule, left to chance. Through ignorance of Nature's hygienic laws a woman often loses not only her health, but also the beauty that is & dependent upon it. The young mother commits many grave er- rors when caring for her baby by too often rely- ing solely upon her in- tuition, or upon the ad- vice of ignorant friends. Many parents neglect to give their children the information and advice needed at the period of adolescence because, not possessing full knowl- edge as to the phenom- ena of such a time and not realizing the dan- gers of silence, they feel diffident and embar- rassed about referring to the s u b j e c t. All through her life, from infancy to old age, a woman fre- quently suffers from conditions which she might have avoided had she been properly informed as to the rules of iii Thi Mother and Her Baby. PREFACE AND INTRODUCTION health. Yet each woman must solve the hygienic problems of clothing, food and bathing, the ventilation of the home, and the physical, mental and moral training of the children. It is to supply the information that keeps a woman well and happy and guides her in bringing up a family strong in body, in mind and in morals, that this book has been written. The proper person to instruct a woman in many of these matters no doubt is her family physician. But the busy practitioner seldom can take the time to discuss the details of right living and explain how disease is to be pre- vented. These things he, too, leaves to chance. In fact, the doctor is seldom consulted except to treat some one who is sick, and then must spend his whole time in getting the patient well. After she has allowed the doctor to depart, how often does the young mother or the sick girl recollect something about which she had neglected to ask advice! Thus it happens that for directions about the details of her life, when sick and well, a woman must rely upon an accurate book which she can consult at all times. Un- fortunately, many of the books sold as health guides for women are unreliable and of a doubtful character. Pre- tending to be physiological, they are in reality prurient and suggestive, and cater to a depraved taste. In this book the endeavor is made to give all the information a woman requires for any of the emergencies that may occur during her own life and for the preservation of health and beauty. The author has used simple language throughout, avoiding technical terms, and has endeavored to make the statements so plain and clear as to be easily understood by every one. At the same time he has written only what is in accordance with the latest scientific knowledge. More- over, in giving advice, he has avoided generalities and has made his directions pointed and definite. iv PREFACE AND INTRODUCTION The first part of the book treats of health and beauty, telling how both may be preserved and obtained. The care of the skin, the complexion, the hair, the teeth and the nails, the questions of clothing and dress, food and drink, I and exercise and rest, are taken up in detail. The second part describes the important periods of a woman's child- hood, maidenhood, wifehood and motherhood, giving the practical knowledge that prevents disease and promotes woman's health and happiness. The management of child- birth is then considered, with full directions as regards the preparations for the confinement, the labor itself, and the care of mother and baby after the latter is born. This is followed by "The Baby, and How to Care for It," including the bathing, clothing, feeding, exercising, training and amusing of the well baby and the management of the sick baby. Next come the diseases peculiar to women, the causes of which are pointed out, that they may be avoided. Prevention is given prominence and methods of treatment are described in cases where simple home remedies may be applied without harm and in emergencies. Great care has been used in the selection of illustra- tions, that they be both appropriate and in sufficient num- ber to elucidate the text; they have been inserted in the form of scientific drawings, photographs and special artists' sketches. A manikin, drawn, colored and put together with great exactness, and explained with a descriptive key, ac- companies each book for the use of those who are interested in the study of anatomy. Any unavoidable medical or other terms requiring elucidation are fully explained in a glossary. A complete index has been added, so that anything in the book mav be found in a few seconds. MYER SOLIS-COHEN. 41 10 Parkside avenue, Philadelphia. 1905. EXPLANATION OF MANIKIN CHART. 10. IX. 12. 13- 34. I5-. 16. 17. 18 20. ax. 22. 23- 24. 25. 26. 27. 28. 29. 30. 3i. 32. 33- 34. 35. 36. 37. 38. 39- 40. 41. The large breast-muscle. 42. The broad muscle of the back. The serrated muscle. 43. Commencement of the external 44. oblique muscle. 45. External j musc i es between the ribs. 46 Seventh rib. Twelfth or floating rib. 47- Internal oblique muscle, forming 4°. a broad thin sheet at the me- dian line. 49 The long thigh muscle. Ligament formed by the lower end of the long thigh muscle. Si- Hip muscle. 52. The muscle of the buttocks. 53- The fat of the buttocks. 54- I^er 16 ) extensor muscles of the 55 * Outer ) thi * h ' and 19. Flexor muscles of the 56. thigh. Mammary gland or breast. One of the bones of the spine. 57- Collar-bone. 1st rib. 58. 7th rib. 12th or floating rib. 59- Breast-bone. The muscles between the ribs. 60. Hip bone. (One of the bones of the pelvis). Upper front corner of the hip 61. bone. Upper back corner of the hip bone. The socket of the hip. 62. Prominence on the bone of the 63. buttocks. Bone of the buttocks. (One of the bones of the pelvis). 64. Passageway for blood vessels and nerves. 65. The bone of the seat. (One of the bones of the pelvis). 66. The lowest bone, or lower end, of the spine. (One of the bones 67. of the pelvis). 68. Triangularis sternis muscle. 69. Beginning of the external oblique muscle. 70. Diaphragm, which divides the 71. chest from the abdomen. (Cut 72. through). 7s- Upper border of the hip bone. 74. (One of the bones of the pel- 75 vis). Concavity on the inner side of the 77. Mo bone. 78. Ridge of bone forming the lower border of the above. Junction of the two pubic bones. Pubic bone. Upper end of the bone of the but- tocks. Part of the bone of the buttocks on which we sit. One of the bones of the spine. The bone of the seat. (Cut in half). (Same as No. 35). and 50. Ligaments connecting the above with the bone of the but- tocks. Upper, ) Middle, Mobes of the lung. Lower, ) Bronchial tubes. (Cut across). Mammary gland or breast, cut through so as to show its struc- ture. (Same as No. 20). Nipple (cut through), showing how all the milk ducts converge there. Breast bone cut in half. (Same as No. 26). One of the bones of the spine. (Cut in half). One of the bones of the spine. (Cut in half). One of the bones of the spine. (Cut in half). (Same as No. 47). The bone of the seat. (Cut in half). (Same as Nos. 35 and 48). Muscles of the spine. Spine, cut open so as to show the spinal cord and the nerves com- ing from it. The muscle that surrounds and closes the anus. (Cut through). Trachea or wind-pipe. (Cut across). Portion of the pleura, or mem- brane covering the lungs. A portion of the heart. Diaphragm. (Same as No. 39) Large blood vessel leaving the heart. (Cut across). Lower branch of the above. Duct. (Cut across). Membrane covering the liver. Liver. (Cut across). Stomach. (Cut across), and 76. Coils of the large intes- tines. (Cut across). Rectum. (Cut across). Pancreas. EXPLANATION OF MANIKIN CHART. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. IOO. 101. Esophagus or gullet. (Cut across). Subclavian vein. (Cut across). Pulmonary artery. Pulmonary artery. (Cut across). Large vein entering the heart. (Cut across). A portion of the heart (cut across so as to show one of the cham- bers), and 86. Vein. (Cut across). Artery. (Cut across). Uterus or womb at the end of pregnancy. Cervix or mouth of the womb at the end of pregnancy. Inner wall of the womb at the 112 end of pregnancy. The child in the womb. Placenta or after-birth. Vagina. Labia minora. Labia majora. Anus. Bladder. Abdominal or Clitoris. Junction of belly cavity. across). (Same (Cut 43). The non-pregnant across). the pubic bones, as No. 102. 103. 104. 105. 106. 107. 108. 109. no. III. 113- uterus. (Cut 114. 115. 116. 117. 118. 119. 120. 121. 122. Ovary. The round ligament supporting the uterus. Fimbriated extremity of the ovi- duct or fallopian tube Membrane dividing the two lobes of the great brain or cerebrum. Portion of the great brain or cere- brum. Cerebellum or little brain. (Cut across). Medulla. The uppermost bone of the spine. Spinal cord. Esophagus or gullet. (Same as No. 79). The most prominent bone of the spine. Trachea or wind-pipe. (Same as No. 65). Cerebrum or great brain. Nasal center. Roof of mouth or hard palate. Soft palate. Tongue. Chin bone. Larynx or speaking box. Thyroid gland. (This sometimes becomes a goitre). Breast bone or sternum. (Same as No. 26). TABLE OF CONTENTS. PART I. HEALTH AND BEAUTY. PAGS PREFACE AND INTRODUCTION 5 CHAPTER I. THE BASIS OF BEAUTY. Standards of Beauty: According to Voltaire; among different ages and among different peoples; with the cultivated — Modern Ideas of Beauty: Symmetry, proportion, curves, color, gradation — Human beauty not complete without expression — Youth not necessary to beauty — Health an essential — How every woman can acquire, increase or retain beauty — The perfect woman 25 CHAPTER II. BATHING AS A MEANS OF HEALTH AND BEAUTY. The structure of the skin — The cleansing bath — The cold, or hygienic, or hard- ening bath — How one catches cold — The action of the cold bath — How to promote the reaction — Forms of the cold bath: The cold full tub bath; The cold half-bath; The cold sponge bath; The cold shower or douche bath — The reaction after a cold bath — Several directions for cold bathing — The hardening effect of cold bathing — The Turkish bath — Sea ba tiling — The care of the complexion — Care of the ears — Facial massage — The use of cold cream — Powders — General hygienic measures -The pre- vention of wrinkles and their removal 33 (ix) x CONTENTS CHAPTER III. THE CARE OF THE TEETH, THE NAILS AND THE HAIR. PAGE Perfect teeth necessary from the standpoint of health as well as beauty — How to preserve the teeth: Powder, brush, mouthwash — Cleansing and mani- curing the nails. — The structure of the hair — How to care for the hair: Brushing, combing, shampooing, massage, curling the hair — Decora- tions for the hair — Hints on hair dressing 44 CHAPTER IV. THE FIGURE— HOW TO DEVELOP A GRACEFUL CARRIAGE. Standard of beauty in the figure — The prevention of deformities — How deformities are acquired — School a factor in producing deformities — How to detect deformities — Mechanical means to prevent deformities — How to improve the figure — The correct standing position — The position to be assumed when sitting — The proper method of walking — Exercises for developing a graceful carriage — How to utilize housework in develop- ing the figure — Exercises for developing the figure 51 CHAPTER V. CLOTHING FROM THE HYGIENIC AND ARTISTIC STANDPOINT. The Hygiene of undergarments — The material that best preserves heat — The best absorbent of moisture — The best material for underwear — Stockings — Outer Garments : Materials for various conditions — The influence of color — Constriction to be avoided — Shoes — Beauty in dress — The colors that may be worn by the different types 64 CHAPTER VI. FOOD AND DRINK. The hours for meals — Taking sufficient time to eat — Rest after meals — The different kinds of food and how to prepare them — Animal foods — Milk CONTENTS xi PAGE and milk products — Eggs raw and cooked in various ways — Meats and how to prepare them — Fish and shell-fish — The relative digestibility of different animal foods. — Vegetable Foods: Sugars, cereals, roots and tubers, green vegetables — Fruits — The different beverages: Drinking water; coffee; tea; cocoa and chocolate; alcoholic drinks 73 CHAPTER VII. WORK, REST AND RECREATION. Work in its relation to health — Child labor — The length of the working day — The necessity for rest — The noon hour — The ability to relax — The weekly and yearly vacation — The hygiene of sleep — Amount of sleep required — The bed and the bed-clothes — The way to lie — The bed-room — Rules for sleeping — The necessity for recreation — Mental recreation — Physical recreation: Walking, running, climbing, bicycling, horseback riding, rowing, canoeing, swimming, lawn tennis, tether tennis, golf, basket ball, bowling, fencing, punching the bag, dancing 83 PART II. A WOMAN'S LIFE. CHAPTER VIII. ANATOMY AND PHYSIOLOGY. Sex Throughout Nature: In plants; in the lower animals; in man. Woman's physical characteristics — The female sexual organs: In plants; in the lower animals; in woman. Woman's reproductive organs: The womb. the fallopian tubes — The ovaries — The pelvis 0; xii CONTENTS CHAPTER IX. THE PERIOD OF PUBERTY : PASSING FROM CHILDHOOD TO WOMANHOOD. PAGE The changes that occur at adolescence — Variations in the age of puberty due to climate, race, mode of life and heredity — Delay in the appearance of the chief sign of puberty — The mental changes at puberty — The reli- gious changes — The mother's duty — The hygiene of puberty ioo CHAPTER X. THE MONTHLY PHENOMENA. Ovulation — Menstruation — Time of onset and cessation — Character of the menstrual discharge — Duration of the flow — Quantity of the discharge — Other symptoms exhibited at this period — The menstrual interval — Pain during menstruation — Connection between menstruation and ovula- tion — Vicarious menstruation — The hygiene of the menstrual period. ... 106 CHAPTER XL PURITY. The danger of silence — A mother's responsibility — What constitutes purity — A mother's duty to her daughter — To preserve true modesty and inno- cence — Secret vice — Hygiene as a prevention and treatment 1 1 1 CHAPTER XII. MARRIAGE AND COURTSHIP. The views of various thinkers — The origin of marriage and the family — Mar- riage customs among different people — Courtship according to modern ideas: In continental Europe, in England, in America — Love the basis for marriage — The nature of love, according to the poet and the philoso- pher — Passion versus affection — Love as a passion is transient — Passion may be followed by a steadier sentiment — Marriages based on passion are unhappy — Province of courtship to cultivate mutual esteem and CONTENTS xiii PAGE friendship — The money question should be considered before marriage — A wrong standard of requirements — Marriage for position or wealth — Sincerity during courtship — The training of a girl for wifehood — Quali- ties needed by a workingman's wife — The proper age for marrying — The danger of early marriages — A mutual understanding about details necessary before marriage 1 1 6 CHAPTER XIII. HEREDITY IN ITS RELATION TO MARRIAGE. CONSANGUINITY. Providing for the health of the unborn — Exchange of confidences — A physi- cian should be consulted — When these precautions are disregarded — Where the hereditary taint is slight — Drunkenness an obstacle to marriage — Insanity and epilepsy a bar to marriage — Deaf-mutism in its relation to marriage — Instinctive criminality a form of degeneracy — Consumption a disease in which heredity is sometimes a factor — The marriage of syphi- litics — Consanguineous marriages 132 CHAPTER XIV. THE BASIS OF HAPPINESS IN MARRIED LIFE. Love is kept by art — The influence of the personal appearance — Care in the personal appearance — Dressing for the world rather than for the home — The invasion of the home by conventionalities — The husband neglected for the children — The avoidance of contention — The economic depend- ency of woman — Humiliation dwarfs a woman's character — The question of pocket money — Race suicide — Healthy home life necessary 140 CHAPTER XV. PREGNANCY: THE DEVELOPMENT OF THE CHILD. An explanation of Nature's mysteries — Reproduction: In plants; in the lower animals; in man. — Conception — The development and nourish- ment of the embryo or unborn child — The placenta and umbilical cord — Changes in the mother during pregnancy — Lightening 150 xiv CONTENTS CHAPTER XVI. THE SYMPTOMS OF PREGNANCY. PAGE Determination of the existence of pregnancy — The commonest symptoms of pregnancy: The cessation of menstruation; Morning sickness; Appear- ance of the face; Changes in the breasts; Changes in the size, shape and appearance of the abdomen — Quickening: Alterations in the nervous system — Change in color of the mucous membrane — Hearing the fetal sounds — The physician's examination 156 CHAPTER XVII. THE LIFE OF A WOMAN DURING PREGNANCY. Diet — Dress : hygienic or maternity waists and corsets ; the abdominal band- age — Exercises to strengthen the muscles and preserve the figure — Bath- ing during pregnancy — Work, exercise and rest — Maternal impressions — Keeping the mind in pleasant channels — How to render labor easy — Care of the breasts during pregnancy — Preparation of the nipples — Care of excretions and discharges : The urine ; the bowels ; leucorrhea — Marital relations during pregnancy 161 CHAPTER XVIII. THE MENOPAUSE—" CHANGE OF LIFE." Age at which "change of life" occurs — Method of oncoming — Symptoms of the menopause: Headache, flushes of heat, derangement of the digestive and nervous systems — A mistake to attribute all symptoms at middle- life to the menopause — The physiology of the menopause — Importance of familiarity with the normal phenomena — The recognition of danger signals — Hygiene of the menopause 167 CONTENTS xv PART III. CHILD-BIRTH. CHAPTER XIX. PREPARATIONS FOR THE CONFINEMENT. PAGE Have the best, if possible; if not, have the best possible tinder the circum- stances — The lying-in room — Arrangement of the bed — Things needed for the confinement: Absorbent pads, occulsive bandages or napkins, the abdominal binder, the baby's basket, the baby's clothes, etc. — Prepara- tion of the patient — Engaging the physician and nurse — The Accoucheur: Physcian vs. midwife — The nurse: Trained nurse vs. monthly nurse — Selection of a nurse ; her duties 175 CHAPTER XX. THE PHYSIOLOGY OF CHILD-BIRTH. Causes of labor — How to calculate the day of confinement — The duration of pregnancy — Methods of calculation — Importance of knowing the date of the last menstruation — Child-birth : The first stage of labor ; the second stage ; the third stage — The Puerperium — The lochia 's amount and odor — The danger signals — Afterpains — Changes in the breasts 185 CHAPTER XXI. THE MANAGEMENT OF LABOR. The knowledge required to make a woman helpful in the lying-in room — The Diagnosis of Labor: "Dropping", labor pains, the show — Duration of labor — Surgical cleanliness the guiding factor throughout the labor — A Talk on germs — How the birth-canal becomes infected — Puerperal infection can always be prevented — How to prevent puerperal infection — Th» management of the first stage of labor — Diet during the first stage — xvi CONTENTS PAOB The administration of an anesthetic — The management of the second stage — Care of a premature infant — Treatment of an asphyxiated baby — Care of the mother during the third stage 196 CHAPTER XXII. THE CARE OF THE MOTHER AFTER LABOR. The prevention of infection — Rest and quiet — The position to be assumed in bed — Getting up — Visitors — Diet for a nursing mother — Bathing — Urination — The bowels — Care of the breast and nipples — The mammary binder — General hygienic measures — The treatment of distended breasts. 209 PART IV. THE BABY CHAPTER XXIII. APPEARANCE AND DEVELOPMENT OF THE NORMAL INFANT. Color and appearance of the skin— Shape and development of the head; the fontanelles— The face at birth— The baby's hair— An infant's tongue — The baby's gums— Cutting the Teeth : The first or milk teeth; the second or permanent teeth; teething a normal process. — The shape of an infant at birth— Position assumed by the baby— The infant's size and weight at different ages— The baby's bowels— The baby's urination — The other functions of the baby 2I 9 CONTENTS xvii CHAPTER XXIV. THE FEEDING OF INFANTS. BREAST-FEEDING. PAGE Mother's milk the best food for the baby — The baby's thirst — Composition of human milk — How to modify breast milk — Conditions affecting the milk — Rules for nursing the baby — Feeding during the first few days of life; regularity in feeding; frequency of feeding; how long to nurse; how the baby should be held — Mixed feeding — The wet-nurse; choice of the wet-nurse — Weaning the child ; indications for weaning in the child ; in the mother — Methods of weaning — The time for weaning 228 CHAPTER XXV. THE FEEDING OF INFANTS. ARTIFICIAL FEEDING. High mortality due to artificial feeding — Difficulty of providing a proper substitute for human milk — Substitutes for mother's milk — Composition of cow's milk — Modified cow's milk — The percentage modification of cow's milk — Milk laboratories — Home modification of cow's milk — Care and selection of the ingredients — Preparation of the baby's food — Steriliza- tion and pasteurization — Mixtures for average infants at different ages — Frequency of feeding — Selection of bottle and nipple — Heating the food — How to give the child the bottle — Care of the bottles and nipples — Pep- tonized milk — Condensed milk — Patent and proprietary foods — The feeding of older children 241 CHAPTER XXVI. BATHING THE BABY. Articles required — Temperature of the water — Hour for the bath — The best place — How to wash the baby — How to hold it — Pat the baby dry, then rub — Care of the hair and ^calp — Care of the gums and teeth — Cleansing after bowel movements — Powders ^0. xviu CONTENTS CHAPTER XXVII. CLOTHING FOR THE INFANT AND THE CHILD. PAGI Dressing the Infant — Character of the Infant's clothes — The baby's binder — The diapers — The infant's shirt, petticoat, dress, socks, nightclothes and other garments — The Baby in Short Clothes: Stockings, drawers, diaper- supporters, foot-gear, bibs, creeping aprons, outing clothes, night slip, wrapper — Children's Clothing: Underwear, outer garments, shoes, cloth- ing for out-of-doors, night attire 267 CHAPTER XXVIII. THE BABY'S SLEEPING HOURS. Amount of sleep required — Regularity in sleeping hours — Baby's position when sleeping — Time for sleeping — Preparing baby for bed — The awaken- ing in the morning — Ventilating the baby's sleeping room — The Baby's Bed: Bassinet, cradle, crib, clothes-basket — How to make the baby's bed — How to keep on the covers — Care of the bed — Keeping the air of the sleeping-room pure 274 CHAPTER XXIX. EXERCISING AND AMUSING THE BABY. Exercising the Baby: The infant's first airing — The proper method of holding a new-born infant — Taking the baby out — How to carry an older baby — The baby's first exercise — When the baby can hold its head up unsup- ported — After the child can stand and walk — Amusing the Baby: Toys for baby and child — How to make playthings at home — Games that \>oth exercise and amuse the child 283 CHAPTER XXX. MENTAL AND MORAL TRAINING. The moulding of character lies in the mother's hands — The control of the bladder and bowels — How to deal with children — A child's sensitiveness — Children's questions — Kindness and gentleness — A child requires pleas- CONTENTS xix PAGE tire — Politeness — Children's fears — The child a great imitator — How children learn conduct — Practice vs. precept — Making a child truthful — Children's imagination and temper — Obedience and how to enforce it — The spoiled child — Threats and punishment — Order and neatness — Learning to talk — The use of money — Children's pets — Stories told to children — Children in the society of their elders : Before company ; at the table — Education: Kindergarten, school — The training of backward and mentally deficient children 292 CHAPTER XXXI. WHEN THE BABY GETS SICK. How to Tell When a Baby is 111: Its cry, cough, position, movements and gestures; grinding the teeth, difficulty in suckling; appearance of the face and head, chest, abdomen and tongue — The baby's temperature — How to take the temperature — The pulse in sick children — The breath- ing — The baby's bowel movements — The Management of Sick Children: Selection of the sick-room; ventilation, heating — The bed; articles needed in the sick-room; cleansing of the sick-room — The care of the patient — How the child should be dressed in bed — Feeding the sick child — Admin- istering medicine to the child — Treating the throat — Administering a rectal injection — Attention to the urine 305 CHAPTER XXXII. THE COMMON AFFECTIONS OF INFANCY AND CHILDHOOD. The Highly Contagious Diseases: Measles, rubella, scarlet fever, diphtheria, membranous croup, small-pox. — The management of a highly contagious disease. — Isolation: Preparation of the room; method of disinfecting the linen, hands, dishes, vessels, urine and feces; the nurse's attire; care of the food; frequent disinfection; disinfecting the mouth and nose; convalescence; disinfecting the sick-room; disinfecting the bedding and clothing; disinfecting a privy, etc — Care of the body after death — Quarantine — The Management of the Mildly Contagious Diseases: Chick- en-pox, whooping-cough, typhoid fever, consumption. — The intestinal disorders of infancy 323 xx CONTENTS PART V. DISEASES PECULIAR TO WOMEN, CHAPTER XXXIII SYMPTOMS OF WOMAN'S DISEASES AND THEIR TREATMENT. PAGB Symptoms of Woman's Diseases: How to observe pain; its location, charac- ter, degree, duration, frequency, modifications; danger-signals. — Tempo- rary Treatment of Pain: Headache, pain in the abdomen, backache — Discharges: White or leucorrhea, yellow, bloody; their prevention and treatment. — Pruritis or Itching: Its cause and treatment— Constipation : Correction without drugs, by habit, exercise and diet 347 CHAPTER XXXIV. DISORDERS OF MENSTRUATION. Irregularity — Suppression — Cessation — Pain, during, before, and after the period — Flooding — Scanty flow — The sudden arrest of the monthly sickness by exposure, etc. — Treatment — Vicarious menstruation 361 CHAPTER XXXV. MISCARRIAGE AND ITS PREVENTION. The course of a miscarriage — The causes of a miscarriage — The Signs of a Mis- carriage: Pain, hemorrhage, the expulsion of the ovum — The danger of an abortion or miscarriage — The prevention of a miscarriage — How to avert it when threatened — Treatment of an inevitable miscarriage — Its after treat- ment • 367 3* « CONTENTS xxi CHAPTER XXXVI. STERILITY— ITS CAUSES, PREVENTION AND CURE. PAQir The woman not always to blame — Causes of Sterility in Women: Abnormali- ties, displacements, lacerations, inflammation — General conditions, such as obesity, anemia, etc. — Alcoholism — Absence of affinity — Lack of mod- eration — Prevention of sterility — The cure of sterility i^z CHAPTER XXXVII. THE CAUSES OF DISEASES PECULIAR TO WOMAN. Neglect of hygienic rules — Lack of proper exercise — Improprieties of dress — Improper food — Want of sufficient rest — The development of the mind at the expense of the body — Evils in the modern system of education — The girl's health given little consideration — Imprudence during menstruation — Mismanagement during and after child-birth — Artificial termination of pregnancy — Unhygienic marital relations — Chronic constipation — The majority of the conditions causing women's diseases are preventable . 377 CHAPTER XXXVIII. THE PREVENTION OF THE DISEASES PECULIAR TO WOMEN. The prevention of diseases lies in the woman's hands — When disease has oc- curred a physician must always be consulted — The importance of keeping the general health at its highest point — Attention must be paid to the man- ner of supporting the clothes and to the mode of life generally, especially during the period of puberty — Many diseases are prevented by the observ- ance of surgical cleanliness during a labor or miscarriage and by the exer- cise of prudence and care afterward — The prompt repair of all lacerations occurring during child-birth would be the greatest factor in banishing invalidism from womankind — The question of personal purity and of marrying only one of good moral character -&j zxii CONTENTS CHAPTER XXXIX ACCIDENTS AND EMERGENCIES. PAGE Foreign Bodies in the Eye ; in the Ear ; in the Nose ; in the Throat — The Effects of Heat — Burns and Scalds — The Treatment of Sunburn — Sunstroke or Heatstroke — Heat Exhaustion — The Effects of Cold — Freezing and its Treatment — Frost Bite — Treatment of Chilblain — The Effects of Injuries — The Condition of Shock — Contusion or Bruises — Wounds — Arrest of Hemorrhage — Removal of Foreign Bodies from a Wound — Cleansing the Wound; Closing and Dressing; Keeping the Part at Rest; Poisoned; by- Germs — Stings of Bees, Wasps and Hornets — Snake Bites — Bite of a Mad Dog — Sprains, Dislocations, Fractures — The Action of Poisons — Burns with Poisons — Drowning 393 GLOSSARY. Explaining the Meaning of the Medical and Other Terms Used in the Book. . 421 INDEX. Complete Index So Arranged that Anything in the Book May be Found at Once 441 PART I. HEALTH AND BEAUTY. CHAPTER I. THE BASIS OF BEAUTY. Standards of Beauty: according to Voltaire; among different ages and among different peoples; with the cultivated. Modern ideas of Beauty: Symmetry, Proportion, Curves, Color, Gradation. Human beauty not complete with- out expression. Youth not necessary to beauty. Health an essential. How every woman can acquire, increase, or retain beauty. The perfect woman. "A thing of beauty is a joy forever ; Its loveliness increases ; it will never Pass into nothingness." —Keats. BAN'S idea of beauty represents the best of what he sees. By observing and comparing all about him he finds what pleases him most; this he calls beauty. One's standard of beauty will depend largely on what one has been accustomed to. Voltaire, the great French philosopher, says: "Ask of a toad what is beauty, pure beauty, he will answer you that it is his female, with two large, round eyes projecting from her little head, a large and fat throat, a yellow belly and a brown back. Ask the devil, and he will tell you that the beautiful is a pair of horns, four claws and a tail." Ideas of Beauty in Different Countries. — The senti- ments of mankind with regard to female beauty have varied with different ages, nations and peoples. A North American Indian's ideal of female beauty differs from that of a China- 25 26 THE BASIS OF BEAUTY man. It is said that among the ancients a small fore- head and joined eyebrows were much admired in a woman, and that in Persia to-day large, joined eyebrows are highly esteemed. In some parts of Asia, we are told, black teeth and white hair are essential to beauty, in the Mariana Islands it be- ing customary among the women to blacken their teeth with herbs. Park relates of the Moors of Africa that with them corpulence and beauty are nearly synonym- ous terms. The gentle sex take great pains to acquire this accumulation of fat ear- ly in life; for this purpose young girls are compelled every morning to drink a large bowl of camel's milk. Appreciation of Real Beauty. — It is only the high- ly cultivated, however, who can appreciate real beauty. Ruskin says that no import- ance whatever is to be at- tached to the opinions of races who have never re- ceived any ideas of beauty whatsoever; that ideas of beauty are only received by minds under some certain degree of cultivation. Those who have this cultivation do not vary in their views as to beauty, but all hold the same opinion. Whatever may be. the difference of estimate among unpracticed or uncultivated tastes, there will be unity of taste among the experienced; therefore, the Beauty and Health. THE BASIS OF BEAUTY 27 result of repeated trial and experience is to arrive at prin- ciples of preference in some sort common to all, and which are part of our nature. THE MODERN IDEA OF BEAUTY. According to modern ideas beauty must respond to certain tests. Of these, the most important are symmetry, proportion, curvature, color and expression. By symmetry is meant the balance obtained when two parts are placed opposite each other. In animals opposite sides are balanced. The two eyes, cheeks and ears, the two arms, and so on, are equally distant from the median line. This symmetry is less distinct in plant life; but there is still a balance maintained between boughs on opposite sides of a tree, for instance, and the leaves and sprays on each side of the boughs. Flowers, as a rule, have their petals symmetrically arranged. The majority of fruits may be divided into almost identical halves. Even in the arrange- ment of her scenery, Nature follows this plan. The beauty of a valley lies in its opposite sides, which rise to equal heights; a beautiful stream flows in a winding course, so that one turn balances another. Proportion is the gradual tapering by which two un- equal parts are connected. The tapering of the arm, the narrowing at the waist and at the neck, are all instances of proportion. This same property is seen in the tree, which sends out shorter and smaller branches toward the top. Curvature is another important test of beauty. All forms of acknowledged beauty, according to Ruskin, are composed exclusively of curves. What makes woman, on the whole, more beautiful than man is the predominance of curves in her outline. According to Professor Kollmann, no line on her body is short and sharply angular; they all swell, or vault themselves in a gentle curve. The neck 28 THE BASIS OF BEAUTY and rounded shoulders are connected by gracefully curved lines, whereas a man's neck is placed more at a right angle to the more straight and angular shoulders. All the parts are well covered over with adipose tissue and connected by those gradual transitions which produce the gently rounded outlines; whereas in a man everything — muscles, sinews, blood-vessels, bones — is more conspicuous. Color and Its Gradations. — Color is generally regarded as a less essential ingredient of beauty than form. It is said to be the kind of beauty in which the eye takes most delight. In "The Spectator'' Addison gives a vivid descrip- tion of Nature's use of color in imparting beauty to the human face : "Nature has laid out all her art in beautifying the face. She has touched it with vermiflion, planted in it a double row of ivory, made it the seat of smiles and blushes, enlivened it with the brightness of the eye, hung it on each side with curious organs of sense, given it airs and graces which cannot be described, and surrounded it with such a flowing shade of hair as sets its beauties in the most agree- able light." An important element in color is gradation. Ruskin says that what curvature is to lines, gradation is to shades and colors. He states that gradation is so inseparably a quality of all natural shade and color that the eye refuses in art to understand anything in either which appears with- out it; while, on the other hand, nearly all the gradations of Nature are so subtle and between degrees of tint so slightly separated, that no human hand can in any wise equal or do anything more than suggest the idea of them. He is of the opinion that when the eye is quite uncultivated it sees that a man is a man and a face is a face, but has no idea what shadows or lights fall upon the face or features. If the eye be cultivated to some degree of artistic power, it will then see shadows distinctly, but only the more vig- II? THE BASIS OF BEAUTY 29 orous of them. Let it be cultivated still further, and it will see light within light and shadow within shadow, and will continually refuse to rest in what it has already discovered, that it may pursue what is more removed and more subtle, until at last it comes to give its chief attention and display its chief power on gradations which to an untrained faculty are partly matters of indifference and partly imperceptible. Importance of Expression. — Human beauty is not com- plete without expression. Form alone soon ceases to fasci- nate. It is expression, ever changing, that lends attraction to beauty and sustains one's interest. An index as to the mind and character, it has a great part in our estimate of a person. In the expression lies the individuality. The in- fluence of thoughts and emotions is seen in the face. Ruskin tells how the action of the intellectual powers upon the features is shown in the fine cutting and chiseling of them. The removal from them of signs of sensuality and sloth, by which they are blunted and deadened, substitutes energy and intensity for vacancy and insipidity. The want of those qualities alone has spoiled the faces of many fair women and rendered them uninteresting. YOUTH NOT NECESSARY TO BEAUTY. Youth, although usually associated with beauty, need not necessarily accompany it. Helen of Troy, whose beauty caused such a long and bloody war, was over forty years of age when Paris fell in love with her and carried her from her native home. Cleopatra, the famous Egyptian charmer, had passed her thirtieth year when she fascinated Marc Antony. At forty, Madame Recamier was universally regarded as the most beautiful woman in Europe. There is a difference, however, in the kind of beauty of the girl of sixteen and of the woman of thirty-five. Each age has its own type. A woman of advanced years makes herself 30 THE BASIS OF BEAUTY ridiculous when she tries to look youthful; she should en- deavor to enhance the mature charms which are proper to her age. This will give her a more real beauty. BEAUTY DEPENDS UPON HEALTH. Ruskin says that if a thing is the result of the complete fulfillment of a natural law it will be beautiful; if of the violation of a natural law it will be ugly. He considers it is easily demonstrable that the pleasure afforded by every living form is in proportion to its appearance of healthy vital energy. In other words, beauty depends upon health. When Health Goes Beauty Fades. — In disease the eye loses its lustre, the cheek its bloom; the hair becomes harsh and dry, the skin rough. Beauty soon fades when sur- rounded by unhygienic conditions. On the other hand, by constant attention to the rules of health a woman may de- velop a degree of beauty, although without such care she might not be in the least attractive. What Makes and Mars Beauty. — However shapely the hands and nails, without proper care they can never be really beautiful. It is the attention paid to the hair that gives it the fine and soft appearance so much admired. A smooth and clear skin is an indication of health. The figure can be greatly improved by attention to position and car- riage and by the practice of proper exercises; it may become misshapen and deformed by faulty position and by neglect of ordinary hygienic rules. Color, which has been shown is an important element of beauty, is dependent altogether upon the condition of the health. The sallow, the yellow, or the pale skin are all indications of disease. Beautiful teeth are due to the owner's intelligent care oftener than to Nature's gift. Indiscretion in diet and ignorance as to the proper kind and amount of exercise necessary may be re- THE BASIS OF BEAUTY 31 sponsible for the existence of fat in some cases and for its absence in others. How to Preserve Beauty. — Health, without question, is the path that leads to beauty. Cosmetics, drugs, and other artificial means only lead one astray. Every woman has as her birthright a beauty which she can acquire, in- crease or keep throughout her lifetime, if only she respect and obey Nature's commands and warnings. Yet through ignorance she may lose it all. It is one of the purposes of this book to point out and explain in a simple yet scientific manner the rules of hygiene which must be observed in order to obtain and preserve health and beauty, and to show how defects due to the non-observance of these rules may be corrected. With this object in view, chapters have been written on bathing and the care of the teeth, nails and hair. The proper positions for sitting, standing and walking are given, with exercises for developing the figure and acquiring a graceful poise. Clothing and food and drink are next con- sidered from the hygienic standpoint. This is followed by some practical suggestions on the subject of work, rest and recreation. THE PERFECT WOMAN. This study of female beauty has shown that it means something more than a pleasing outline; ennobling and en- dearing qualities of heart and mind are necessary to it, and health is essential. The perfect woman, who combines all these qualities, has thus been described by Wordsworth: 32 THE BASIS OF BEAUTY She was a phantom of delight When first she gleamed upon my sight; A lovely apparition, sent To be a moment's ornament. Her eyes as stars of twilight fair ; Like twilight's, too, her dusky hair ; But all things else about her drawn, From the Maytime and the cheerful dawn ; A dancing shape, an image gay, To haunt, to startle and waylay. I saw her upon nearer view, A spirit, yet a woman, too ! Her household motions light and free, And steps of virgin liberty; A countenance in which did meet Sweet records, promises as sweet; A creature not too bright or good, For human nature's daily food; For transient sorrows, simple wiles, Praise, blame, love, kisses, tears and smiles. And now I see with eye serene, The very pulse of the machine ; A being breathing thoughtful breath, A traveler between life and death. The reason firm, the temperate will, Endurance, foresight, strength and skill; A perfect woman, nobly planned, To warn, to comfort and command. And yet a spirit still, and bright With something of an angel light CHAPTER II. BATHING AS A MEANS TO HEALTH AND BEAUTY. The structure of the skin. The cleansing bath. The cold or hygienic or hardening bath. How one catches cold. The action of the cold bath. How to promote the reaction. Forms of the cold bath: The cold full tub bath; the cold half-bath; the cold sponge bath; the cold shower or douche bath. The reaction after a cold bath. Directions for cold bath- ing. The hardening effect of cold bathing. The Turkish bath. Sea bath- ing. The care of the complexion. Care of the ears. Facial massage. The use of cold cream. Face powders. General hygienic measures. The pre- vention of wrinkles and their removal. Chapped hands. "Cleanliness may be defined to be the emblem of purity of mind. ,, — Addison. HE uses and purposes of the bath are many. Bathing is resorted to as a cleansing measure, as a harden- ing process which renders a person less liable to catch cold, as an exercise, as a hygienic or curative procedure, and as a means to beauty. THE STRUCTURE OF THE SKIN. In order to understand the action of the different kinds of baths, and the reasons for their use, one must be familiar with the structure of the skin. The skin is composed of two layers, an outer thin, horny layer called the cuticle and an inner layer which contains blood vessels, glands and nerves, and is known as the true skin. A separation of these two layers may be seen in the ordinary blister which raises the outer skin or cuticle away from the inner skin. The red, sensitive surface, which is exposed when the blister bursts, is the inner or true skin. 3 33 34 BATHING AS A MEANS TO HEALTH The outer skin acts as a protection to the more delicate parts beneath. Like all other tissues of the body it is com- posed of cells. (See Chapter XV.) New cells are continu- ally being formed on the inner surface of this layer, while the old cells are being continually thrown off or shed in the form of dry, minute scales, appearing as a fine, white dust on the body and as dandruff on the head. There are no nerves in this outer layer, which conse- quently has no sensibility. The epidermis contains the pig- ment which gives color to the skin. The different shades of color are due to the varying amounts of pigment present. The sun's rays stimulate the formation of pigment; the races living in the warmer countries have a darker skin than those residing in cooler climates; exposure to the sun dur- ing the summer months produces tan and freckles in a fair skin. In the true skin are situ- ated muscle fibres which have the power of contract- ing with cold, and of relax- ing with heat. It is the former that gives to the skin the appearance of goose flesh. Running through the skin are various small nerves which receive sensations of touch, pain, heat and cold. The skin contains two kinds of glands: oil glands and sweat glands. The former are found all over the body, being especially abundant on the face. They are situated near the roots of the hairs and se- crete an oily substance which keeps the skin soft and pliable. The sweat glands are also distributed all over the body, lying deep in the true skin. From each sweat gland a long, nar- Section of the Skin (Magnified), Showing the Nerves. BATHING AS A MEANS TO HEALTH 36 row tube extends up through the skin and conveys the sweat to the surface of the body. Section of Skin Showing the Hairs and Oil Glands. (Magnified.) 7, 8, 9, Oil glands. 11, Root of hair. 6, Sheath of hair. Section of Skin Showing the Sweat Glands and Ducts. (Magnified.) 12, Sweat glands. 7, 13, 14, Ducts of sweat glands. THE CLEANSING BATH. It has been shown how the outer skin is constantly shedding dead, dry scales, and how the oily glands are de- positing grease on the surface of the skin. Both the scales and the grease tend to collect on the skin, and with or with- out dirt to form a coating which stops up the mouths of the tubes from the sweat glands — often spoken of as the pores of the skin — thus preventing the proper functions of those glands. To remove this accumulation, which may be so fine as to be almost unnoticeable, a cleansing bath is necessary. Warm and temperate baths are best suited to secure cleanliness. As water alone cannot dissolve the grease upon 36 BATHING AS A MEANS TO HEALTH the skin, the use of a pure soap is required. Baths should not be taken within two hours after a meal. As heat re- laxes the blood vessels in the skin and opens the pores, a person is liable to take cold after a warm bath unless she goes immediately to bed, thus preventing exposure, or else takes a cold sponge or shower, followed by a brisk rubbing, which restores tone to the blood vessels, thus causing the skin to return to its normal condition. THE COLD OR HYGIENIC OR HARDENING BATH. A cold bath followed by brisk rubbing accustoms the blood vessels of the skin to variations of temperature and is therefore employed to stimulate the whole system and to harden the body against catching cold. How One Catches Cold. — To understand the action of the hardening bath it is necessary to have some knowledge as to how one catches cold. When cold strikes the skin the blood vessels in the skin contract and send the blood to the internal organs. If the excess of blood remains in the in- ternal organs for too long a time, a condition develops which we speak of as "cold," characterized by inflammation of the nose, throat, or bronchial tubes, and recognized by a cold in the head, sore throat, or cough. The Action of the Cold Bath.— The object of the cold bath is to train the skin to become warm again after having been acted upon by cold. As stated before, when the cold water comes in con- tact with the skin, the blood vessels of the skin contract. Later, the time depending upon the reactive ability of the individual, these same blood vessels dilate and thus allow the circulation in the skin of a greater quantity of blood than before. This is called the reaction, which consists in the restoration to the skin of the heat that has been abstracted. It is the most important element in all cold applications. Copyright William 11. Rau. THE ANGEL MOTHER. In the coming of baby life mother life is often sacrificed. Yet mother love still hovers around the baby's couch coming fro ■unseen world to smooth the pillow and to protect her darling. BATHING AS A MEANS TO HEALTH 37 The benefit of the cold bath does not come from the chill that the cold water produces, but from this reaction or glow or feeling of warmth that follows the bath. How to Promote the Reaction. — In a person not ac- customed to cold bathing a brisk rubbing for several minutes after the bath is usually required to produce this reaction. As one becomes accustomed to the cold bath, however, the reaction occurs more and more quickly, requiring less and less rubbing, until finally it may occur as soon as the cold water strikes the body. The reaction is promoted or in- creased by the supplying of heat to the body before the bath by means of a hot tub or sponge bath or by a brisk rub, by active exercise during or after the bath, and by the adminis- tration of stimulants either before or after the bath. Forms of the Cold Bath.— There are various forms of the cold bath, namely: the full tub bath, the half bath, the shower bath, and the sponge bath. Everybody is able to take a cold bath, but everyone cannot at once, without having been accustomed to it, take the same kind of a cold bath. Yet all, except the very old, can be trained so as to be able to take any form of the cold bath with benefit and without discomforts The Cold Full Bath.— The cold full bath is also known as the plunge or dip. A person merely jumps into a tub containing water at a temperature of 72° to 59 Fahrenheit and jumps right out again. The Cold Half Bath. — In a cold half bath the person sits in a tub containing water of a temperature of from 85 ° to yo° Fahrenheit which reaches to the level of the navel. During the whole time of the bath, which should not last longer than one minute, the person rubs the front of her body with both hands, while someone else rubs her back with one hand and with the other dashes cold water on her shoulders. 38 BATHING AS A MEANS TO HEALTH The Cold Sponge Bath. — In the cold sponge bath the person may stand directly on the floor or in a foot bath con- taining twelve inches of warm water. She then, with a sponge or wash cloth, freely applies water of a temperature of 65 to 50 Fahrenheit to her arms, chest, back, abdomen, legs and thighs. The Cold Shower Bath.— In the cold shower bath the water issues from a number of perforations called a rose, situated a few feet above the person. The chief benefit of the shower bath or douche lies in the mechanical stimulation of the skin, caused by the force of the water, which pro- motes the reaction. The pressure of the water should be not less than one atmosphere, that is, fifteen pounds to the square inch. When the force is too slight there is no me- chanical irritation, but instead a chilling is produced by the evaporation of the light spray on the skin. There is, there- fore, an objection to taking the douche by means of tubing attached to an ordinary faucet unless the required pressure can be obtained. In most city houses the pressure in the second story is not over ten pounds to the square inch, and in the third story it may be only three or four pounds. The Reaction After a Cold Bath.— After every kind of a cold bath it is essential that a complete reaction take place, in other words, that the person become red and warm. To accomplish this the body after the bath should be rubbed with a rough towel until it glows. Persons not accustomed to cold bathing will be able to warm up after a bath if, be- fore applying the cold water, they lie for about ten minutes in a tub full of water at a temperature of 95° to ioo° Fahren- heit, or sponge the body for a minute or two with water of the same temperature, or rub the body into a glow. General Directions for Cold Bathing.— The best time for taking a cold bath is immediately upon rising, while one is still warm from the bed. Before the cold bath is taken the BATHING AS A MEANS TO HEALTH 39 face and head should be wet with cold water to prevent the blood rushing to the head. If a person feels chilly after the bath and does not become warm after brisk rubbing she should go to bed until she has reacted, after which she may get dressed. There is no danger of taking cold after the bath if reaction occurs, as the warm blood coursing through the dilated vessels in the skin acts as a protection to the body. One can go out into the open air immediately after a cold bath that has been followed by a good reaction. Persons not used to the cold baths may first employ water of a temperature a little higher than that given and then gradually reduce it from day to day. It is best to be- gin systematic cold bathing in the warmer months. The Hardening Effect of Cold Bathing.— The harden- ing effect of the cold bath comes from its training the ves- sels of the skin to dilate after being contracted by cold, so that variations in the temperature and draughts, instead of chilling the body, will produce a feeling of warmth. THE TURKISH BATH. The Turkish bath is a form of physical exercise and is of hygienic importance in promoting the circulation, in- creasing the nourishment of the various tissues, and getting rid of waste matters. It is particularly beneficial to persons of sedentary life, who have no other form of exercise, to the obese, and to those of a gouty and rheumatic tendency. Method of Giving the Turkish Bath. — After undress- ing, the person about to take a Turkish bath drinks a glass of hot or cold water and lies down upon a couch in a room of a temperature of no° to 130 Fahrenheit. If she does not perspire promptly she is rubbed or given a hot full bath, a hot spray bath or a hot foot bath. After perspiration has begun the subject enters a room heated to a temperature of 150 to 200° Fahrenheit, remaining there but a few minutes until 40 BATHING AS A MEANS TO HEALTH she perspires very vigorously. She is then conducted to the shampooing room and placed upon a marble slab. Here she is first rubbed from head to foot with the bare hands or with Turkish mitts until all the loosened scales have been removed and then is shampooed with soap, the lather be- ing rubbed in with a clean brush or with a mass of flax, manilla, horsehair, or other fibrous material. When the whole surface feels like polished marble the subject is given a cold douche at 6o° Fahrenheit or less, after which, with a sheet wrapped around her, she lies down on a couch until dry. The effect is similar to that of other hot baths. SEA BATHING. An excellent exercise, as well as one of the most in- vigorating forms of the cold bath, is surf bathing. The im- pact of the waves and breakers upon the skin and the stimu- lation due to the salt in the water help to promote a reaction. Chilling is to be especially avoided, as it is a sign that the person is not reacting well; consequently as soon as a person feels cold or her teeth chatter or her lips look blue she should immediately come out of the water. As surf bathing is an exercise it should not be indulged in when one is overheated or exhausted. The best time for the ocean bath is in the morning but the bath must not be taken until at least two hours after a meal. During her menstrual period and in the last months of pregnancy a woman must not indulge in sea bathing. THE CURATIVE BATHS. HYDROTHERAPY. Various forms of baths are employed as a means of treating diseased conditions. A cold tub bath is used in treating typhoid fever and fevers generally. The various sweat baths are used in many conditions, especially kidney BATHING AS A MEANS TO HEALTH 41 trouble and rheumatism. A description of these baths is not required in a work of this character. THE CARE OF THE COMPLEXION. The face should be washed carefully every morning and night and at least once or twice during the day. Too much washing, however, is harmful. The toilet of the face should begin with the thorough cleansing of the hands, as pimples and other diseases of the face may be caused by rubbing into the skin the minute microbes which are ever present in the hands. The face is then washed with clean water. It is best to use only cold water as it stimulates the blood vessels and improves the circulation in the skin in the manner described when speaking of the cold bath. Moreover, the use of warm or hot water is likely to produce chapping and roughening of the face, especially in winter when it is exposed to cold. If, however, after the face has been bathed with hot water, cold water be rubbed on it, the blood vessels will recover their tone and the injurious effects mentioned will be avoided. The best time for using hot water on the face is at night be- fore retiring. If the water from the tap is hard, it may be rendered soft and more cleansing by the addition of a few drops of ammonia or a pinch of borax. The water should be applied with the hands, or with a wash cloth. The greatest care must be exercised in keeping the latter thoroughly clean. A sponge is usually objectionable, as it cannot, as a rule, be kept perfectly clean. A complexion brush may be used for the nightly scrub. The use of soap on the face as a rule is unnecessary for a perfectly healthy skin. It may be permissible, however, but only in moderation, for persons with oily skins or those ex- posed to an atmosphere laden with dirt. The best time for the use of soap is at night before going to bed. Oftener than twice a day, night and morning, is positively harmful. After 42 BATHING AS A MEANS TO HEALTH being washed the face should be carefully dried with a soft towel. Care of the Ears.— The ears should only be cleansed with a damp cloth and should never be washed with soap and water. Nothing should ever be put in the ear, and no one but a skillful physician should attempt to remove the wax. Facial Massage. — It is a good plan in the morning, or better twice a day, to thoroughly knead and pinch the face with the finger tips. There is nothing better to stimulate the circulation of the skin and to improve the complexion. This is especially valuable when the complexion is sallow, and when there is a tendency to pimples and blotches. Rubbing the face with a silk handkerchief after the toilet has been completed gives it a pleasing polish which is not a shine. It sometimes is of advantage to rub a little alcohol or bathing whiskey on the face after the bath. The Use of Cold Cream. — One way to cleanse the face during the day, is to simply wipe it first with warm water and then with cold water, and after this carefully dry it. In- stead of this method, however, the face may be cleansed with cold cream in the following manner: A good cream made of wax and oil of almonds and containing neither vas- eline nor animal fat, should be applied to the face and then wiped off gently with a soft cloth. Directly after the nightly scrub a simple application of cold cream may be made, the cream being thoroughly worked in the skin for about ten minutes with the tips of the fingers or the palm of the hand and then gently wiped off with a soft towel. This anoint- ing of the face at night with cold cream or with a little lano- lin or almond oil is particularly serviceable when the skin is unnaturally dry. Face Powders.-— If the skin is very greasy or if the weather is hot a small quantity of powder made of rice, tal- BATHING AS A MEANS TO HEALTH 43 cum, starch, bismuth, zinc oxide or magnesia may be applied to the face. General Hygienic Measures. — Good health being nec- essary for a clear complexion, attention to diet, exercise, etc. y are important aids in preserving a beautiful skin. HOW TO PREVENT WRINKLES AND HOW TO REMOVE THEM. There are two ways of preventing wrinkles. One is to cultivate a kindly and cheerful disposition, wrinkles fre- quently being caused by t^he setting of the muscles of the face in certain lines that occur when the temper is bad and the disposition sullen or melancholic. Occasionally, how- ever, what appears to be a deep wrinkle may be merely a condition due to a clogged state of the pores. The other method of preventing wrinkles is the care of the face in the manner just described, massage being es- pecially important. In massaging to prevent or efface wrinkles, the tips of the fingers should be moved lightly up and outward with a rotary motion. Crow's-feet, or the fine wrinkles which appear around the eyes, are sometimes re- moved by pinching with the fingers of both hands. Fre- quently puckering the lips, as if about to whistle, may ban- ish the small wrinkles around the corners of the mouth. Chapped Hands. — The most frequent cause of chapped hands is the practice in the winter time of bathing the hands in warm water without subsequently rinsing them in cold water. Women who wash and scrub are especially liable to have the skin of their hands become rough and cracked, even when the outside air is only moderately cold. For many years the author has been treating and preventing chapped hands by means of a preparation, consisting of equal parts of alcohol, glycerin and rose water. This is to be rubbed freely and thoroughly on the hands at bed time and at other convenient occasions. .CHAPTER III. THE CARE OF THE TEETH, THE NAILS AND THE HAIR. Perfect Teeth are necessary from the standpoint of health as well as beauty. How to preserve the teeth: Powder, brush, mouth-wash. Cleansing and manicuring the Nails. Structure of the Hair. How to care for the hair: Brushing, combing, shampooing, massage. Curling the hair. Hints on hair dressing. "My Love doth in herself contain All this World's Riches that mav far be found; If Pearls, her Teeth be Pearls, both pure and round; If Ivory, her Forehead Ivory ween; If Gold, her Locks are finest Gold on Ground ; If Silver, her Fair Hands are Silver Sheen." — Spenser. EAUTY is in no part of the body so much the result of care and attention as in the teeth, the nails and the hair: Decayed teeth spoil an otherwise beau- tiful face and only too frequently are the result of neglect; shapely hands may look unsightly because the nails are not well kept; and in many instances beautiful hair results from constant care. THE CARE OF THE TEETH. Perfect teeth not only add to the personal appearance but they are necessary to the general health in that they permit of thorough mastication of the food. The teeth must not be treated roughly. They must not be used, for instance, for cracking nuts. Particles of food remaining in the teeth after eating should be removed by means of dental floss or of a soft 44 GIVING THE BABY ITS DAILY OUTING. The mother should exercise the greatest care in giving the baby sufficient outdoor life and tinder the most favorable conditions. Careful directions are given by the author, telling what every mother should know in order to secure the best results. THE TEETH, THE NAILS AND HAIR 45 orange wood or quill toothpick, or by means of a tooth- brush and lukewarm water. At least twice during the twenty-four hours, best before going to bed and as part of the morning toilet, the teeth should be cleansed with a pure soap or a powder that will polish slightly without harming the enamel. A good tooth powder may be prepared from equal parts of powdered borax, precipitated chalk and powdered orris root. The brush should not be too broad. It may be made of wood, badger skin or felt, but is best made of bristles. The bristles should be long, moderately stiff and elastic. They should be of uneven lengths and should not be placed too closely together. A new tooth brush should be soaked in cold water for several days before being used. After a brush has become soft or ragged from long use it should be discarded. The teeth should be brushed up and down and across, both inside and outside. It is well to rinse the mouth with a mild antiseptic solution at bedtime or every night and morning or after each meal. An excellent mouthwash con- sists of tincture of myrrh, rose water and alcohol in equal parts, flavored with a drop of oil of almond, and containing formalin in the proportion of i drop to the ounce. Dissolv- ing a teaspoonful of spirits of camphor and a teaspoonful of tincture of myrrh in the water makes another excellent mouthwash. Inasmuch as acids injure the dentine they should not form part of the mouthwash. At least twice a year the mouth and teeth should be examined by a competent dentist so that any commencing decay may be detected in time. THE CARE OF THE NAILS. The nails are kept clean by means of soap, warm water, and a nail brush and the frequent use of a wooden, ivory or 46 THE TEETH, THE NAILS AND HAIB metallic nail cleaner. The latter should always be blunt. A penknife or other sharp instrument should not be used as it scratches the under surface of the nail, thus making a place that favors the lodgment of dirt. It is better to use an orange stick or a soft wooden toothpick for cleansing the nails. An excellent instrument is a finger-nail sheathed in a folded handkerchief or towel. Once or twice a week the skin overhanging the root of the nail should be pressed back to prevent it encroaching too far over the half moon and thus becoming torn and ragged. For this also the orange stick should be used. Manicuring the Nails. — The nails should be manicured once a week. For this purpose a nail file, a pair of nail scis- sors, an orange stick, a chamois nail polisher and a small box of nail powder must be provided. The fingers should first be dipped in w T arm, soft, soapy water, to which a few drops of cologne or compound tincture of benzoin has been added. The nails will be softened in a few moments, and then should be filed into a curve so that the whole nail will, as nearly as possible, approach the shape of an almond. The skin is now gently pressed from the root of the nail with the orange stick. The nails are next carefully dried and rubbed thor- oughly with plain vaseline, after which they are polished with the chamois, care being taken not to heat the nails with the friction. The nails are once more rinsed and dried and are then rubbed with a little fine powder. Instead of being filed the nails may be cut with a pair of scissors. Finger nails are always cut in a curved direc- tion ; toe nails should always be cut straight across. Stains are removed from the nails by a solution of one part of acetic acid to sixteen parts of rose water. THE HAIR AND HOW TO CARE FOR IT. The hairs lie imbedded in the scalp, each root being THE TEETH, THE NAILS AND HAIR 47 contained in a long shaft into which the mouths of the oil glands empty, as shown in the accompanying diagram. In order to preserve the hair, the scalp must be kept perfectly clean and free from dandruff, a condition which is obtained by shampooing, massage and daily brushing. Dan- druff consists of the old dead cells of the outer skin or epi- dermis which have been thrown off by the scalp in the form of dry scales. It is most abundant when the scalp is unhealthy. Brushing the Hair. — The hair should be brushed for several minutes every morning and night. The frequent stimulation of the circulation of the scalp produced by this increases the growth of the hair. Brushing also removes dandruff and distributes throughout the hair the natural o i 1 which comes from the scalp. There is no necessity of brushing the hair a certain number of l^P' ' - • l\) •'! f t i trLes ^ a s some people seem | ' ; ' { ;\^ ;;{ ' | to think. The brushing should merely be continued until a feeling of warmth, without soreness, is present in the scalp. A stiff brush with little tufts of bristles, widely separated, should be used for adults : one somewhat softer must be employed for children and for those with very sensitive scalps. The brush, how- ever, should not be so stiff as to produce any soreness. A wire brush should never be used as it breaks the hairs and pulls them out. The Hairs and the Oil Glands (Magnified) 6. The hair shaft. ii. The root of the hair. 7, 8 and 9. The oil glands. 48 THE TEETH, THE NAILS AND HAIR How to Comb the Hair. — Thorough combing does not cause a serious loss of hair as many women fear; it removes only the loose hairs that are ready to fall and whose place will soon be taken by new and more vigorous ones. The hair, nevertheless, must be treated very gently. The comb should be grasped between the thumb and first two fingers and drawn down the length of the hair. It should never pull the hair roughly in raking out the snarls. In some cases it is better to separate the snarls with the fingers. The comb should be coarse and have smooth teeth, with blunt ends, set widely apart and with round edges where they are joined to the back. The old fashioned fine-tooth combs should be discarded, as they not only pull out the strong hairs but their fine points often irritate the scalp. Cleansing the Brush and Comb. — Once a week the brush and comb should be cleansed by being shaken in hot water to which a little ammonia has been added. The brush should be held parallel to the surface of the water while be- ing shaken. After they are washed it is often well to disin- fect the brush and comb by placing them for ten or fifteen minutes in a solution containing a drop or two of formalin or twenty grains of boric acid to an ounce of water. The comb should then be carefully wiped between the teeth. The bristles of the brush must be wiped so that they will dry soft. Standing the brush on its bristles, while it is drying in the sun, will prevent the water soaking into the back and ruining it. It is well not to use a comb and brush belonging to another person. Massage of the Scalp. — Daily massage of the scalp will improve its circulation and increase the growth of the hair, especially when the scalp is pale and thin. The finger tips should first be moved vigorously over all parts of the scalp CAEB OF THE TEETH, THE NAILS AND HAIE 49 and later, being placed firmly on the scalp, should move the scalp over the underlying skull. Shampooing the Head. — Shampooing is necessary to cleanse the scalp and keep it free from dandruff. Although the loose hairs are removed by shampooing, those that are left are stimulated to a better growth. The frequency with which shampooing is required depends upon the rapidity with which dandruff and dirt collect, and thus varies from once a month to once a week or oftener. To shampoo the hair, tincture of green soap or any good, pure soap should be rubbed thoroughly into the scalp with the finger tips. A little warm water is then added and a good lather is made which must be rubbed vigorously into the scalp with the finger tips or with a stiff nail brush. After this the hair should be rinsed with warm water, using several waters un- til the last is perfectly clear. The danger of catching cold is averted if the scalp be then douched with cold water. The hair should be dried thoroughly with soft, warm towels, and, if possible, also with the heat of the sun or of a fire. Turkish towels should not be used as they are too rough, and tend to pull out the hairs. The hair should be shaken from time to time while drying. After the scalp is dried it should be massaged well with the finger tips until the head feels in a glow. The scalp always feels dry immediately after wash- ing, but, as a rule, it soon becomes oily again owing to the improvement in circulation and the stimulation of the oil glands. When, on the other hand, it remains dry, it may be rubbed with pure vaseline, olive oil, or almond oil, which, however, should not be rubbed through the hair. The removal of lice and nits from the hair will be de- scribed in detail in Chapter XXXI. Curling the Hair. — Curling the hair is not objectionable if it is not done with too much vigor. Curl papers are not likely to do much harm if they are not put on so tightly as 4 60 THE TEETH, THE NAILS AND HAIH to pull on the roots of the hair. The incessant use of the curling iron, however, has a tendency to make the hair un- naturally dry and probably spoils the ends. Hints on Hair Dressing.— In dressing the hair care must be taken not to make violent traction upon the roots, which has a tendency to loosen the hair and cause it to fall. The hair should be rolled loosely and not squeezed into a tight knot. "Rats" and false hair are said to injure the growth of the hair b}^ overheating the scalp. The assertion is also made that tangling the hair, by combing it in the wrong way in order to make the pompadour stand up, is injurious and loosens the hairs, which are more apt to be broken off. Mrs. Symes says that every woman should discover the most becoming v/ay of wearing her hair, and then stick to it no matter what fashion may dictate. "Suitable and be- coming hairdressing," she writes, "may redeem even a very plain face, and it is deplorable to see the hair ill treated by neglect or dragged into a style which makes it unbecoming to the face it should adorn. "A woman may have an ill-shaped mouth or crooked nose, or little eyes, and still be pretty, if her hair is becom- ingly arranged, but if all her other features are good, and she has an extremely high forehead with the hair growing upon it in an awkward line, she will never be more than a plain looking woman, unless she takes means of compromising this enemy to good looks "Study yourself and you will be surprised how you can improve, not only the beauty of your face, but, when wear- ing evening dress, even the appearance of your neck and shoulders. "By dressing the hair low on the nape of the neck the thin woman can take a great deal off its length if she wishes to do so." CHAPTER IV. THE FIGURE— HOW TO DEVELOP A GRACEFUL CARRIAGE. Standard of Beauty in the Figure. The Prevention of Deformities. How de- formities are acquired. School a factor in producing deformities. How to detect deformities. Mechanical means to prevent deformities. How to improve the figure. The correct standing position. The position to be assumed when sitting. The proper method of v/alking. Exercises for developing a graceful carriage. How to utilize housework in developing the figure. Exercises for developing the figure. "The human form divine." — Pope. BEAUTIFUL figure is seldom the work of Nature unaided. Through want of proper exercise and consequent absence of muscular development, a perfect frame may not appear to advantage. Mus- cular weakness, due to the same cause, combined with faulty positions, may even produce noticeable deformities. A body perfectly formed loses much of its beauty if not associated with elegance of poise and grace of carriage. On the other hand, one less endowed by Nature may possess a striking figure, owing to her physical develop- ment and general bearing, which have both been acquired. It is in the power of every woman to attain a graceful car- riage and well-developed figure and to avoid deformities. Standard of Beauty in the Figure. — To say that there is but one standard of beauty in the human form would be indeed wrong. The types are various. One, like the Venus de Milo, is tall and majestic; another delicate and diminu- tive, like the Venus de Medici. There are certain measurements, however, which have 61 52 THE FIGURE been accepted by artists generally as being those of the ideal female figure. The height of such a model is five feet five inches; the waist twenty-seven inches; the bust, under the arms, thirty-four inches, and over the arms forty- three inches. The circumference of the upper arm is thir- teen inches, of the wrist six inches, of the thigh twenty-five inches, of the calf of the leg fourteen and a half inches, and of the ankle eight inches. The weight of this ideally propor- tioned woman should be one hundred and thirty-eight pounds. These dimensions are somewhat larger than those of the Venus de Medici, which is regarded by many author- ities as the type of perfect female beauty. The height of this figure is five feet, less than that of the average American woman. The head is small and the face oval in shape, the breadth being two-thirds of the length. The waist measures thirty inches in circumference and is four inches in length, being a much larger waist than that of the fashionable woman of to-day. Deformities May Be Avoided. — Such perfection is ne- cessarily a gift of Nature. Many irregularities, however, occur in the figure which are due to deformities that might have been prevented, and to faulty positions that were as- sumed through ignorance. THE PREVENTION OF DEFORMITIES. It is always much easier, to prevent deformities than to remedy them after they have occurred. How Deformities are Acquired. — Many deformities oc- cur during infancy and are directly due to the ignorance of the nurse or the mother. Children who are improperly nourished often develop a condition known as rickets, in which ail the bones are THE PRIDE OF WOMANHOOD. Health and bianly require that intelligent attention be given to the care of the hair, skin, teetli an J nails. These are won pride. Directions are given in this volume. THE FIGURE 63 soft. When a child suffering from this disease starts to walk, its legs always become bowed. Improper methods of holding the baby may lead to serious deformities, especially of the spine. The proper way in which an infant should be held when carried about and when nursed is described in Chapters XXIV and XXIX. The back and neck must always be supported. It is not well to hold the baby in the arms too much. The Hindoo nurse seldom or never takes the infant on her knee or in her arms. She puts it down on the floor or on a mat. where it lies quietly until it gets sufficient strength to roll about. Improper clothing may also produce deformities, cor- sets and tight lacing being especially harmful. Faulty position, however, is the most common cause. The proper position for standing or sitting will be described later in this chapter. Faulty positions in bed lead to curvature of the spine, especially in persons who are weak or debilitated. One should not always sleep on the same side, but should change about. Soft beds and high pillows are especially liable to produce deformities. A hair mattress should be used, with a rather low, elastic pillow. Spinal curvature is also frequently caused by carrying books or other weights always on the same arm. When these objects must be carried, they should be supported first on one arm, and then on the other. School as a Factor in Producing Deformities. — A curved spine is usually acquired in school, owing to the fact that children of all sizes must sit at a uniform-sized desk. The desks and seats in the school-room should be ad- justable, so that they can be fitted to any child. The desk should be one inch higher than the pupil's elbow and should have an inclination of about ten to fifteen decrees, its ed^e 64 THE FIGURE projecting slightly over the edge of the seat. The seat should be not less than eighteen inches broad, so as to sup- port almost the whole thigh, and of such a height that the feet rest firmly on the floor when the knee is bent at a right angle. With the child sitting in an erect posture the dis- tance from the eye to the desk should be sixteen inches. Kow to Detect Deformities. — The deformity should be recognized and corrected before it becomes too marked. As it usually comes on gradually and insidiously, it at first attracts little attention. The first thing to be noticed will be a considerable de- crease of muscular power and a feeling of general depres- sion and fatigue from the slightest exercise. The child is listless and inactive and has a tendency to lounge and loll about in decided contrast to the usual activity of youth. There is a disposition to stoop and to appear awkward, care- less and ungraceful. If the girl be examined, the muscles of the back will be found wasted and the ribs will be plainly seen. The shoul- der-blades will be prominent, and one will be a little higher than the other. The knobs of the spine will pro- ject and, instead of being in a straight line, will form a curve. In order to bring this out it will be necessary to mark the skin along the knobs of the back with ink or with a thick pencil, or to rub it until it shows a blush of red. If a plumb-line be then dropped from the top of the head along the back while the girl stands as erect as she can, the curva- ture will be plainly discerned. The deformity may be so marked that it can be easily seen without the use of a plumb-line. How to Prevent Deformities. — Various appliances have been used at different times to prevent deformities. Shoulder braces at one time were much used, and stays and corsets were also very popular. Even backboards were employed, THE FIGURE 65 and certain ingenious collars to hold up the head were at- tached to braces, stays or back-boards. A century ago educa- tion chairs, stocks, inclines, horizontal planes, the windlass, stretching chairs and braces were the means of making young women grow up with straight figures. All such mechanical contrivances are very injurious and although they may hold the back straight for the time being they really tend to in- crease the deformity. The body is held erect by muscles. A muscle is developed and strengthened by use and weakened by disuse. If an arm be kept in a sling for several weeks its muscles will become thin and wasted and in time the arm will lose its power. In the same manner braces which keep the spine straight take the work from the muscles, which thereby become weakened. In consequence the girl is un- able to hold herself straight without the continued use of the brace. The proper method to prevent deformities and to cor- rect them is with appropriate exercises to strengthen the muscles which support the part, and thus by natural means to overcome the deformity. HOW TO IMPROVE THE FIGURE. There are many ways of developing a good figure and a graceful carriage. First and most important, is the as- suming of a proper position while sitting, standing or walk- ing, while at rest and while at work. There are many exer- cises, with and without mechanical contrivances, for im- proving the figure and there are many sports and games which will aid in its development. The Correct Standing Position. — Without a graceful carriage a beautiful form may appear to disadvantage. Not only is correct poise beautiful, but it is in itself of educa- tional and hygienic importance. In a slovenly manner of 58 THE FIGURE standing the muscles of the back and abdomen do not get their proper share of work, and the person becomes readily fatigued. The most common fault with women is that in standing they project the abdomen. In an endeavor to pre- vent the shoulders becoming round they throw back the upper part of the body, at the same time pressing forward the abdominal walls. This position usually tires the back muscles and causes many of the aches and pains felt in this region. To stand straight, a girl should place her feet almost parallel, the heels being one to six inches apart, as may be easiest, the toes turning outward a little, as is most natural and comfortable for the individual. She should let her arms hang easily by her sides. When the chest is drawn up to a high position, all the other parts of the body naturally fall into their proper relations with it. The weight of the body should be thrown forward on the ball of the foot and toes, rather than on the heel. The ease and balance of this position may be tested by rising on the toes as far as possible, maintaining the position for a moment, and coming down gently until the heels touch the floor. When this can be done without los- ing the balance, the proper position has been assumed; but if the person has to take a step forward or backward to recover her equilibrium, the center of gravity is misplaced and the position must be resumed until, after a few at- tempts, the proper position is found and kept. In this posi- tion the shoulders, hips and ankles will be in a straight line. The correct carriage may be tested by passing the hand over the back; if the ends of the shoulder-blades can be felt, the carriage is correct. The Position to be Assumed When Sitting. — A girl should sit on the whole seat of a chair, not just on the edge. When she is seated back in her chair, the seat should be THE FIGURE 67 about three-fourths as deep as her thigh. Her feet should rest easily upon the floor, or on a footstool if the chair is too high. The erect position is maintained by drawing up the crown of the head. A girl should never lounge in a chair or allow herself to flop. If she is too fatigued to sit straight she should lie down until she is rested. She should never sit in a chair resting on one foot or lean her head upon her hand or bend the head forward or stoop at the shoulders. She should always lean forward from the hips and not from the waist. Unless proper postures are maintained no amount of exer- cise can overcome the deformities that will be produced. The Proper Method of Walking. — In walking, the cor- rect standing position must first be assumed. A girl should hold her chin up, her chest forward and her abdomen in. The shoulders will then fall into their proper position and not have to be pushed back. In walking up stairs she should hold herself erect, keeping the back, neck and head in a straight line. She should not bend forward in passing from step to step. She should never run up stairs, but should place each foot flat on the step, taking deep breaths as she slowly ascends. She may walk down stairs very grace- fully by not springing upon the steps, but by bending the knees and dropping the weight from step to step with as little motion as possible. EXERCISES FOR DEVELOPING A GRACEFUL CARRIAGE. The remarkably erect figures of the Turks, mentioned by travelers, have been ascribed to the wearing of a heavy turban. About two centuries ago a Frenchman named Andry, having noticed the erect attitude of milk- maids who carried small pails on their heads, applied the same principle to the improvement of the figure. He caused 58 THE FIGURE a weight, such as a powder box, to be balanced on the fore part of the head where it would be most apt to fall, thus exercising the muscles of the back and neck. He introduced this balancing as a game in which children might be inter- ested. It was adopted in a convent for girls, a forfeit being demanded whenever the object was dropped. Probably the best exercise to develop a good carriage is to carry around on the head a light object, such as a bean bag. This should be balanced first in the correct standing position and then as the girl walks about the house and up and down stairs. HOW TO UTILIZE HOUSEWORK IN DEVELOPING THE FIGURE. If housework tends to spoil the figure it is because no attention is paid to the positions assumed. Yet by ob- servance of hygienic principles housework may be often utilized in developing the figure. Many girls spend most of their time in working about the house and have little opportunity for games and sports or sometimes even for ordinary exercise. It is of extreme importance, therefore, that they utilize their work as a means of improving their figures rather than allow them to become deformed by it. When sitting at any kind of work, such as sewing or paring apples, a woman should avoid the temptation to stoop. It is so easy to curve the back and shoulders and on getting up to sometimes forget to straighten out again. After several years of such bad habits the shoulders will be round, the head will protrude forward, the neck will be thin and the chest flat and narrow. When standing to one's work, the erect posture must be maintained. Kneading bread, with the shoulders thrown back, will develop splen- did arm muscles. For this, however, the molding-board must be at the proper height. One of the best physical THE FIGUKE 59 exercises and one that gives the shoulders splendid devel- opment is the old-fashioned scrubbing on hands and knees. One must remember, however, to keep the back straight, the chest forward and the abdomen drawn in. It is well to develop both sides equally by first using one hand and then the other. Likewise when sweeping, the broom should be changed from side to side to prevent one-sided development. The same principle must be applied when ironing. In this case it is most important to have the iron- ing-board at a comfortable height. One should be properly dressed for housework. The best costume consists of a loose flannel blouse and short skirt made like a gymnasium suit, with the collar loose and low. Corsets and high-heeled slippers are entirely out of place. EXERCISES FOR DEVELOPING THE FIGURE. Every woman should devote at least a few minutes dur- ing the day to exercise of some kind. Walking, running, climbing, bicycling, horse-back riding, rowing, canoeing, swimming and dancing are excellent forms of exercise. Playing at lawn tennis, tether tennis, golf, basket ball, bowling, fencing and punching the bag also greatly aid in developing the figure as well as in preserving the general health. These various forms of exercise are described in detail in Chapter VII. Where a woman is unable to indulge in sports and games, as is so frequently the case, she can at least spare a few minutes for certain simple exercises which require no apparatus. The gain in health and in physical appear- ance will more than compensate her for all the time she spends. Breathing Exercises.— One of the chief benefits of all exercises is the development of deep breathing that occurs 60 THE FXGUBE with them. Breathing exercises themselves are very im- portant. Proper expansion of the lungs not only develops the chest and thus improves one's health, but it helps to ward off many diseases. If the lungs are always supplied with a full amount of air they are less liable to be attacked by consumption. Those who are unable to develop deep breathing by means of sports and games can at least prac- tice breathing exercises for a few minutes each day. These exercises are especially important to those with poor chest expansion, and to persons just recovering from pneumonia or pleurisy. In all breathing exercises the chief thing is to inhale deeply and slowly until unable to get any more air in the lungs. A woman will receive more benefit if when the chest is full she will hold the breath while she counts ten. These breathing exercises may be combined with va- rious movements. From a position down at the sides the arms during the inspiration may be raised slowly, with the palms up and the arms back and extended, coming together above the head just as the inspiratory act has been completed. The breath should be held for ten seconds and then let out slowly through the mouth, the arms at the same time being brought down in front until they reach their first position as the last bit of air is forced out. This should be repeated five or ten times. The best time for the exercises is in the morning be- fore breakfast. They should be taken in a room well ven- tilated, but free from draught, in which the windows are down from the top and open from the bottom. Loose- fitting clothing or the night dress should be worn, the feet being bare or stockinged to allow the greatest movement. Before beginning the exercise the woman should evacuate her bladder, clear her nose of all mucus and drink a glass of water that is not too cold. THE WOOING— ROMEO AND JULIET. From earliest days poets have sung of the happy moment in a woman 's life when she hears from her lover avowing his devo- tion: "When my lips meet thine thy very soul is wedded into mine." THE FIGURE 61 Toe Rising. — The woman should stand with her hands on her hips, her body upright, her chin high and her toes turned out. With the heels together she should rise slowly on the balls of her feet, keeping the knees straight, and should then lower the body steadily until the heels touch the ground. She should repeat these exercises from fifteen to twenty, or even to fifty times. Twisting Exercises. — In the same position as in the first exercise, turn the body first to one side and then to the other, rubbing the hands across the abdomen at the same time, and keeping the head in line with the body. This may be repeated from five to ten or fifty times. Bending Forward and Backward. — Standing in the same position, bend forward as far as possible, leaning the face forward and kneading the abdomen with the hands. Then bend backward, allowing the chin to rest on the chest. This may be repeated five to ten times, or gradually in- creased to thirty times. Bending to the Side. — Bend the body to the side in a straight line, without bending forward or backward, until the extended hand touches the knee, the other hand being brought into the opposite arm pit. Then bend to the other side, reversing the conditions. This may be repeated five to ten times. Elevating the Shoulders.— This is a quick movement, excellent for correcting round shoulders and expanding the chest. Elevate the shoulders as high as possible without drawing in the head; then lower them as far as possible. Then draw the shoulders forward, crossing the arms at the wrist; then draw the arms up in a cross position, and as soon as they reach the level of the chin separate them and carry them forward in a circle on each side of the body. Windmill Exercise. — Bend the body at right angles to the legs and keep in this position throughout the exercise. 62 THE FIGURE With the right hand touch the floor in line with the right foot, bending the right knee. At the same time extend the left arm straight above the head. Then straighten the right knee and carry the right arm up above the head, at the same time bringing the left hand down so as to touch the floor in front of the left foot and bending the left knee. The body must not be raised during this exercise which may be repeated five to ten times. The Deep Knee Bend. — With the heels raised, lower the body as far as possible by bending the knees, while hold- ing the trunk erect. Rise, straightening the knees and bring- ing them together, not allowing the heels to touch the ground until the legs are straight. This is to be repeated ten to twenty-five times. Floor Exercises. — The following exercise strengthens the abdominal muscles and is of great value in preventing constipation and even rupture. Lie at full length upon the floor with the hands under the hips. Raise both legs slowly without bending the knees until they are at right angles with the body. Then slowly return them to the original position. Repeat this five to ten times. Lying as before, first bring one leg slowly to the posi- tion at right angles with the body and then as it is returned to the original position bring up the other leg. The following exercises may be performed after the abdominal muscles have been strengthened by the two given above: Lie at full length on the floor, with the hands under the hips, as before. Bend the knees and bring them up on the abdomen as far as possible. Then return them to the starting position. Repeat this movement ten times, and then again repeat it, bringing the knees up on the abdomen, one at a time, for fifteen or twenty times. Lie full length on the floor, with the hands clasped be- hind the neck, the elbows on the floor. Bring the elbows THE FIGURE 63 in slowly, bending the body forward until the face touches the knees. Return to the original position. This must be done without taking the feet from the floor. At first it will be necessary to have some weight on the feet, or to hook the toes under a bureau or chair. Repeat this exer- cise several times. Forward Drop. — Kneel on the floor, placing the hands fifteen inches apart, and stretch out the body and legs. Lower the body as far as possible by bending the elbows, keeping the back stiff and the legs extended. Then push up the body until the arms are straight. Repeat this four or five times at first, increased to ten or twelve times as you become more accustomed to it. A similar movement, though somewhat less difficult, may be performed between two upright bars or in a nar- row doorway. Stand about eighteen inches from the bars or door jams, resting the open palms against them, and by bending the elbows allow the body to drop forward through the doorway. Then push the body back to the original position by extending the arms. Repeat several times. CHAPTER V. CLOTHING FROM THE HYGIENIC STANDPOINT. The Hygiene of Undergarments: The material that preserves heat best; the best absorbent o£ moisture; the best material for underwear. Stockings. Outer Garments: Materials for various conditions; the influence of color. Constriction to be avoided. Shoes. Beauty in Dress. The colors that may be worn by the different types. Wraps and Coats. Waterproof Clothing. Non-inflammable Clothing. "A kind and gentle heart he had, To comfort friends and foes; The naked every day he clad, When he put on his clothes." — Goldsmith. STUDY of clothing must include a consideration of the various objects for which clothing is worn. These objects are the protection of the body against cold, wet, and injury, the absorption of moisture from the skin, and the improvement of the personal appear- ance. The proper material and color of a garment depend largely upon the particular purpose for which it is worn. Thus underwear is made of a different material from an outer garment. The color of a dress, too, is chosen, as a rule, with reference to the prevailing style or whether it is becoming to the wearer. There are two conditions to be fulfilled by an under- garment; it must keep the body warm and it must absorb moisture. The Material that Best Preserves the Heat. — A gar- ment keeps a person warm by not permitting the heat of the body to escape ; consequently it must be what is called a poor conductor of heat. The power of preserving the heat of the 64 CLOTHING FROM HYGIENIC STANDPOINT 65 body depends chiefly upon the nature of the material, the texture of the 'garment, and the number of garments worn. Wool and silk are poor heat-conductors. Cotton and linen conduct heat well. As air is a very poor heat-conductor, the greater the amount of air in the meshes of a material, that is, the looser its texture, the warmer the garment will be. For the same reason when several garments are worn one over another the layers of air confined between them will act as non-conductors of heat and keep the body warm. The Best Absorbents of Moisture. — Wool and silk ab- sorb moisture very easily ; cotton and silk very poorly. Wool and silk absorb the perspiration which then slowly evapor- ates without producing any reduction in the temperature of the skin; cotton and linen, on the other hand, allow the perspiration to pass through them to the external surface, where it rapidly evaporates, causing thereby a loss of heat and sometimes producing a chill. The Best Material for Underwear. — The best material for underwear consequently is flannel or wool, as each is both a poor conductor of heat and a good absorbent of moisture. If of a finely combed texture they will not irri- tate the skin. Silk is as good, but more expensive. When cotton or linen is woven loosely, with large meshes, it pre- serves the body heat owing to the poor conductivity of the air contained in the meshes. Stockings. — Stockings should be made of wool, or at least have woolen feet, in order that they may rapidly ab- sorb the moisture from the feet. They should not fit too snugly, but should be large enough to allow the feet to ex- pand when walking. They are best made in rights and lefts with straight inner edges or, better still, with a separate compartment for the great toe. Underclothing should al- ways be removed on retiring and be allowed to air during the night. 5 66 CLOTHING FEOM HYGIENIC STANDPOINT Clothing should not be too heavy. Light, moderately loose garments are warmer than heavy, close-fitting ones, affording more space for the non-conducting layer of air. Materials for Various Conditions. — For use in hot weather, cotton and linen are the best materials for outer garments; for cold weather wool is the best. The Influence of Color.— Some colors absorb and re- flect the heat of the sun's rays more than others. White ab- sorbs the heat less and reflects it most; consequently gar- ments of that color are the coolest. Yellow is the next cool- est color and then come red, green, blue and black, the last absorbing the heat most and hence being the warmest color. Starching and ironing close the air spaces in clothing, and by thus rendering it more impervious help to render it warmer. Starched garments are therefore more com- fortable in cold weather and unstarched in hot weather. Constriction to be Avoided.— Skirts should not be sup- ported from the waist, but should be suspended from the shoulders by means of a waist or suspenders as shown in the Waist and Suspenders for Supporting the Skirts from the Shoulders. accompanying figures. Clothing should not interfere with the breathing, or compress any of the abdominal organs. The article of a woman's dress that has caused more sick- CLOTHING EHOM HYGIENIC STANDPOINT 6? ness and injury than any other is the corset. The ordinary corset should never be worn. The hygienic corset, or one of the corset waists now on the market, such as the equipoise or Ferris waist, is not so harmful. Circular elastic garters inter- fere with the circulation of the blood and frequently produce vari- cose veins; consequently they should never be worn. The stock- ings should be fastened to some part of the underclothing. Shoes.— The shoe should have a flat sole and should be nearly straight on the inner edge and curving gently on the outer side. The heels should be broad and low. When the heels are high they weaken the arch of the foot by causing a wasting of the mus- cles and ligaments. The shoe should be three-fourths of an inch longer than the foot; the latter works forward in walking and unless it is given sufficient room will develop corns and bunions. The shoe, however, should not be so loose as to allow the heel to rub. Shoes made of plain leather permit the proper ventilation of the feet. Patent leather shoes, however, are impermeable to air and do not allow sufficient evaporation of the perspiration of the feet; consequently they should not be worn con- tinuously. It would even be better not to wear them at all. The Toilet. 68 CLOTHING FKOM HYGIENIC STANDPOINT As rubber also will not permit air to pass through it, boots and overshoes of this material should not be worn longer than necessary. BEAUTY IN DRESS. When dress is regarded from the standpoint of im- proving the personal appearance, there are many things be- sides material and texture to be taken into consideration, the most important of which is color. There are certain types of women who appear to better advantage when ar- rayed in certain colors. On this account a gown which appears beautiful upon one woman may seem the opposite when worn by another. Every woman should understand her own type or style of beauty, and dress accordingly. There are many books which give the different colors that can be worn by women when the hair, eyes and complexion are of certain shades. These teach one to make a much closer differentiation than just according to the color of the hair. For instance, a distinction must be made between red hair with blue eyes and red hair with brown, gray, or green eyes. The following colors are suggested by Miss Oakley for the various types : The Black-Haired Type. — Black hair is most frequently combined with black eyes and sallow complexion. The best settings for such a combination are black, relieved with transparent white, a dark, warm gray and occasionally a flame color or a dull red. When the black-haired type has pale skin and blue eyes the possible range of color is wide, although yellows and greens are absolutely excluded. Blue is the best color, blues of the sapphire shades, and blues of the Chinese colors. The dark reds, such as cardinal, may be worn, also very pale shell-pink, blue-grays and white, both cream and blue-white, and black, both solid and transparent. The Girl with Red Hair. — The following colors are CLOTHING FROM HYGIENIC STANDPOINT 69 possibilities for the entire class of the red-haired type. White of a creamy tone, black, invisible green, rich bottle- green, rich blue-green, olive-green, gray-green, stone-gray, claret color, maroon, plum color, amethyst, brownish purple, pale yellow, gold color, pale amber, and the reds approach- ing amber. All the girls of this general type, however, must avoid blues of all shades, blue-white, pale green, scarlet, all bright reds, bright rose-pink, all violet-pinks, blue-purple, and lavender. Some distinction must be made in regard to the different variations of this type. Thus the woman with blue eyes and red hair should wear chiefly the greens, stone-gray and yel- low, the creamy white and the black; those with gray and green eyes may, in addition, dress in the browns and purples, while the brown-eyed variety look best in the dark reds and ambers, although they may wear any of the colors belong- ing to the general type. The Brown-Haired Woman. — The typical example of this type, with warm, brown skin and brown eyes, may choose any of the following colors: all reds, amber, all yellows, cream-white, brown, maroon, olive-green, rose-pink in small quantities, all warm blue from dark to light, tan colors, fawn colors, tea colors, and flame colors. She must, however, avoid all cold and pale blues, light green, all cold greens, pale violets, violet-pinks, grays, purple, black, blue-white, and even the transparent blue-white and gray of white muslin. A girl with the same color eyes and hair, but whose skin is of a thick, creamy white, may wear black, cream-white, purple, violet, amber, olive-green, light or dark reds, es- pecially dark reds, all the rich, dark red purples and maroons, some dark blue-green like peacock, russet, and rose-pink. The following colors, however, are impossible with this tpye: blue-white, all light and cold blues, grays, mauve-pinks, cold yellows, and pale greens. 70 CLOTHING FBOM HYGIENIC STANDPOINT The chestnut-haired woman with fair skin and Hue eyes may employ almost any color except the mauves and mys- terious pale colors, but the chestnut-haired woman with gray eyes or green eyes, especially if her complexion be dull or sallow, must choose more carefully. She may wear olive- green, relieved with pale pink, white with contrasts of old gold and yellows, dark and light blues, purple relieved with white, lilac combined with burnt cream, and black with con- trasts of green, especially- the yellow greens. The Blonde Type. — -In quite contrast to the warmer types is the cool blonde, with her thin, white transparent skin, her pale golden or flaxen hair and blue or violet eyes. This girl may wear jet-black, blue-black, cold, pale green, blue- white, cold grays, all cold blues, heliotrope-purples, cold, pale, violet-pink, cold lilacs, and lavender, but must avoid all reds, warm blues, yellow greens, olives, browns, yellows, warm violets, ambers, cream-white, fawns, tans, and russets. Somewhat different from the type just mentioned is the golden blonde, of which there are two varieties. The golden blonde with the warm, roseate skin usually has hazel eyes, and can select her colors from turquoise-blue, rose-pink, v/arm greens — from dark to light, cream-white, reds, yel- lows, ambers, purple, violet, black, warm grays, fawns, brown, and flame color. Although she can wear practically everything, she does not look so well in cold blues, mauve pinks, cold greens — light or dark, blue-white, lavender, cold lilacs, and cold grays. , For the golden blonde with gray, green, or light hazeli eyes and a luminous creamy white skin quite a different choice of colors must be given. This type can wear olive- green— light and dark, black, cream-white, all soft yellow greens, stone-grays, blue-grays, gray-blue, turquoise-blue, pale peacock-blues, transparent white, mauve-pinks, ame- thyst — light and dark, heliotrope in all shades, and pale CLOTHING FEOM HYGIENIC STANDPOINT 71 amber. She must avoid orange, brilliant yellow, scarlet, tan color, heavy blue-green, blue-white, blue-purple, cold blues, lavender, fawns, frank pinks, and all reds from dark to light. When the Hair Turns Gray. — There is a type with greenish gray hair seen sometimes with brown skin and brown or dark gray eyes. Any of the following colors go well with such a combination: dark greens, both olive and blue greens, browns, including a light brown approaching fawn, amber, all rich yellows, yellow-pink, dark reds, the warm, rich dark blues, purple, brownish purple, and cream white. The following colors, however, cannot be worn: all cold and pale greens, all cold light blues, grays, mauve-pink, cold lilacs, blue-white, cold yellows, like sulphur color, and black. When the gray hair is accompanied with a lighter, clear complexion, and with color in the cheeks, the browns must be entirely omitted, although black and gray may be used. The best color for a pale complexion and snow-white hair, with gray or blue eyes, is entire black. For a prematurely gray-haired woman with blue eyes and a fine, clear com- plexion either pale or ruddy, the best combinations are blue and white, and pale rose-pink and black, although purple and even green may be worn.^ WRAPS, COATS AND THE LIKE. As wool is impermeable to wind and is of a very low heat conductivity, it makes an excellent protection against the cold; consequently it is the best material for wraps, coats, and shawls. One should not wear mufflers and fur boas around the neck as they render the skin sensitive and in- crease the liability to catch cold. Before or immediately on entering a warm apartment all coats and wraps should be removed. In cold weather it is sometimes well, on coming in from the street, to wait a few minutes in the vestibule before entering the warm house, so 72 CLOTHING FROM HYGIENIC STANDPOINT as to make the change from one extreme to the other more gradual. In this way there will be less likelihood of catch- ing cold. WATERPROOF CLOTHING. Rubber, being impervious to air as well as to water, should consequently be worn as little as possible. Rain- coats made of cravanette or of wool that has been rendered waterproof by certain processes, are therefore much prefer- able to India rubber garments and mackintoshes. Rubber overshoes are often necessary to protect the shoes, but they should never be worn unnecessarily and should be removed as soon as the person enters the house. The same may be said of mackintoshes and gossamers. NON-INFLAMMABLE CLOTHING. It is said that cotton and linen clothing may be rendered fireproof by being immersed in a starch solution containing a heaping teaspoonful of powdered borax to each half pint of the solution. The fabric is said not to be injured thereby, nor is any disagreeable odor imparted to it. It may be washed and ironed just as readily after the immersion as before. The recommendation has been made that the clothing of those who are exposed to the risk of fire in their daily occupation be treated in the above manner. A REAL MADONNA Is one who is able to transmit to her children health cjuI i in their infancy. Beauty will also be found with health. Such a mother observes carefully the laws for perfect motherhood. CHAPTER VI. FOOD AND DRINK. The hours for meals. Taking sufficient time to eat. Rest after meals. The different kinds of food and how to prepare them. Animal foods. Milk and milk products. Eggs raw and cooked in various ways. Meats and how to prepare them. Fish and shell-fish. The relative digestibility of different animal foods. Vegetable foods: Sugars, cereals, roots and tubers, green vegetables, fruits. The different beverages: Drinking-water, coffee, tea, cocoa, chocolate, alcoholic drinks. "In general, mankind, since the improvement of cookery, eat about twice as much as nature requires." — Franklin. HE object of food is to supply new matter to the tis- sues, which are constantly undergoing waste and to furnish the body with the materials for the manu- facture of muscular force and bodily heat. The character of the food a person shall eat depends a great deal upon the mode of life. One who takes a con- siderable amount of bodily exercise requires a different kind of diet from one who leads a sedentary life. People usually eat more than is required to make up for the waste in the tissues. Children need to provide material for growth as well as for wear and tear, and consequently must eat much more proportionately than adults. But as they get older they continue this habit of eating very generously, although the excess is no longer needed for growth. In this habit lies the cause of much of the indigestion from which so many women suffer, and of the obesity that is so common 73 74 FOOD AND DRINK at middle life. In old age still less food is needed, because less force is then being exerted. The great fault with most Americans, among the rich as well as among the poor, is that they eat too hastily and partake too freely of animal food. Meat should not be eaten oftener than twice a day ? once a day being quite sufficient. The Hours for Meals. — The time of the principal meal will depend on the character of a person's work. It is customary in America to eat three substantial meals a day. People in the rural districts and many classes in the cities, including the great bulk of wage earners, eat breakfast immediately after rising, the heaviest meal or dinner at noon, and a light supper about six o'clock. Professional and business men, however, and all those who lead seden- tary lives and are not occupied in physical labor or outdoor pursuits, usually eat their heaviest meal or dinner after their work is over, between half-past six and half-past seven in the evening. This class of men usually breakfast at from half-past six to half-past eight in the morning and lunch between one and two in the afternoon. There should be definite times for meals ; irregularity in eating frequently injures the digestive system. Taking Sufficient Time to Eat. — Sufficient time should always be allowed for meals. The hasty mid-day lunch of shop girls and of professional and business men is one of the most frequent causes of indigestion. There should be an intermission of at least one hour in the middle of the day, part of which should be devoted, both before and after eating, to rest or pleasant conversation. If one has but little time for the mid-day meal it is better to take a very light lunch, or even only a plate of soup and a glass of milk with a few crackers, than to gulp down a more substantial dinner. The habit, however, of going without the mid- day meal is most pernicious. FOOD AND DUINK 75 Rest After Meals.— No bodily exercise or severe mental effort should be indulged in directly after meals. If the blood be taken from the stomach to the muscles or brain digestion may be retarded. After a heavy meal rest is especially necessary, and may be taken while one is sipping coffee or smoking. As sleep, however, retards digestion, a person should not retire for two or three hours after a heavy meal. THE DIFFERENT KINDS OF FOOD AND HOW TO PREPARE THEM. Foods may be divided into animal foods and vegetable foods. The necessary constituents for a perfect food are provided in the most digestible form by a mixed diet, which contains both vegetable and animal food, the best ratio being one part of raw animal food to three parts of raw vegetable food. A person doing hard muscular work, how- ever, requires a larger amount of vegetable food than one who leads a sedentary life. ANIMAL FOODS. The animal foods include milk and its products, eggs, meats and fish. Milk and Milk Products.-— Milk is the cheapest, most easily digested and most perfect food we have. It is uni- versally used as an article of diet by both civilized and uncivilized peoples. As a rule milk is easily digested. Al- though spoken of as a liquid food, it is converted, as soon as it reaches the stomach, into a finelv divided solid through its being curdled by the stomach juices. One should drink milk slowly, sipping or chewing it, that is to say, mixing it thoroughly with saliva, in which case the curds that are formed are of small size. When a glass of milk is drunk down all at once it becomes con- verted into large, indigestible, cheese-like masses. If milk disagrees, it may be rendered more digestible by the addi- 76 FOOD AND DRINK tion of lime water in the proportion of two or three tea- spoonfuls to the glass, of aerated water such as vichy or seltzer, or of ordinary water. A tolerance for it may be established by giving it at first in small doses of one or two tablespoonfuls every quarter or half hour and then gradually in larger quantities and at longer intervals. Cream is one of the most digestible of the fatty foods. In the form of ice-cream it is wholesome and agreeable when made simply, but when it contains rich flavoring extracts or much fruit it is less easily digested. When cream or butter are used in cooking they are best added after the food has been removed from the fire. Butter, as a rule, is easily digested when raw, but is less so when cooked. The fatty product margarin, prepared from ox fat, is quite as digestible and wholesome as butter and, when mixed with butter, forms what is known as but- terin, which is much cheaper than butter and is not at all harmful when properly made. Cheese is not easily digested except when grated very fine and mixed with other food. Eggs Raw and Cooked in Various Ways. — Eggs are most digestible when soft boiled and least so when fried. A hard-boiled tgg is not digested rapidly unless it is cooked until the yolk becomes mealy, and is thoroughly masticated. Next to boiled eggs in point of digestibility come raw eggs. Eggs must be cooked at a low temperature or they are rendered tough. Meats and How to Prepare Them. — Meat is not only one of the most important of all the foods, but it forms the bulk of the diet of the average American. Raw meat is readily digested when thoroughly masticated, but not being so palatable as cooked meat, is rarely eaten by civilized people. Cooking renders meat more attractive in color, more agreeable in taste and more digestible. FOOD AND DRINK 77 How to Stew Meat. — Meat is most digestible when properly stewed. The proper way to stew meat is to cut it up into small pieces and place it in cold water, which is then subjected to moderate heat for some time. By this process the juices and flavor will be dissolved out and be present in the fluid in which the meat has been cooked. This fluid is then eaten with the meat, thus making a savory and easily digested dish. Boiling Meat. — When a large mass of meat is to be cooked in water, or boiled, the flavor and juices must be retained in the meat. This is accomplished by first rapidly coagulating the surface of the meat by exposing it to a high temperature, and then allowing the interior to cook slowly at a much lower temperature; consequently the water should be boiling when the meat is put into it, after which it is allowed to cool, and when it falls to a tempera- ture of about 180 F. the whole mass should be boiled until it is thoroughly cooked. Roasting or Broiling, — The most savory way of cook- ing meat is by roasting or broiling. Broiling or grilling over an open fire can be done only when the portion of meat is small in size; larger pieces of meat may be roasted, both in the old way of turning the meat on a spit before the grate, or in the modern fashion of placing it in an oven. The exposure to the very hot air seals the juices which help to cook the inner part. When roasted in the oven the meat should be placed for a short time in a very hot oven until the hot air rapidly coagulates the outside of the meat and thereby prevents the escape of the juices. The meat should then be kept for a considerable time at a lower tem- perature, usually by placing it in a cooler part of the oven. The largest part of the juices will be retained if the meat be frequently basted by pouring over it the fat that accumu- lates in the dish, thus sealing it more thoroughly. 78 FOOD AND DRINK Fried Meat is Indigestible.— -Fried meat is the least digestible of all, especially when cooked in the improper manner ordinarily practiced. According to this incorrect method some of the fat penetrates the meat, thus rendering it tough and indigestible, while at the same time the hot partly decomposed fat irritates the stomach. The follow- ing correct method of frying does not render the meat nearly so indigestible: A deep dish is filled with oil or melted fat, which must be boiling at a temperature of from 350° to 380 F., and the meat is immersed in it. The sur- face of the meat is at once completely seared and made impermeable. As soon as the meat is cooked, which occurs with great rapidity, it is removed from the oil or melted fat and permitted to drip. Broths and Beef Juice. — The method of making broths and beef juice is given in Chapter XXV. FISH AND SHELL-FISH. Fish is a highly nutritious food, and for the most part is easy of digestion, the fatty kinds, however, such as sal- mon, whose flesh is of coarse fiber, being less digestible than those which are not so rich in fat. Oysters are nutritious and wholesome, but the nourish- ment is presented in a very diluted form. They are more digestible when eaten raw than when cooked. They must always be cooked at a low temperature, so as not to be rendered too tough. Lobster and crab meat, being coarse and tough, are consequently rather indigestible. THE RELATIVE INDIGESTIBILITY OF THE DIFFERENT ANIMAL FOODS. The following list, compiled from the figures of Pen- zoldt, Jessen, Richert and Beaumont, gives an idea of the relative digestibility of the different kinds of animal food; those most digestible are mentioned first: FOOD AND DBINK 79 Milk, bouillon, pigs' feet, trout, boiled calf's brains, raw eggs, hard-boiled eggs or omelet, raw beef sausage, boiled brains, sweetbread, raw oysters, boiled carp, boiled pike, boiled sharper, raw beef chopped fine, half-cooked beef, well- cooked beef, raw mutton, cooked veal, boiled codfish, cooked pork, roasted mutton, beefsteak, cooked ham, boiled lean beef, boiled fish, young boiled chickens, roasted partridge, boiled pigeon, roasted bacon, boiled calf's foot, raw ham, boiled salmon, pickled and smoked herring, roasted pigeon, roasted fillet of beef, beef tongue, smoked bacon, roasted hare, roasted partridge, roasted goose, roasted duck. VEGETABLE FOODS. The various vegetable foods may be divided into sugars, cereals, roots and tubers, peas and beans, green vegetables, fruits and nuts. Sugars. — The sugars of commerce are usually forms of cane-sugar, which is chiefly derived from the sugar-cane and the sugar-beet. Molasses and syrup are crude forms of cane-sugar; maple-sugar contains certain other sub- stances in addition to it. The chief value of sugar lies in the fact that it gives strength to muscles and helps to produce fat Sugar should be taken well diluted, as it is best borne by the stomach and intestines when eaten in this way. Milk and the majority of the fruits, for instance, which are easily digested, rarely contain more than 4 per cent, to 6 per cent, of sugar. The reason that candies, jams, preserves and syrups are often indigestible is that the sugar they contain is in too concentrated a form and causes an acid to form in the stomach. When eaten at all, candy is best taken after a meal. Taken between meals, it disturbs the digestion and spoils the appetite. Cereals. — By cereals are meant the grains that are used 80 FOOD AND DRINK for food. They are rarely eaten until they have been gran- ulated or ground into powder, forming flour. Cereals must be cooked before they can be utilized as food. All starchy foods require long cooking. The coarser meals may be boiled and eaten with sugar and milk or cream. Flour is usually made up into bread, which is one of the most nutritious forms of food. It is an important sup- plement to meat and fish, but is not a perfect food in itself. Too hot or too fresh bread is very indigestible, as it is con- verted, by chewing, into a tough, dough-like mass. Stale bread is much more digestible, as it crumbles into finer particles. Toasting bread thoroughly until it is brown and crisp renders it more digestible, but to toast only the sur- face and leave the interior soft does not increase its digest- ibility to any degree. Roots and Tubers. — The most valuable of the vege- tables that grow beneath the ground is the potato, new or young potatoes being more nutritious than old ones. Pota- toes should be baked or roasted in their skins to retain all their nourishing qualities, a great part of which is lost when they are boiled or stewed. They must be cooked for a long time in order to convert the raw starch into a digest- ible form. Potatoes are most digestible and mealy when baked; they are least so when stewed, boiled, fried or cooked in chunks to be swallowed in considerable masses. Carrots, parsnips and beets are not easy to digest. Turnips have little nutritive value. Tapioca and sago are nutritious, though the first takes too long a time to digest. Peas and Beans. — These contain more protein than any other vegetable. This is the element that makes meat so nourishing. Peas and beans thus form good substitutes for meat when for any reason the latter cannot be taken. They are not quickly digested, however, being least digest- ible when simply boiled and most digestible when mashed. FOOD AND DRINK 81 The Green Vegetables. — The green vegetables are eaten chiefly because of their agreeable flavor, and because they add variety to the diet. They have little nutritive quality. They are very laxative, however, and counteract any ten- dency to constipation. Fruits. — The various fruits are usually eaten as a relish, as their value as a food is comparatively small. The banana is the most nutritious of the raw fruits. Cooking usually renders fruit more digestible, but cooking in water causes it to lose part of its nutritive ingredients. THE DIFFERENT BEVERAGES. Drinking Water. — The average person requires from four to eight glasses of water daily. Drinking water may be cooled, but it ordinarily should not be extremely cold, especially when one is overheated. The excessive use of cold drinks is responsible for many of the cases of intestinal disorders that occur in the summer. At meal times water should be taken very sparingly and only when the mouth is empty, as the tendency to wash half-masticated food into the stomach is very injurious. Large quantities of water taken with the food dilute the juices of the stomach too much and thus interfere with the digestion of the food. A small quantity of cold water, however, taken just before a meal has a tendency to increase the appetite. Sore throat is often caused by the drinking of ice water after having swallowed something hot. Coffee. — Coffee affects different people variously. Some are made very nervous and sleepless by it. As a rule it cannot be taken by dyspeptics, especially if cream and sugar are added to it. It should not be drunk when the mouth is full, and thus wash down food which has not been thor- oughly masticated. Coffee should never be given to chil- dren. Tea, when taken in small quantities, may do no harm, 6 82 FOOD AND BRINK but when drunk to excess may have very injurious effects. It then not only produces wakefulness, nervousness, excita- bility and even muscular trouble, but it frequently gives rise to digestive disorders as shown by flatulence, a feeling of disturbance in the region of the stomach, and constipa- tion. It often may give rise to irregularity of the heart, pain in the chest and sleeplessness. Children should never be given tea to drink. Cocoa and Chocolate differ from tea and coffee in being nutritious as well as stimulating. They never produce nervous symptoms even when taken to excess. They may be given to children. CHAPTER VII. WORK, REST AND RECREATION. Work in its relation to health. Child-labor. The length of the working day. The necessity for Rest. The noon hour. The ability to relax. The weekly and yearly vacation. The hygiene of sleep. Amount of sleep required. The bed and the bed clothes. The way to lie. Fresh air in the bedroom. Rules for sleeping and preventing insomnia. The necessity for Recreation. Mental recreation. Physical recreation: Walking, running, climbing, bicy- cling, horseback riding, rowing, canoeing, swimming, lawn tennis, tetter tennis, golf, basket ball, bowling, fencing, punching the bag, dancing. "Alternate rest and labor long endure." — Ovid. WORK IN ITS RELATION TO HEALTH. HE health may be affected by the character of one's occu- pation. Having to work in overcrowded, badly venti- lated rooms renders a person liable to disease. Various deformities may be produced when the work demands constrained attitudes of the body or unequal exertion of both sides. Frequently a sedentary occupation, through the conse- quent lack of exercise and fresh air, bears a causal relation to ill health. Nevertheless, the detrimental influence of any occu- pation upon health and length of life may be considerably re- duced by attention to the ventilation of the working-room, by eating in a proper manner well-prepared, digestible food, and by participation in active outdoor exercise. Child-Labor.— One of the chief factors that tend to impair the vitality of the race is the tender age at which girls are often sent to work and the long hours which they must spend at monotonous labor. This produces a physical deterioration in the mothers which shows its influence in the offspring. It is S3 84 WOBK, BEST AND EEOEEATION wrong for children under fourteen years of age to work in mines, factories or workshops. In childhood the various organs are constantly undergoing development. For this fresh air, healthy outdoor exercise and freedom from care are necessary. Stunting the growth of the child and depriving it of the benefits of education are two of the surest means of causing the men and the women to be undeveloped physically, mentally and morally. The Length of the Working Day. — The length of the working day depends to a great extent upon the occupation, but as a rule it should never exceed ten hours for men and eight hours for women and youths; the greater the physical exertion or the mental strain required in an occupation, or the greater the danger to which the worker is subject, the shorter must be the working day. Working overtime ought never to be allowed. THE NECESSITY FOR REST. The Ability to Relax. — A woman should be able to relax at intervals. When the eyes are steadily engaged in near work they should be rested every half hour or every hour during the day by being made to look off into the distance for a moment or two. It is well to relax the mind in the same way by now and then ceasing thoughts of one's work and for a moment recalling something pleasant that has been seen, read or noticed. One tending to become nervous is advised by Dr. Walker to stop and take a few deep breaths as a way of relaxing the ten- sion. An English physician who has had wide experience in treating nervous patients suggests as a means of meeting a shock and breaking its force that a person stop for a minute and fix the attention on some trivial object, such as a hen out- side in the yard. For instance, before opening a telegram one is advised to go to a window and look intently at some object outside. DRESSING THE HAIR. This is too often considered a matter of little importance, yet the laws of health and beauty require that early in life the girl be taught to care for her beautiful tresses. WORK, REST AND RECREATION 85 The Noon Hour. — In the middle of the day a rest from work of af least one hour should be taken so that time will be allowed for half an hour's freedom from work after luncheon. This time should be spent by those who have been standing all morning in reclining, and by those who have been sitting in walking in the open air. A person employed in manual labor might spend this time in reading, but one who has been using the brains should spend it in active exercise. The Weekly and the Yearly Vacation. — At the end of each week a person should rest for at least twenty-four hours. Once a year, too, a complete rest of not less than two weeks should be taken; preferably in the summer time. The vacation restores the weakened muscles and digestive organs to their normal healthy condition after the close strain, of the winter's work. THE HYGIENE OF SLEEP. The value of sleep depends much more upon its soundness than upon its duration. When disturbed by dreams it is of much less value than when it is dreamless. The Amount of Sleep Required. — The average adult re- quires eight hours of continuous sleep each day. Children require much more sleep, as stated in Chapter XXVIII. Aged persons do not need quite so much. Persons who have to rise early during the week would do well to lie in bed longer on the day of rest. The Bed and the Bed Clothes. — One should sleep on a fairly hard but comfortable mattress with a springy yet firm surface. Feather beds and feather pillows should be disre- garded altogether. One good hair pillow is usually sufficient. The covers should be light but warm, two light blankets being warmer than one that is heavy, on account of the layer of air between them. The bed clothing should be thoroughly dried and aired every day, being preferably exposed to the sun. The Way to Lie. — It is a bad habit to prop the head with 86 WOBK, BEST AND EBCREATION many pillows, which tends to cause a strain on the muscles of the neck and produce round shoulders or other deformities, besides often being the cause of nightmare and restlessness. Not more than one pillow or bolster should be used. Some girls make a practice of sleeping without any pillow at all, on the theory that lying perfectly flat on the back is not only con- ducive to restful sleep, but keeps the shoulders straight. It is usually considered best to lie on the right side. One should lie stretched out rather than curled up. Fresh Air in the Bedroom. — It is necessary to have plenty of fresh air in the room during both winter and summer. Cold air will not render one liable to taking cold, provided the body is well protected with the covers. Rules for Sleeping and Preventing Insomnia. — No gar- ment should be worn at night that has been worn in the day- time. During the night all the day clothing should be well aired. When a person is tired and sleepy she should go to bed and not lie around dozing all the evening. One should not go to bed hungry, but instead may take some light, simple food before retiring. The taking of a glass of warm milk or a cup of hot bouillon before going to bed may draw the blood from the brain to the stomach of those who persist in planning and thinking after their heads touch the pillow, thus serving to induce sleep. When the mind is excited or full of business or other worries, it may often be calmed before bed-time and turned into pleasant channels by half an hour's reading of a light novel or short story. A hot bath taken before retiring, or a hot pack, or the application of hot compresses to the spine after getting in bed, will often aid in producing sleep in a person subject to insomnia. THE NECESSITY FOR RECREATION. For the preservation of the health habitual recreation is absolutely essential. There are two kinds of recreation — men- WORK, REST AND RECREATION 87 tal and physical. The kind a person needs depends altogether upon the vocation; a change is what is required. A person whose work is largely physical requires physical rest and mental exercise at the end of the day's work. One who continually uses the mind needs to relax the mind and exercise the body. MENTAL RECREATION. An overworked mind finds rest in pleasant conversation, in cheerful games which are not too intricate, in seeing plays and hearing operas, in reading pleasant books and in the culti- vation of fads. A hobby, such as the collection of stamps, rare prints, old coins, old china, old furniture, and the like, furnishes an agreeable diversion by taking one's mind off the daily wor- ries. On the other hand, recreation involving some mental labor may be of advantage to a person whose work is physical and whose mind is little exercised. For such a one chess-play- ing is an interesting diversion and even Sunday-school teaching may prove beneficial. These forms of recreation, however, are injurious to one whose mind is constantly on a strain, such as a public school teacher. PHYSICAL RECREATION. Every one who is not employed in some laborious occupa- tion requires physical recreation. Especially is this true of those who lead sedentary lives. For an exercise to be of benefit it must give pleasure and be accompanied by freedom from cares. A walk taken simply for the pleasure of it is much more beneficial as an exercise than a walk to or from one's place of business, the first being a diversion, the second often a strain. There are various forms of physical exercise, some of which can be participated in by all while others require special apparatus and grounds. As stated in Chapter IV, the various forms of physical exercise, including games and sports, are especially useful in developing the figure. 88 WORK, REST AND RECREATION Walking. — The most natural form of exercise and the one most generally utilized is walking. This is a very valuable exercise when sufficient time is taken for the natural swing of the leg to bring the foot forward at the completion of each step. The girl should hold her chest high, moving her legs freely from the hips with a long swinging step and letting her arms hang easily at her sides. Rapid walking utilizes every muscle of the body, and by agitating the body at every step stimulates the functions of the abdominal organs. Running is beneficial, but should not be pursued to the point of exhaustion or of respiratory embarrassment. The combination of alternate slow running and walking is an even better exercise than either alone. Climbing or walking up a grade is excellent if done with frequent resting. Before attempting mountain climbing it is well to practice first on small hills. A light loose dress should be worn, consisting of a flannel waist and a short skirt. The shoes should be easy fitting with thick soles and broad low heels. They may have spikes or nails in the heels if the climbing is to be long and hard. When the health is delicate, or the heart or lungs weak, climbing should never be undertaken without the advice of a physician. Bicycling. — If pursued at a moderate gait and for moder- ate distances, bicycling is in many respects an ideal exercise, but it is harmful when continued to the point of exhaustion. Horseback Riding not only develops the legs and thighs, but stimulates the abdominal organs through the agitation caused by the up and down motion of the horse. When the girl rides in a side saddle she should use one with reversible pom- mels, sitting one time on the right side and another time on the left. Riding astride with a divided skirt develops the body more symmetrically and in the opinion of the author is not objectionable. WORK, REST AND RECREATION 8tf Rowing. — Nearly all the muscles of the body are brought into play by rowing, especially those of the forearm, shoulders and back. The abdominal muscles are used in the forward swing, while the back muscles are exerted in the backward pull. The bracing of the feet develops the muscles of the legs and thighs. The swing should come from the hips. The car- riage is much improved by this form of exercise if during it the body is held in the proper position. The most important point to bear in mind is to keep the back flat and not to bend the head. It is well to wear flannels while rowing. Canoeing does not exercise so many muscles as does row- ing, but develops chiefly the muscles of the upper back, arms and wrists. The side movement or twisting of the trunk which comes in with a double-bladed paddle is beneficial in stimulating the internal organs. A girl should neither row nor paddle unless she has learned how to swim. Swimming brings nearly all the muscles into play. It straightens round shoulders, develops the muscles of both the arms and legs, throws the chest forward, and by keeping the back on the stretch in the effort to keep the head above water, tends to develop a graceful poise. Lawn tennis has always been popular. It is one of the few sports in which most girls can indulge. A vigorous game, necessitating running to all parts of the court, it not only de- velops all the muscles of the body, but makes the shoulder joints and the waist supple, strengthens the wrist and brings grace and agility to the motion of the arms and legs. Tether tennis does not require a court or expensive appa- ratus ; it can- be played in the smallest yard. A girl should wear flannels or a sweater when playing this game, as she is very apt to become overheated and may become chilled after perspiring. Probably more exercise can be derived in a shorter length of time from this game than from any other. Golf enjoys great popularity among the wealthier classes, SO WORK, REST AND RECREATION its greatest benefit coming from the walking and the length of time spent out in the open air. Basket Ball is an ideal exercise, developing all the muscles equally and increasing the power of the heart and lungs. In match games, however, the physical benefits do not compensate for the nervous strain and exhaustion. Bowling is a vigorous game and one very popular during the winter months. The twisting of the trunk that it brings is beneficial to the abdominal organs. The disadvantages of this game, however, are that the ventilation in bowling alleys is usually poor, and the exercise is usually of a one-sided char- acter. Fencing. — For those who have the time to devote to it and the money to provide the equipment, there is hardly a better all-around exercise than fencing. Girls should learn to fence with both hands, so that their arms and legs will be developed symmetrically. Practice at fencing will bring a lighter step, grace of movement and a more agile form. Punching the Bag. — An excellent form of indoor exer- cise is the use of the punching bag. If one of the men in the house owns such an apparatus the girls should certainly take advantage of it. By its use every muscle of the body is brought into play. The bag should hang about on a level with the shoulders. A light flannel gymnasium suit should be worn during this exercise. A pair of light gloves will also be needed. Dancing is sometimes the only form of exercise a girl will have during the winter. It is a useful form of exercise, and probably more than any other tends to develop grace of move- ment. PART II. A WOMAN'S LIFE. :' THE TRYST BY THE SHADY WALL. Young manhood enamored by the loveliness of beautiful womanhood feels that "But to see her was to love her.'" CHAPTER VIII. ANATOMY AND PHYSIOLOGY. Sex throughout nature: In plants; in the lower animals; in man. Woman's physical characteristics. The female sexual organs : In plants ; in the lower animals; in woman. Woman's reproductive organs: The womb, the vagina, the Fallopian tubes, the ovaries. The pelvis. "Shalt show us how divine a thing A woman may be made/' — Wordsworth. I N the first part of this book, on "Health and Beauty, general hygienic rules have been given which apply to every one, irrespective of sex. The present sec- tion deals entirely with the phenomena which are peculiar to woman, giving those particular rules which are to guide her through a healthy and, consequently, happy adolescence, maidenhood, wifehood and motherhood. Be- fore any suggestions are made as to the precautions to be observed during each period, the physiology of that period is described, so that the suggestions may be followed in- telligently. In discussing physiology, a broad view of life has been taken, showing woman's true position in nature and her relation to the others of God's creatures. SEX THROUGHOUT NATURE. All living matter possesses the power of reproduction. This is, in fact, one of the characteristics which distinguish it from non-living matter. In all the higher forms of life, both animal and vegetable, a special portion of each or- 93 94 ANATOMY AND PHYSIOLOGY ganism is set apart for this distinct purpose. The elements necessary to the formation of a new plant or animal are usually not all found in one individual but are divided be- tween two, which are known as male and female. These must unite to form the new organism. The offspring de- velops from one element, the female, as soon as the other element is added to it. In flowers this distinction of sex is recognized, the stamens representing the male element, the pistil the female. Willow trees show this sexual differen- tiation, some producing only those catkins or pussy-willows which consist entirely of pistils and others blossoming only into stamen-bearing catkins. In the familiar corn or maize the "tassel" is the male flower, the "silk" is the female. FEMALE ORGANS IN PLANTS AND THE LOWER ANIMALS. Each sex has its generative organs well developed. In the centre of every -flower stands the pistil, the upper por- tion forming the style and the stigma, the deep-seated por- tion being the ovary, which contains, the ovule. When the flower is fertilized by the male element — the pollen — the ovary begins to develop and to form seeds, which, when planted, put forth leaves and stalks and finally bear flowers, just as did their parents. The pod with its peas or beans and the apple or pear with its seeds represent the ovary of the plant. In the animal kingdom sexual organs are possessed by even the lowest members. The ovary of the fish, for in- stance, is familiar as the roe. It contains countless ova which, when deposited, are known as spawn. These ova, upon being fertilized, become the eggs, from which later the baby fish are hatched out. In birds the ovum is fertilized while in the ovary, and is then laid in the form of an tgg, to be hatched outside the mother's body. Every woman who has dressed a hen has ANATOMY AND PHYSIOLOGY 95 seen its ovary with the unfertilized ova and the fertilized eggs. Sexual Organs of Flowers. A. Flower, showing the stamens around the ovary. B. Ovary before fertilization, showing a few stamens still attached. C. Ovary after fertilization. It is developing and forming seeds. D. The fully developed ovary (the pod), containing seeds. It has been cut across to show the seeds. E. A seed. In all the lozver animals the embryo, as the unborn off- spring is called, develops and obtains its food outside of the parent's body. The chick, for example, lies within an egg f nourished b} r the white and the yolk, and protected by the shell. In the higher animals, such as the mammals, the off- spring must obtain its nourishment from its mother while it is developing as well as after it is born. It also must be pro- tected by her body. The organ in which the embryo lies 98 ANATOMY AND PHYSIOLOGY while being formed into a living child is called the uterus or womb. WOMAN'S REPRODUCTIVE ORGANS. The Uterus (also called womb, matrix, bed, nest and mother) is a hollow organ, shaped like an inverted pear. It is about two inches and a half long, one inch and a Front View of Woman's Reproductive Organs. U. The uterus or womb. C. The cervix or neck of the womb. V and V. The vagina. (This, normally, is a tube. In the picture a longitudinal cut has been made along the top or roof, and the sides are pulled out.) O and O'. The ovaries. T and T'. The oviducts or Fallopian tubes. P and P'. The funnel- shaped distal ends of the Fallopian tubes. (The right-hand side of the picture shows the ligament that holds the womb in place. The left of the picture shows the ligament cut away and the tube pulled out of position.) ANATOMY AND PHYSIOLOGY 97 quarter wide and three-quarters of an inch thick. The walls are composed of thick muscles, leaving a triangular cavity only big enough to hold about half a teaspoonful of liquid. It ends below in a neck, called the cervix, traversed by a narrow canal, called the cervical canal, an inch and a half long. The upper end of this canal, where it opens into the cavitv of the uterus, is called the internal os or mouth; the lower opening is the external os or mouth. The body and the neck of the womb are both lined with a mem- brane containing glands, which secrete mucus. When too much of this mucus is secreted the condition called leu- corrhea, or "the whites," results. The neck of the womb projects into a tube, called the vagina, about four inches long. The walls of this tube normally lie in contact but are capable of being stretched to a considerable extent. The vagina also is lined with a mucous membrane containing glands that secrete mucus which acts as a lubricant. It opens externally, but in a maiden is partially covered by a thin membrane called the hymen. The uterus is supported by means of ligaments fastened to each side and attached to the bones. It is slung between the two ligaments just as a person is supported in a ham- mock. Along the upper border of the ligaments lie the ovi- ducts or Fallopian tubes, which open into the womb at the top on each side. They are narrow tubes, about four inches long, running outward from the corners of the womb and opening like funnels at their other extremities, where they are in contact with the ovaries, connecting them with the womb. They also are lined with mucous membrane. The ovary is like an almond in shape and size and hangs in the fold of the ligament just below the Fallopian tube, at its distal end. It is a gland secreting ova or eggs. It prob- 7 ys ANATOMY AND PHYSIOLOGY The Lower Abdomen in a Woman. A side-view, with the organs cut in half, showing the shape and position of the womb and its relations to the other organs. 1. Uterus (or womb). 2. Cavity of womb. 3. Neck of womb (or cervix). 4. Cervical canal. 5. External os (or mouth) of the cervix. 6. Vagina, 7, 19 and 20. Vulva (or external parts). 8. The bladder. 11. The rectum, outer wall. 12. The same, cut open. 13. The anus. ANATOMY AND PHYSIOLOGY 99 ably also secretes a substance necessary to woman's health, about which not much is known. The Pelvis. The uterus and its appendages, as the tubes and ovaries are called, lie in a bony basin, called the pelvis. WOMAN'S OTHER PHYSICAL CHARACTERISTICS. The average woman weighs about twenty pounds less than the average man and is five inches less in height. Her shoulders are narrower and more rounded and set further back; the collar bone is longer and less curved, giving the chest greater prominence; the pelvic bones are larger and spread out more, making the hips much broader in outline. All the other bones, however, are smaller and more deli- cately fashioned. The presence of fat under the skin gives a more rounded and smooth appearance generally. CHAPTER IX. THE PERIOD OF PUBERTY: PASSING FROM GIRLHOOD TO WOMANHOOD. The changes that occur at adolescence. Variations in the age of puberty due to climate, race, mode of life, and heredity. Delay in the appearance of the chief sign of puberty. The Mental Changes at Puberty. The Religious Changes. The Mother's Duty. The Hygiene of Puberty. "Standing with reluctant feet Where the brook and river meet, Womanhood and childhood fleet!" — Longfellow. I N the child the sexual organs are but partially devel- oped and remain inactive. At about the end of the fourteenth year, however, they begin to functionate, and the girl becomes capable of reproduction. The period at which this occurs is called puberty or adolescence. In addition to the changes in the generative organs, other alterations take place in girls at this period. The figure begins to assume the aspect of womanhood, the breasts become developed, the pelvis and abdomen enlarge, the voice undergoes a change, hair appears in the arm-pits and about the pubic region, and the menstrual flow, or monthly sickness, is established. VARIATIONS IN THE AGE OF PUBERTY. Although puberty usually occurs about the thirteenth or fourteenth year, it may appear earlier or later, its onset being influenced by climate, race, mode of life, and heredity. In tropical climates it may occur at nine or ten years of age ; in Egypt and Sierra Leone it occurs normally at ten years. In these climates it is said not to be an uncommon thing for a girl to be a mother at twelve. 100 THE GOLDEN WEDDING DAY. Let prudence with good nature strive, to keep the flame of love alive, Then, come old age when' er it will , your friendship shall contin THE PERIOD OF PUBERTY 101 Puberty occurs late in the cooler climates and among the peoples normally inhabiting them. In Lapland, for in- stance, menstruation does not appear until the eighteenth year. The Teutonic and Anglo-Saxon races while in their [European homes arrive at adolescence oftenest in the fif- teenth year. In the United States and Canada puberty usually occurs about the fourteenth or fifteenth year. In Hungary the three races, Slavonic, Magyar and Jewish, living side by side in the same climate, reach adolescence, respectively, when sixteen, fifteen and thirteen years of age. Hindu girls of Calcutta and negresses of Jamaica, also living in the same climate, begin menstruat- ing at the eleventh and fifteenth year, respectively. Some writers state that blonds mature earlier than brunettes. Menstruation in Jews begins a year or two in advance of other races in this country. In negroes and Creoles the monthly sickness appears earlier than in white people. The influences of city life, with its excitement of par- ties, theatres and the like, association with the other sex, and sexual temptations, tend to hasten the oncoming of puberty. It is said that diet has an influence, that stimulat- ing foods, such as pepper, vinegar, mustard, spices and con- diments generally, tea and coffee, and an excess of animal food have a clearly appreciable influence in prematurely bringing about this condition. Heredity may affect the time of puberty, it being a matter of common observation that in some families men- struation may begin early through several generations. DELAY IN THE APPEARANCE OF THE CHIEF SIGN OF PUBERTY. Although other signs of puberty may occur at the usual time, the menstrual flow may be late in making its appear- ance. 102 THE PERIOD OF PUBERTY This is usually due to a condition of anemia or im- poverished blood, caused by want of sufficient sunlight, fresh air, exercise, good food and sleep, and by a too close appli- cation to study. The mother is often alarmed when the menstruation is delayed, and may try various home remedies to bring it on. The non-appearance of this phenomenon need not be a matter of concern, provided the general health is otherwise good. No medicine should be given for the purpose of bringing on the monthly sickness. Let the girl have plenty of good, nourishing food, sunlight, fresh air and out-door exercise. In time everything will be all right. If, however, the girl seems in poor health, or if she suffers much from pain, headache, nervousness and general discomfort, she should be taken to the family physician. Under treatment directed to her general condition, she will probably become a healthy, normal girl. The services of a gynecologist or specialist in women's diseases are almost never required. The fault seldom lies with the generative or- gans; it is unwise, moreover, to call attention to them. A modest young girl should never be subjected to an examina- tion, even by a female physician, unless there is ground for suspecting something serious to be the matter. The mere fact of menstruation being delayed is not sufficient cause. THE MENTAL AND RELIGIOUS CHANGES AT PUBERTY. As womanhood unfolds, other changes occur besides those of the body. The girl is in a state of restlessness and of nerve irritability; her mind is confused with feelings of undefined longings and desires, and of vague dissatisfaction with all about her. She often tends to become morbid, fanciful, self-conscious and supersensitive, and her feelings are easily hurt. About this same time a change in the girl's religious THE PERIOD OF PUBERTY 103 nature may be noticed. Mothers and Sunday-school teachers should fully understand this change, that they may guide the girl aright through this epoch in her spiritual being. The Phenomena of Religious Changes. — It is at this period, between the innocence of childhood and the fixed ideas of maturity, while the girl is yet impressionable and has already capacity for spiritual insight, that those ap- parently sudden changes of character in the spiritual life, known as conversion, usually occur. Sometimes the changes are gradual rather than sudden. The ideas of God and duty and religious observance, which during the earlier years may have been external to the child, having been embodied in precept or custom or in her own playful imagination, now, during the period of adolescence, take root in her life and have a vital significance; they be- come her own. The majority of girls at this time go through a period of storm and stress. They have a sense of incompleteness and imperfection; often they become brooding, depressed and morbidly introspective. Many doubts arise to distress them; there is a constant friction against their surround- ings. This is the most important stage of these changes; on its outcome the future religious attitude of the girl de- pends. Ill health and want of proper guidance at such a time are responsible for many cases of religious indifference. THE MOTHER'S DUTY. The duty of the mother is plain. Dr. Capp says : "The daughter is fortunate whose mother makes their intercourse a sympathetic companionship, especially at the age of puberty, when those changes in body and mind take place which develop the girl into a woman. "Of the changes in her body no one can speak to her better than a mother; but it will call for infinite tact and 104 THE PERIOD OF PUBERTY the nicest judgment to so discuss them that maiden modesty and the charm of feminine instinct be not disturbed, and that proper hygienic considerations shall be inculcated. Certainly, the child should not be left to derive knowledge upon such subjects from servants or chance friends, who are not likely to be properly informed. It is not a time calling for alarm. The whole process is physiological, a growth and development according to the laws of nature; no new thing is happening." Sound practical advice in this connection is also given by Dr. Jane Walker: "Mothers and guardians of girls should obtain their entire confidence with regard to their monthly functions; it will save much misery, both to body and mind. "Here let me say that it is the duty of a mother to be open with her girl in this connection. When, from the changes that are occurring in the girl's body, her mother suspects that menstruation is about to take place, it is her duty to tell her what lies before her. What she will say will vary with the daughter's age, and also with the extent of the mother's own knowledge. If the latter has some acquaintance with physiology and natural science, she will be in a better position with regard to this question than one who has had no scientific teaching at all. Probably the simplest plan is to draw the girl's attention to the various signs of approaching womanhood, and then to tell her that this is one of them. In whatever way the com- munication is made, it must not be omitted, for no one can realize the shock endured by a perfectly ignorant girl on experiencing her first monthly period. Many of the ills suffered in later life are traceable to neglect and ignorance at this time. Moreover, if the mother does not herself tell the girl, someone else will probably do so, and the com- munication may be made with coarseness, which will have THE PERIOD OF PUBERTY 105 an injurious effect on the girl's character. A mother should at this period of her life be a girl's best friend, with whom she feels there can be no reserve. " THE HYGIENE OF PUBERTY. During this trying period of her life, the child should be kept free from all excitement. She should spend a great deal of her time out of doors, playing various games, with- out becoming fatigued with too much exercise. Light oc- cupations will give her something to occupy her mind and take her thoughts off herself. She should have plenty of sleep, nine hours at least, but she must not be permitted to lie in bed after waking in the morning. During the menstrual period the daughter should re- ceive special care and attention. She needs quiet and rest and must not apply herself too closely to her studies. The hygienic management of menstruation itself is considered in detail in the following chapter. The Mother or Physician Should be Consulted Without Hesitation. — Dr. Button emphasizes that, as the girl ap- proaches puberty and is instructed regarding what is about to occur, it must be impressed upon her that her mother and her physician are her confidential advisers, either of whom she can freely consult regarding any trouble with the menstrual function, without being considered at all im- modest; that the subject is a sacred one, which she may discuss freely with her mother or physician for the purpose of information and advice, and maintain her dignity and modesty; but that to discuss it lightly with companions, in jest, is improper, immodest and vulgar. CHAPTER X. THE MONTHLY PHENOMENA. Ovulation. Menstruation. Time of onset and cessation. Character of the menstrual discharge. Duration of the flow. Quantity of the discharge. Other symptoms exhibited at this period. The menstrual interval. Pain during menstruation. Connection between menstruation and ovulation. Vicarious menstruation. The hygiene of the menstrual period. "The common ingredients of health and long life are : Great temp'rance, open air, Easy labor, little care/' — Sir P. Sidney. E VERY month there occur in a woman two phe- nomena, menstruation and ovulation. Neither is B3S2I dependent upon the other although they usually, but not always, occur at the same time. Ovula- tion, however, may be present several years before men- struation begins. THE PHENOMENON OF OVULATION. The ovary has been described as a gland secreting eggs. These eggs or ova develop one at a time. At regular in- tervals the most mature egg or ovum swells to the size of a pea or cherry and bursts through the wall of the ovary. This occurrence is known as ovulation, and takes place once a month during the period from puberty to the menopause. This period lasts on the average from the fourteenth to the forty-fifth year, although it has begun as early as the ninth and has ended as late as the fifty-ninth year. Ovu- 106 THE MONTHLY PHENOMENA 107 lation may begin before menstruation, as has been said, and may cease before the menopause. When the ovum is discharged from the ovary, it en- ters the funnel-shaped outer end of the Fallopian tube and travels through this tube into the uterus. Connection Between Menstruation and Ovulation. — Although there is no direct connection between the two, menstruation and ovulation depend upon a common cause, being due to the same periodic nervous impulse. As a rule, the ovum is discharged at the height of the menstrual con- gestion, but it may leave the ovary at any time during the menstrual interval. THE OCCURRENCE OF MENSTRUATION. About the same time the ovum is discharged, a change takes place in the lining membrane of the womb. This becomes swollen and congested, due to an increase in the number and size of the blood-vessels. When Conception Occurs. — If the ovum, in its journey through the tube, should be impregnated by a sperma- tozoon or male cell which has worked its way up from the vagina, it becomes attached to the wall of the uterus. In this case the swollen and congested mucous membrane con- tinues to develop and helps to form the coverings for the ovum or egg with its contained embryo or unborn child, When Conception Does Not Occur. — If, on the other hand, the ovum is not impregnated, the new and dilated blood-vessels rupture, filling the uterus with blood. The uterus thereupon contracts and expels the blood. This monthly discharge of blood from the womb is known as menstruation. Time of Onset and Cessation of Menstruation. — In the preceding chapter menstruation was shown to be the prin- cipal event of puberty. It begins in this country at the 108 THE MONTHLY PHENOMENA fourteenth year but the time of its first appearance is in- fluenced by the factors already mentioned. The menstrual flow usually ceases about the forty-fifth year, but it may stop before a woman is forty. On the other hand, it often continues beyond the forty-fifth year. The period at which it ceases is known as the menopause or "change of life." A chapter is devoted to the considera- tion of this important epoch. Character of the Menstrual Discharge. — The menstrual discharge consists chiefly of blood, but contains mucous secretion from the glands of the uterus and vagina. It is dark in color. As a rule it should not clot. A peculiar odor is imparted to it by the secretions of the glands of the vagina. Duration of the Flow. — The normal duration of the flow is from two days to a week. It rarely lasts less than three days. After the bloody flow has ceased it is commonly followed for a day or two by a mucous discharge or leu- corrhea. Quantity of the Discharge. — The amount of fluid dis- charged is given by Penrose as from two to nine ounces, and by Hirst as four to six ounces. It is seldom measured accurately. Instead, it usually is estimated by the number of napkins worn in twenty-four hours and is considered excessive if the napkins must be changed more than three times a day. The flow is greatest during the first two or three days and then grows less until it ceases. Other Symptoms Exhibited at this Period. — A woman usually experiences at this time a feeling of weight and heaviness in the generative organs, caused by their con- gestion and swelling. There is also a state of more or less nervous excitability, depending, as a rule, upon the woman's temperament. A nervous person is usually made worse at such a time. The breasts usually swell and may even A TIRED MOTHER AND HER BABE. After her hard day's work the weary mother is more ready for sleed? than her baby whom she has just put to bed. THE MONTHLY PHENOMENA 109 secrete milk. The neck becomes enlarged through the swelling of a gland that lies just above the breast-bone. Sometimes the tonsils also become swollen; a singer may thus lose her voice at such a time. The heart usually beats quicker and more forcibly. The skin becomes redder from an increase of blood and may be flushed at times. Dark rings appear under the eyes and brown patches, known as liver spots, may show upon the skin. The Menstrual Interval. — Twenty-eight days usually elapse from the beginning of one menstrual period to the beginning of another. The menstrual interval, however, may vary within the limits of health. The flow sometimes occurs with regularity every two, three or five weeks. In the first instance the flow may be normal in amount every four weeks but scant at the alternate periods. Irregularities often occur when the general health is poor and when certain diseased conditions are present. These are discussed in a subsequent chapter. Pain During Menstruation. — A normal menstruation is painless. When pain is suffered before, during or after the menstrual period, it is an indication that there is something wrong with the general health, or with the local condition. The subject of painful menstruation and the methods for its relief are treated in the afore-mentioned chapter. VICARIOUS MENSTRUATION. The name vicarious menstruation is given to the dis- charge of blood at the menstrual period from some part of the body other than the uterus. This bleeding may come from the nose, the throat, the lungs, the stomach, the bladder, or the rectum and anus. It may occur in addi- tion to the normal flow. It is a rare condition, though as a rule of no serious import, being usually found in debilitated, 110 THE MONTHLY PHENOMENA nervous women. In some cases, however, it is indicative of defective development. THE HYGIENE OF THE MENSTRUAL PERIOD. It is important that a woman should, so far as possible, have rest and quiet while menstruating. Especially is this true during the earlier years, when the mental and physical disturbances of puberty occur. Rest in bed is desirable, though not essential except in the very nervous. In every case all mental and physical work should be reduced as much as possible. A woman must be careful to avoid heavy lifting, over-fatigue in walking, too long standing, riding a horse or wheel, dancing and participating in violent sports during this period. Not only must she not indulge in sea bathing, but she cannot use cold water in any way — as tub, shower or sponge bath. All the hygienic rules given in the early chapters of this book are to be closely followed. In regard to the mental and nervous symptoms that may occur at such a time, Dr. Walker gives the following excellent advice: "Watch yourself carefully during these periods, and if you observe that you are unusually irritable, keep a tighter grasp on your self-control and try to appreciate the fact that you are not quite your best self. "If the world looks dark and people appear unfriendly, remember that you are being influenced by your physical condition, and do not pass judgment until you are feeling more nearly normal. You will then generally find that the world is just as bright and your friends are just as loyal as you had believed them before." CHAPTER XI. PURITY. Tfcs danger of silence. A mother's responsibility. What constitutes purity. A mother's duty to her daughter. To preserve true modesty and inno- cence. The dangers of secret vice. Hygiene as a prevention and treatment 'Love Virtue, she alone is free ; She can teach thee how to climb Higher than the sphery clime ; Or if Virtue feeble were, Heaven itself would stoop to her." — Milton. THE DANGER OF SILENCE. BARENTS seldom realize that silence in regard to the matter of purity is fraught with the greatest danger to their children. They naturally feel some hesi- tancy and diffidence about broaching so delicate a subject. In their cowardice they frequently delude them- selves with the thought that possibly their child will escape learning of the evils existing in the world. But as a mother, writing in a leading popular magazine, some years ago said: A Mother's Responsibility. — "A knowledge of the utter corruption of human nature must in some degree reach the most sheltered woman of the present day, and it lies with every mother to accept the responsibility of seeing that it comes in the right way. If the alternative were between the knowing and not knowing of certain things on the part in 112 PURITY of young girls, a mother might feel a natural pang at the thought of disturbing the vestal purity of the girlish imag- ination; but it is usually a very different alternative from this. The choice lies too often between knowing the right things and knowing the wrong — between looking at the most solemn realities of life in an earnest, reverent spirit, or making them the subject of mysterious and giggling con- fidences, and doable entente, though mothers may fondly dream otherwise. It is quite time that we women and mothers should face this question squarely, and that we should come to a true idea of what constitutes purity. What Constitutes Purity. — "Purity means spotlessness, not mere ignorance. It is a mental poise — that attitude toward evil which can only be taken and maintained where a knowledge of evil exists. It is not what one knows that constitutes impurity, but what one loves. * * * * A Mother's Duty to Her Daughters. — "It is an immense advantage to a woman to have made her children her com- panions. The. habit of talking with them and explaining difficulties of various kinds will open the way for such teach- ing as this, and if, in addition, she has informed herself in scientific matters, so that she can lead the way from phys- iological botany to human physiology, she will find the familiarity with scientific terms and the habit of dealing with the subject impersonally a great aid. "When a natural and healthful curiosity is met by a frank and simple statement of facts, the greatest danger is avoided. All temptation to discussion of these matters among girls is removed. Knowledge, instead of weaken- ing and corrupting the character, really strengthens and purifies, if it be the right kind of knowledge, rightly given. There must be a pure and right way of looking into what- ever God has ordained. Let us seek until we find it, and then gently guide our daughters till they find it too, ,, PURITY 113 These same ideas are expressed by Dr. Capp, in his little book on "The Daughter," in which he says : TO PRESERVE TRUE MODESTY AND INNOCENCE. "To preserve the charm of true modesty and innocence, it is safer for a girl that she be instructed concerning the requirements of personal purity, rather than be allowed to grope amid chance experiences and to run the risks of un- friendly influences. Experience is the only teacher for all, but in many things the lessons may be taken at second hand, and the wise do well to profit by the experiences of others. Although it may be a difficult duty to perform, no careful mother will neglect to properly instruct her daughter in matters relating to the sexual nature. Thoughts upon this subject cannot be avoided, but will arise as mind and body develop, and they should be wisely and intelligently di- rected in confidential talks skillfully planned and discreetly managed by the mother. "Sexual matters are not motives and aims in life, but they imperiously mingle with and influence all motives and aims. They are inseparable from existence, and though important, must be made subordinate, and though irre- pressible, must be held in subjection. To ignore them is as fatal to happiness and success in life as to allow them to be the objects of chief pursuit. To underrate their influence is a great mistake; it must be justly appreciated in order to maintain an effective control by the stronger forces of the intellect and the will. Let it be remembered how large a portion of human misery results from the disorderly ani- mal passion. Much of this should be withheld from the knowledge of the young, but enough, for their own safety, may be pointed out by the mother, and be accompanied by such admonitions as seem suitable in each individual case. That the duty is a delicate one and is surrounded by diffi- 8 114 FTJKXTY culties affords no reason for its avoidance, but rather calls for redoubled tact and a superior skill, which will not fail of their aim when instigated by the loving instinct of a true mother's heart. "The subject is obviously not one for promiscuous dis- cussion, but nothing is gained in private by veiling it with mystifying reserves and ingenious evasions, which serve [ often to keep smoldering an unsatisfied curiosity that had better be laid to rest by a little necessary plain and whole- some truth. Here, as upon many other social subjects, greater safety to the individual and to the community lies in knowledge tending to wisdom rather than in ignorance, if only the mind is maintained in a proper attitude toward the facts." THE DANGERS OF SECRET VICE. Fearing to suggest a habit of which the child may have no previous knowledge, a parent usually fails to warn the child of the dangers of secret vice. Few real- ize how prevalent is this evil, and how many the oppor- tunities for learning of it. Schools, especially boarding schools, have long been the chief breeding places for bad habits. A servant, and especially the nurse, is frequently the instructor. A child may accidentally produce a pleas- urable sensation and voluntarily repeat it without being aware that she is doing wrong. This is especially liable to occur in the presence of irritation or of any physical defect. Children can dissemble so skillfully that they may never be suspected. Because a child looks innocent is no indication that it is so. A mother must never allow her love to blind her to possible imperfections in her child. It is an injus- tice to the child not to warn her of the pitfalls into which she may stumble. Perfect frankness regarding so frequent a cause of general ill-health, chronic invalidism, and some- times even insanity, will save a girl much physical and PURITY 115 mental suffering as well as moral loss. Even though the results may not be as grave and irremedial as is often thought, they are serious and often lasting. A mother's duty is plain. Hygiene as a Prevention and Treatment. — To prevent as well as cure improper habits or tendencies, the child's thoughts should be diverted from sexual matters and pre- vented from centering upon herself. All associations and modes of life which have such a tendency should be discoun- tenanced. A wise supervision must be exercised over books and companions. Busy occupations furnish a means of monopolizing the time and keeping both body and mind from running into morbid states. Healthful amusement and judicious exercise are important; outdoor life and interests should be encouraged. The girl should go to bed whole- somely tired, so that she may promptly fall into a sound sleep, undisturbed by dreams. CHAPTER XII. MARRIAGE AND COURTSHIP. The views of various thinkers. The origin of marriage and the family. Mar- riage customs among different people. Courtship according to modern ideas: in Continental Europe, in England, in America. Love the basis for marriage. The nature of love, according to the poet and the philosopher. Passion versus affection. Love as a passion is transient. Passion may be followed by a steadier sentiment. Marriages based on passion are unhappy. Province of courtship to cultivate mutual esteem and friendship. The money question should be considered before marriage. A wrong standard of requirements. Marriage for position or wealth. Sincerity during court- ship. The training of a girl for wifehood. Qualities needed by a working- man's wife. The proper age for marrying. The danger of early marriages. A mutual understanding about details necessary before marriage. 'Hail, wedded love, mysterious law, true source Of human offspring." — Milton, ||1t1N a book dealing with a woman's life, so important an 5g» ■ event as marriage should not be passed over with- sIBsj out some mention. Apart from its causal relation to many physical ills, married life has an influence upon a woman's nervous and mental conditions through which it may affect the health. Much of the misery and un- happiness that comes after marriage might be prevented by a calm reflection beforehand on its duties and responsi- bilities, and by a mutual interchange of ideas during the period of courtship. In the belief that a study of marriage from the historical and philosophical standpoint may make a woman better fitted for becoming the head of the house- hold and the mother of a family, the author has collected the views of various thinkers of different countries and periods, 116 MARRIAGE AND COURTSHIP 117 of which he can say with Montaigne, "I have here made only a nosegay of culled flowers, and have brought nothing of my own but the string that ties them. ,, THE ORIGIN OF MARRIAGE AND THE FAMILY. The institution of marriage has its origin in a law exist- ing throughout the animal kingdom for the perpetuation of the species. Among many of the animals the parents live together for a longer or shorter period, but among others no such conjugal tie is recognized. As a rule, however, the mother is attached to her young and provides for them until such a time as they can look after themselves. In the human race are seen all the gradations from the promiscuity of primitive peoples to the monogamy of modern civilized communities. From the necessary rela- tions of the father, mother and child to each other arises the family. Unable to live alone, the child requires both nourish- ment and protection; the former is supplied by the mother, the latter by the father. MARRIAGE CUSTOMS AMONG DIFFERENT PEOPLES. Marriage customs vary considerably in different parts of the world. Letourneau has described them in detail. Marriage by Capture. — The most primitive form is what is known as marriage by capture. This is practised among the natives of Australia and the surrounding islands and of the Philippines. The man captures a woman be- longing to another tribe and subsequently enters into a treaty with that tribe by which, after a certain ceremony, he is permitted to retain the woman as his wife. The mar- riage rites in Mongolia, and among the Esquimaux, are a form of simulated capture which takes place after the mar- riage has been arranged by the parents. The Esquimaux 118 MARRIAGE AND COURTSHIP pretend to kidnap the girl. In Mongolia the woman in her bridal attire gallops off on a horse, pursued by the bride- groom and the wedding guests. Marriage by Barter. — Another form of marriage is that by barter, traces of which may still be seen in a number of civilized countries. In Africa the girl belongs to her parents, who in a friendly way barter her for an ox or for a cow. Among the Indians marriage is usually a commercial enterprise. The husband buys his wife, or, if a poor man, is obliged to work to gain her. He binds himself for a stated time to the girl's parents, for whom he must hunt, dig- and scoop out canoes. In some tribes a certain period of servi- tude was always customary. The husband was obliged to give a tenth part of the game that he killed to the father and mother of his wife. In ancient Greece and Rome the girl was bought by presents or by services rendered to the father. At a later period the father gave her a dowry but still might marry her without consulting her wishes. In Scandinavia also and in certain parts of Germany the marriage was no more than a sale of the young girl, the husband having to buy her from the father. But by de- grees instead of this method that of a dowry paid by the woman was substituted. COURTSHIP ACCORDING TO MODERN IDEAS. With the progress of civilization the condition of woman has improved. The woman has acquired a certain independence and in most civilized countries no longer is married without her choice being consulted. For many cen- turies the prospective husband has had to woo her and ob- tain her consent. Thus the period of courtship has arisen. Customs vary in different countries as to the manner of MARRIAGE AND COURTSHIP 119 courtship and even as to the social intercourse between young unmarried persons of opposite sexes. Courtship in Continental Europe. — On the continent of Europe the match is usually determined upon or at least sanctioned by the parents before the young folks meet. As a rule a man may not call on a girl until he first through a third person asks to marry her, and only in the event of the consent of her parents being obtained will he be permitted to see and speak to her. The English Idea of Courtship.— -In England oppor- tunities for social intercourse are less restricted so that young people may be able to study and know each other well. It is not customary, however, for a man to be seriously at- tentive to a girl for an indefinite length of time without de- claring his affection or at least making his intentions known to the father. Social Intercourse in America. — Still greater advan- tages and liberty of choice are afforded in America. Here men and women may form close friendships and learn to know each other's thoughts and hopes without necessarily looking forward to a closer tie. Thus a more intelligent choice is made possible. Choice of a Life Partner. — The duties of marriage, says a French philosopher, begin before marriage. They begin with a mutual choice of the man and the woman. This choice should not be made lightly without thought, but should be determined by a serious and noble conception of the duties and end of marriage. LOVE THE BASIS FOR MARRIAGE. All writers agree that without love no one should marry. "Never marry but for love," was William Penn's injunction, "but see that thou lovest what is lovely." Miss Mulock can understand women's renouncing love, or dying of it, or 120 MARRIAGE AND COURTSHIP learning to live without it; but marrying without it, either for "spite," or for money, necessity, pity, or persuasion, is to her utterly incomprehensible. She says, "Out of duty or gratitude it might be possible to work, live, or even die for a person, but never to marry him." THE NATURE OF LOVE. The Poet's View. — From earliest times love has been the theme of poets including the Hebrew King Solomon, the Grecian Homer and the Roman Virgil. In "The Lay of the Last Minstrel" Scott gives the following description: True love's the gift which God has given To man alone beneath the heaven : It is not fantasy's hot fire, Whose wishes soon as granted fly ; It liveth not in fierce desire, With dead desire it doth not die ; It is the secret sympathy, The silver link, the silken tie, Which heart to heart and mind to mind In body and in soul can bind." The Philosopher's View of Love. — Somewhat different from the poet's picture of love is the philosopher's definition. Herbert Spencer says that love is habitually spoken of as though it were a simple feeling, whereas it is the most com- pound, and therefore the most powerful, of all the feelings. To the physical elements forming the nucleus of the whole are added the feelings produced by personal beauty that con- stitute simple attachments. With these there is united the complex sentiment termed affection, which is here greatly exalted. Then there is the sentiment of admiration, respect and reverence, which in this relation becomes in a high de- MARRIAGE AND COURTSHIP 121 gree active. There comes next the feeling called the love of approbation, which is gratified in a degree passing every other experience by being preferred above all the world and that by the one admired above all others. There also is added that indirect gratification which results from the pref- erence being witnessed" by others. Further, the allied emo- tion of self-esteem comes into play, being agreeably excited by the proof of power at having succeeded in gaining such attachment from and sway over another. There is also the pleasure of possession, the two belonging to each other. In addition the relation allows of an extended liberty of action and of an exaltation of sympathies which doubles one's own pleasures and adds to them the pleasures of another. These all greatly exalted unite to form the mental state we call love. PASSION VERSUS AFFECTION. Love as a Passion is Transient. — It is universally recog- nized that love considered merely as a passion usually has but a short duration. Like all other passions it tends to be changeable, transient and accidental. It generally passes away with beauty and youth, and seldom outlives the freshness of physical charms. In the opinion of Walter L. Sheldon, the distinguished ethical culturist, that sentiment which the poet tells of, and which is sung or presented in music, or pictured in the story, is simply the portrayal of a spasm in life — beautiful and entrancing as it may be. He believes that in three-fourths of the cases, if not in nine- tenths of them, it is all involved in a period of one, or two. or three years, perhaps only the few months before marriage and the few months after. PASSION MAY BE FOLLOWED BY A STEADIER SENTIMENT. Sheldon does not consider this sentiment by any moans the only lofty aspect of the love-passion or of the love-union. 122 MARRIAGE AND COURTSHIP In a course of lectures on the subject of marriage he said: M That spasm may be only a short phase through which the deep feelings may have to pass — or it may not be an essential part of the experience at all. Over and over again, after the passion has subsided, it would seem as though the union were at an end. But where it was an actual attachment, something more than a mad ebullition of passion, there has come little by little another and steadier sentiment which has gradually found its place and held on to the end. Again and again there has been a tragedy because the two people have not waited for this new phase of affection to arise. They had thought their love was dead only because the transient excitement was over ; whereas in reality the real love-sentiment may be only just getting started. Many of the happiest unions which have ever existed have probably been between people who went through this experience of disappointment because of the illusions which had been fostered mistakenly in their youth. Time must be given for a further reunion to arise on a spiritual plane, but where prose and poetry must jostle together in the daylight of stern reality. The Second Experience of True Affection. — "In that second experience it is no longer the sentiment-standpoint of two souls with a single thought or the two hearts that beat as one — a fantastic impossibility — it is an awakening to the actualities of life, and to all its possibilities. An affection may then arise which can admit of imperfections in the one for whom it exists, which can cling in spite of weakness and selfishness and caprice. And in this kind of an affection where the two may be only imperfectly united, there is a possible realization of each in the other by which the life of each does become more complete in the other. And that very completion and fullness may come in putting up with the other's imperfections, by a union for better and for worse." 1 ^ ^ o O" ^ ^. as s to to 3. J— 1 O 3 r o i? *-< o *n rs. a. s s CO 1 0. St* w O <^ ^ "^ s H P o to O o ^5 ^-s-> o § » * r*~ £ w S~ EC! i o Oo ■^ o ^. <^ CO 1*j 3 W £ ^ < 1 e^ § H . <"> ^s & 8 ^ 1 s: «*. ^ ^ <3 MARRIAGE AND COURTSHIP 123 Romantic Love Cannot be True Love. — Felix Adler believes that a great deal of the disappointment in marriage may be attributed to false expectations founded upon the romantic idea of love, the false idealization of the beloved person. To attribute perfection to the object of love is characteristic of the romantic idea, which is inspired by the desire of each to enjoy the perfection of the other. This indulgence in delusions and dreams he objects to, because it is false ; and falsehood, especially in the fundamental relations of life, is sure to enact its penalties and to bring reaction in after years. There are some persons, he admits, especially women, who have the art of obstinately adhering to their illusions in defiance of their better knowledge. But in general, he says, when it appears that the idol has feet of clay, then one of two things must happen; either the marriage continues intact while love is dead, supported by the force of custom or by fear of exposure, and becomes a sort of lacklustre fellow- ship, a weary chain that is dragged to the end with what patience one can command; or else, in bolder and more reckless natures, the idea to meet the embodiment of one's ideal some- where, persists, and the attempt is made to find outside of marriage, in unwholesome and illicit ways, the satisfaction which the marriage relation fails to bring. For these reasons he believes that romantic love cannot be true love. Marriages Based on Passion are Unhappy. — Franklin believed that headstrong motives of ungoverned passion result in unhappy marriages. He wrote: " Passions are extremely tran- sient and unsteady, and love, with no other support, will ever be short-lived and fleeting. It is a fire that is soon extinguished, and where there is no solid esteem and well-cemented friendship to blow it up, it rarely lights up again, but from some accidental impulses, by no means to be depended upon, which a con- trariety of tempers, the fatalities of sickness, or the frowns, of fortune, may forever prevent, as age most certainly will. 124 MARRIAGE AND COURTSHIP "What has been observed seems to point out that a blind, a sudden and intoxicating passion has a natural tendency, under its own direction, to occasion unhappy mar- riages, and produce scenes of grief and repentance." Province of Courtship to Cultivate Mutual Esteem and Friendship. — "Friendship and esteem," Franklin says, "are derived from principles of reason and thought, and when once truly fixed in the mind are lasting securities of an at- tachment to our persons and fortunes ; participate with, and refine all our joys ; sympathize with, and blunt the edge of every adverse occurrence. However it may be in common life, there certainly cannot be any steady or lasting happi- ness in a married one where a mutual esteem and friend- ship of the strongest and noblest kind does not subsist. Let it therefore be the sacred business of our courtship to culti- vate one, and on no account engage ourselves in wedlock without it." THE MONEY QUESTION SHOULD BE CONSIDERED BEFORE MARRIAGE. "How much, or how little a fortune will content us," writes Franklin, "depends chiefly on our way of thinking. Be this as it will, it should seem very proper before all mar- riages for both parties to know truly and fairly what they have to expect on this head, and seriously to consider with themselves whether it will be sufficient so far to answer their desires, as to prevent future murmurings and anxieties, and prudently allow them to enjoy life as they intend. All deceit herein should be carefully avoided; we may otherwise impose on ourselves and ruin all our future felicity." A WRONG STANDARD OF REQUIREMENTS. Many men are prevented from marrying, and many marriages are made unhappy, because the woman often has MARRIAGE AND COURTSHIP 125 been accustomed as a daughter to comforts and luxuries which become her standard of requirements for all time. Only Those in Equal Circumstances Can Marry Under Such a Standard. — This wrong standard of requirements, according to Sheldon, works pathetically in making it in- evitable that only those persons accustomed to the same plane of luxuries in their homes may join in the marriage relationship. The man most adapted to a woman frequently dare not think of her, because he is in humbler circumstances and would not be able to sustain her on the plane in which she has been living. Thus the actual freedom of choice is restricted. Marriage for Position or Wealth. — A consideration be- fore marriage of social position is almost as important as that of the money question, for the marriage of persons from different planes of society may lead both to embarrassment and unhappiness. When, however, too much attention is paid to these matters the marriage seldom results happily. Franklin says that the finer sentiments are never felt or known in that alliance where interest and fortune only are considered. Envy may be raised among the weak and silly, but pity and contempt among the wise and judicious. The slaves to dross can never be animated with a spirit of a gen- erous, an elevated and inflexible friendship. "Gold is their idol," he declares, "'tis that they wed." SINCERITY DURING COURTSHIP. One of the most freqent causes of unhappiness in mar- ried life is the false view of one's mind and disposition presented during courtship in order to win the affections. Franklin considers the masking of our tempers and appear- ing what we really are not to be a most dangerous folly, and an imposition highly culpable, so that he is really at a loss to judge whether the absurdity or iniquity of such a scheme 126 MARRIAGE AND COURTSHIP be the greatest. "In such a case," he says, "we have raised and supported an affection by false appearances ; when those are seen through, as most certainly they will be, what title have we to love or friendship? None, and consequently no prospect of social happiness. "Let us, my friend, on the contrary, observe a religious sincerity, appear in our native characters, undisguised and unaffected. If under those we gain esteem and friendship, our prospects of maintaining them are as secure as our own minds and dispositions may be lasting. Let us be outward- ly what we really are within, and appear in such a character as we steadfastly design to continue. Hereby we shall lay a strong foundation for our future happiness in marriage. ,, THE TRAINING OF A GIRL FOR WIFEHOOD. Housekeeping is not a simple undertaking, but a most complicated one, which cannot be successfully taken up without previous training. The mother therefore should train her daughter in the management of the household by allowing her to exercise some of the duties and responsibili- ties connected with the house. QUALITIES NEEDED BY A WORKING-MAN'S WIFE. In order to elicit the opinion of the working classes on matters connected with their social condition, an English- man named John Cassell offered prizes for the best essays on various subjects. Louisa Bell, a seamstress and the widow of a factory hand, in her prize essay on "Indiscreet Marriages," says: "Working men are much too apt to choose their wives without any reference to their former domestic lives and habits. Bitterly enough sometimes they repent this precipitancy. A working-man's wife should have been well and diligently brought up by good parents. She should know how to perform every household duty, and MARRIAGE AND COURTSHIP 127 be able to make or mend the clothes of the family. Her health should likewise be good. Ill-health and over-delicacy of constitution sound very interesting in some of the highly- strained fictions of which our working women are so fond; but in real, common, every-day life, strength and health in an operative's wife are beyond all sentimental notions of re- finement and beauty. . . . Economy in Dress. — "Neatness and a due attention to dress are not only commendable, but imperative on every woman, and man also; but dressing must not be carried be- yond the due bounds necessary to self-respect and the re- gards of others. A working woman's pride should be to possess a good stock of neatly made under-clothing; and a couple of gowns, or at most three, may then well suffice her. With economy these three gowns will last a long time. . . "Cleanliness and simplicity should be the height of their ambition instead of the cheap finery which in a week's space becomes soiled and unfit to be worn. "Very few of the working class of women, unless dress- makers by trade, know how to make their own attire.* Many are perfectly helpless in this respect. The sums they are compelled to pay in putting out such work would educate the children, and provide better fare for the family. It is no excuse to urge, as many do, that they pinch themselves and families in food or firing to provide fine clothes. Working people require good nourishment, and to subtract from a husband's dinner to buy a new bonnet or a new dress is no apology, but adds to the folly and selfishness of a passion which at all risks must be gratified Training in Marketing and Cooking. — "Marketing is another art — for art it is — in which a workman's wife is woefully deficient; and, lacking it, her weekly money will ♦This was written of the English working woman. It probably is not true of the American factory girl of today. 128 MARRIAGE AND COURTSHIP seldom go far, or yield satisfactory returns. She buys in- ferior meat, because she can get more for her money, forget- ting that it wastes in proportion to its inferiority. She buys the bony portions of an ox or sheep, because it is apparently cheaper, and never takes into account the dead loss of the bone, for the very slender portion of skill she possesses in cooking is insufficient to teach her how to convert even bones into nutriment. In this latter accomplishment she has neither experience nor any desire to gain it. She boils her stews, and makes them hard and indigestible. She cannot, in fact, cook even a potato fit to be eaten, and is utterly in- competent to render the cheap parts of meat nourishing and tender. Yet such knowledge goes far to render the working class man's home replete with comfort and happiness. Savory meals and palatable food are regarded by all, rich or poor, as one of the elements of domestic comfort — and not unreasonably; wanting these, the workman surely seeks solace in the tap-room or the liquor-vaults." THE PROPER AGE FOR MARRYING. Law and custom in different countries do not agree upon any one age as being the most suitable for marriage; opinions vary greatly. Speaking from the physiological standpoint, it may be said that marriage should not take place until the full growth and development has been at- tained. The idea of the ancients, which is still held by peo- ple in certain countries, that with puberty a woman enters upon the child-bearing period is a mistaken one. A woman should not marry before she has reached her twentieth year, nor a man before the age of twenty-four. It would be even better for a woman to wait until she is twenty-four, at which age she may be considered fully developed. Individuals who have not yet themselves reached ma- turity cannot possibly beget properly developed and healthy MARRIAGE AND COURTSHIP 129 offspring. This is true of man and animals alike. No breeder permits his stock, however healthy, to bring forth young be- fore they have arrived at maturity. The offspring of such are always small and weak. It is the common practice among fanciers to destroy the first litter of pups, as they are usually found to be sickly. THE DANGER OF EARLY MARRIAGES. In the human family, it has been noted from very early times that the children born of parents who have not them- selves reached maturity are wanting to a greater or less ex- tent in strength, stamina, courage and general develop- ment. Aristotle noticed that the children were puny and of small stature in those cities of Greece where it was the cus- tom for young people to marry before maturity. Montes- quieu observed in France that when fear of being sent to war caused great numbers of young people to marry long before the proper period, the children were small, wretched and unhealthy. To be called the child of a boy or girl has always been equivalent to being called a coward. This Mac- beth well knew when he exclaimed to Banquo's ghost : "What man dare, I dare Approach thou like the rugged Russian bear, . . . . or, be alive again, And dare me to the desert with thy sword ; If trembling I inhibit thee, protest me The baby of a girl. ,, Strahan says that a vast number of the children of the immature are born prematurely to the great danger of the imperfectly developed mothers; that a much larger per- centage of them are idiotic, dumb, blind, scrofulous, and otherwise imperfect and deformed than of the children of parents generally; that they have a less firm hold on life than 130 MARRIAGE AND COTJRTSHXP the children of mature parentage, and that many succumb to scrofulous and nervous affections, a great number dying of convulsions before or during the period of the first denti- tion. As a class, such children are decidedly not long-lived, and those who do attain the age of maturity are generally delicate and under-sized physically, often obtuse and more or less dwarfed mentally, if not distorted, at least blunted, morally, and are wanting in spirit, energy and courage. The Misery Caused by Early Marriages. — The folly of early marriages may be seen in its economic aspect as well as in its physiological. Mrs. Bell writes : "It is no uncom- mon thing among the operative class to see a couple present themselves for marriage whose united ages do not amount perhaps to thirty-four years — the girl-wife sixteen, the boy- husband two years her senior. All the money they can col- lect or save is spent in making holiday on the wedding day. Their home is one poor room, void of all furniture, save a bed of the humblest description, a chair or two, and a table with one or two cooking utensils. The earnings of both — for in these cases the wife is generally employed at some of the slop-work so prevalent in London, work for which the very lowest amount of remuneration is given — can bare- ly sustain their mutual wants. When children come, what with the utter inexperience of the mother, and the reckless habits of the premature father, all speedily in that poor household becomes dirt, waste, confusion and misery. The young pair have known no youth, none of the freedom from \the yoke of care, which should be one of the especial privileges of that happy time; but all becomes faded, wan, spent. The gloom of middle age comes on, when life should be in its first promise of spring; and age ensues in the middle of existence — age and premature decay. Being the very nature of immaturity to be fickle, boys and girls rashly fancy they love; and not understanding the nature of true affec- MARRIAGE AND COURTSHIP 131 tion, its endurance and devotion, without which it is not worthy of the name, they unite themselves in irrevocable bonds, grow soon after mutually weary and disgusted, and ultimately part even after dwelling together for years, hav- ing shared the precocious troubles which they have brought on their own hands." A MUTUAL UNDERSTANDING ABOUT DETAILS NECESSARY BEFORE MARRIAGE. There are many matters of importance in the married life which are seldom discussed beforehand. The man and woman are each in ignorance as to the other's views of many subjects until after the wedding day. Brutal instincts never before suspected may then be discovered, with result- ing unhappiness, discord and ill-health. Neglect to fully ac- quaint oneself beforehand with the other's opinions in regard to the married life is unfair to both. A way should be found — direct or indirect — of settling all questions before the ir- revocable step is taken. CHAPTER XIII. HEREDITY IN ITS RELATION TO MARRIAGE. CONSANGUINITY. Providing for the health of the unborn. Exchange of confidences. A physi- cian should be consulted. When these precautions are disregarded. Where the hereditary taint is slight. Drunkenness an obstacle to marriage. In- sanity and epilepsy a bar to marriage. Deaf-mutism in its relation to marriage. Instinctive criminality a form of degeneracy. Consumption a disease in which heredity is sometimes a factor. The marriage of syphi- litics. Consanguineous marriages. "The gods visit the sins of the fathers upon the children." — Euripides. I T is most unfortunate that, no matter how debased, crippled or deformed people may be, they are allowed to marry and become the parents of a suffering, helpless family. Judgment and common sense should always arise to prevent the union of those who are unfit, mentally or physically, for bearing children. Providing for the Health of the Unborn. — Dr. Richard- son said: "The first step toward the reduction of disease is, beginning at the beginning, to provide for the health of the unborn. The error commonly entertained, that mar- riageable men and women have nothing to consider ex- cept wealth, station or social relationships, demands cor- rection. The offspring of marriage, the most precious of all fortunes, deserves surely as much forethought as is be- stowed on the offspring of the lower animals. If the inter- marriage of disease were considered in the same light as the intermarriage of poverty, the hereditary transmission 132 THE BEDTIME PRAYER. Every mother should teach her child to scud up petition if it be only the beautiful and simple, 11 Now I lay me down to take my shop, I pray Thee, Lord, my soul to keep." HEREDITY. CONSANGUINITY. 133 of disease, the basis of so much misery in the world, would be at an end in three, or at most four, generations." Exchange of Confidences. — Strahan advises that all persons who contemplate matrimony, or to whom attention and overtures are being made with a view to marriage, should look upon a mutual exchange of confidences upon this matter of hereditary or family disease as absolutely es- sential, and that, too, at an early period of the intimacy, be- fore the affections have become deeply engaged. Too often knowledge of the existence of the family skeleton, when given at all, is only given when matters have gone so far that only those of strong will find it possible to give up the loved one because of an evil so distant and shadowy as this family taint appears to the eyes of the lover. A Physician Should be Consulted. — Before the mar- riage of a person in whose family there is an hereditary disease, a physician should be consulted and the whole mat- ter should be laid before him candidly and honestly. The de- cision of a competent physician should be accepted as final. The importance of adopting such a course cannot be em- phasized too strongly. Where these Precautions are Disregarded. — Untold misery is entailed by the disregard of such precautions. Stra- han thus describes the day of reckoning: "In some cases it comes very soon, as where the first-born's vacant face is scanned day after day, and the heart sinks as the terrible fact forces itself upon the parent that his child is an idiot, or where the young wife suddenly loses all that made her god-like, all that made her human, and the husband finds himself with a creature in his arms at which his soul re- volts. * * * * "But in many cases the evil day does not arrive until middle life; and then, when the fear once felt has worn away, when the deception practiced has faded from the 134 HEREDITY. CONSANGUINITY. memory, and the grave admonition of the physician is for- gotten, the son in whom the father hoped to live again, the girl on whom the mother's heart is set, is torn from the family circle a raving maniac, a tortured epileptic, a drunken criminal, or, happily, a suicide. Then arise sad regrets, but it is too late; the laws of Nature have been ignored, gratifi- cation has been purchased, and the price must be paid. The sins of the fathers shall be visited upon the children/' Where the Hereditary Taint is Slight. — In addition to the cases in which the hereditary predisposition to disease is so decided that marriage should not be considered, there is a still larger class of those in whom the taint is so miti- gated that, with a properly selected partner, a fairly healthy family may be reared. If a member of a neurotic family — that is one in which insanity, epilepsy, drunkenness or suicide has at any time appeared—marries a healthy member of a healthy family, the tendency to nervous disease, if not too deeply marked in the parent, may be totally lost in the children. But when he marries into another neurotic family disaster will surely fall upon the luckless children. Even when the disease has appeared in but one or two members of the family it shows the existence of the ten- dency and will probably reappear in the children of such an unfortunate marriage. DRUNKENNESS AN OBSTACLE TO MARRIAGE. There is probably no disease or vice which causes deeper degradation in the individual and more acute suffer- ing in the family than drunkenness. It is the starting point of insanity, epilepsy, crime, and endless diseases in posterity. Idiocy is often due to the family taint of drunkenness, about twenty-five per cent, of the idiots being children of intemperate parents. In Norway, when the duty on liquor was removed and intemperance began at once to increase HEREDITY. CONSANGUINITY. 135 among the people, idiocy increased 150 per cent, and in- sanity 50 per cent, among the children born during the next ten years. In the following family history, given by Morel, the degenerating effect of drunkenness upon the stock is well shown : First Generation. — Father, a drunkard. Second Generation. — Son, a drunkard. Was disgust- ingly drunk on his marriage day. Third Generation. — Seven grandchildren. First died of convulsions. Second died of convulsions. Third was an idiot at twenty-two years of age. Fourth, melancholiac, with suicidal tendency— became demented. Fifth, peculiar and irritable. Sixth, has been insane repeatedly. Seventh, nervous and depressed, and indulges in most despairing an- ticipations as to his life and reason. No woman should marry a confirmed drunkard; nor should she become engaged to the son of one until his dis- position and character have been most carefully inquired into. INSANITY AND EPILEPSY A BAR TO MARRIAGE. When insanity is inherited in any family, it usually appears in only one, two or three members of each genera- tion; but it may be transmitted to the next generation by those who do not themselves become insane. A person who at any time has been insane should never marry. A mem- ber of a family in which any mental disorder has appeared should not marry into another neurotic family. If, however, such a one be a man, and show no evidence himself of the family failing, he may sometimes marry into a healthy family with but a minimum of clanger to the offspring, al- though it were best not to run the risk of progeny. Such permission, however, can never be granted to a woman, as 13b' HEREDITY. CONSANGUINITY. there are certain epochs in her life when the chances for losing her reason are very great if there be an hereditary taint of insanity in her family. Epilepsy may practically be regarded as an hereditary affection. Although at times it may seem to be brought on by an injury or fright or nervous irritation it seldom attacks one who does not inherit a neurotic temperament. In fact when there is insanity in a family, the children are liable to be epileptic. Consequently one subject to this disorder should not marry. DEAF-MUTISM IN ITS RELATION TO MARRIAGE. There are two classes of deaf mutes which must be care- fully differentiated before the question of marriage is con- sidered. In one family predisposition plays no part; in the other the disease is of an hereditary character. Where deafness has followed some injury to the organ of hear- ing before or shortly after the power of speech has been attained, it should not be a hindrance to marriage, as it is never transmitted. Deafness present at birth, however, is usually dependent upon some family defect, being a con- dition of degeneracy closely allied to idiocy. Clouston considers it a physiological sin that marriage between such persons should be legal. INSTINCTIVE CRIMINALITY A FORM OF DEGENERACY. The habitual criminal is an abnormal type of individual, the result of a family degeneracy. He is a moral imbecile, lacking the moral sense in the same manner as the idiot lacks intelligence. The hereditary character of this form of degeneracy, which is known as instinctive criminality, has been recognized from the earliest times. Like every family trait, it may be transmitted to all or only to some HEREDITY. CONSANGUINITY. 137 of the members of each generation. This is well illustrated in the following genealogical tree given by Rossi: m.- Thief. ? R. S. M. Insane. Convicted of wounding. A Convicted of wounding and fraud. A drunkard. — M.- Thief. — M. Thief. L 1 1. Il 1 M. L k Pickpocket. Five times feigned madness. Com c fra icted >f ud. Thief. Receiver of stolen goods. Thief. Honest and Healthy M. Thief. Convicted of wounding. Of all the persons convicted of wilful murder in Eng- land and Wales between the years 1879 and 1888, 32 per cent, were found insane. It is needless to say that a member of a degenerate family should never marry and thus transmit the criminal tendency. HEREDITY IS SOMETIMES A FACTOR IN CONSUMPTION. Consumption is a contagious rather than an hereditary disease. It is caused by a minute germ which, on entering the system, produces destructive changes, chiefly in the lungs. The germ is present in the spittle of consumptives and may be transmitted by kissing or using the same spoon, fork or tumbler. It also is set free from sputum which has not been disinfected and may enter the lungs with the in- spired air. Those Liable to Consumption. — While consumption itself is not inherited, it often occurs in persons who from birth are characterized by lowered vital resistance. This condition of inability to resist disease may be transmitted. It is often found in those who have a family 138 HEREDITY. CONSANGUINITY. history of consumption. It may also occur in those whose parents have lowered vital energy caused by other affec- tions, such as alcoholism, syphilis, cancer, diabetes, unfavor- able age for or too rapid procreation, or privation, exhaus- tion or depression affecting the mother during pregnancy. As a rule, however, the condition is acquired. It may result from depression, as grief, disappointment, fear, shame, anxiety, shock, religious gloom and terror. It is often caused by privation, including want of proper food, want of air, want of heat, want of cleanliness, want of shel- ter, want of clothing, want of light and want of enjoy- ment. Very frequently it comes from exhaustion, such as dissipation, over-eating and over-drinking, over-exercise, exhausting or unresting labor, physical or mental, pro- longed lactation, lactation continuing during pregnancy, too frequent and rapidly succeeding pregnancies, the effects of certain diseases (typhoid fever, measles, influenza, dia- betes), and from violent or consuming emotions, such as rage, jealousy, greed, inordinate ambition, and the like. Persons who have this condition of underdevelopment and lessened vital force may transmit it to their children. If they marry into a family with the same failing, this tendency in the offspring will be more marked. As a rule, however, by careful attention to the laws of hygiene and the methods of living described in this book, the tendency to consumption may be overcome. A person with such an hereditary taint, by proper living, may not only avoid hav- ing consumption herself, but may so eradicate this family failing that it will not appear in the children. THE MARRIAGE OF SYPHILITICA Syphilis is not an hereditary disease, strictly speaking, but it may be transmitted to the offspring from either parent. A person who has once had this disease should HEREDITY. CONSANGUINITY. 139 not be married until a physician has declared the disease cured and has given his permission for the marriage. The period of danger may last from two or three years after the onset of the disease to ten or fifteen years after it, depending upon the faithfulness with which the treatment has been carried out. CONSANGUINEOUS MARRIAGES. The question of consanguineous marriages is usually settled by the law, in many States the marriage of first cousins being forbidden. There is no physiological reason, however, why such marriages should not take place. A committee appointed by the New York State Medical So- ciety to investigate the influence upon the offspring of con- sanguineous marriages stated in its report that if the family be free from degenerative taint, marriage among its mem- bers in no way diminishes the chances of healthy offspring. Other authorities have also agreed that there is no greater amount of disease or deformity among the offspring of parents related to each other by blood than among the chil- dren of parents not so related, provided the parents be equally free from tendency to disease or degeneration. Such marriages, however, are almost certain to trans- mit in an accentuated form any disease or defect already present in the family. Inasmuch as at the present time there can scarcely be found a perfect human family — almost every family having a taint or tendency to disease of some kind — and as all such imperfections are transmitted and rapidly deepened in the family by the intermarriage of its members, it is best that such unions in all cases be for- bidden. They should be discountenanced even in healthy families, for such union may wake up some pathological character which has been latent for one or two generations. CHAPTER XIV. THE BASIS OF HAPPINESS IN MARRIED LIFE. Cove is kept by art. The influence of the personal appearance. Care in the personal appearance. Dressing for the world rather than for the home. The invasion of the home by conventionalities. The husband neglected for the children. The avoidance of contention. The economic dependence of woman. Humiliation dwarfs a woman's character. The question of pocket money. Race Suicide. Healthy home life necessary. "Unjustly all our nymphs complain, Their empire holds so short a reign, Is after marriage lost so soon, It hardly holds the honeymoon : For if they keep not what they caught, It is entirely their own fault; They take possession of the crown, And then throw all their weapons down. Though by the politician's scheme, Who'er arrives at power supreme, Those arts by which at first they gain it, They still must practice to maintain it." — Swift. * LOVE IS KEPT BY ART. pjfTIEAN SWIFT says that the reason why so few mar- ybgj riages are happy is because young ladies spend their Ellis) time in making nets to catch men's hearts, not in making cages to keep them. The same thought was expressed by Ben Jonson when he remarked that "Love comes by chance, but is kept by art." According to Ben- jamin Franklin happiness in married life is preserved by 140 Copyright, 1904, by William H. Rau. MOTHER THE QUEEN OF THE HOUSE. After the children come to manhood and womanhood the mother and father find old age made happy by the presence of those able to grace the hearthstone and help bear the burdens of life. HAPPINESS IN MARRIED LIFE 141 carefully avoiding litigious wranglings and capricious con- tentions, and by cultivating dispositions of reciprocal conde- scension and such a uniformity in tempers that the pleasures of one may be the pleasures of both. "An ambition," he says, "to please each other, and oblige by all the little turns of behavior, that so frequently will occur to a polite and well-disposed inclination, must have a won- derful good effect to support our affections, secure mutual esteem and friendship. Minds of any refined cast have an exquisite relish for these soothing and expressive marks of tenderness, and they can't fail of meeting with a most grateful reception. We should make it our mutual study to render ourselves agreeable and amiable by all the innocent arts of invention, and every laudable stratagem of conduct. . . . The little oversights and sallies of frailty, to which human nature is ever liable, and from which the most perfect charac- ters are not exempt, should be passed over and die unnoticed " The Obligations of Marriage. — A distinction is drawn by Felix Adler between the inducements that lead to marriage and the obligations ensuing, after the marriage is effected. The inducements to marriage, he says, are often of an ephemeral sort; beauty, for instance, or charm, or accomplish- ments. But there is no stipulation that the marriage shall last only so long as those last. The obligations of marriage are to perpetuate and enhance the spiritual life of the world, to keep burning the flame of mentality on earth; to subject oneself to the modifying influence of the other sex, and to throw all the profit of this influence into the life of the offspring; to confer perpetual benefits each on the other, especially benefits of the highest kind, by ministering each to the others moral growth. The Influence of the Personal Appearance. — It is remarkable what an influence personal appearance exerts on marital happiness. Too little attention to dress in the 142 HAPPINESS IN MARRIED LIFE privacy of the home and too much in the conventionality of the outside world has frequently been the cause of dis- satisfaction. Care in the Personal Appearance. — Franklin advises people to be most careful and exact in their personal ap- pearance. "It is surprising/' he says, "but too common to see (amongst both sexes) many, who before marriage were very assiduous in the adorning and neatness of their per- sons, that afterward grow negligent and highly culpable by the reverse, which attention and remissness, I verily be- lieve, is often one of the first and most effectual methods to cool the affection, and estrange the hearts of many a couple. And herein, according to the most impartial observations I have made, the ladies are most blamable." Dressing for the World Rather Than for the Home. — Sheldon asserts that "the wife dresses too much with an eye to the outside world, rather than with a thought as to what will please her husband's eye. She may wonder why he does not take more interest in her toilet, and may not be aware of the fact that her husband's taste may not be that of her conventional women friends. What might charm him would perhaps be simplicity, while the world outside asks for display. Why is it that a wife thinks less about the charm of her dress at her private dinner-table to the one pair of eyes opposite to her, than she does about the dress she is to wear if there are to be guests at the table? Why is it that the world's eye in this regard may become of even greater importance than the eye of the husband?" The Invasion of the Home by Conventionalities. — The domination of the sanctity of our homes by the outside world is an appalling circumstance which menaces the institution of the family, according to this same writer. "For just this rea- son," he says, "a kind of estrangement may set in between husband and wife, making the tie between them prosaic and HAPPINESS IN MARRIED LIFE 143 common-place. Each is a little disappointed in the other, partly for the reason that they have thought too little about pleasing each other in the home and about having the home and home-life just for the sake of themselves. "It is my conviction that the woman, who, if she fol- lowed her own spontaneous inclinations, would be the home- maker and care supremely to have a perfect home for its own sake, has for a time been carried out of her own most instinctive disposition, through a transient submission to conventionality. "If, as is true to-day over many parts of the world, the wife is little by little growing disappointed in the husband, as being prosaic and not caring for the family or for herself in the way she had hoped, I believe one of the causes for it lies right here. The man, the husband, does not feel at ease or at home in many parts of his own house. He does not feel at home even with his own wife. He is vaguely conscious that the woman of his choice belongs not only to him, but to a great show-world outside. Down in his heart there is a lurking disappointment. The home does not seem to come overwhelmingly first in the thought of his wife." THE HUSBAND NEGLECTED FOR THE CHILDREN. Sheldon also asserts that nowadays the husband is often neglected by the wife for the sake of the children, where he is not neglected for the sake of the conventional outside world, although he believes that every mother will be up in arms against him at this point. The average mother will ask, "Can a woman do too much for her children ?" He an- swers: "Yes, especially where the service for the children may not apply to their actual needs, but be rendered in order to keep up to a conventional standard. In this way, too, the man is led to feel as if he has a house and home, not for him- self, but for his children. The tendency here has gone to an 144 HAPPINESS IN MARRIED LIFE extreme. In the old days it was otherwise. Wife and chil- dren were all neglected for the sake of the head of the fam- ily. He was the sovereign and it was a brutal sovereignty. "To-day the situation is precisely the contrary. The needs of the child come first. The mother asks it and the father and husband grants it from a sense of duty, if for no other reason. But in many a man, at the present time, there is developing on this score a spirit of rebellion. The wife may not be conscious of it because of her devotion for her children. Later on she becomes aware that something has happened in the lack of interest for herself or the home on the part of the husband. The cause for this, however, may never dawn upon her, because the change took place in those years when she was completely rapt up in her little ones. ,, THE AVOIDANCE OF CONTENTION. The conditions described by Sheldon are not the only ones that are responsible for unhappiness in married life. Misunderstandings between husband and wife are often caused by disputes and contentions over little things. Neither listens to Pope's advice: "At every trifle scorn to take offense, It always shows great pride or little sense." Unhappiness may often be avoided and the mutual love and respect retained until the end by observing the warning of Swift : "Let prudence with good nature strive, To keep the flame of love alive, Then, come old age whene'er it will, Your friendship shall continue still: Thus a mutual, gentle fire, Shall never but with life expire." "A little observation and reflection on the common scenes of matrimony," wrote Franklin, "may supply us with HAPPINESS IN MAREIED LIFE 146 many instances to show how much these trivial jarrings spoil the harmony, and interrupt the felicities of it. "What fermentations and heats often arise from break- ing of china, disordering a room, dinner not being ready at a precise hour, and a thousand other such impertinent bagatelles. "But trifling as these things may be in themselves, it is too notorious they often occasion such feuds and feverish animosities amongst married people, as frequently give a bitter tincture to and discompose many hours of their lives; and are sometimes of so bad a consequence as to inflame their minds with such spleen and distaste that irreparable breaches are thereby opened." THE ECONOMIC DEPENDENCE OF WOMAN. The emancipation of woman from her original posi- tion as a slave in the household has been most erratic, ac- cording to Sheldon. Whereas there has come a freedom in the disposal of her hand before marriage, and the aboli- tion of slavery after marriage, there is still to a large extent a dependence on the economic side which does practically hold woman to a position of serfdom. "It is," he says, "per- haps the most painful experience through which the average woman must undergo, who has no income of her own, when, after the first year of marriage and the two have settled down to an equilibrium of existence, she finds herself com- pelled to resort to a multitude of petty artifices in order to secure the small sums essential for her personal needs or requirements. This has stifled the budding soul of more women than almost any other experience. And the man may discover it only when it is too late. It may perplex him why his marriage-life has grown prosaic; why the charm has been vanishing out of his home life. Humiliation Dwarfs a Woman's Character. — "There is IO 148 HAPPINESS IN MARRIED LIFE a certain degree of dependence which may be ennobling on the character. But if it is carried beyond a given point, it works in precisely the contrary way; the nature is stunted or dwarfed. And this dwarfing process is going on in thousands of families all over our land, because the wife is subject to so much of this exacting humiliation. The man himself may suffer indirectly even more from this than the woman. He has lost something out of his married life which cannot be replaced. Instead of the wife and com- rade, little by little he discovers that he has only a house- keeper or a mother for his children. And the responsibility for it may lie altogether at his own door. He has failed to treat his wife as a comrade; and they are both victims of his mistake." The Question of Pocket Money.- — A writer many years ago in a woman's magazine held that on account of the treat- ment of wives by their husbands as regards pocket money, many a nice, bright girl, who has become self-supporting and knows the comfort of freedom in the matter of spending money, hesitates and needs a very strong attraction before she is drawn into marrying anyone, thus shutting off from the race the very force and talent which it needs in mothers. "If a wife has not sufficient wisdom to know when to spend money in accordance with her own and her husband's means," writes this contributor, "she has not sufficient wis- dom to keep a house or to bring up her children, and she should not, in fact, be allowed to marry. Of a man having a wife of discretion, yet, still unwilling to let her spend as she sees fit, it may be said that he has no business to marry and establish a household unless he can afford a house- keeper and a housekeeper's wages, and pay those wages to the wife every Saturday night, or at such other time as she chooses. The woman who combines in herself, as the majority of wives do, the office of housekeeper, cook, cham- HAPPINESS IN MARRIED LIFE 147 ber-maid, governess, nurse, and seamstress, ought to have something more than her clothes and the title of mistress in recompense. When she is discharged from any of these offices, and has a servant of her own whose wages are regu- larly paid, it is still something of a humiliation to her to see that person with more money than she herself, able to please her whim in purchases, always with a dollar or two in her pocket ready for the emergency of charity, or gift, or ex- penditure, while she herself in that rank and condition where more is expected of her is unable to take a ticket for this affair, or give a coin to that beggar, or send to the shop for a purchase until she has asked for the money." PRESIDENT ROOSEVELT ON RACE SUICIDE. One of the most important problems of the married life confronting the American people of to-day is that of race sui- cide. In an address before the National Congress of Mothers at their meeting at Washington, in March, 1905, President Roosevelt said: "The Nation is in a bad way if there is no real home, if the family is not the right kind, if the man is not a good husband and father, if he is brutal or cowardly or selfish, if the woman has lost her sense of duty, if she is sunk in vapid self-indulgence or has let her nature be twisted so that she prefers a sterile pseudo-intellectuality to that great and beautiful development of character which comes only to those whose lives know the fullness of duty done, of effort made and self-sacrifice undergone.. . . Healthy Home Life Necessary. — "No piled-up wealth, no splendor of material growth, no brilliance of artistic de- velopment, will permanently avail any people unless its home life is healthy, unless the average man possesses hon- est} 7 , courage, common sense, and decency, unless he works hard and is willing at need to fight hard ; and unless the average woman is a good wife, a good mother, able and will- 148 HAPPINESS IN MAREIED LIFE ing to perform the first and greatest duty of womanhood, able and willing to bear, and to bring up as they should be brought up, healthy children, sound in body, mind and character, and numerous enough so that the race shall in- crease and not decrease Woman's Task, Motherhood. — "Just as tne happiest and most honorable and most useful task that can be set any man is to earn enough for the support of his wife and family, for the bringing up and starting in life of his children, so the most important, the most honorable and desirable task which can be set any woman is to be a good and wise mother in a home marked by self-respect and mutual forbearance, by willingness to perform duty, and by refusal to sink into self-indulgence or avoid that which entails effort and self- sacrifice.. . . "No mother has an easy time, and most mothers have very hard times, and yet what true mother would barter her experience of joy and sorrow in exchange for a life of cold selfishness, which insists upon perpetual amusement and the avoidance of care, and which often finds its fit dwelling place in some flat designed to furnish with the least possible ex- penditure of effort the maximum of comfort and of luxury, but in which there is literally no place for children? Respect Due a Good Wife and Mother. — "The woman who is a good wife, a good mother, is entitled to our respect as is no one else; but she is entitled to it only because, and so long as, she is worthy of it. Effort and self-sacrifice are the law of worthy life for the man as for the woman, though neither the effort nor the self-sacrifice may be the same for the one as for the other. . . . The Woman who Merits Contempt. — "There are many good people who are denied the supreme blessing of chil- dren, and for these we have the respect and sympathy al- ways due to those who, from no fault of their own, are denied THE MOTHER'S MORNING DELIGHT. 77 is the mother's pleasure in the morning to give the bath. The child, while it is taken from its crib by the sunny u . and made ready for the bath, plays in its mother's ai HAPPINESS IN MARRIED LIFE 149 any of the other great blessings of life. But the man or woman who deliberately foregoes these blessings, whether from viciousness, coldness, shallow-heartedness, self-indul- gence or mere failure to appreciate aright the difference between the all-important and the unimportant — why, such a creature merits contempt as hearty as any visited upon the soldier who runs away in battle, or upon the man who re- fuses to work for the support of those dependent upon him, and who, though able-bodied, is yet content to eat in idle- ness the bread which others provide. "The existence of women of this type forms one of the most unpleasant and unwholesome features of modern life.... The Mother "Blessed."— "The man is but a poor creature whose effort is not rather for the betterment of his wife and children than for himself; and as for the mother, her very name stands for loving unselfishness and self-abne- gation, and, in any society fit to exist, is fraught with associations which render it holy. "The woman's task is not easy — no task worth doing is easy — but in doing it, and when she has done it, there shall come to her the highest and holiest joy known to mankind ; and having done it, she shall have the reward prophesied in Scripture; for her husband and her children, yes, and all people who realize that her work lies at the foundation of all national happiness and greatness, shall rise up and call her blessed." CHAPTER XV. PREGNANCY : THE DEVELOPMENT OF THE CHILD. An explanation of Nature's mysteries. Reproduction: In plants; in the lower animals; in man. Conception. The development and nourishment of the embryo or unborn child. The placenta and umbilical cord. Changes in the mother during pregnancy. Lightening. "Come forth into the light of things, Let Nature be your teacher.' , — Wordsworth. The physiology of so important an event as pregnancy should be understood by every woman. Emphasis has already been laid on the necessity of a mother explaining Nature's mysteries to her daughter in an intelligent and tactful manner. Matters of this kind, however, should be regarded in a broad light, the whole world being included in the view. The description given on the following pages, it is hoped, will not only make the matter clear to the mother, but will also suggest to her a, way to present this delicate subject to her daughter. REPRODUCTION THROUGHOUT NATURE. It has been shown earlier in this book how Nature has provided all living matter with the power of reproduction, or of forming new members of the family. Everything Composed of Cells.— When seen under the microscope, all plants and all animals are found to be com- posed of minute bodies, called cells. The shape and kind 150 PREGNANCY 151 Lung Cells. (Magnified.) of these cells vary in different structures. The roots of a tree are made of one kind of cell, the leaves of another, the bark of a third, the fruit of still a fourth, and so on. In the same way skin, muscle, bone, hair and nails are each composed of a dif- ferent kind of cell. All new individuals begin with one cell, which divides and subdi- vides until it forms many cells, each of which grows and divides again. The ovule in a seed divides, some of the cells forming roots, others becoming stem and leaves. Various Methods of Reproduction. *— -The original cell that forms the new body is produced in va- rious ways. In the yeast plant and in the hydra the new cells appear as buds on the parent cell. Sometimes, as in seaweed and in the green slime or algae seen on stagnant pools, the parent cell divides into two daughter cells. In all higher forms of life, however, a union of two dissimilar cells is necessary to form the first cell of the young organism. Most plants and animals develop certain cells, w T hose sole object is to perpetuate the species. These cells usually are of two kinds. One kind becomes converted into the young cell as soon as it comes in contact with the other. The first is called the female cell, the second the male cell. Muscle Cells. (Magnified.) 152 PREGNANCY In flowers the pistil is the female element, its stigma and style forming a tube leading down to a sort of nest, called the ovary, in which lies the ovule or female repro- ductive cell. The pollen on the stamens represents the male reproductive cell. When blown by the wind, or car- ried on the antennae or sucking tubes of insects down the style of the pistil it fertilizes the ovule which lies at the bottom. As soon as the ovule comes in contact with the pollen it begins to divide and finally becomes a seed, capable of pro- ducing another plant. In animals, as a rule, a union of the male and female elements is necessary. As the impregnated cell divides, a living creature begins to be formed, which, at first, is not always like the parent. From the egg laid by the butterfly crawls the caterpillar, which later builds its cocoon and emerges a fully developed butterfly. The tadpole is hatched from the egg of a frog and, after continuing to grow as a water animal, it one day sheds its skin and becomes a frog. REPRODUCTION IN HUMAN BEINGS. Every month a woman discharges from the ovary a mature ovum, which enters the funnel-shaped end of the Fallopian tube and travels down toward the uterus. If at this time any male cells, called spermatazoa, happen to be in the tube, having worked their way up through the uterus from the vagina, one of them may penetrate the ovum or female reproductive cell. The moment the two cells unite, conception has oc- curred, and the resultant cell formed by this union is the beginning of the future child. This cell divides into two cells and then into four, eight, sixteen, and so on, as is shown in the figure on the following page. As the cell or egg divides it passes into the cavity of the uterus, where it lodges in one of the folds of the thick- PREGNANCY 153 ened lining membrane. Here for nine months it develops, first into an embryo with gills and a tail, then into a fetus or crudely formed child, and finally into a normal infant. The shell or outer part of the egg is formed by the mem- branes. The developing child lies surrounded by the waters or amniotic fluid. As the cells continue to divide, they be- come specialized, some going to form the skin, others to make muscle, bone, and so forth. ZONA PELLUCIDA POLAR GLOBULES. The Developing Ovum. The dividing cells which are to form the living child are here shown. The numbers indicate the different stages in the development of the ovum. Nourishment of the Child within the Womb. — The fetus is nourished by the mother's blood, which enters its body at the umbilicus or navel. Three long blood-vessels extend from a thickened spot on the uterine wall, called the placenta (which forms part of the afterbirth), to the child's navel, at which point they enter the body. These vessels are surrounded by a jelly-like substance, which protects them from injury and with which they form the umbilical cord. 154 PREGNANCY Shortly after the child is born the umbilical cord is tied off and severed, the infant's end then drying up and later falling off. CHANGES IN THE MOTHER DURING PREGNANCY. Changes occur during pregnancy in the mother as well as in the child. The womb or uterus becomes enlarged as the fetus increases in size; it rises from the pelvis into the abdomen at the fourth month, is at the level of the navel at the sixth month, and at the ninth month reaches its highest point, a little below the pit of the stomach. The accom- panying illustration shows the comparative size and posi- tion of the uterus during the different periods. During the ninth month the child's head leaves the abdomen and enters the pelvis, the top of the womb dropping to where it was at the eighth month. This occurrence is familiarly spoken of as "lightening" or dropping. The walls of the abdomen be- come stretched, with the forma- tion in the skin of white, bluish or reddish streaks. They also be- come loaded w T ith fat, giving a fuller appearance to the figure. Pressure of the uterus on the Section of the Abdomen in a bladder and rectum interferes Pregnant Woman. w j th the j r f unct i onS) causing COn- Showing the size of the womb ... ,. i £ . • .• at the different periods of preg- Ration and frequent urination. nancy. The figures indicate the Pressure on the veins may give month of pregnancy. fise tQ nemorr } w id S } or piles, and to varicose veins of the legs and vulva or external parts. The nerves of the uterus are so upset by the stretching that PREGNANCY 155 they carry the irritation to the stomach, thus producing nausea and vomiting. The nervous system itself also undergoes a change, which shows itself in alterations in disposition, in perver- sions of taste, such as a longing for pickles or some other odd article of food, in a tendency to become melancholic The Child in the Womb. and in the occurrence, at times, of severe neuralgia, espe- cially of the face and teeth. For some unknown reason the teeth during pregnancy exhibit a tendency to decay. It is a common saying that a woman loses a tooth for each child she bears. CHAPTER XVI. THE SYMPTOMS OF PREGNANCY. Determination of the existence of pregnancy. The commonest symptoms of pregnancy: The cessation of menstruation; Morning sickness; Appearance of the face; Changes in the breasts; Changes in the size, shape and appear- ance of the abdomen. Quickening: Alterations in the nervous system. Change in color of the mucous membrane. Hearing the fetal heart sounds. The physician's examination. "Coming events cast their shadow before." — Campbell. DETERMINATION OF THE EXISTENCE OF PREGNANCY. S a rule, it is not a difficult matter to determine whether a woman is pregnant, although cases have occurred in which mistakes were made. Physicians have operated on a supposed abdominal tumor only to find a pregnant uterus. There are certain symptoms, however, which are us- ually present in a woman who is with child. But they may occur in conditions other than pregnancy, and they may be absent, though the woman be "in a family way." The physician is the only person who is competent to decide. The Commonest Symptoms of Pregnancy. — The most common symptoms of pregnancy experienced by the mother are (i) cessation of menstruation, (2) "morning sickness," (3) changes in the size, shape and appearance of the ab- domen, (4) changes in the breasts, and (5) quickening. THE CESSATION OF MENSTRUATION. As soon as a woman becomes pregnant, menstruation usually ceases. But its absence may depend upon other 156 ■^ i THE SYMPTOMS OF PREGNANCY 157 causes, as in the condition known as amenorrhea, which is described in Chapter XXXIV on "Disorders of Menstrua- tion." In some few cases there is a slight bloody discharge during the first three months of pregnancy. It will thus be seen that the sign is not an invariable one. THE MORNING SICKNESS. At the sixth or seventh week of pregnancy nausea and vomiting appear, usually lasting to the third month, being worse when the woman first arises from bed in the morn- ing, whence it derives the name "morning sickness. " It is not always present and may exist in many other conditions. THE APPEARANCE OF THE FACE. After conception has occurred, dark, irregular splotches, resembling freckles, called chloasmata or liver marks, may appear in the brow and cheeks, sometimes running so closely together as to form .the so-called "mask of pregnancy." Dark rings also often form under the eyes. These, too, occur in other conditions and cannot be regarded as diagnostic. CHANGES IN THE BREASTS. During pregnancy the breasts become enlarged and distended. The veins can be plainly seen. As the disten- sion continues, white Hues or striae, resembling cracks, ap- pear in the skin. Appearance of the Nipples. — The nipples themselves also become more prominent. The colored areola sur- rounding them becomes darker in color and broader in ex- tent. Little glands in this areola often become enlarged to the size of buckshot and project conspicuously. As pregnancy advances, a drop or two of a cloudy liquid, called colostrum, can be squeezed or milked out of the breast. The woman usually experiences a tingling sensation in the 158 THE SYMPTOMS OF PREGNANCY breasts, owing to their congestion, and later a feeling of fullness when the colostrum begins to appear. All of these changes may occur without the existence of pregnancy; some, and rarely all, may be absent, even though that condition be present. CHANGES IN THE ABDOMEN. Increase in Size. — There is a progressive enlargement of the abdomen as the womb increases in size. Enlargement of the abdomen, however, occurs in many other conditions, and, on the other hand, it has existed without attracting the woman's notice. Alteration in Shape. — After the ninth month a change takes place in the shape of the abdomen as the child's head sinks into the pelvis and its body falls a little forward. This phenomenon is known as "lightening" or "dropping." With it there is a lowering of the waist line; the upper part of abdomen becomes flatter and the navel more prominent. Change in Appearance. — The umbilicus or navel be- comes gradually pushed out or everted. At the sixth month it is on a level with the surface of the abdomen, and later begins to pout. It is surrounded by a black ring. From this ring a black line extends along the middle of the ab- domen upward to near the pit of the stomach and down- ward to the pelvis. The line is given the name of linea nigra, which means black line. Owing to the stretching of the abdomen, white lines or striae, looking like cracks, appear in the skin, especially in the region of the flanks and the hips and along the outer side of the thighs. THE OCCURRENCE OF QUICKENING. A living fetus, or unborn child, moves about within the womb, but not until about midway between the fourth and fifth months are the movements powerful enough to THE SYMPTOMS OF PREGNANCY 159 be felt by the mother. The sensation the mother ex- periences when the fetus moves is called "quickening." It has been felt as early as the third month, but may not be noticed at all until the last month. During the advanced stages of pregnancy fetal movements can usually be felt by a person laying a cold hand suddenly upon the woman's abdomen. There are two kinds of sensations conveyed to the hand: a heaving and a sensation compared to that' of a finger-tap under a blanket. Necessarily, movements are never felt when the fetus is dead. They may be undetected even when it is living. There are many things, moreover, which may simulate these movements and thus lead one astray. ALTERATIONS IN THE NERVOUS SYSTEM. A pregnant woman usually exhibits some disorder of the nervous system, becoming more sensitive .and irritable. Her disposition may change from placidity to vivacity, or from amiability to sullenness or moroseness. Sometimes the moral nature is affected, with impairment of the ability to distinguish between right and wrong. The appetite may become very fanciful and the most unusual articles of diet may be craved. Often a woman experiences a sense of dizziness or a feeling as if she were going to faint, or she may even lose consciousness. Neuralgia, especially of the face and teeth, is not uncommon. Such symptoms, of course, cannot solely be regarded as indicative of pregnancy. CHANGE IN COLOR OF THE MUCOUS MEMBRANE. During the second half of the period of gestation, and sometimes as early as the second month, the mucous mem- brane of the vagina assumes a bluish or purplish hue, which has been compared to the color of the lees of wine. About 160 THE SYMPTOMS OF PREGNANCY the same time the color of the mucous membrane about the entrance changes from a pink to a bright scarlet. These are not infallible signs, however, as they may be produced by other conditions and may even be absent throughout the whole of pregnancy. HEARING THE FETAL HEART SOUNDS. After the fifth month, if the fetus is alive, its heart sounds can usually be heard by applying the ear to the woman's abdomen. The place where they commonly are heard best is a spot about an inch below the navel, to the left (sometimes to the right) of the median line. The heart of the unborn child beats at the rate of 120 to 160 a minute. Two sounds are heard with each beat. The sound has been compared to the ticking of a watch under the pillow. It must not be mistaken for the woman's heart beat, which is a single sound, keeping time with her pulse. Many con- ditions may prevent the fetal heart sounds being heard. THE PHYSICIAN'S EXAMINATION. There are some signs of pregnancy that are found on an internal examination, which, of course, only the phy- sician can make. It is impossible, however, for any one to make a positive diagnosis of pregnancy before the sixth week, and sometimes not until the fourth month. THE DISORDERS OF PREGNANCY. The disorders and diseases that occur during pregnancy will be considered in a later chapter. CHAPTER XVII. THE LIFE OF A WOMAN DURING PREGNANCY. Diet. Dress: hygienic or maternity waists and corsets; the abdominal bandage. Exercises to strengthen the muscles and preserve the figure. Bathing during pregnancy. Work, exercise and rest. Maternal Impressions. Keeping the mind in pleasant channels. How to render labor easy. Care of the breasts during pregnancy. Preparation of the nipples. Care of excretions and discharges: the urine; the bowels; leucorrhea. Marital relations during pregnancy. "For life is not to live, but to be well." — Martial. nTTHANY women make no change in their lives with the feiyJ advent of pregnancy, but continue as though their I gggg J condition is attendant with no danger. Such a view is erroneous; the border line between health and dis- ease may easily be passed during pregnancy unless the woman is careful about her mode of life and reports to her physician any unusual symptoms that may develop. The health of the child as well as of the mother depends in great measure upon the hygiene of this period. THE DIET DURING PREGNANCY. During pregnancy the diet should be simple and in ac- cordance with the directions in Chapter VI. Meat should be eaten but once a day and then only in small quantities. Cereals, fresh vegetables and fruits should form the princi- pal articles of food. Milk should be taken in large quantities — plain, diluted with plain or effervescing water or with lime-water, cooked with vegetables, or made into puddings, 11 161 162 LIFE DURING PREGNANCY etc. Rich and indigestible food must be avoided. Water should be drunk freely, at least one or two quarts during the day. Alcoholic drinks are prohibited. The woman should also take very little tea or coffee. Morning sickness may sometimes be prevented if be- fore getting up, while lying flat on her back in bed, the woman takes a hot drink of milk, broth, cocoa, chocolate, tea, or coffee, with or without toast, and remains in bed for half an hour afterwards before attempting to get up. THE DRESS OF THE PREGNANT WOMAN. More so than at any other time the rules laid down in Chapter V on "Clothing" should be strictly observed during Waist with buttons for sup- porting the skirts. Skirt Supporter or suspenders. Abdominal bandage. pregnancy. Silk or wool must be worn next to the skin, the shirt having a high neck and long sleeves. The use of gar- ters should be discountenanced. All compression about the waist must be avoided. The ordinary corset therefore must be discarded but in its place an hygienic waist or corset made LIFE DURING PREGNANCY 163 especially for pregnant women may be worn. Of these there are many upon the market, including the Ferris maternity waist, the Jenness-Miller waist and the Wade hygienic cor- set. Heavy skirts and tight bands must be avoided. The skirts should be suspended from the shoulders by means of suspenders or a waist. When the abdominal walls are weak the muscles be- come so overstretched that after labor they may fail to prop- erly hold up the various organs, with resultant protuberant abdomen, filling of the stomach and intestines with gas, movability of the kidneys and dropping of the stomach and other viscera. These consequences are prevented and the abdominal muscles strengthened by the practicing before pregnancy of the exercises described in Chapter IV and by participation in various sports such as those mentioned in Chapter VII. The maternity waists and corsets just de- scribed will furnish some support to the abdomen. Great re- lief may be afforded by wearing a broad, properly adjusted abdominal bandage made of flannel, muslin or ribbed wool, or of silk and elastic. High-heeled shoes are very injurious, as they throw for- ward the trunk, which already tends to fall in that direction, and cause the woman to bend back her head and shoulders to keep her balance, thus straining the muscles along the spine. BATHING DURING PREGNANCY. It is especially important during pregnancy to promote excretion by the skin. For this purpose frequent warm tub baths with an abundant use of soap are required They are taken best at night just before retiring. For its general hygienic effect a cool sponge bath in the morning, such as described in Chapter II, is beneficial. Very hot and very 164 LIFE BUSING PBEGNANCY cold baths, foot-baths, and surf-bathing are dangerous dur- ing pregnancy. WORK, EXERCISE AND REST DURING PREGNANCY. Work.— A pregnant woman should reduce her work to below what she is accustomed to, and never allow her- self to become fatigued. She must avoid jarring and strain- ing. She cannot work on the sewing-machine, move heavy furniture, lift a heavy weight, reach to a shelf, or do violent sweeping. Exercise.— Moderate daily exercise should be taken, at least during the early months. A woman may walk in the open air and sunlight or she may be driven in an easy car- riage over smooth roads, but she must not handle the reins herself. General massage may be given, which, however, must not include the abdomen. Horseback-riding, bicycling, golf, tennis, dancing, swimming, and all similar forms of violent exercise are to be avoided. The woman should not take a sea-voyage while in this delicate condition, nor should she travel much. Rest and Sleep.— The pregnant woman requires plenty of sleep. She should undress after the mid-day meal and lie down for an hour or so. MATERNAL IMPRESSIONS. In every bushel of chaff there can usually be found a grain of wheat. Similarly, despite the doubts cast by many physicians, there is an element of truth in the popular belief that strong impressions made on the mother during preg- nancy leave their imprint on the child. Sudden emotions of grief, fear and anger often do have an influence on the developing fetus. The pregnant woman, therefore, must be protected from disagreeable or heart-rending sights and associations, bad news, fright, and the like. She should lead a placid, quiet life LIFE DURING PREGNANCY 165 amid cheerful surroundings and with pleasant diversions, reading good books, looking at beautiful pictures, and listen- ing to delightful music. She must not worry over her ap- proaching confinement or study all about the various compli- cations that occasionally are met with. Nor should she listen to gossiping neighbors or a thoughtless nurse recount- ing the difficulties of that process. Her mind should rest at ease with the knowledge that labor as a rule is a perfectly natural and normal process through which hundreds of women pass successfully every day, and that complications and accidents are of very rare occurrence. How to Render Labor Easy. — A woman may also de- rive comfort from the thought that if she live according to the directions given in this book, especially those in regard to clothing and exercise, she will be more apt to have an easy and uncomplicated labor, followed by a normal con- valescence. If the woman become melancholy or show any signs, however slight, of a deranged mind, the physician must be informed of the fact. More than at any other period of her life the wife during pregnancy requires the most thoughtful consideration of her husband. CARE OF THE BREASTS DURING PREGNANCY. The clothing should not be allowed to press upon the breasts. If the latter cause distress on account of their in- creasing size and weight, they should be supported accord- ing to one of the methods described in Chapter XXII on the management of the woman after labor. They should be washed daily with soap and warm water, any scales upon the nipples being removed. Preparation of the Nipples. — When the nipples are flat or retracted they must be drawn out during the latter 166 LIFE DURING PBSGNANCY months of pregnancy, so that they will develop into a shape that the baby can grasp. This may be done by gently pulling them out from the breast with the thumb and index finger every night and morning, or by the use of the breast pump, or by covering them with a nipple protector or a nipple shield. The nipples will be rendered less sensitive and less liable to fissures if, during the last month of pregnancy, they are washed every morning with cold water and then anointed with a mixture containing equal parts of water and glycerole of tannin, applied with a piece of absorbent cotton. CARE OF EXCRETIONS AND DISCHARGES. The Urine. — The urine in its relation to pregnancy is thoroughly discussed in Chapter XIX. The Bowels. — The various methods of relieving consti- pation mentioned in Chapter XXXIII should be employed when that condition occurs during pregnancy. Leucorrhea. — A white, mucous discharge sometimes oc- curs from the vagina during pregnancy, and is treated ac- cording to the directions given in Chapter XXXIII. MARITAL RELATIONS DURING PREGNANCY. The marital relations need not necessarily be suspended throughout pregnancy, except during the early and late months, when they must cease on account of the liability to abortion at these times. Moderation, however, must always be strictly observed. Continence sometimes is rec- ommended, and is imperative if the woman have a tendency to abort. During the days corresponding with the usual menstrual period intercourse must always be avoided. CHAPTER XVIII. THE MENOPAUSE-"CHANGE OF LIFE. >t Age at which "change of life" occurs. Method of oncoming. Symptoms of the menopause: Headache, flushes of heat, derangement of the digestive and nervous systems. A mistake to attribute all symptoms at middle-life to the menopause. The physiology of the menopause. Importance of famil- iarity with the normal phenomena. The recognition of danger signals. Hygiene of the menopause. "Old age comes on apace to ravage all the clime." — Beattie. HE period during which a woman experiences the monthly sickness lasts on the average from thirty to thirty-two years. The final cessation of men- struation is spoken of as the menopause, climac- teric, or "change of life/' AGE AT WHICH THE MENOPAUSE OCCURS. In this country the menopause occurs, as a rule, be- tween the ages of forty and fifty, usually about the forty- sixth year. The age depends upon various conditions. When menstruation begins early it usually ends late, and when it begins late, ends early. The menopause may ap- pear prematurely in very fat women, in those suffering from consumption, Bright's disease, and diabetes, and in women who have borne a large number of children in rapid succession and have suckled them. It may be retarded in the presence of disease of the womb, tubes or ovaries, espe- cially when there is a fibroid tumor of the uterus. "Change of life" appears later in the northern part of Europe than in the southern, in England than in America, in country 167 168 THE MENOPAUSE women than in city women, and among the idle and well- to-do than among the laboring classes. METHOD OF ONCOMING. The menopause occurs in a variety of ways. In the majority of cases the amount of blood passed at each monthly period becomes gradually diminished until it ceases altogether. In other instances the menstrual flow stops abruptly and permanently. Sometimes one or more periods are skipped, after which the flow again occurs, per- haps with a lessened amount, followed by more irregularity and then by the final cessation. SYMPTOMS OF THE MENOPAUSE. If the woman's general health is good and if there is no disease of any kind, the menopause may be ushered in with no more symptoms than those already noted. No marked general disturbance is present in such a case. Many women, however, suffer from very annoying con- ditions for one or two years. Headache is a common symp- tom. "Flushes of heat" may occur frequently throughout the day, sometimes as often as several times within an hour. They consist of a feeling of heat over the whole body or over a part, followed by sweating and a cold, chilly sensation. The digestive apparatus often gets out of order. Large accumulations of fat may develop. There is a marked derangement of the nervous system at this period, affecting even the mental condition. The woman may exhibit slight vagaries, a loss of interest in the daily affairs of life, and in extreme cases even melancholia and other forms of in- sanity. A Mistake to Attribute All Symptoms at Middle Life to the Menopause. — It is a great mistake, however, to ascribe all disturbances occurring at .this time to "change THE MENOPAUSE 168 of life." Many serious conditions have been overlooked by such superficial observation. Every symptom com- plained of should be investigated just as thoroughly as at any other age. THE PHYSIOLOGY OF THE MENOPAUSE. All the organs of generation become smaller at the climacteric and gradually cease to functionate. Many of the disagreeable sensations experienced at this period are due to the absence in the blood of the product secreted by the ovaries. Shrinking occurs in external as well as in- ternal organs, as shown by the wasting of the breasts. Importance of Familiarity with the Normal Phenom- ena. — Owing to her ignorance as to what constitutes the normal occurrences to be expected at the menopause, a woman is unable to recognize dangerous symptoms when they appear. Every year many women lose their lives in consequence of this ignorance. They view the danger sig- nals with complacency, regarding the warnings as part of the normal phenomena of the climacteric. It is, therefore, most important for every woman who has reached her fortieth year to acquaint herself with the normal symp- toms that accompany "change of life' 5 and to be able to recognize the symptoms of disease that frequently occur at the same time. THE RECOGNITION OF DANGER SIGNALS. When diseased conditions are present, Nature gives certain warnings which must be regarded if the disease is to be checked in time. The following phenomena are not normal: (i) Profuse bleeding at the time of the meno- pause; (2) Slight bleeding occurring oftcner than once in four weeks; (3) The apparent reappearance of menstrua- tion, or of slight irregular hemorrhages, after the meno- 170 THE MENOPAUSE pause has been established and menstruation has been ab- sent perhaps for many months. Such symptoms should always be viewed with alarm. When they occur, a woman should immediately consult her physician. Any bleeding from the vagina in a woman who has passed the menopause should arouse the gravest suspicion. As a rule, it is usually caused by a diseased con- dition, usually by a tumor of some sort. If the tumor be a fungous growth, a polyp, or a fibroid, the condition may not be so serious as if it be a cancer. In the latter instance delay in seeking medical advice usually means death, while promptness may result in a cure. Penrose says of cancer of the cervix that "in the early stages the disease may be eradi- cated with every probability of a permanent cure," but that "the great majority of women come to the operator when the disease has extended too far to permit any radical treat- ment." HYGIENE OF THE MENOPAUSE. When entering upon the "change of life," a woman should carefully observe the rules of hygiene laid down in the first part of this book. It is most important that the general bodily health be maintained. Frequent warm baths are required to keep the skin acting well. The diet should be simple and unirritating. Meats should be restricted. An increase in the amount of vegetables eaten is advisable. Sugar is apt to set up a fermentation in the stomach; con- sequently sweet dishes, such as cakes, candies, preserves, jellies and sweet puddings must be taken in moderation, and when indigestion is present avoided altogether. The woman will also have to refrain from eating pastry, hot breads, fried food and rich dishes. She should drink water freely, taking three pints a day if possible. Stimulants are to be avoided; alcohol in any form is prohibited. The bowels are to be kept THE MENOPAUSE 171 open, by suitable food and exercise or by purgatives or laxa- tives when required. An outdoor life is of advantage, gentle exercise in the open air being essential. Massage is benefi- cial, especially to those who for any reason are unable to take active exercise. It may be given twice a week by a skillful masseuse. The Turkish bath is an excellent form of exercise, com- bining the effects of massage and of the hot bath. It is par- ticularly useful at this period in distributing the blood throughout the body and in aiding the skin in getting rid of waste matters. It must not be taken, however, without the physician's permission or advice. The nervous system also demands attention. Domestic burdens should be lightened and the woman should be re- lieved of worry and responsibility as much as possible, but she must not be left without congenial occupation. Some form of amusement should be provided. A change of lo- cality and surroundings is sometimes demanded. In cer- tain cases it may be necessary to resort to the rest-cure. Pruritis or itching should be treated as described in Chapter XXXIII. PART III. CHILD-BIRTH. CHAPTER XIX. PREPARATIONS FOR THE CONFINEMENT. Have the best, if possible; if not, have the best possible under the circum- stances. The lying-in room. Arrangement of the bed. Things needed for the confinement: Absorbent pads, Occlusive bandages or napkins, The abdominal binder, The baby's basket, The baby's clothes, etc. Prepara- tion of the patient. Engaging the physician and nurse. The accoucheur: physician vs. midwife. The nurse: Trained nurse vs. monthly nurse. Selection of a nurse; her duties. "The readiness is all." — Shakespeare. N preparing for the confinement, one should know what is best to do and, if possible, put that knowl- edge into practice. But, unfortunately, a woman is not always able to do as she wishes. The best is oftentimes unattainable, in which case the best under the circumstances must suffice. Whenever possible the direc- tions given in this chapter should be implicitly followed; they are simple and necessary. However, persons who for any reason are unable to adopt the first and best sugges- tions made may be able to carry out the simpler methods also given, which, though less desirable, are yet serviceable and good. THE LYING-IN ROOM. The room usually selected for the confinement is the prospective mother's own bed-room. It ought to be large and sunny, well lighted, well ventilated and properly heated. A communicating room for the nurse is a great convenience, leaving the mother the exclusive use of her own. Matters are also made easier if the bath-room be 175 178 PB.EPAE.ATIONS FOB TUT: CONFINEMENT near. All unnecessary furniture, heavy curtains, and all bric-a-brac should be removed. If a carpet is on the floor it may be taken up, or the portion about the bed may be pro- tected by a large rubber mackintosh, or oilcloth, or by sev- eral layers of newspaper. A rug should be removed. It is well to take out of the room anything that might collect dust, which often is a carrier of disease germs. The Arrangement of the Bed. — The bed should prefer- ably be narrow and high and placed where it will be out of draughts. As it must be accessible from both sides, it should not be placed with its side against the wall. The mattress should be firm; hair is the best material. To prevent its sagging in the middle, three table boards, or shelves from a book-case, may be placed in the middle of the bed between the mattress and the spring. When the bed is arranged for the labor, draw-sheets of rubber and cotton are sometimes placed across the middle of the bed over the under sheet. This is known as the permanent bed, but, though convenient and elegant, is often dispensed with. Over the "permanent bed," when it is used, otherwise over the mattress, are placed a second rubber draw-sheet and a second cotton draw-sheet, some- times folded once. These constitute the temporary bed 9 which is removed immediately after delivery. If the bedstead is double, instead of single, the tem- porary bed is arranged at the side where the patient is to lie, being securely fastened with large safety pins. Instead of the rubber sheet, a piece of mackintosh may be substi- tuted, or a piece of oilcloth that has been thoroughly scoured. When these are not to be had, use may be made of an old clean comfortable or of clean wrapping paper or even of clean newspapers. On the spot where the hips will lie is pinned an ab- sorbent pad, which, as soon as soiled, is to be taken off and FUEPAKATXOltfS FOE THE CONFINEMENT 177 burned, to be replaced by a clean one. Consequently sev- eral must be provided. They are best made of nursery cloth, consisting of two layers of muslin, each one yard square, with a layer of absorbent cotton, wood wool, jute, bran or sawdust, two to four inches thick, loosely quilted between them. They can be made at home or bought in the shops. They must be baked in the oven, or boiled for half an hour in a clothes boiler and thoroughly dried, then pinned up in a sheet and put away out of the dust. If towels or napkins or old pieces of muslin are used, they must be prepared in the same manner. It is well to have two sets of coverings, one for use during labor, and one to put on after the delivery. THINGS NEEDED FOR THE CONFINEMENT. The Occlusive Bandages or Napkins. — These are best made of carbolized gauze and salicylated cotton, which, however, are rather expensive. A cheaper dressing is made out of rolled absorbent cotton, or wood wool, and washed cheese cloth. Two thicknesses of the cotton, seven or eight inches long and four or five inches wide, are enclosed in a quarter yard of the gauze or cheese cloth and so folded as to make a pad (sixteen or eighteen inches long and four or five inches wide), the edges being stitched. Sometimes old pieces of muslin or other material, which have been boiled, are used. Three or four dozen will be required. The hands that make them must be scrupulously clean. When made beforehand they should be put into a clean pillow case, or wrapped in a sheet, and thus boiled, steamed or baked. They then should be kept covered and put away in a clean place, free from dust. The abdominal bandage or binder is made of washed, unbleached muslin, about a yard and a quarter long and about half a yard wide. Sometimes it is made only long 12 178 PREPARATIONS FOR THE CONFINEMENT enough to go around the abdomen once, in which case it is furnished with buttons and buttonholes in front and laces at the sides. It must be firm to give the stretched muscles support, but care must be taken not to have it fastened tighter above than below. Other Articles Required. — There should also be in the lying-in room a table, a chair, two basins and a bucket. The woman should have the following articles on hand, ready for the confinement. The absolutely necessary things are given in italics; the full list can only be obtained by the well-to-do. Hand towels, ether (one-half pound), brandy (two ounces), vinegar (four ounces), tincture of green soap (four ounces) or anew cake of pure soap, antiseptic tablets of corrosive sub- limate (one bottle), a large, Bed-pan. coarse, new sponge; a skein of bobbin (sterilized), a fountain syringe, a bed-pan, a new soft rubber catheter, absorbent cotton (a small package), salicylated cotton (a one-pound package), carbolized gauze (five yards), nursery cloth (eight yards), unbleached muslin (two yards), large safety pins, carbolated vaseline (a one-ounce bottle), fluid extract of ergot (one ounce), a pair of scissors to cut the cord. As soon as the labor has begun, three pitchers should be filled with water that has been boiled for half an hour and clean towels should then be tied over their tops. This is the only water to be used about the patient. THE BABY'S BASKET. The baby itself must not be forgotten. A basket for the baby's things must be purchased or made at home. The cheapest arrangement is to buy an ordinary wicker hamper or shallow basket and a camp stool. The basket is attached PREPARATIONS FOR THE CONFINEMENT 179 firmly to the camp stool, lined with muslin and trimmed with silk, lace and ribbon or other suitable material, with a pocket at each corner. The frill from the basket covers the place where it joins the camp stool. The basket should contain large and small safety pins, a bath thermometer, talcum powder, a line, soft sponge, a soft hair brush, castile soap, cold cream, alcohol for rubbing, blunt scissors for the nails, six wash-cloths of Shaker flannel, six inches square, old linen for cleansing the mouth, and a bath blanket. THE BABY'S CLOTHES. The following list of clothes will be required for the baby. In stating the number needed, two figures are given, the least number one can get along with and the number one ought to have. A mother may be able to economize still further by washing frequently and thus using the same gar- ment again: Four to six flannel or knit bands or binders; three to six dozen diapers ; four to six pairs of knitted woolen socks; three to four woolen shirts; four flannel night-skirts; four flannel day-skirts; four to six white day-skirts; six to ten slips; six to ten dresses; material for four or five flannel bands; a soft pillow, fourteen by eighteen inches; soft pillow covers; knit wrapping blankets; sacques, wrappers, bibs, caps, blankets, veils, and so forth. The way these clothes are to be made is described in Chapter XXVII on "Clothing for the Infant and the Child:' Other Conveniences for the Nursery. — Several other articles will be needed for the baby. They are: A bath-tub and two flannel bath aprons* Six old, soft damask towels. Bathing towels made from diaper cloth will answer when the damask ones are unob- tainable. They should be repeatedly scrubbed and boiled to be rendered soft. * Described in Chapter XXVI on "Bathing the Baby." ISO PREPARATIONS FOR THE CONFINEMENT A small-sized clothes bars or clothes horse. This will be used for airing the baby's clothes and holding its towels. A low chair without arms. This is for the nurse to sit on when washing the baby. A screen. It should have a firm, square frame, solidly covered with cretonne, burlap or denim, so that it will afford real protection from draughts or light. A bamboo screen with curtains hung on rods will not answer. PREPARATION OF THE PATIENT. When the time for confinement approaches, a woman should keep her bowels loose, by means of laxatives if neces- sary. As soon as she begins to experience the pains she should be given a rectal enema containing a pint of soap- suds and a teaspoonful of turpentine. She should take a warm general bath and should wash the external genitals thoroughly with soap and warm water. She should not take a vaginal douche unless she is subject to a contagious discharge, or unless she has been so instructed by the doctor. ENGAGING THE PHYSICIAN AND NURSE. The Accoucheur. — As soon as pregnancy is suspected, the physician should be engaged. He should have general supervision over the life of the woman, her diet, clothing, exercise, and so forth, during the whole period between conception and labor. Pregnancy, although usually a normal process, is sub- ject to various complications, for whose recognition and treatment a physician is required. The kidneys, in par- ticular, need constant watching, as they frequently become affected during this period. A four-ounce specimen of mixed night and morning urine should be sent to the phy- sician for examination every two weeks until the last EXERCISES FOR DEVELOPING THE FIGURE. i. Forward drop in a narrow doorway, 2. Breathing exer* rises combined with arm movements. 3. Arm exercises. 4. Bend- ing to the side. 5. Bending backward. 6. Bendi ard. PREPARATIONS FOE THE CONFINEMENT 131 month, when it should be sent every week. A statement of the exact amount of urine passed during the twenty-four hours should accompany the specimen. When such symptoms as scanty urination, severe head- ache, dizziness, or swelling of the feet or face occur, they should be reported to the physician at once. A midwife, in the opinion of the writer, is not desirable, except in those cases where it is impossible to secure the services of a physician or a medical student. The midwife rarely understands the meaning of surgical cleanliness, which is the most important factor in preventing infection or blood-poisoning. She, moreover, is unable to meet the various complications as they arise, but always must send out for a doctor, who often arrives too late. Promptness at such a time in recognizing and meeting a serious condition is all-important. The Nurse. — A woman must choose between a trained nurse and the so-called monthly nurse. A trained nurse or graduate nurse, one who has com- pleted a course of training in a hospital, should be procured if she can be afforded. Such a person not only has the requisite knowledge as well as experience, but she has learned how to obey the orders of the physician. The monthly nurse, on the other hand, has not had care- ful hospital training, being merely a woman who makes a practice of nursing maternity cases for thirty days. Never- theless she often has acquired skill and experience with constant practice. Some monthly nurses, indeed, are very capable, and many are adaptable and able to carry out the doctor's orders in an intelligent manner. Frequently, how- ever, they arc filled with wrong ideas and queer, old-fash- ioned notions about the care both of mother and baby. Oftentimes they feel their experience to be of such great im- portance that they pay no attention to the advice or orders 182 PREPARATIONS FOB THE CONFINEMENT of the physician; they regard the care of the patients as their own particular business rather than the doctor's. In consequence, the monthly nurse is often directly responsible for much injury to mother and child. Still she is always a great help in the absence of any one better, and she is all the majority of women are able to afford. The selection of a nurse should receive careful consid- eration. The woman must be known to be competent. It is not safe to employ a woman who is not known. Often the physician is able to recommend some one in whom he has confidence. In addition to ability, the nurse must have certain favorable personal qualities. She must be able to adapt herself to circumstances, to improvise when she can- not procure the object she requires. She also must possess tact, so as to get along with the family and the servants. Honesty and honor are two necessary traits: the first, be- cause the nurse sometimes is almost in charge of the house and always has access to every part; the second, because there is no family secret kept from the nurse, no skeleton she does not see. The duties of the nurse comprise everything that has to do with the care of both patients. She tends to the mother, washes her, arranges her meals, and so on, and at the same time takes charge of the baby, bathing it and car- ing for it in every way. The nurse, ordinarily, does not perform any work out- side of her own particular duties. She is not expected to wash the baby's clothes, with the exception of the diapers and flannels, nor wash her own garments, nor do the gen- eral cooking or sewing or cleaning. She may do all these, however, if she be so disposed, or if she be engaged with that understanding. The patient's meals, however, she is supposed to prepare. Where no servants are kept, the monthly nurse often prepares the meals for the family, and PREPARATIONS FOR THE CONFINEMENT 183 when not engaged in caring for her patients may tend to some of the other household duties. The nurse must be properly cared for, in order that she maintain her own health as well as keep at the highest point of efficiency. Provision should be made for her obtaining sufficient sleep and getting some outdoor exercise every day. It is in relieving the nurse at such times that solicitous rela- tives can be of most service. The nurse should be engaged several months before the expected confinement. At this time all arrangements about the work to be done and the compensation to be received should be definitely settled. As the day for the confinement approaches, the nurse should be within reach, and a few days beforehand, espe- cially if the patient has already borne children, she should go to the house and remain there until after the confine- ment. She should, of course, be able to recognize the signs of labor and to know when to send for the physician. As soon as the process has begun she should arrange the bed and prepare the patient. A STUDY IN PENSIVENESS. These exquisite- heads, with their soft contours and delicate coloring, arc a marvel of beauty. The faces by the magic of the artist's brush bespeak rare kindliness, sanctity and loveliness. CHAPTER XX. THE PHYSIOLOGY OF CHILD-BIRTH. Causes of labor. How to calculate the day of confinement. The duration of pregnancy. Methods of calculation. Importance of knowing the date of the last menstruation. Child-birth: The first stage of labor; the second stage; the third stage. The Puerperium. The lochia's amount and odor. The danger signals. Afterpains. Changes in the breasts. "A mother is a mother still, The holiest thing alive." — Coleridge. S has been told in previous chapters,* when the pollen from the stamens of the apple blossom falls upon the pistil and is carried to the ovary, it fertilizes the ovule that lies within. The ovary thereupon grows bigger and bigger, developing into the fruit which contains the seeds from which are to spring new apple trees. As the apple becomes fully ripened, certain degenerative changes occur in the stem supporting it, which makes its connec- tion with the parent branch so frail as to be easily broken. A breath of wind will cause it to fall to the ground. The phenomena that occur in animals are much sim- ilar. As the ovum which contains the unborn offspring reaches full maturity it becomes separated more or less from the wall of the uterus by means of a degenerative process and is finally expelled, in human beings at the end of about forty weeks. Causes of Labor. — Every four weeks, as has been shown, t the womb has a tendency to contract. In the non- * See Chapters VIII and XV. fSce Chapter X. 186 ISO THE PHYSIOLOGY OF CHILD BIRTH pregnant uterus this results in the expulsion, in the form of the menstrual flow, of the blood that has accumulated there. During the development of the child this monthly contraction is hardly noticed until the end of the tenth lunar month, when the separation between the ovum and the womb is complete. By this time the distension of the uterus has become so great that the slightest additional impulse stimulates it to contraction. When a ship is ready to be launched, a single blow from a hammer will start it down the ways. So with the uterus when at the end of two hundred and eighty days it has been overstretched with a ripened ovum, the occurrence of the monthly contraction — or a little extra exercise, or a dose of purgative medicine, or a jolt, or a jar — will be suffi- cient to stimulate it to expel its contents. In this manner pregnancy is terminated by the birth of the child. HOW TO CALCULATE THE DATE OF CONFINEMENT. It is important for a woman to be able to estimate with some degree of accuracy on what day she will be con- fined. All her preparations are made in accordance with this calculation. The nurse is engaged for a certain date. The physician arranges his work so as to be ready for a call at the expected time. Not only is much unnecessary trouble and annoyance given to mother, doctor and nurse by lack of accuracy in calculating the date of the confine- ment, but the baby may come at a time when no prepara- tions have been made for its reception. THE DURATION OF PREGNANCY. Confinement is said to occur about two hundred and seventy-one days from the date of conception. As it is impossible to determine accurately just when conception occurs, it is customary to make the calculations from THE PHYSIOLOGY OF CHILD BIRTH 187 the menstrual period immediately preceding conception. Labor may usually be expected to begin two hundred and eighty days after the first day of the last menstruation. Pregnancy, therefore, lasts about forty weeks, or ten lunar months of twenty-eight days each, or a little over nine calendar months. It is thus seen that labor comes on at the tenth menstrual period from the beginning of preg- nancy. METHODS OF CALCULATION. A very common way of calculating the date on which confinement may be expected is to start with the first day of the last menstruation, count backwards three months, and then add seven days. For example, if the first day of the last menstruation was on May ioth, counting three months backward would bring it to February ioth, and adding seven days would make February 17th the date on which confinement may be expected. This method will give only an approximate result, inasmuch as months are not of equal length. This difficulty is overcome by adding six days in April and September, five days in December and January and four days in February. Various tables have been compiled to make the comput- ing more accurate as well as simpler and easier. One com- monly used is given on the following page. This table is divided by horizontal lines into twelve parts, one for every month in the year. In each compartment are two rows of figures, the upper one being the days of the month in their regular order. To determine the probable day of confine- ment, find in this upper row the date of the first day of the last menstrual period; the figure immediately below it is the day of the month on which labor may be expected, the month itself being designated in the margin. For instance, if the last menstrual flow began on March 9th, the woman will probably be confined on December 14th. 188 THE PHYSIOLOGY OF CHILD BIRTH H 55 i-i ft O O to O H Q W a H O ►H) H sO CO iH f iH •OO iH CNOn rH OO So i-too o s on no oo »o s f £ lOO »H f On CO 00 cns iHn© rH n£> O *0 of 00 CO r>.CN *>£ wo iH ^on CO 00 cns rH NO lO on Tf< 0O i-( rH CO S rH tH CN nO rH lO O NO co O lO CN 00 f cn S CO CN nOCN CN CN f o CNCO CO On CNCN CN0O CNCN rH S CNCN o nO CC CN | 00 lO S »H ! S f NO O lOO f 00 COS CNnO rH lO v© CO lOCN f rH COO rH CNOn t-i oo CO On O sO CO ON lO CN COf CN r>i eo CN vOCN CN COO CNCO CN On CNCN HS O NO On lO 1-1 co f r>. co nOCN rH lOrH COON CN00 *4 ^s tH CN CNOn rH 0O OS On nO 00 ""> t^f no CO r-t lOCN COO rH CNOn rH 00 O^ 4 rH 00 OS c^ nO oo »o S f no eo lOCN coo CNON rHOO PkZ WD r--. co CM v© CN CM inn CN TfrH CNCO COO CNCO CN On CNCN rH 0O CNCN o s CNCN sO CO rHCN H» OS ON NO 00 ^ sf no CO lOCN iH f rH CO o 1-4 CNOn rH 0O ON NO tH 00 lO t>. f NO CO tH lOCN iH f rH eoo rH CNOn rHOO 2< CO O NO CO On lO CN ■^ o CNCO CO On CNCN CM OO CNCN HN CNCN OO CNCN On to rHCN oof r-i CN S CO rHCN sOCN rHCN »OrH iHCN f O HN CO ON tHS O nO ONlO 00^ SCO nOCN tH lOrH iH f O COO CNCO rHS S" °° ex ■o O c >> to 1 i OJ J3 rt rC til u •i-i 0) • — 5 bfl cd c = rfl cu 13 -Q u U i B+H be 75 tC c O 8J •u -S <-» a> .13 P THE BABY'S TOILET. This is a glimpse of a tidy home in a foreign land where the mother is giving baby its bath. See the directions for the Americn mothers to follow. THE PHYSIOLOGY OF CHILD BIRTH 189 In these methods of reckoning, the date obtained must be regarded only as an approximate one. Labor may occur within the week preceding or the week following that date. It is the exception rather than the rule for labor to occur exactly in two hundred and eighty days. This figure is based on the supposition that menstruation occurs every twenty-eight days. Probably the very best way to estimate the duration of pregnancy is to ascertain the number of days between the last normal monthly period and the one preceding it, and multiply this number by ten. As the time of confinement is calculated from the first day of the last menstruation, it is most important for the woman to know just when this flow occurred. Many women, especially those about to be confined for the first time, fail to remember the exact date, thereby causing much worry and annoyance to themselves, to their family, and to the physician. The physician is able to estimate the duration of preg- nancy by noting the position of the womb.* CHILD-BIRTH OR LABOR. Labor is that natural process by which a woman expels from her uterus and vagina the matured ovum. This ovum, at the end of two hundred and eighty days, consists of the fully developed child, surrounded by the membranes, at one end of which is the placenta. THE THREE STAGES OF LABOR. Labor is divided into three stages. During the first stage the birth-canal expands until it is of a sufficient size to allow the child to pass through. The second act con- sists in the expulsion of the child. In the last stage the * See illustration in Chapter XV. 100 THE PHYSIOLOGY OF CHILD BIRTH remainder of the ovum — the membranes and the placenta- is delivered. Before labor begins, the child usually lies head down- ward in a sack filled with water, the walls of the sack being formed by the membranes, which are everywhere in contact with the inner surface of the womb. The water contained in the sack and surrounding the child is called the liquor amnii, familiarly spoken of as "the waters." At the upper part of the uterus, between it and the membranes, is the placenta, which connects the large blood-vessels of the mother with the vessels in the um- bilical cord. Before labor begins the lower part of the womb is narrow, the neck is stopped up with a large plug of ten- aceous mucus, and the inter- nal mouth or os is tightly closed. Beginning of Labor. This is before the birth canal has become dilated. The thick cervix or neck of the womb is shown, opening at right angles into the long vagina. In front of the vagina is the bladder; be- hind, the rectum. THE FIRST STAGE OF LABOR. Labor begins with a series of contractions of the womb, lasting about a minute, and re-occurring at inter- vals of from five minutes to half an hour at first, usually of about fifteen minutes. The intervals decrease as labor progresses, finally being reduced to only two or three min- utes. The contractions drive the waters down through the in- THE PHYSIOLOGY OF CHILD BIRTH 181 ternal mouth into the neck of the uterus, where, covered only by the thin membranes, they dilate the neck and the inter- nal mouth easily and gently. As with repeated contractions the womb becomes smaller and smaller, the head of the child is driven down in the same direction as the bag of waters and further distends the lower part of the uterus and its neck, until at last the neck has been stretched so wide as to be completely obliterated. The same force then proceeds to dilate the outer mouth, or external os, until the latter is big enough to let the head through. The Uterus or Womb at the Beginning of tut. Imkst Stage of Labor, Before the Parts Have 1 f.p. o.i — Os Interims or internal mouth. <\r.— Os externus or external mouth. Between o.i, and o.e. lies the cervical canal. Just as this occurs, the membranes bulging in front usually rupture, allowing the waters to escape. Sometimes the membranes are so tough (hat they have to be punctured. 192 THE PHYSIOLOGY OF CHILD BIRTH When the child is born with the unbroken membranes around it, it is said to be born with a caul. In some cases the membranes rupture early, causing what is known as a dry labor. With the full dilatation of the external os, the first stage ends and the second begins. The Uterus or Womb at the End of the First Stage, After the Parts Have Been Dilated. oi — Internal mouth or os. oe — External mouth or os. oi to oe — Cervical canal. THE SECOND STAGE OF LABOR. During the second stage of labor the head descends through the vagina, advancing slowly and stretching ail the tissues before it. Now, not only does the uterus con- tract, but the abdominal muscles also are brought into play and help to drive the child downward through the birth- canal. The moulding and stretching of the parts to fit the child usually takes about an hour and a half or two hours. At the end of this time the whole birth-canal will have THE PHYSIOLOGY Q? 0H1L.B BIRTH 193 been fully dilated. The vulva, or external opening, then be- gins to distend, and when the aperture is sufficiently large, the head passes through, followed shortly after by the rest of the body. With the birth of the child the second stage ends. THE THIRD STAGE OF LABOR. After the expulsion of the child the uterus continues to get smaller. As the uterus contracts the placenta becomes detached from it and lies within the womb until, with further contractions, it is finally driven out into the dis- tended cervix or into the vagina, with the membranes attached to it and trailing after it. Having expelled the placenta, the uterus contracts until its cavity is obliterated. It then remains firmly contracted, squeezing the ends of the blood-vessels that were broken when the placenta was torn loose, and thus preventing hemorrhage. Labor itself terminates with the expulsion of the placenta or after birth. THE PUERPERIUM. The period immediately following the delivery of the child and the after-birth, comprising the time consumed by the uterus in regaining its natural size, is spoken of as the puerperal state, or the puerperium, or the lying-in period. In a normal case it lasts six weeks. The process by which the womb becomes reduced di- rectly after labor to the size of the healthy, non-pregnant organ is called technically "the involution of the uterus." It is brought about in two ways. The tissues of the womb shrink, while part of them becomes converted into fat and is expelled with the discharges. The Lochia. — This discharge, which always occurs after labor and is called the lochia, consists of blood, degenerating tissue, and the normal secretion of the parts. For the first 13 194 THB PHYSIOLOGY OF CHILD BIRTH five days it is red in color, from which it takes the name of lochia rubra, or red discharge. During the next two days it is yellow and is called lochia serosa. It then assumes a whitish color and is known as lochia alba. This last stage lasts until the seventh to the fourteenth day, or even longer. The amount of the discharge is conveniently estimated by noting the number of napkins or pads soiled in the twenty-four hours. These pads for the first four or five days should not normally have to be changed oftener than six times in the twenty-four hours. The odor of the discharge is an index as to the condi- tion of the patient. It should resemble that of fresh blood or raw meat while the discharge is red, but thereafter it should be that peculiar to these parts. When decomposition occurs the odor becomes putrid. This is an important danger signal. When it occurs the physician must be notified at once; the woman's life may be in peril. AFTER-PAINS. For several days after labor in women who have already borne children the muscle of the uterus relaxes a little at times. This loosens the hold on the broken blood- vessels and permits them to bleed slightly. The blood that oozes out in this manner collects in the uterine cavity where it forms clots of considerable size. These clots act as an irritant to the womb, exciting it to active contractions in an effort to expel them. The contractions of the uterus cause pains or cramps, which are known as after-pains. They continue until the clots are expelled. DIFFICULTY OF URINATION. The muscles of the abdomen are so worn out and strained after labor that sometimes for several hours or days they cannot act in emptying the bladder, which organ 'THE PHYSIOLOGY OF CHILD BIRTH 195 consequently becomes distended and must sometimes be relieved by means of a catheter. This may be used only by a physician or graduate nurse, and only after the failure of the various expedients to induce the voiding of urine volun- tarily, described in Chapter XXII on "The Care of the Mother After Labor." CHANGES IN THE BREASTS. During the latter part of pregnancy a thin, glistening fluid, called colostrum, is found in the breasts, from which it may be squeezed out. Directly after labor it is increased in quantity and becomes a little whiter and more opaque. At the end of about forty-eight hours the breasts undergo a decided change; they suddenly enlarge and may become very tense. Sometimes they are painful and tender on pressure, and impart a hard and lumpy sensation to the touch. The veins under the skin enlarge and show very distinctly. Instead of colostrum, the breasts now contain normal human milk, which is described in detail in Chapter XXIV on "Breast Feeding." The management of the mother, both during and after labor, is given in the following chapters. CHAPTER XXI. THE MANAGEMENT OF LABOR. The knowledge required to make a woman helpful in the lying-in room. The Diagnosis of Labor: "Dropping," labor pains, the show. Duration of labor. Surgical Cleanliness the Guiding Factor Throughout the Labor; A talk on germs; How the birth canal becomes infected; Puerperal infection can always be prevented; How to prevent puerperal infection. The Manage- ment of the First Stage of Labor: Diet during the first stage; The adminis- tration of an anesthetic. The Management of the Second Stage of Labor. Care of the New-born Infant: Care of a premature infant; Treatment of an asphyxiated baby. Care of the Mother During the Third Stage of Labor. "The hour arrives, the moment wish'd and fear'd ; The Child is born, by many a pang endear'd. And now the Mother's ear has caught his cry ; Oh, grant the Cherub to her asking eye ! He comes — she clasps him. To her bosom press'd, He drinks the balm of life, and drops to rest." — Rogers. T is not the author's purpose in this chapter to write a treatise on obstetrics. Nor is it his intention to so instruct a woman that she will be qualified to assume full charge of a labor. It must not be supposed that with a few minutes' reading a person can become proficient in what requires years of study and practice to acquire. The delivery of the child, known also as child-birth, labor, obstet- rics, parturition, midwifery and tokology, is too serious a pro- cedure to be entrusted to any but the most skillful hands. A 196 Copyright, 1903. by William H. Rau, THE BRIDE. All the wdrld loves a lover and stops to do homage to the lovely bride, whether she appears in the simple homemade gown, o more elaborate bridal gown, amid palms and flowers. THE MANAGEMENT OF LABOB 197 physician should be engaged whenever possible; next in order of proficiency come the medical student and the midwife. In assisting the physician, however, a woman can be of great service, especially if she is familiar with the work required of her. The present chapter will be devoted to instructing a woman in the requisite knowledge that will make her presence valuable in the lying-in room. Before the date of the expected confinement, which is to be calculated according to one of the methods given, the prepa- rations for it mentioned in chapter XIX must be made. The occlusive bandages, the abdominal binder and the other articles required, including the baby's clothes and the baby's basket, should be in readiness. THE DIAGNOSIS OF LABOR. It is important for a woman to be able to recognize when she is in labor, in order, on the one hand, to summon the physi- cian in time, and on the other to avoid ludicrous mistakes. "Dropping." — A valuable premonitory sign is the "drop- ping" or sinking of the child's head in the pelvis, which is asso- ciated with a flattening of the upper part of the abdomen and a greater prominence of the lower portion. This may occur over night at the beginning of the last month of pregnancy in women who have never borne children, and two weeks or less before labor in a woman who is already a mother. Labor Pains. — The sign that labor has actually begun is the occurrence of labor pains. These are of a characteristic duration, situation and nature. They last but a minute and are separated by intervals of from live minutes to half an hour, being usually about fifteen minutes apart. The pain is felt in the abdomen or in the back, or it may seem to pass from the navel to the spine. The Show. — As the neck of the womb stretches, there is 188 THE MANAGEMENT OF LABOR a slight oozing of blood which stains the large plug of mucus that fills the cervical canal. With the further dilation of the neck or cervix this blood-stained plug of mucus is expelled, when it is known as the "show." DURATION OF LABOR. It would be a most desirable thing if one were able to esti- mate just how long a labor will last. This, however, cannot be done with any degree of accuracy. The duration may vary from one hour or less to many hours, and in rare instances to a week or more. Women who have already borne children are in labor on an average about eight hours; those having their first baby must expect to be confined double that time or longer. The probable length of time may often be judged from the his- tory of a woman's previous labors. The author believes that the process will be much shortened in a strong, healthy woman who has lived hygienically and has taken plenty of exercise, especially if she has practiced those movements that strengthen the abdominal muscles. SURGICAL CLEANLINESS THE GUIDING FACTOR THROUGHOUT LABOR. A Talk on Germs.— Disease germs or bacteria are very minute ; thousands could be present on the head of a pin with- out being seen with the naked eye. These microscopic organ- isms multiply with great rapidity; in the course of several hours two or three individuals can increase to billions. Whenever; disease germs get inside the body they manufacture a poison which may produce disease and even cause death. While dan- gerous wherever found, they are especially so in certain locali- ties, such as the interior of the womb and of the abdomen, in the latter place giving rise to peritonitis. The introduction of a disease germ into the body is called THE MANAGEMENT OF LABOR 189 infection. The presence of such a germ in the body is known as sepsis. Any article that has a germ on it is said to be in- fected or septic. By disinfecting or sterilizing an object we remove all germs from it and render it aseptic, sterile or sur- gically clean. There is consequently an important difference between ordinary cleanliness and surgical cleanliness. The former signifies that all dirt has been removed; the latter that all germs as well as dirt are absent. How the Birth Canal Becomes Infected. — Disease germs are never normally present in any of a woman's organs of gen- eration. They must come from without. When present in any part of the birth canal they have as a rule been introduced by the finger or hand, by an implement or instrument, or by the water. They can, however, themselves effect an entrance if deposited upon the external parts by one of the agents men- tioned or by the bed linen, the body clothing, the mattress, the vulvar pads or by the material used to wash the vulva or ex- ternal parts (rags, cloths, sponges, cotton, etc.). As soon as any germs have been introduced into the birth canal they are liable to multiply and cause both a local inflammation and a poisoning of the whole system. Such a condition occurring after labor is known to physicians as puerperal infection, puer- peral sepsis or puerperal fever, and more popularly as child- bed fever or blood poisoning. At any time other than during labor or shortly after it, the introduction of germs into the vagina is not attended with such serious results, because the cervix or neck of the womb is usually tightly closed and shuts off the germs from the parts above. But during the period from the beginning of labor, when the cervix begins to dilate, to the end of the puerperium, when it has firmly contracted again, a germ can easily travel through the open neck, then out the tube, and finally enter the abdominal cavity. In the womb the germ produces a septic inflammation; in the tube it may cause an inflammation, going 200 THE MANAGEMENT OF LABOR on to the formation of an abscess known as a pus tube ; in the abdomen it will set up a peritonitis. All these conditions give rise to blood poisoning. Puerperal Infection Can Always be Prevented. — Know- ing how child-bed fever is caused, it is possible to prevent it. If germs are never introduced into the birth canal they can do no damage there. The entrance of germs is prevented by not inserting into the vagina of a woman in labor, or even bring- ing in contact with the parts, anything that is not surgically clean. Some women indeed are lucky and may have germs in- troduced without suffering any evil consequences. But the majority are bound to pay the penalty. Most of the deaths that have occurred during or shortly after child-birth have been caused by puerperal infection, a preventable disease. If a woman should regard the precautions given in this chapter as being too troublesome and "fussy," let her reflect that they save human lives. Anything less is fraught with danger. No better picture of the result of carelessness and negligence can be given than the one presented by the physician and man of letters, Oliver Wendell Holmes : "It is as a lesson," he says, "rather than as a reproach, that I call up the memory of the irreparable errors and wrongs. No tongue can tell the heart-breaking calamity they have caused. They have closed the eyes just opened upon a new world of love and happiness ; they have bowed the strength of manhood into the dust; they have cast the helplessness of infancy into the stranger's arms, or bequeathed it, with less cruelty, the death of its dying parent. There is no tone deep enough for regret, and no voice loud enough for warning." How to Prevent Puerperal Infection. — The only way to prevent puerperal infection is to keep disease germs out of the woman's vagina. This is accomplished by observing surgical cleanliness or asepsis. Nothing that is not sterile must enter the birth canal. In addition to this there must be ordinary THE MANAGEMENT OF LABOR 201 cleanliness in everything concerning the woman. It is partly on account of their knowledge of asepsis that the physician is to be preferred to the midwife and the trained nurse to the monthly nurse. All the directions given in Chapter XIX concerning the preparations for the confinement are to be rigorously followed : the room, the bed and the dressings should be made ready in the manner described. The rules laid down in this and the fol- lowing chapter must be obeyed to the letter. Only water that has been boiled may be used about the patient, even when it is to be made up into a disinfectant solution. All articles that come in contact with the woman in labor should be boiled for at least five minutes, or if boiling would injure them they should be immersed for half an hour in a disinfectant solution, such as bichlorid of mercury i to iooo or carbolic acid I to 20. But it is not sufficient that everything employed about a woman in labor be rendered aseptic; it must be kept so. The moment a sterile object touches something that is not sterile the object is itself no longer sterile, but has become infected. An instrument that has been boiled remains aseptic or sterile if held in a hand that has been sterilized, but when touched by a hand that has not been rendered sterile it is no longer surgically clean. Consequently before they can touch any object or any part of the patient which is to remain sterile the hands them- selves must first be sterilized. A common and efficient method of sterilizing the hands is to scrub them for ten minutes with a nail brush, tincture of green soap and hot water, the latter being changed several times, and follow this by a thorough scrubbing with alcohol and then by an immersion for at least two minutes in a 1 to 1000 bichlorid of mercury solution. After this process the hands must not touch anything that is not sterile, for a hand that has been thoroughly sterilized becomes infected as soon as it touches the face or dress or any other object which has not been ren- 202 THE MANAGEMENT OF LABOH dered aseptic. Consequently, should a person with sterile hands inadvertently touch something not surgically clean, should she for example scratch her face or brush her hand against her dress, she must immediately immerse her hands in the bichlorid solution or even scrub them again before so doing. THE MANAGEMENT OF THE FIRST STAGE OF LABOR. During the labor, only the physician and the nurse should be in the lying-in room. Relatives and friends whose services are not required should be excluded. It is especially necessary to keep out those loquacious neighbors who de- light in describing serious or fatal cases which have come to their notice. The nurse, too, must refrain from alluding to any dangerous or harrowang cases she may have attended. As stated in Chapter XIX, the first step in the management of a labor is to give an enema of a pint of soapsuds containing a teaspoonful of turpentine. When gonorrhea is known or sus- pected to be present the vagina should be scrubbed with soap and water and then douched with a I to 2000 bichlorid solution. Under ordinary circumstances, however, a douche is unde- sirable. The hair may be brushed and arranged in two braids. After the bath, given as directed in Chapter XIX, the patient is dressed in a clean nightgown, wrapper and easy slippers. In cold weather she should wear in addition a thin woolen undershirt and woolen stockings. In the daytime the woman may then be up and about, walking about the room, sitting in a chair or lying on a lounge. During a pain she may obtain some relief by lying down or sitting with the body inclined forward, the hands grasping a chair in front. At night it is better for the woman to sleep. She is usually ordered to bed when the physician finds upon internal examination that the external os or mouth has reached the size of a silver dollar, although he often waits until the os is fully dilated. After this time the woman should never sit on a closet, but should always use a vessel of some sort. THE MANAGEMENT OF LABOH 203 Diet During the First Stage of Labor.— When labor comes on in the daytime it is necessary at frequent intervals to supply liquid nourishment, such as milk, broths and the like, with a very small quantity of bread, toast or crackers. The woman should drink large quantities of water, plain or effer- vescent, and may be allowed a moderate amount of tea and coffee. The Administration of an Anesthetic. — Many physicians make a practice of giving an anesthetic when the pains become severe. Ether is the safest anesthetic. Ordinarily it is em- ployed not to put the woman to sleep, but merely to obtund the sense of pain. Ether must not be given too long; conse- quently it is administered as late in the labor as possible, being usually deferred until the second stage w T hen the abdominal muscles are brought into play. It is important not to give too much ether, therefore the anesthetic should not be given until just as the pain is coming on. A light towel is then thrown over the face, and as the patient exhales, a few drops are poured on the towel just below the tip of the nose, so that the vapor is sucked into the lungs as the patient breathes in. It takes only a little ether to obtund the sensibilities, and no more should be given than is necessary for this. As soon as each pain passes off the administration of ether should be suspended, to be assumed with the onset of the next pain. THE MANAGEMENT OF THE SECOND STAGE OF LABOR. As the second stage draws near, a large, clean, new sponge or some clean towels should be at hand to catch the waters when they break. With the advent of this stage of labor and the participation in it of the abdominal muscles the woman will want something to pull on to aid her in her bearing-down efforts. To supply this need a "puller" may be made by tying a twisted sheet, a roller towel or a rope to the foot of the bed. The woman pulls on this while she braces her feet against the footboard of the bed. 204 THE MANAGEMENT OF LABOB, The patient will often feel better if the small of her back is pressed upon by the nurse or rubbed briskly or if a hot water bottle is applied to it. Occasionally washing the patient's face and hands w r ith cold water will prove very grateful. A cramp in the leg may be relieved by forcibly stretching out the limb, at the same time pulling the foot up toward the knee. As the time of actual delivery approaches, the nurse or attendant must see that everything is at hand. The patient should be placed in the desired position on her back or side. If on the latter, a clean pillow should be placed between the knees, or the upper limb should be supported by the nurse. A sterile obstetric pad is then placed beneath the hips and a sterile sheet is draped over the side of the bed or pinned around the waist with the side next the accoucheur left open and the long end fastened beneath the patient's arm. The physician should have within easy reach a basin containing a disinfectant solu- tion for his hands and another basin containing bits of cotton in an antiseptic solution. Near by should be the material for tying the cord and the scissors for cutting it, all of which must be sterile; a glass containing a warm solution of ten grains of boric acid to the ounce of water, pieces of soft linen and a medi- cine dropper ; and a bottle of fluid extract of ergot, with a tea- spoon. A sterile douche bag should also be in readiness, with sterile hot and cooled water and an aseptic bath thermometer. A warmed blanket should be at hand in which to receive the baby. Hot and cold water, which need not be sterilized, should be easily available in tubs, basins or buckets, for resusci- tating the infant should it be asphyxiated. Inasmuch as the actual delivery is the work of the physi- cian and of him alone, a description of it here would be out of place. Suffice it to say that the skill of an accoucheur con- sists in preventing tears and other accidents and in meeting the various complications as they arise. As soon as the baby's head is delivered the eyes are wiped V-:-/'^::^' THE MANAGEMENT OF LABOR 205 with a piece of soft linen which has been soaking in the boric acid solution, more of the solution being introduced later by means of the medicine dropper. CARE OF THE NEW-BORN INFANT. As soon as the baby is born it is held by its thighs and legs, head downward, while the physician crooks his little finger, covered or not with a piece of old linen, and introduces it in the baby's throat back of the tongue, so as to clear the air passages of any blood or mucus that may have been inspired during the passage through the birth canal. The infant is then wrapped in a warmed towel and laid upon its right side with its face turned away from its mother. As soon as the umbilical cord has ceased to beat it is tied about two fingers' breadth from the child's body with a firm double knot, the ends of the string being then tied with a single and with a bow knot. The physician then places his hand upon the baby's abdomen so that the cord lies between the fingers, and holding the scissors close to those fingers with his other hand, he cuts the cord off on the outer side of the knot. The child is then wrapped in a warm blanket and put in a safe place, preferably its basket or crib. Care of a Premature Infant. — A premature child should be placed in an incubator. In its absence a clothes basket, bath- tub or wooden box may be used. This should be lined first with heavy wrapping paper and then with heated cotton or blankets and filled for half its depth with cotton wool. The child is laid in this and surrounded with hot water cans or bottles, and cov- ered all but its face and bottom with lamb's wool, cotton wool or cotton batting, held in place by gauze bandages. A piece of absorbent cotton or wool should be placed between the child's thighs. A blanket or shawl then covers the basket with the exception of the baby's head. The incubator is to be kept at a temperature of between 85 and 05 degrees Fahrenheit. 206 THE MANAGEMENT OF LABQB, A Premature Infant in an Incubator. The Treatment of an Asphyxiated Baby. — If the child does not breathe after birth, the cord should be immediately tied and cut as described below, and one of the following methods of inducing artificial respiration, or all in succession, should be tried. The child may be alternately folded and unfolded like a book, as shown in the accompanying -illustrations. It may be supported by the feet, with the forehead resting on a table, while THE MANAGEMENT OF LABOR 207 Folding and Unfolding an Asphyxiated Baby, in an Effort to Start tiif. Breathing. The various steps in the movement are numbered in order. light compression with the thumb and fingers is made on its chest about twenty times a minute. Wrapped in a towel and 208 THE MANAGEMENT OP LABOR grasped by the shoulders, the baby may be swung first between the physician's knees and then over his shoulders. Another method is to stretch the baby's arms high above its head and then press them down to its sides. The child's neck may be placed over a mug, and through a clean towel spread over the child's face the physician may very gently blow a little air into the child's mouth. Slapping the buttocks and rubbing the back and chest vigorously may start the breathing. The infant should frequently be placed in a hot bath to prevent chilling. While in such a bath ice water may be poured on the chest and abdomen. Sometimes the shock of placing the baby alternately in hot and cold water will stimulate the respirations. CARE OF THE MOTHER DURING THE THIRD STAGE OF LABOR. Meanwhile the mother must be receiving attention. As soon as the child's body is born she must be given a teaspoonful of the fluid extract of ergot in a little water. At the same time the womb is grasped through the abdominal wall, with the palm of the hand placed above, the thumb in front and the fingers behind, and is rubbed, kneaded, squeezed and pressed upon to stimulate it to contract and thus prevent hemorrhage. After a while the uterus will be felt to contract firmly. Then during a pain the physician presses down the womb and squeezes out the after-birth. The kneading and pressing are continued for fifteen minutes more. All the soiled towels and pads are then removed, the parts cleaned, and those sheets known as "the temporary bed" slipped out. A sterile, folded, dry, warmed sheet or another sterile obstetric pad is then placed under the patient. A pad or compress, consisting of one or two folded towels, is laid above the navel, and the binder is adjusted so as to reach from the ribs to the hip bones, being pinned from above downward so as to fit snugly. Then with surgically clean hands the occlusive bandage is applied between the thighs and pinned to the binder both in front and behind. CHAPTER XXII. THE CARE OF THE MOTHER AFTER LABOR. The Prevention of Infection. Rest and Quiet: Position to be assumed in bed; Getting up; Visitors. Diet for a Nursing Mother. The Life of the Nursing Mother. Bathing During the Puerperium. Rules Concerning Urination. Attention to the Bowels. Care of the Breasts: Care of the nipples; The mammary binder; Emptying the breasts; Care and cleanliness; The treat- ment of congested and distended breasts. "Look here and weep with tenderness and transport ! What is all tasteless luxury to this? To these best joys, which holy Love bestows? Oh Nature, parent Nature, thou alone Art the true judge of what can make us happy." — Thomson. HE chief concern of both the physician and the nurse in charge of a woman after labor is the prevention of infection. This is attained by the same precautions in regard to surgical cleanliness as were necessary during the labor itself. Absolute cleanliness of the patient, of every one who attends her and of everything that comes in contact with her, will usually avert the commonest and most fatal com- plication of this period — puerperal sepsis. This is by far the most important consideration. There are other matters, how- ever, which add to the comfort and safety of the patient. The life of the woman must be carefully regulated both H *\JU 210 CAHE OF THE MOTHEit AFTEE LABOR during the period immediately following labor and through- out the whole of lactation. REST AND QUIET. The mother must have absolute mental and physical rest for the first few days after labor. She must not be disturbed by loud noises or by a glaring light. For these first few days no extended conversation should be allowed in the lying-in room. Position to be Assumed in Bed.— The woman after deliv- ery should lie flat on her back, for the first six hours without a pillow. According to Hirst, she should remain on her back for at least a week. Davis, however, believes that this position, if too long continued, has a tendency to favor backward displace- ment of the womb. As soon as the patient feels rested and comfortable and there is no longer any danger from hemor- rhage or relaxation of the womb, the author permits his patients to move about in bed, turn on either side or lie upon the abdo- men, and after several days he allows the shoulders to be raised a little. The patient is then gradually propped up higher in bed until in a few days she can be placed in a sitting position. Getting Up.— The patient should be kept in bed until the womb has so shrunken in size that it has again returned to the pelvis and until there is no longer any blood in the lochial dis- charge. This state usually is reached in from ten to fourteen days. A safe rule would be for the woman to remain strictly confined to the bed for two weeks. If she gets up beforehand her womb is liable to be displaced. After the fourteenth day she may put on stockings, bedroom slippers and a flannel wrap- per and pass the day upon a lounge, rising to use the commode and sitting up as long at a time as she can without fatigue. As a rule she should not walk about the room for a week longer or go down stairs until the end of the fourth week. These directions, however, must often be varied to suit the individual case. CAKE OF THE MOTHER AFTER LABOR 211 Visitors.-— The patient's husband and mother are the only visitors to be allowed in the lying-in room, and they must not come too frequently. Even they can remain for but a short time and must avoid exciting subjects in their conversation. All other visitors are to be excluded during the first week. After this period the patient's relatives and intimate friends may see her for a few minutes, if they be of cheerful disposi- tion. But the nurse must keep out those inquisitive "busy- bodies" who often come pouring into the room inquiring minutely as to the particulars of the case and offering sugges- tions and advice based on their experience with cases which they believe to have been similar and which they want to de- scribe in detail. THE DIET FOR A NURSING MOTHER. The diet during the first three days should be very light, consisting chiefly of milk, with the addition of toast or crackers, gruel mush, grits or boiled rice and a little stewed fruit or baked apples. Gradually soft-boiled eggs, custard, junket, light puddings, broths, soups, jelly, sponge cake, ice cream, a charlotte russe, fresh fruit and vegetables are added to the dietary during the first week. The white meat of fowls, sweet- bread, lamb chops, fish and oysters may be given during the second week, and beef, bacon and potatoes during the third week. The puerperal woman should avoid rich and indigestible foods and alcoholic drinks. Throughout the whole of lactation, the period during which she nurses her baby, the mother must be careful to eat only what is digestible and nutritious, observing all the directions given in chapter VI as to thorough mastication of the food and regular- ity in the time of meals. The diet may have to be modified as described in chapter XXIV, should it be necessary for any rea- son to alter the character of the milk. THE LIFE OF THE NURSING MOTHER. In addition to being careful about her diet, the nursing mother must take regular exercise in the open air. She must, 212 CAEE OF THE MOTHER AFTER LABOE however, be kept free from fatigue, both mental and physical, and also from worry, anxiety or nervous excitement. Late hours are always to be avoided. Inasmuch as a powerful emo- tion, such as fright or violent anger, may render her milk unfit for use, a woman who has been subjected to such an influence should avoid nursing her baby for some hours afterward, emptying her breasts by means of a breast pump and giving the child barley water for one or two feedings. BATHING DURING THE PUERPERIUM. In the morning, about an hour after breakfast, the patient should be bathed in tepid water with a washrag and soap. In the evening she may receive a light alcohol rub. The genital region should be cleansed and dressed every four hours and after each evacuation of the bladder or rectum. The nurse, after seeing that everything she requires is at hand, places the patient on a douche pan and arranges the coverings. She then sterilizes her hands and, gently separating the labia, pours on the parts from a pitcher a disinfectant solution such as a I to 2000 bichlorid solution. The parts are then dried with bits of sterile cotton and a fresh sterile occlusive dressing, made as described in chapter XIX, is applied, being held in place by a T bandage or by pinning its ends to the abdominal binder. RULES CONCERNING URINATION. After labor there frequently is a tendency to retention of urine. If the woman is unable to pass her urine she should be placed on a warm bed pan or douche pan half full of warm water. If this fails, a hot application such as a turpentine stupe should in addition be made over the kidneys, bladder or external parts, or a clean sponge or a large piece of cotton wet with warm sterile water should be placed between her thighs, or the patient should listen to the sound of running water. Often if left to herself the patient is better able to urinate. Sometimes THE PRIDE OF THE HOUSEHOLD. II '//(•// the father first looks at his first bom in the arms of tin nurse or of the mother, a thrill of [vide and paternal love spring into his heart for the little life which has conic into the home. es CARE OF THE MOTHEE AFTER LABOR 213 if raised by means of pillows to a semi-recumbent or a sitting position she can then empty her bladder. If these expedients fail and no urine has been passed six hours after labor, resort must be had to catheterization. This is to be entrusted only to the skilled hands of the physician or the trained nurse, and must be performed aseptically with all the precautions required by surgical cleanliness. Should any germs enter the bladder, they may set up an inflammation that is very difficult to cure. After this the woman is to be catheterized three times a day if necessary, in every instance recourse having first been made to each of the expedients mentioned above. ATTENTION TO THE BOWELS. Constipation is the rule after labor. At the end of forty- eight hours it is well to administer a laxative of some sort. The choice of the drug employed will depend upon the patient's in- clination or prejudice. Castor oil may be given in warm milk or in a frothy liquid, such as porter or soda water. A good plan is to give half a bottle of citrate of magnesia on the even- ing of the second day after labor, and the other half the follow- ing morning before breakfast. If the bowels do not move within two hours an enema should be given. CARE OF THE BREASTS. Emptying the Breasts. — The infant should be nursed at regular intervals of two hours, as described in chapter XXIV. When, owing to the death of the child, mechanical measures are necessary for emptying the breasts, a breast pump may be employed, the breasts at the same time being rubbed and mas- saged with oiled finger tips in a direction toward the nipple. Sometimes the use of massage and the breast pump is required to supplement the child's sucking when the latter is not suffi- cient to thoroughly evacuate the breasts. Care and Cleanliness. — The observance of care and clean- 214 CARE OF THE 110THER AFTER LABOR liness in regard to the breasts and nipples is the best preventa- tive of subsequent trouble. The breasts should never be han- dled by either the nurse or the patient with fingers that are not thoroughly clean. Care of the Nipples. — After each nursing the nipples should be washed by means of some absorbent cotton with warm or cold water and castile soap or with a solution of boric acid 10 grains to the ounce, and should then be dried with a soft cloth. After each washing the skin of the nipple and the sur- rounding parts should be anointed with sterile olive oil or sterile cocoa butter applied by means of fresh absorbent cotton or a piece of clean linen. A supersensitive nipple may often be relieved with extract of witch hazel. A nipple shield must be used when the nipple becomes chapped or cracked or when it is very tender or of such a size and shape that the baby cannot obtain a satisfactory hold. A glass shield with a rubber nipple is the one most frequently employed. It should be simple and should fit tightly. If filled with warm milk and inverted over the nipple the child will often take it better. It should be boiled after being used, and should be kept in a boric acid solution. A depressed nipple should be drawn out by means of the breast pump, suction being applied by a rubber bulb or by the mouth through a piece of rubber tubing, or a bottle should be filled with very hot water, emptied rapidly, and quickly inverted over the nipple. The Mammary Binder. — The support of the patient's breasts by means of the mammary binder will increase her com- fort and may prevent serious disturbances. There are many forms of this binder. The simplest is a straight bandage of unbleached muslin, properly shaped by darts, applied with a compress under the outer portion of each breast. The Murphy binder is likewise made from a straight piece of muslin, but has a notch for the neck and two deeper notches for the arms. CARE OF THE MOTHER AFTER LABOR 215 Another bandage can be made out of a handkerchief folded as a triangle and passed under the breasts and tied behind the neck, the lower end being kept in position by being fastened with safety pins to the abdominal binder or to a strip of muslin or a bandage tied around the waist. One handkerchief may be Breast Supported by a Handkerchief. applied to each breast. The obstetrical breast support with knitted bosom is much less cumbersome and therefore more desirable when the patient is out of bed. The Treatment of Congested and Distended Breasts. — When the flow of milk is excessive the breasts may become dis- tended or even congested, despite all care. Congestion is apt to occur shortly after the breasts assume their function of sup- plying milk. Both conditions are treated by the dietetic and other measures mentioned in chapter XXIY for reducing the quantity of the milk. A purge must always be given. Cover- ing the breasts with sterile gauze will soak up the leakage and prevent it from soiling the clothing. Should the milk fail to 216 CARE OF THE MOTHER AFTER LABOR escape, a condition known as caked breast results. This is best treated by washing the breasts with soap and water just before the child is nursed or the breast pump is applied, and then with aseptic hands gently rubbing warm sterile olive oil on them for ten to twenty minutes, massaging them from below upward and from the base toward the nipple. Preceding the massage hot fomentations or cloths soaked in lead water and laudanum may be applied for fifteen to twenty minutes, care being taken to cleanse the nipple thoroughly before putting it in the baby's mouth. When inflammation or an abscess develops the baby must be immediately taken from the breast and the physician summoned. PART IV. THE BABY. CHAPTER XXIII. APPEARANCE AND DEVELOPMENT OF THE NORMAL INFANT. Color and appearance of the skin. Shape and development of the head; the fontanelles. The face at birth. The baby's hair. An infant's tongue. The baby's gums. Cutting the Teeth: The first or milk teeth; the second or permanent teeth; Teething a normal process. The shape and appearance of an infant at birth; Position assumed by the baby. The infant's size and weight at different ages. The baby's bowels. The baby's urination. The other functions of the baby. "To aid thy Mind's development, — to watch Thy dawn of little Joys, — to sit and see Almost thy very Growth, — to view thee catch Knowledge of objects, — wonders yet to thee." — Byron. MOTHER should be familiar with the appearance of the healthy baby in order to be able to tell when it is abnormal or sick. The normal weight at dif- ferent ages should therefore be known. Unless the mother knows when the various teeth should be cut and when the child should begin to notice, she will be unable to, decide whether her baby is developing properly or not. COLOR AND APPEARANCE OF THE SKIN. At birth the skin is of a decided lobster red color and is covered thickly in many parts with a peculiar whitish, waxy substance known as the vernix cascosa. After this has been removed and the baby has been bathed, the skin is found to be soft and extremely delicate and covered with a coating of fine down, which begins to fall out dur- 219 230 THE NORMAL INFANT ing the first week. By degrees the color fades into some shade of pink or, where a slight degree of jaundice is pres- ent, to a yellowish-red tint. As the infant grows older the color changes to a delicate pinkish white. SHAPE AND DEVELOPMENT OF THE HEAD. The head is large in comparison with the chest, being nearly as long as the trunk. The shape of the baby's head, Skull at Birth, Showing the Fontanelles. as seen from above, is normally round or oval, the circum- ference being about thirteen inches. The head of a newly- born child may have a startling shape, as the result of pro- longed pressure. One side may be flattened while the other bulges, or the head may be long and narrow. The idiotic ex- pression that such a shape sometimes imparts to an infant often causes much distress, alarm and anxiety to the parents. In almost every case, however, the abnormal appearance does not represent a permanent deformity but passes away, usually in a few days or a few months. No attempt should ever be made to squeeze the head into shape. Just behind the forehead is a diamond-shaped spot, about three-eighths of an inch to an inch and a quarter long < PQ w w H o PQ THE NOEMAL INFANT 221 and seven-eighths of an inch wide, where the bone is absent, the brain being covered only by a thin membrane and the skin. This is known as the anterior fontanelle. Depression of this spot indicates that the child is not properly nour- ished. The spot seems to enlarge as the infant grows older, up to about the ninth month, but the increase may be apparent rather than real. From the ninth to the twelfth month it seems to remain about the same size; it then grad- ually becomes smaller and should be closed by the nine- teenth or twentieth month. At the back of the head is a smaller and less significant opening, known as the posterior fontanelle. The Face at Birth. — The face in infancy occupies only one-eighth as much space as the rest of the head. Not un- commonly, at birth, it. is swollen and the features are out of shape. This is usually due to pressure and will soon pass away. The eyes are of a dull, grayish blue, expressionless and almost always half open when the child is awake and entirely shut when it is asleep. Some time elapses before the child knows what it sees. The Baby's Hair.— The hair at birth is often thick, dark, and one or two inches long, but it may be short, fine, of a light brown shade, and small in amount, coming down to a round point on the forehead and leaving the temples bald. During the second and third weeks the first hair often falls out, that on the back of the head being worn away by the rubbing on the pillow. The new hair grows in very slowly and is of the same character as the first but lighter in color. An Infant's Tongue and Gums. — During the first week of life the tongue is comparatively dry, long and narrow and slightly coated. The gums at birth are of a light pinkish color, smooth, firm, and quite narrow, and rather sharp and hard at the S22 THE NOEMAL INFANT edges. Some months later the edges grow broader in front and become more prominent. CUTTING THE TEETH. The first teeth may appear at any time during the first year of life, usually about the end of the sixth or seventh month. They often are cut earlier than this, but may be delayed until the second year. The teeth usually come in groups, with an interval between the cutting of each group. Names and Time of Appearance of the Milk Teeth.— There are twenty milk teeth or temporary teeth, ten on each jaw. The two middle ones are called the central in- cisors; next to these come the lateral incisors, then the canines, next the anterior molars and finally the posterior molars. The canine teeth of the upper jaw are often spoken of as the eye teeth, those of the lower jaw as the stomach teeth. The two lower central incisors are the first to appear, coming through the gums about the seventh month. Then follows an interval of three weeks in which no teeth are cut. Between the age of eight and ten months the two central upper incisors push through, followed closely by the lateral upper incisors. Then there is another interval of from one to three weeks, ended by the eruption of the four anterior molars and the four lower lateral incisors, which appear one at a time, in no particular order, during the period between the twelfth and fifteenth months. No teeth are then cut for two or three months until the child is eighteen months old, when, during the next six months, the canines come through. After a third pause of two to four months the posterior molars make their appearance, which occurs between the twentieth and thirtieth months of life. The Second or Permanent Teeth. — There are thirty- THE NORMAL INFANT 223 two permanent teeth, four incisors, two canines, four bi- cuspids and six molars in each jaw. The first four teeth appear at about the sixth year back of and next to the second molars of the milk teeth; they are called the six- year molars. In the seventh or eighth year the temporary incisors are replaced by the permanent ones. The tempo- rary molars fall out during the ninth or tenth year, and the bicuspids appear in the space left. In the eleventh year the permanent canines take the place of the temporary ones, and in the twelfth year the four second molars are cut. If the second teeth do not come in as they should, or are crowded out of position, an ugly deformity is liable to oc- cur unless the child is treated by a dentist. Teething a Normal Process. — Teething is not a dis- ease; it is a perfectly normal process. Other disturbances that occur while the teeth are pushing through must not be attributed to teething. Whenever the baby is sick, the cause of the trouble should be thoroughly investigated and the child should be taken to a doctor. Many a child has been allowed to suffer, and often to die, because its symp- toms were attributed to teething. Sometimes the child does exhibit various symptoms which are due to the eruption of the teeth and which disappear as soon as it is over. Dis- ordered dentition is shown by slight diarrhea, loss of appe- tite, feverishness, fretfulness, some eruption of the skin. irritability or other nervous symptoms. This is the excep- tion, however, rather than the rule. Lancing rarely is nec- essary. There is no objection to rubbing the gums slightly with the fingers, but they should never be rubbed with any hard substance, such as the finger-nail or a thimble. THE SHAPE AND APPEARANCE OF AN INFANT AT BIRTH. The trunk of an infant at birth is egg-shaped with the larger part below, the chest being poorly developed and the 224 THE NOBMAL INFANT abdomen large and prominent. The shoulders and hips are narrow, their circumference at birth being less than that of the head. The arms are short and well rounded. The legs are even shorter than the arms, being little longer than the trunk, and are less rounded. They have the appearance of being crooked owing to the tendency of the infant to turn the feet in and thus produce a seeming bowing of the legs. The cord begins to dry up immediately after birth and after twenty-four hours a red line forms around its base. It then gradually separates, falling off about the fourth or fifth day. The stump that is left afterwards retracts within the navel. The Position Assumed by the Baby. — At birth it lies comparatively still but soon it begins to move its arms and legs continually. The normal position for an infant to lie in is on its side, with the head turned slightly, the thighs drawn up and the back presenting one long concavity. THE INFANT'S SIZE AND WEIGHT AT DIFFERENT AGES. The average height or length of the new-born infant is about nineteen inches, although the normal range is be- tween sixteen and twenty-two inches. The weight at birth is, on the average, seven pounds, but may be as low as six and a half or as high as ten pounds within normal limits. During the first week, and often for a longer period, the baby loses in weight. Throughout the next three weeks and the second month it gains about one ounce a day, and during the third and fourth months gains about five ounces a week, or three-quarters of an ounce a day. The following table of Griffith shows how a child should gain in height and weight from birth up to the sixteenth year: THE NORMAL INFANT 225 TABLE SHOWING THE BABY'S GROWTH IN HEIGHT AND WEIGHT. AGE. HEIGHT. WEIGHT. Birth 19 in. 7 lbs. 9 oz. i week . 7 a 7V2 " 2 weeks . • 7 " 10/2 " 3 i 2 tt month months . 8 tt ti 2 " \ Gained 1 oz. a day ; 7 oz. 20>^ 21 in. f a week. it a 3 a 22 a i 2 y 4 - i (Gained y 4 oz. a day; 5^2 ( oz. a week. 4 it 23 n 13H 5 (« 23/2 it 15 " 1 ► * Double original weight. g > j Gained % oz. a day ; 4^ ( oz. a week. 6 f< 24 n i6y 4 - j ► 7 a 24^ tt i7 x A it -s 8 a 25 a 1854 it ► Gained y 2 inch a month. 9 <« 25^ a lsy 4 tt „ .... Gained about 1 lb. a month. IO « 26 a lgy 4 " ii H 26^ n 20^ it i year 27 n 21^ it j .... Treble original weight. 2 3 years 31 35 a it 27 32 " . .. Gained 4 inches a year. 4 << 37^ it 36 tt -> 1 • Double original length. f Gained 3 inches and 4 lbs. ( a year. 5 «( 40 tt 40 it i" 6 7 << 43 45 tt tt 44 48 it « ii ;• f Gained 2 inches and 4 lbs. ( a year. 8 (i 47 tt 53 it i f Gained 2 inches and 5 lbs. ( a year. 9 <( 49 tt 58 tt 10 ii tt 5i 53 tt tt 64 70 it ii !- f Gained 2 inches and 6 lbs. { a year. 12 tt 55 it 79 it ) 13 tt 57 tt 88 ti (i f Gained 2 inches and about ( 9 lbs. a year. 14 15 ti 59 61 tt 100 109 tt " 16 ii 63 it 117 tt ) The systematic and frequent weighing of infants during the first year of their lives is considered by Rotch to be of great importance, and far more useful as a means for ascer- taining their nutritive condition than any other one method known. The weighing of the baby determines whether the food is sufficiently nourishing in quality, or great enough 15 226 THE NORMAL INFANT in quantity. The first symptom of oncoming disease, es- pecially of a chronic form, is loss of weight. The child should be naked when weighed or always have on clothes of the same weight. The same pair of scales should be em- ployed at each weighing. It is advisable to weigh the baby at a stated interval after a feeding, as an infant is always heavier after eating. THE BOWEL MOVEMENTS OF A BABY. The bowels of a new-born infant generally move once or twice during the first day of life. For the first two or three days, until the child begins to nurse well, the passage consists of a thick, sticky, odorless, black or greenish black substance, called meconium. It then becomes of a golden yellow color, which sometimes changes upon exposure to the air to a greenish yellow, and shows a large proportion of water. It has very little odor and frequently contains small masses of undigested milk. For the first six weeks the bowels move two to four times in every twenty-four hours. From this age to that of two years there are us- ually but one to three movements daily, the passage being of greater consistency and a little darker in color and hav- ing a rather more fetid odor. If the soiled diaper is allowed to be exposed to the air, the color takes on a slight greenish tint. After the child is two years of age and is on a varied diet the passages become completely formed, with a dis- tinctive fetid odor. THE BABY'S URINATION. The urine of a healthy infant is generally like water in appearance, has very little odor and does not stain the diaper. The baby urinates about six to ten times a day, the frequency varying greatly in different children and under different circumstances. As the baby gets older, the frequency diminishes to about six times a day or less. THE NOEMAL INFANT 227 Other Functions of the Baby. — These functions vary as to the time of their development. The average infant usu- ally cries as soon as it is born, and during the first year of its life expresses its distress and desires by crying. It seldom cries without some reason, although the cause may be trivial. A baby may smile to show its pleasure by the time it is a month old, but it does not laugh until five or six months of age. Its hearing is established very soon, but it usually does not recognize objects before the sixth or eighth week. By the time it is three months old, or sometimes a little while before, it begins to make efforts at grasping after objects. The baby is able to lift its head a little before the age of two months and by the time it is three or four months old can hold it up without support. It is not able to sit up unsupported until at least six months of age, but may be- gin to attempt to sit up between the ages of three and four months. By the seventh or eighth month the child begins to creep about on its hands and knees. It sometimes makes efforts to stand when it is six months old, and by the time it is nine or ten months of age is often able to stand with- out support and frequently to walk a few steps by holding on to the furniture or to someone's hand. By the time it is a year old, a strong child can walk a little without help, but fifteen or eighteen months is early enough for this ac- complishment. As the child grows older it begins to imitate sounds. By the age of eight or nine months it may utter several syllables intelligently, and when a year old can often say a few words, such as "papa" and "mamma." When eighteen months of age it can usually express itself by the use of a few words aided by gestures, and by the end of the second year it can usually speak in short sentences. CHAPTER XXIV. THE FEEDING OF INFANTS. BREAST FEEDING. Mother's milk the best food for a baby. The baby's thirst Composition of human milk. How to modify breast milk. Conditions affecting the milk. Rules for Nursing the Baby. Feeding during the first few days of life; Regularity in feeding; Frequency of feeding; How long to nurse; How the baby should be held. Mixed feeding. The Wet-Nurse; Choice of the wet- nurse. Weaning the child; Indications for weaning in the child, in the mother. Methods of weaning. The time for weaning. "Suck, baby, suck! mother's love grows by giving; Drain the sweet founts that only thrive by wasting." — Lamb, ^plHERE are two methods of feeding an infant — by the ^y breast and by the bottle. The best food for a baby ^81i unquestionably is its mother's milk. The stomach of a new-born babe is sufficiently developed to digest the human milk nature intended for it, but is unequal to the task of digesting cow's milk. The for- tunate child that is nursed by its mother is much less liable to be attacked by disease than is a bottle-fed baby, and is to a certain extent exempt from digestive disturbances. Nursing doubtless is the greatest inconvenience of motherhood, and its demands are most exacting; it neces- sitates a woman's being with her baby at stated hours throughout the day and night, thus seriously interfering with her work or pleasure. But this self-sacrifice a mother owes to her baby. If she bring a child into the world, she must be willing to provide it with the best nourishment. 228 s. >] ^. § '--.j P- s> c-o o a *"-H ■^-+1 ^ o 38- ^ -x "Sh rs- O ^ *s. § § R, «*. § 1? ?s ^ 3, "^ §- W r> CP <>». > 3 - c"> O Oj K § ?5 w ^H > 3" to" ^-4-. s -* >-H SH. s tf e*«i -* Cfl 3 Co O) *s« a s" £r Co »--h o «s. ■"<