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- Herausgeber: Booksell-Verlag
- Kategorie: Ratgeber
- Sprache: Englisch
In "Tokology: A Book for Every Woman," Alice B. Stockham presents a groundbreaking exploration of women's health, reproduction, and sexuality, framed through the lens of late 19th-century progressive thought. This seminal work combines scientific insights with an accessible literary style, reflecting Stockham's commitment to educating women about their bodies and advocating for their autonomy. Written during a time when women's voices in medicine were largely marginalized, "Tokology" serves as both a medical manual and a feminist manifesto, challenging societal norms and encouraging personal empowerment through knowledge. Alice B. Stockham, a physician and early advocate for women's rights, drew on her extensive medical training and personal experiences to craft this essential text. Her work is informed by a desire to shift the narrative around women's health from a domain controlled by men to one where women could take charge of their own bodies and destinies. Stockham's commitment to holistic health and education made her a pioneer in the fields of obstetrics and gynecology, with "Tokology" reflecting her revolutionary spirit. This book is highly recommended for anyone interested in the intersections of health, gender, and empowerment. Stockham's insights remain relevant today as they inspire a deeper understanding of women's agency in health matters. "Tokology" is not just a historical document; it is a timeless call to action for women to claim ownership of their health. In this enriched edition, we have carefully created added value for your reading experience: - A succinct Introduction situates the work's timeless appeal and themes. - The Synopsis outlines the central plot, highlighting key developments without spoiling critical twists. - A detailed Historical Context immerses you in the era's events and influences that shaped the writing. - A thorough Analysis dissects symbols, motifs, and character arcs to unearth underlying meanings. - Reflection questions prompt you to engage personally with the work's messages, connecting them to modern life. - Hand‐picked Memorable Quotes shine a spotlight on moments of literary brilliance. - Interactive footnotes clarify unusual references, historical allusions, and archaic phrases for an effortless, more informed read.
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Veröffentlichungsjahr: 2023
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Tokology : A book for every woman
Table of Contents
CHAPTER I.PAINLESS CHILDBIRTH.
“I know of no country, no tribe, no class, where childbirth is attended with so much pain and trouble as in this country.” Thus replied a traveler who had been many years in foreign lands, upon being interrogated as to the comparative sufferings of savage and civilized women. His occupation and sympathies had brought him into close relationship with all classes of people, and therefore fitted him for an intelligent and discriminating judgment in this matter.
Neither in India, Hindostan, China, Japan, the South Sea Islands, South America, nor indeed in any country do women suffer in both pregnancy and parturition as they do in this. Possibly among the higher classes in Europe there may be equal suffering; but the peasantry everywhere is comparatively exempt.
The usual testimony of missionaries and travelers is that the squaws of our own Indian tribes experience almost no suffering in childbirth, and the function scarcely interferes with the habits, pleasures or duties of life. I have myself seen a squaw of the Ottawa tribe carrying her pappoose upon her back, strapped to a board, when it was only twenty-four hours old.
Mrs. Armstrong, one of the early missionaries in the Sandwich Islands, says: “With native women the labor was not long nor severe; the mother, instead of remaining in bed, arose, bathed in cold water, walked and ate as usual.”
Dr. Storer says: “There is probably no suffering ever experienced which will compare, in proportion to its extent in time, with the throes of parturition.” Dr. Meigs says: “Men can not suffer the same pain as women. What do you call the pains of parturition? There is no name for them but agony!”
It is too true that women go down to death in giving birth to children. Thousands of women believe that this pain is natural and that for it there can be no alleviation. “In sorrow shalt thou bring forth children” is thought to be a curse that applies to all women of all time.
If this pain and travail is a natural accompaniment of physiological functions—if it is a curse upon women, then why are the rich, the enlightened and more favored daughters of earth greater sufferers than the peasantry, the savage, the barbarian, and those who we call heathen? Is it not possible, by research and comparison, to learn the natural and true mode of life, so that motherhood may, among enlightened people, be relieved from this burden of suffering? May it not prove that our traditions and teachings upon this subject have been altogether erroneous?
American women in education and enlightenment, in freedom and progress, are the peers of the best and noblest of their sex. From individual, social and national interests, they ought to be conversant with all that pertains to this subject, so closely allied to the interests of the race.
We find in women of superior education and marked intelligence an exaggerated development of the emotional nature, and a corresponding deterioration of physical powers. Weakness, debility, and suffering is the common lot of most of them. Not one in a hundred has health and strength to pursue any chosen study, or to follow any lucrative occupation, and what is vastly worse, most are unfitted for the duties and perils of maternity.
Dr. Gaillard Thomas says: “Neither appreciation of, nor desire for, physical excellence sufficiently exists among refined women of our day. Our young women are too willing to be delicate, fragile and incapable of endurance. They dread above all things the glow and hue of health, the rotundity and beauty of muscularity, the comely shapes which the great masters gave to the Venus de Medici and Venus de Milo. All these attributes are viewed as coarse and unladylike, and she is regarded as most to be envied whose complexion wears the livery of disease, whose muscular development is beyond the suspicion of embonpoint, and whose waist can almost be spanned by her own hands.
“As a result, how often do we see our matrons dreading the process of child-bearing, as if it were an abnormal and destructive one; fatigued and exhausted by a short walk, or ordinary household cares; choosing houses with special reference to freedom from one extra flight of stairs, and commonly debarred the one great maternal privilege of nourishing their own offspring. These are they who furnish employment for the gynecologist, and who fill our homes with invalids and sufferers.”
Understanding and following physiological laws, pregnancy ought to be as free from pathological symptoms, and parturition as void of suffering with American women as with any on earth, or even with the lower animals.
Dr. Dewees says: “Pain in childbirth is a morbid symptom; it is a perversion of nature caused by modes of living not consistent with the most healthy condition of the system, and a regimen which would insure a completely healthy condition might be counted on with certainty to do away with such pain.”
The great English scientist, Professor Huxley, says: “We are indeed, fully prepared to believe that the bearing of children may and ought to become as free from danger and long debility to the civilized woman as it is to the savage.”
The following paragraphs from one of the essays in Dr. Montgomery’s classical work on Pregnancy, give practical details of cases in illustration of the belief in painless parturition.
“In a letter to me Dr. Douglas states that he was called about 6 A. M., Sept. 26, 1828, to attend a Mrs. D., residing on Eccles St.
“On his arrival he found the house in the utmost confusion, and was told that the child had been born before the messenger was dispatched for the doctor. From the lady herself he learned that, about half an hour previously, she had been awakened from a natural sleep by the alarm of a daughter about five years old, who slept with her.
“This alarm was occasioned by the little girl feeling the movements, and hearing the cries of an infant in bed. To the mother’s great surprise she had brought forth her child without any consciousness of the fact.
“A lady of great respectability, the wife of a peer of the realm, was actually delivered once in her sleep; she immediately awakened her husband, being alarmed to find one more in bed than there was before.
“I have elsewhere mentioned the case of a patient of mine who bore eight children without ever having labor pains. Her deliveries were so sudden and void of sensible effect that in more than one instance they took place under most awkward circumstances, but without any suffering.”
Dr. J. King, in his work on Obstetrics, speaks of attending cases where there was no sensation of pain.
He found that by placing the hand upon the abdomen, the muscular contractions were distinctly felt, and examination proved the progress of labor, while, excepting a suppressed breath, the patient experienced no change from the ordinary condition.
Some very marked cases have come to my own knowledge proving the possibility of painless labor. I attended a neighbor of mine in four different confinements. I never was able to reach her before the birth of the child, although I lived only across the street, and according to her injunctions, always kept my shoes “laced up.” She sent for me, too, at the first indication of labor. There was always one prolonged effort and the child was expelled. The heads of her children were temporarily distorted, showing pliability of the osseous structure.
Another lady patron had two children without a particle of pain. With the first she was alone with her nurse. During the evening she remarked that she felt weary and believed that she would lie down. She had been on the bed no more than twenty minutes when she called to her nurse, saying: “How strangely I feel! I wish you would see what is the matter,” when to their astonishment the child was already born.
Two years later I was summoned to the same lady about ten at night. The membranes were ruptured, but no other visible indication of labor. Investigation revealed dilatation of the cervix and although she soon fell into a quiet slumber, I noticed regular and distinct contractions. The child was born about two in the morning without any sensation of pain. I have no doubt that in her previous confinement the contractions went on the same, and if she had been one to mark her symptoms closely, she would have felt them as one feels muscular contractions in the performance of other natural functions.
The cases that have been cited, so far as is known, were persons in excellent health, and some were persons of exceptionally fine and strong constitutions. Dr. Holbrook in his “Parturition without Pain,” says: “Those women of savage nations who bear children without pain live much in the open air, take much exercise, and are physically active and healthy to a degree greatly beyond their more civilized sisters. These instances tend directly to prove that parturition is likely to be painless in proportion as the mother is physically perfect and in a sound condition of health. They certainly tend even more strongly to prove that pain is not an absolute necessity attendant on parturition.
“The course of modern scientific investigation, moreover, has gone far to justify a belief that this terrific burden upon humanity can be almost entirely removed, and that the pain can be as completely done away with as the danger and disfigurement from small-pox. At the same time, this immeasurable benefit to humanity cannot be obtained without proper use of means, and the continuance of such use for a considerable period.
“The doctrine of the ablest thinkers on the subject will be found to agree in this: That it is the previous life of the mother—the whole of it, from her birth to the birth of the child—which almost entirely determines what her danger, her difficulty, and her pain during childbirth shall be. Her easy or difficult labor, in fact, is almost entirely her own work. Her conduct during gestation, it is true, is more immediately influential in the result than remoter periods, and bears more greatly upon the future life of her offspring than even upon herself.”
Dr. Oliver Wendell Holmes once said that he believed that any disease, no matter how virulent, how malignant or how deep-seated, whether it was cancer, consumption or cholera, any disease could be cured if the physician was called in time. But with his wonted humor he added: “There are cases in which the physician should be called at least two hundred years in advance.”
With Dr. Holmes, I believe it will take many years to eradicate diseased conditions which are the heritage of this generation, and thus to produce men and women of physical perfection. Science has proven, however, that any woman possessing sufficient vitality to make procreation possible, can do much, even during pregnancy, to alleviate the sufferings of that period, as well as the final throes of travail. Pain and suffering have so long been the customary attendant upon the maternal functions, that many are slow to believe they can ever be alleviated. Painless childbirth is thought to be an impossibility. The reader is begged to lay aside all previous prejudices, and it is believed that when this volume has been thoroughly studied he will be convinced that women in bearing offspring should furnish no exception to the laws of nature, and that pregnancy and parturition may and ought to be devoid of suffering.
In Tokology, technical terms have been avoided as much as possible. For the few used the reader will find helpful hints in the Glossary, page 354. If possible, the few remedies prescribed in Tokology should be procured at a Homœopathic Pharmacy, or of a Homœopathic Physician. They are, however, sometimes found already prepared in a drug store.
CHAPTER II.CONCEPTION—FETAL DEVELOPMENT.
The reproductive apparatus of woman consists essentially of ovaries, oviducts, uterus, vagina and mammary glands.
The ovaries (Plates II and VI) are two almond-shaped bodies, situated about two and one-half inches distant on either side of the uterus. They are inclosed in the broad ligaments and suspended by a thread-like cord from the womb, also attached to the outer extremities of the oviducts. They consist of a stroma in which vesicles are imbedded. It is within these vesicles that the ova, or eggs, are found. Every four weeks, during the child-bearing period an ovum matures, and bursting through the vesicle, as well as the surrounding membrane of the ovary, is conveyed to the womb by the oviduct.
While not the largest, the ovary is the most important of the generative organs of woman. Upon these apparently insignificant structures depends the creative power giving the grand office of motherhood, a power akin to the divine. Maternity! the holiest shrine of human life, to which poets do homage, and true men bow in reverence!
The ovaries contain the fructifying principle, and also bestow on woman the characteristics of sex. These mysterious bodies are the grand source of feminine attractions. Remove all other generative organs and you do not change her in this regard—remove the ovaries, and she becomes masculine not only in character but appearance. Her figure changes, her voice becomes coarse and of lower pitch, her throat enlarges, and, in some instances, whiskers appear. Any diseased condition, too, of the ovaries produces great constitutional as well as emotional disturbances.
The oviducts or fallopian tubes (Plates II and VI) are minute cylindrical openings from the superior and lateral portion of the uterus, about three inches in length and terminating in fimbriated or finger-like extremities. The latter are minute muscular bodies, which grasp the ovum as it bursts through the membranes of the ovary, and convey it into the oviduct on its way to the uterus. The ovum is less than ¹⁄₁₂₀ of an inch in diameter, and the cavity of the oviduct is so small that it would scarcely allow the entrance of a hog’s bristle.
The uterus (Plates II, III, IV, V and VII) is a pear-shaped muscular organ situated in the inferior portion of the pelvis, between the bladder and rectum. It is less than three inches length and two inches in width, and one in thickness. It is pear-shaped, the cervix naturally pointing to the coccyx.
The canal or opening into the uterus through the cervix is small, capable of admitting a probe ¹⁄₈ to ¹⁄₄ of an inch in diameter. The walls are muscular, and in the unimpregnated state about half an inch in thickness. The cavity of the uterus is small and conical, having three openings, two at its upper portion into the oviducts, and one into the vagina. The latter is called the Os uteri or mouth of the womb. The upper broad portion is called the fundus. It weighs from one to two ounces. It is difficult to realize how very diminutive this organ is in the virgin state, especially when we consider its power of distension during pregnancy.
The external portion of the uterus is covered by the peritoneum, a serous membrane which is continuous with the lining of the abdomen and covering of all the viscera. The uterus is held in place by ligaments formed of folds of the peritoneum. The broad ligament enveloping the oviduct and ovaries extends to either side, and is firmly attached to the sides of the pelvis. The round ligaments, formed from obliterated bloodvessels of fetal life and peritoneal covering, pass from the upper portion of the womb to the outside of the pelvic bone and terminate in muscular and cellular tissue beneath the integument. There are also folds of peritoneum between the womb and bladder in the front, and the womb and rectum in the back, that assist in holding it in position. It is besides largely supported by the elasticity of the vagina and muscles of the perineum. So well sustained is the uterus that only serious violations of physical laws can cause deviations of position.
The Vagina (Plates II and III) is simply the external outlet or passage from the uterus. It is longer in back than in front, being from three to four inches in front and from five to six inches in the posterior portion. It is a cylindrical tube of firm elastic tissue, capable of great distension. The neck of the uterus dips into the upper part of the vagina about three-fourths of an inch. The communication between these organs is the cervical canal, which in health is found closed, admitting a probe with difficulty. The uterus and vagina are not one and the same as many suppose, yet communicate with each other. The vagina serves as a passage for the menstrual fluid, for the fetus at birth, and for the reception of the male organ in copulation, and in a state of health assists the perineal muscles in sustaining the uterus.
The mammary glands or breasts (Plate XI) are accessory to the generative system. They secrete milk which supplies the child with nourishment after birth. They are rounded and prominent, keeping their form and position through life, if the surrounding muscles and tissues have not been weakened by pressure of clothing.
Conception or impregnation takes place by the union of the male sperm and female germ. Whether this is accomplished in the ovaries, the oviducts or the uterus, is still a question of discussion and investigation by physiologists.
The ovum, or egg, matures and is taken up by the fimbriated extremities of the oviducts at the time of menstruation. To reach the outer world it must pass the length of the oviducts, the cavity and canal of the uterus and vagina. The fructifying principle of the semen consists of zoosperms, which under strong magnifying powers are seen to be filaments endowed with power of propulsion.
Once entering the uterine cavity there is no reason why they should not be able to pass into the oviducts or even to reach the ovaries. The probabilities are impregnation can take place at any point in the generative tract, providing the ovum and sperms come in contact while they still live. It is pretty well proven that the ovum after maturing and being dislodged from the ovaries may retain its life from six to eight days, and also be that length of time in making its exit from the uterus. That the sperms are viable, also, for some days, if retained in their own element at a certain temperature, has been established quite definitely.
With many women the ovum passes off within twenty-four or forty-eight hours after menstruation begins. Some, by careful observation, are able to know with certainty when this takes place. It is often accompanied with malaise, nervousness, headache, or actual uterine pain. A minute substance like the white of an egg, with a fleck of blood in it, can frequently be seen upon the clothing. Ladies who have noticed this phenomenon testify to its recurring very regularly upon the same day after menstruation. Some delicate women have observed it as late as the fourteenth day.
Nourishment and development of the embryo.—There are three distinct periods of nutrition in the uterine development of the human being:
First—Yolk nutrition.
Second—Tuft nutrition.
Third—Placental nutrition.
The period of yolk nutrition in the human is brief and probably variable. The minute size of the egg renders it impossible for it to furnish nutriment for any length of time, as is the case with the embryo of the fowl. From five to eight days after conception takes place, a membrane is formed around the ovum, called the chorion. Outside of this is still another membrane attaching itself to the womb. The internal surface of the chorion is supplied with villi or tufts resembling mulberry seed. Through these the embryo receives its nutrition, until at the close of the second month, from these tufts the placenta, or after-birth, begins to be developed. This is attached to some portion of the uterus, usually the upper lateral portion.
The Placenta is a spongy, vascular organ, at full term eight to ten inches in diameter, and two or three inches thick at center, thinning at the edges, weighing from three-fourths to one and one-fourth pounds. In appearance it is not unlike a piece of liver, only less solid.
It is the proper vascular apparatus serving the combined purpose of fetal nutrition, respiration and excretion. At least, through its absorption all these functions are accomplished.
This, with the membranes surrounding the fetus and umbilical cord, is called the after-birth.
The placenta (Plates VIII and IX) lies in complete juxtaposition with the uterus, with an almost imperceptible membrane interposed. The fibers and bloodvessels of the uterus and placenta do not interlace, as some suppose; each has a distinct set of bloodvessels and capillaries, and a separate circulation. Nutrition and excretion are carried on by exosmosis, or transudation through this very attenuated membrane.
The fetal circulation is an especially interesting phenomenon. Instead of the blood going to the lungs for oxygenation, the entire circuit is performed without this, the placenta serving the office of lungs as well as of the digestive organs.
From the placenta oxidized blood is brought through the umbilical vein, a large portion of it passing to the liver, but all eventually enters the heart by the ascending vena cava. By the Eustachian valve it is directed through the foramen ovale to the left auricle, from this to the left ventricle, which conveys it to the aorta.
Part of the blood, instead of taking this course, enters the right ventricle, and in place of going to the lungs through pulmonary arteries, passes at once to the aorta, through what is called the ductus arteriosus. After traveling the entire circuit, it is taken back to the placenta by two umbilical arteries, which are given off from the iliac arteries.
At birth the ductus arteriosus closes; the umbilical veins form the round ligament of the liver, and the umbilical arteries the round ligament of the uterus in the female, and the urachus, a ligament of the bladder, in the male.
The foramen ovale also closes, establishing a complete septum between the auricles of the heart.
A blue baby or cyanosis neonatorum is the result should this valve fail to close. The venous blood commingles with the arterial blood, and death is the result sooner or later.
The umbilical cord is made up of two arteries and one vein. It is from two to four feet in length, attached at one extremity to the placenta, and at the other to the navel of the child. This is the medium of the circulation between the placenta and the fetus.
The membranes all unite before birth to form one thick, tenacious covering for the child, and also for the cord and fetal surface of the placenta.
This incloses the fluid—the liquor amnii—which serves to protect the fetus from blows or sudden jars. The membranes and the contained fluid form what is known as the “bag of waters.” Not rupturing before birth, they make what is called a veil or caul over the child’s face, to which is attached various superstitions, such as the gift of “second sight,” clairvoyance, etc.
Healthy nutrition of the fetus depends entirely upon the mother. The placenta not only represents the digestive organs, but the lungs of the fetus. Consequently upon the condition of the mother depends the condition of the child. It has no other means of getting nutriment, or of disposing of waste material. After birth it has the same advantage as the adult in correcting errors in diet and nutrition by elimination. The skin, with its miles of perspiratory ducts, then conveys effete matter from the system, the lungs keep up by respiration a constant interchange of oxygen for carbon, while the liver, kidneys and bowels are active in their functions of depurition. In utero these functions are all dormant, consequently giving the fetus a disadvantage for healthy growth. Mothers often show a great solicitude about diet and conditions during lactation, while they are comparatively indifferent to these matters during pregnancy.
Especially should they breathe deeply, and that, too, of pure air. Trall says: “If the mother does not breathe sufficiently the child must suffer. Many a mother gives birth to a frail, scrofulous child, for no reason except that during the period of gestation she is too sedentary and plethoric. I have known women of vigorous constitutions, who had given birth to several healthy children, become the mothers of children so puny and scrofulous that it was impossible for them to be raised to adult age. The reason is that the mother is obstructed in her respiratory system, and although she may breathe enough to sustain her own organization in a fair condition, she does not inhale oxygen enough to supply the needs of an intra-uterine being. Many ‘still births’ are explainable on this principle.”
The duration of pregnancy is nine calendar months or ten lunar months, about 280 days. If the date of impregnation is not known, the count should be made from the beginning of the last menstruation, and add eight days on account of the possibility of its occurring within that period. It is possible in some diseased conditions for the period to extend much beyond this time. I knew one case of amniotic dropsy where pregnancy extended forty-four weeks.
Helen Idleson, M. D., in the Med. Wochenschrift, sums up the results of her investigations as follows: “1. The duration of pregnancy amounts to 278 days, or nearly 40 weeks. 2. The sex of the infant influences the duration, this being longer in female infants. (?) 3. The heavier the child, the longer is the duration. (?) 4. The duration is longer in multipara than in primipara. 5. The younger the woman the longer is the duration. 6. The duration is longer in married than in unmarried women. 7. The first movements of the child are felt, on an average, on the one hundred and thirty-fifth day, but later in primipara than in multipara.
“The growth of the embryo after fecundation is very rapid. On the tenth day it has the appearance of a semi-transparent, grayish flake. On the twelfth day it is nearly the size of a pea, filled with fluid, in the middle of which is an opaque spot, presenting the first appearance of an embryo, which may be clearly seen as an oblong or curved body, and is plainly visible to the naked eye on the fourteenth day. The twenty-first day the embryo resembles an ant or a lettuce-seed; its length is from four to five lines and its weight from three to four grains. Many of its parts now begin to show themselves, especially the cartilaginous beginnings of the spinal column, the heart, etc.
“The thirtieth day the embryo is as large as a horse-fly, and resembles a worm, bent together. There are as yet no limbs, and the head is larger than the rest of the body. When stretched out it is nearly half an inch long. Toward the fifth week the heart increases greatly in proportion to the remainder of the body, and the rudimentary eyes are indicated by two black spots turned toward the sides, and the heart exhibits its external form, bearing a close resemblance to that in the adult.
“In the seventh week bone begins to form in the lower jaw and clavicle. Narrow streaks on each side of the vertebral column show the beginning of the ribs. The heart is perfecting its form, the brain enlarging and the eyes and ears growing more perfect, and the limbs sprouting from the body. The lungs are mere sacs, about one line in length, and the trachea is a delicate thread, but the liver is very large. In the seventh week are formed the renal capsules and kidneys.
“At two months the forearm and hand can be distinguished, but not the arm; the hand is larger than the forearm, but it is not supplied with fingers. The distinction of sex is yet difficult. The eyes are prominent. The nose forms an obtuse eminence. The nostrils are rounded and separated. The mouth is gaping and the epidermis can be distinguished from the true skin. The embryo is from one and a half to two inches long and weighs from three to five drachms, the head forming more than one-third of the whole.
“At the end of three months the eyelids are distinct but shut; the lips are drawn together; the forehead and nose are clearly traceable, and the organs of generation prominent. The heart beats with force, the larger vessels carry red blood; the fingers and toes are well-defined, and muscles begin to be developed.
“At the fourth month the embryo takes the name of fetus. The body is six to eight inches in length and weighs from seven to eight ounces. The skin has a rosy color, and the muscles produce a sensible motion. A fetus born at this time might live several hours.
“At five months the length of the body is from eight to ten inches, and its weight from eight to eleven ounces.
“At six months the length is twelve and a half inches; weight, one pound. The hair appears upon the head, the eyes closed, the eyelids somewhat thicker, and their margins, as well as the eyebrows, are studded with very delicate hairs.
“At seven months, every part has increased in volume and perfection; the bony system is nearly complete; length, twelve to fourteen inches; weight, two and a half to three pounds. If born at this period the fetus is able to breathe, cry and nurse, and may live if properly cared for.
“At eight months, the fetus seems to grow rather in length than in thickness; it is only sixteen to eighteen inches long and yet weighs from four to five pounds. The skin is very red, and covered with down and a considerable quantity of sebaceous matter. The lower jaw, which at first was very short, is now as long as the upper one.
“Finally, at term the fetus is about nineteen to twenty-three inches long, and weighs from six to nine pounds. The red blood circulates in the capillaries, and the skin performs the functions of perspiration; the nails are fully developed.”
There is a superstition that a child born at eight months is not as liable to live as if born at seven months; indeed, many suppose that an eight months’ child never survives. Facts do not prove this idea correct.
Personally I have known several eight months’ babies to live and do well, and I believe that their chance of life is much greater than if born at seven months.
Position of the fetus.—The fetus usually lies with the head downward, the chin resting upon the breast. The feet are bent in front of the legs, the latter flexed upon the thighs. The knees are separated from each other, but the heels lie close together on the back of the thighs; the arms are crossed upon the breast, so placed that the chin can rest upon the hands.
In this way it forms an oval, whose longest diameter is about eleven inches. This is the usual position, yet it often varies from it.
CHAPTER III.PREGNANCY—SIGNS AND SYMPTOMS.
The signs of pregnancy are physiological and pathological; physiological, those common to all women; pathological, those which are the result of and accompany diseased conditions.
Of the physiological, the four principal ones are cessation of menstruation, increase of size, quickening, and the fetal heart beat.
Cessation of menstruation in a married woman may ordinarily be considered a sign that conception has taken place. Yet suppression may be the result of cold, of inflammation, of some chronic uterine diseases, more especially dropsy or tumors, also of any slow, wasting disease like scrofula, consumption and diarrhea.
Occasionally, too, women menstruate during the entire time of gestation. This, without doubt, is an abnormal condition, and should be remedied, as disastrous consequences may result. Also, women have been known to bear children who have never menstruated.
Pregnancy seldom takes place where menstruation has never occurred, yet it frequently happens that women never menstruate from one pregnancy to another. In these cases this symptom is ruled out for diagnostic purposes.
Increase of size begins to be experienced at about the third month, when the uterus enlarges and rises above the brim of the pelvis. Any enlargement previous to this time must be due to bloating, flatulence or excess of fat, to which some are inclined in gestation. This sign, taken alone, can not be relied upon as diagnostic. It may be occasioned by various causes, and often accompanies the very same conditions attending menstrual suppression. Instances occur in every town and neighborhood where women have made elaborate preparations for confinement, only to be disappointed by finding they were suffering from some serious disease causing suppression.
Quickening.—The involuntary movements of the child occur from the eighteenth to the twentieth week. Sometimes these motions begin as early as the third month, and then are a feeble fluttering only, causing disagreeable sensations of faintness and nausea. The “motion” of the child is regarded by women, especially if they have previously borne children, as an unfailing sign. But cases are common where the throbbing in a tumor, or the peristaltic action accompanying flatulence has been mistaken for fetal movements.
Unless the motion is very marked, quick, elastic and distinct, it alone cannot be relied upon as a diagnostic symptom. Taken together with other signs it aids both physician and patient to a positive conclusion.
The fetal heart beat.—The sign by which physicians can with certainty determine pregnancy is by noting the difference between the beating of the fetal and maternal hearts. The ordinary pulse of a woman is from 70 to 80 per minute, while that of the fetus is from 120 to 140.
Auscultation through a stethoscope will reveal this fact, and thus give a certain diagnosis. If it is a throbbing or pulsating in a tumor it would be synchronous with the maternal cardiac action. This symptom is not of much value till after the fourth month. By that time, if a physician’s ear is educated to fine discriminations, he will never make a mistake in his diagnosis.
I can not leave this subject without urging upon women the necessity of educating their own fingers to judge of the heart’s actions by the radial pulse. Get your physician to tell you and study in your books the meaning of a quick, a throbbing, a slow, a weak, feeble or wiry pulse. It is one of the surest guides to abnormal conditions, and is a great aid to nurses in the administration of remedial measures, besides often determining the necessity of medical aid. In my conversations with women, often in an audience of one hundred ladies, I find none who know even the frequency of the normal pulse.
The enlargement of the breasts at about the third month, the secretion of a fluid in them, also the darkening of the areola around the nipples are of frequent or usual attendance upon gestation—but not always; consequently of themselves can not be taken as diagnostic symptoms.
The pathological symptoms are more numerous. Indeed, almost any symptom accompanying any disease may attend gestation. This is a sad reflection upon our enlightened civilization. Were it not for this, Tokology would have no special mission. The facts now are that with most American women the 280 days of pregnancy are days of disease and suffering. The inconvenience, the discomfort and the pains attendant upon this condition, together with the dread of the final throes of travail, transform this period, which should be one of hope, of cheerfulness, of exalted pleasure, into days of suffering, wretchedness, and direful forebodings. It is one long night-mare, and child-bearing is looked upon as a curse and not a blessing. Motherhood is robbed of its divinest joys.
Dr. Cowan says: “The period of pregnancy should be one of increased health, rather than increased disorders. The mother who has hitherto led a true life, will, during this period, experience an exhilaration of spirits, a redundancy of health and cheerfulness of mind that is not to be enjoyed at any other time.” Alas! how few have this experience.
Ordinarily pregnancy is classed both by physicians and women among the diseases. Physical sufferings and mental agonies are the common accompaniments of the condition. Murderous intent fills the mother’s heart, and the fearful crime of feticide is daily committed.
Do physicians offer any relief for this state of things? It is a lamentable fact that most do not. In one of my conversational lectures a lady testified that for seven months before her child was born she never knew one hour’s relief from nausea—that she was not conscious of retaining any nourishment upon her stomach, and that no day elapsed without vomiting blood. No words can describe her sufferings through all those dreadful weeks, even up to the hour of delivery. She consulted three different physicians, and each one told her nothing could be done except to wait for “nature’s relief.” She went home in despair and suffered to the end. When she heard the theories I teach, with suppressed emotion she exclaimed: “Thank God for the hope you give. To my dying day I shall use my feeble voice to promulgate these truths, that others may not grope in the valley as I have done.”
Yes, women can be saved much suffering even during pregnancy. If they study this work intelligently, practicing the precepts therein given, they will ever be thankful for the light and hope obtained.
CHAPTER IV.DISEASES OF PREGNANCY—INDIGESTION—NAUSEA, ETC.
The most common ailments of pregnancy are dyspepsia, nausea, vomiting, constipation, headache, heartburn, flatulence, salivation, diarrhœa, piles, greedy appetite, loss of appetite, longings, neuralgia, toothache, cramps, swellings of the extremities, pain in the side, insomnia, drowsiness, palpitation of the heart, leucorrhœa, pruritus, etc.
Indigestion or dyspepsia is the most frequent complaint afflicting the human family. It is at the foundation of almost every other disease, many of the above symptoms of pregnancy being attendant upon and caused by it. Men and women in every station of life are more or less subject to it; few are entirely exempt. “A good digestion turneth all to health.” Indigestion is usually attributed entirely to a failure of the stomach to perform its functions. The term is also applied to a defect in any of the assimilative operations throughout the digestive tract. The limits of this work will not permit a dissertation upon these processes and their abnormal conditions.
In passing, however, let me say while there are many causes of dyspepsia, there is no one more potent than the common attempt to nourish the body from food which cannot be digested in the stomach. The principal articles upon which the acid gastric juice has no effect are starch and fats. They can be rendered soluble in alkaline fluids only, which are the saliva, pancreatic juice and the bile. By partaking of the starch and fats to excess, the stomach is overtaxed in expelling them, besides which the body fails to get elements of nutrition in proper proportions from them.
The natural food of the infant contains no starch, the carbonates of milk being sugar and butter. Usually the first solid food given to a child contains little else but starch, such as bread from white flour, and potatoes, rendered more indigestible by the addition of butter and rich gravies. These are lacking in nitrogenous and saline products, consequently the muscles, bones and nerves may not be nourished.
A substitution of the products of the entire wheat, barley, oats and other grains would obviate this difficulty, and lessen the frightful mortality of children. Dr. Bellows says: “So perfectly ignorant are people generally of the laws of nature that they give their pigs the food which their children need to develop muscle and brain, and give their children what their pigs need to develop fat. For example, the farmer separates from milk the muscle-making and brain-feeding nitrates and phosphates, and gives them to his pigs in the form of buttermilk, while the fattening carbonates he gives to his children in butter. He sifts out the bran and outer crust from the wheat, which contains the nitrates and phosphates, and gives them also to his pigs and cattle, while the fine flour containing little else than heating carbonates, he gives to his children. Cheese, which contains the concentrated nutriment of milk, is seldom seen on our tables, while butter, which contains not a particle of food for brain or muscle, is on every table at all times of day.”
Cheese, when digested, furnishes more muscle-feeding properties than any other food, and hence is desirable for working men, and all people engaged in out-door pursuits, but should be taken as food, not as a relish only.
The elements digested in the stomach are fibrine (its type found in lean meat), albumen, casein, gluten of the grains, and the nitrogenous principles of fruits and vegetables.
These are the elements that build up the muscles, while the carbonaceous elements, such as sugar, starch and fats, by combination with oxygen, furnish animal heat. Too much of the latter tend to produce inflammatory conditions, and should be partaken of moderately by all people who do not lead an active out-door life.
The pregnant woman, however, is especially liable to suffer from the multiform miseries of dyspepsia. Her nervous organization is peculiarly sensitive at this time. Many symptoms are also caused by reflex action from the gravid uterus upon the sympathetic ganglia which control the alimentary processes.
Morning sickness.—Nausea, with or without vomiting, occurs so frequently in pregnancy that most women think it a natural accompaniment of their condition, relying upon it as a diagnostic symptom. It may begin the day following conception, but usually appears from the sixth to the eighth week. It is unlike nausea which accompanies biliousness, fevers, the effect of drugs, or even sea-sickness. It is a nausea that one feels from the crown of the head to the soles of the feet; one is “sick to the stomach” all over.
Asking the cause of this, ninety-nine out of a hundred aver they believe it to be natural, and more than all, not to be avoided. Besides, the grandmother of the neighborhood has told them that on account of this, the child will be more healthy, and the delivery easier. Facts do not bear her out in either assertion.
The real causes are to be sought in the violation of physical laws, in dress, diet, exercise, etc. The conditions are, first, an irritation in the womb caused by some existing derangement, which by sympathetic or reflex action is communicated to the stomach, and second, that state commonly called biliousness.
The whole body is supplied with nerves distributed from the brain and spinal column. Besides these, ganglia of sympathetic nerves communicate with all nerves and with each other, being so interlaced that almost every part of the body is in communication with every other part. It is really a complete system of telegraphy. Both the uterus and stomach are remarkable in their supply of nerves, and any disturbance in the former is instantly conveyed to the latter.
It is not unusual that an inflammation or displacement of the womb gives no local symptoms—but by reflex action there are headaches, indigestion, neuralgia, and various ailments. So, of the gravid uterus, if from any existing local disease or any cause in the system, it does not take kindly to its new function, and derangement in the organ ensues, instead of causing local pain and distress it will be communicated to other organs, most frequently to the stomach, producing nausea, vomiting, as well as often acute suffering.
What is biliousness? Ladies, you know the condition to which you apply this term. Frequent headaches, aversion to food, aching of the bones, languid, sleepy and tired feeling. You get up in the morning weary, cross, irritable, out of sorts with everybody, and everybody retaliates by being out of sorts with you. What has happened in the human organism? What do you understand by biliousness? Listen to the answers. One says, “It is an overflow of bile,” others, “Too much bile,” “The liver don’t act,” “The bile has reverted back to the blood,” “The bile is secreted by the stomach,” “Too high living,” etc.
Dr. Dio Lewis says: “Biliousness is piggishness.” My habit has been to define it simply as overfeeding. At least, the elements of the bile are in the blood in excess of the power of the liver to eliminate them. This may be caused by either inaction of the organ itself, or superabundance of the materials from which the bile is made. Being thus retained the system is burdened, or to use a homely but expressive phrase, is clogged. To produce this, food may be too great in quantity, or too rich in quality. Especially is it caused by the excessive use of fats and sweets. How does this biliousness produce nausea in the pregnant woman, and why does it show itself in this way, when she was comparatively well previous to this condition?
In the new process of gestation the whole system is roused to action, and nature makes an effort to relieve the organs of all foreign or bilious matter. Her first means to produce this result is by nausea and vomiting. Many women have an attack of bilious fever, more or less severe, in the first months of pregnancy.
Three causes may induce this state of the system: food which is too nutritive or too abundant; lack of exercise conducive to normal action in the assimilative organs; and clothing that in any way restricts this action. At any time, the bands and corsets so universally comprising a part of woman’s dress are injurious, because they restrict the action of the liver and other organs, but they are doubly deleterious when there is a natural increase in size. The direct pressure of the viscera upon the uterus will also produce irritation in that organ.
I was spending a few days with an old friend who was four months advanced in pregnancy. She had had no unpleasant symptoms. One day as we were on the street walking, she was suddenly seized with vomiting. Trying to investigate the cause, I asked her if she wore the dress she was accustomed to. “No,” she said; “I have not had this on for months, and it is too tight.” She loosened it under her cloak, when the symptom disappeared.
In the last months of pregnancy, vomiting is often caused by pressure of the enlarged uterus upon the stomach. This cannot occur where the natural figure has always been unquestionably preserved.
One potent cause of morning sickness is the habit of entering upon the sexual relation frequently during gestation. By this means a hyperæmia in the reproductive organs as well as exhaustion of the nerve supply is produced. By reflex action nausea is the result. Incalculable benefits would be derived if married people imitated the lessons of lower animals in this matter—thereby conserving all forces for the benefit of offspring.
Treatment for morning sickness.—If inflammation or ulceration of the uterus is chronic, one can not expect to overcome the nausea entirely in a short time (Chap. XXI.)
In the case of biliousness, a plain, light diet with plenty of acid fruits, avoiding fats and sweets, will ameliorate if not remove it. Don’t force the appetite. Let hunger demand food. In the morning the sensitiveness of the stomach may be relieved by taking before rising a cup of hot water, hot milk, hot lemonade, rice or barley water, selecting according to preference. For this purpose many find coffee made from browned wheat or corn the best drink. Depend for a time upon liquid food that can be taken up by absorbents.
The juice of lemons and other acid fruits is usually grateful, and assists in assimilating any excess in nutriment. These may be diluted according to taste. With many, an egg lemonade proves relishing and acceptable.
In biliousness, with or without nausea, hot fomentations in the region of the stomach and liver, for an hour once or twice a day, followed by tepid bathing and hand friction will be found invaluable.
Warm or hot enemas are exceedingly beneficial. In order to be effectual, follow minutely these directions. Place in a Fountain Syringe two or three quarts of soft water as warm as can be taken. A tablespoon of salt will make it more effective. Suspend the reservoir as high as the hose will allow. Lie upon the right side with knees flexed. Introduce the long rectal tube, or what is better for many, the vaginal tube far enough in the rectum to pass the internal sphincter muscle. It ought to enter three or four inches. Let the water pass into the bowels slowly, having them manipulated upward by an attendant, especially making passes up the right side.
This causes the water to pass through the ileocæcal valve from the large to the small intestines. Once in the latter, it is taken up by the capillaries of the portal vein, and more or less of it conveyed to the liver. This stimulates a secretion of bile and it is not unusual for five or six free evacuations to follow. It is quite as effectual as an active purgative without any poisonous results of the drug. This enema should be retained from twenty minutes to half an hour. It is also much more efficacious when preceded by the use of a hot fomentation over the liver. This injection is an exceedingly valuable remedial agent both in acute and chronic difficulties. By its use in sick headache, bilious colic, congestions in the stomach or abdominal viscera, the physician’s visit and fee will often be saved.
The exercises recommended in Chap. V, for constipation, are invaluable for biliousness.
Before closing this chapter, let me repeat and emphasize, “Do not force the appetite.” Food which neither relishes nor digests will do more harm than good. Tradition and prejudice have all conspired to so engrave in your being that you must not only eat, but stuff, because you are eating for two, that both you and your friends think food must be taken at all hazards. So, what is your custom? You rise in the morning sick and disgusted. The very smell of food is intolerable. Still you sit at the table instead of getting away from it, and eat probably beefsteak and hot bread, washed down by a cup of coffee. Of course you must take what is the most nourishing! These are scarcely swallowed until you have proofs that so much provision is wasted.
By nine o’clock you make another attempt. You go to the pantry, find some cold chicken, a piece of lemon pie, and a pickle. But no, the stomach refuses these. At eleven o’clock a confidential friend calls. She commiserates you, and knows that both you and the fetus will starve. She goes to her own larder, brings you a piece of pound cake, some custard and jelly; possibly a piece of mince pie. Do these share the same fate? Perhaps not. Her cheery laugh and neighborly sympathy, and the more propitious time of day, make it possible for this to be retained. But pause, my friend. Has the blood received the best nutriment for building a healthy organization for yourself or child?
Very little, if any extra food is essential to nourish the fetus, especially the first few weeks of pregnancy. The total average increase of weight is less than one-half an ounce a day, and one-fourth of this would be an approximate estimate for the first three months. It can readily be seen that simply the suppression of the menses would give nearly, if not quite, all the extra nutriment for the first few weeks, at least. Appropriate food, and the proper conditions for assimilation are far more important than increase in quantity.
CHAPTER V.Diseases of Pregnancy.—Constipation.
Constipation of the bowels is not only a frequent attendant upon pregnancy, but is a common ailment of both men and women. From year to year this symptom is on the increase, until fully nine-tenths of the American women and one-half of the men are afflicted with it.
Every person should have a free, soluble, satisfactory evacuation of the bowels daily. In pregnancy especially, not for one day should constipation be allowed.
Constipation is usually the first notice of bodily derangement, and may be the precursor of a chronic state of ill health. The approach, too, of this affection may be insidious, existing when the subject is not aware of it. The evacuations may be regular, yet not sufficiently free and copious to be compatible with health.
The slightest torpidity of the bowels results in retention of residual matter, which becomes reabsorbed into the system, acting as a foreign and poisonous substance. Other organs of elimination must, on this account, be overtaxed, in the vain attempt to overcome the obstruction.
