Woman
by William J. Robinson · English · Gutenberg #21840 · 528,221 chars · public domain (US)
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Title: Woman
Author: William J. Robinson
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WOMAN
Her Sex And Love Life
by
WILLIAM J. ROBINSON, M.D.
Chief of the Department of Genito-Urinary Diseases and
Dermatology, Bronx Hospital Dispensary Editor of the
American Journal of Urology and Sexology; Editor of The
Critic and Guide; Author of Treatment of Sexual Impotence
and Other Sexual Disorders in Men and Women; Treatment of
Gonorrhea in Men and Women; Limitation of Offspring by the
Prevention of Conception; Sex Knowledge for Girls and Women;
Sexual Problems of Today; Never-Told Tales; Eugenics and
Marriage, etc. Fellow of the New York Academy of Medicine,
of the American Medical Editors' Association, American
Medical Association, New York State Medical Society,
Internationale Gesellschaft für Sexualforschung, American
Genetic Association, American Association for the
Advancement of Science, American Urological Association,
etc., etc.
Illustrated
Twenty-First Edition
1929
Eugenics Publishing Company
New York
Copyright, 1917,
by Eugenics Publishing Company
Press of
J.J. Little & Ives Co.
New York
THE CREATION OF WOMAN
This old Oriental legend is so exquisitely charming, so superior to
the Biblical narrative of the creation of woman, that it deserves to
be reproduced in WOMAN: HER SEX AND LOVE LIFE. There are several
variants of this legend, but I reproduce it as it appeared in the
first issue of THE CRITIC AND GUIDE, January, 1903.
At the beginning of time, Twashtri--the Vulcan of Hindu
mythology--created the world. But when he wished to create a
woman, he found that he had employed all his materials in the
creation of man. There did not remain one solid element. Then
Twashtri, perplexed, fell into a profound meditation from which
he aroused himself and proceeded as follows:
He took the roundness of the moon, the undulations of the
serpent, the entwinement of clinging plants, the trembling of
the grass, the slenderness of the rose-vine and the velvet of
the flower, the lightness of the leaf and the glance of the
fawn, the gaiety of the sun's rays and tears of the mist, the
inconstancy of the wind and the timidity of the hare, the vanity
of the peacock and the softness of the down on the throat of the
swallow, the hardness of the diamond, the sweet flavor of honey
and the cruelty of the tiger, the warmth of fire, the chill of
snow, the chatter of the jay and the cooing of the turtle dove.
He combined all these and formed a woman. Then he made a present
of her to man. Eight days later the man came to Twashtri, and
said: "My Lord, the creature you gave me poisons my existence.
She chatters without rest, she takes all my time, she laments
for nothing at all, and is always ill; take her back;" and
Twashtri took the woman back.
But eight days later the man came again to the god and said: "My
Lord, my life is very solitary since I returned this creature. I
remember she danced before me, singing. I recall how she glanced
at me from the corner of her eye, how she played with me, clung
to me. Give her back to me," and Twashtri returned the woman to
him. Three days only passed and Twashtri saw the man coming to
him again. "My Lord," said he, "I do not understand exactly how
it is, but I am sure that the woman causes me more annoyance
than pleasure. I beg you to relieve me of her."
But Twashtri cried: "Go your way and do the best you can." And
the man cried: "I cannot live with her!" "Neither can you live
without her!" replied Twashtri.
And the man went away sorrowful, murmuring: "Woe is me, I can
neither live with nor without her."
PREFACE
In the first chapter of this book I have shown, I believe
convincingly, why sex knowledge is even more important for women than
it is for men. I have examined carefully the books that have been
written for girls and women, and I know that it is not bias, nor
carping criticism, but strict honesty that forces me to say that I
have not found one satisfactory girl's or woman's sex book. There are
some excellent books for girls and women on general hygiene; but on
sex hygiene, on the general manifestations of the sex instinct, on sex
ethics--none. I have attempted to write such a book. Whether I have
succeeded--fully, partially or not at all--is not for me to say,
though I have my suspicions. But this I know: in writing this book I
have been strictly honest with myself, from first page to last.
Whether everything I have written is the truth, I do not know. But at
least I believe that it is--or I would not have written it. And I can
solemnly say that the book is free from any cant, hypocrisy,
falsehood, exaggeration or compromise, nor has any attempt been made
in any chapter to conciliate the stupid, the ignorant, the pervert, or
the sexless.
As in all my other books I have used plain, honest English. Not any
plainer than necessary, but plain enough to avoid obscurity and
misconception.
Science and art are both necessary to human happiness. This is not the
place to discuss the relative importance of the two. And, while I have
no patience with art-for-art's-sake, I recognize that the scientist
can not be put into a narrow channel and ordered to go into a certain
definite direction. Scientific investigations which seemed aimless and
useless have sometimes led to highly important results, and I would
not disparage science for its own sake. It has its uses. Nevertheless
I personally have no use for it. To me everything must have a direct
human purpose, a definite human application. When the cup of human
life is so overflowing with woe and pain and misery, it seems to me a
narrow dilettanteism or downright charlatanism to devote one's self to
petty or bizarre problems which can have no relation to human
happiness, and to prate of self-satisfaction and self-expression. One
can have all the self-expression one wants while doing useful work.
And working for humanity does not exclude a healthy hedonism; not the
narrow Cyrenaic, but an enlightened altruistic hedonism. And in
writing this book I have kept the human problem constantly before my
eyes. It was not my ambition merely to impart interesting facts: my
concern was the practical application of these facts, their relation
to human happiness.
If this book should be instrumental, as I confidently trust it will,
in destroying some medieval superstitions, in dissipating some
hampering and cramping errors, in instilling some hope in the hearts
of the hopeless, in bringing a little joy into the homes of the
joyless, in increasing in however slight a degree the sum total of
human happiness, its mission shall have been gloriously fulfilled.
For this is the mission of the book: to increase the sum total of
human happiness.
W.J.R.
12 Mount Morris Park W.,
New York City.
Jan. 1, 1917.
CONTENTS
CHAPTER PAGE
I. THE PARAMOUNT NEED OF SEX KNOWLEDGE FOR GIRLS AND WOMEN 23
Why Sex Knowledge is of Paramount Importance to Girls and
Women--Reasons Why a Misstep in a Girl Has More Serious
Consequences than a Misstep in a Boy--The Place Love
Occupies in Woman's Life--Woman's Physical Disabilities.
II. THE FEMALE SEX ORGANS; THEIR ANATOMY 31
The Internal Sex Organs--The Ovaries--The Fallopian Tubes--The
Uterus--The Divisions of the Uterus--Anteversion,
Anteflexion, Retroversion, Retroflexion, of the
Uterus--Endometritis--The Vagina--The Hymen--Imperforate
Hymen--The External Genitals--The Vulva, Labia Majora, Labia
Minora, the Mons Veneris, the Clitoris, the Urethra--The
Breasts--The Pelvis--The Difference Between the Male and
Female Pelvis.
III. THE PHYSIOLOGY OF THE FEMALE SEX ORGANS 49
Function of the Ovaries--Internal Secretion of the Ovaries--
Function of the Internal Secretion--Number of Ova in the
Ovaries--The Graafian Follicles--Ovulation--Corpora
Lutea--Function of the Fallopian Tubes--Function of the
Vagina--Functions of the Vulva, Clitoris and Mons Veneris--
Function of the Breasts--Besides Secreting Milk Breast Has
Sexual Function--The Orgasm--Pollutions in Women--Secondary
Sex Characters--Differences Between Woman and Man.
IV. THE SEX INSTINCT 62
Universality of the Sex Instinct--Not Responsible for Our
Thoughts and Feelings.
V. PUBERTY 65
Physical Changes in Puberty--Physical Changes in the Genital
Organs and in the Rest of the Body--Psychic Changes--Puberty
and Adolescence--Nubility.
VI. MENSTRUATION 71
Definition of Menstruation--Where Menstrual Blood Comes
From--Age of Menstruation--Age of Cessation of
Menstruation--Duration--Amount--Regularity and Irregularity.
VII. ABNORMALITIES OF MENSTRUATION 75
Disorders of Menstruation--Menorrhagia--Metrorrhagia--
Amenorrhea--Vicarious Menstruation--Dysmenorrhea of Organic
and of Nervous Origin.
VIII. THE HYGIENE OF MENSTRUATION 78
Lack of Cleanliness During Menstrual Period--Superstitious
Beliefs--Hygiene of Menstruation.
IX. FECUNDATION OR FERTILIZATION 82
Fecundation or Fertilization--Process of Fecundation--When the
Ovum Matures--Fate of Ovum When no Intercourse Has Taken
Place--Entrance of Spermatozoa as Result of Intercourse--The
Spermatozoa in Search of the Ovum--Rapidity of Movements of
Spermatozoa--Absorption of Spermatozoön by Ovum--Activity of
Impregnated Ovum in Finding Place to Develop--Pregnancy in
the Fallopian Tube and Its Dangers--Twin Pregnancy--Passivity
of Ovum and Activity of Spermatozoön Foretell the Contrasting
Rôles of the Man and the Woman Throughout Life.
X. PREGNANCY 88
Period of Pregnancy in Human Female--Physiologic Process of
Pregnancy--Growth of Embryo from Moment of Conception--
Pregnant Woman Provides Nourishment for Two--Her Excreting
Organs Must Work for Two.
XI. THE DISORDERS OF PREGNANCY 93
Smooth Course of Pregnancy in Some Women--Pregnancy and
Parturition May be Made Normal Processes Through Education
in True Hygiene--Morning Sickness and Its Treatment--Necessity
for Medical Advice in Pernicious Vomiting--Anorexia--Bulimia--
Aversion Towards Certain Foods--Peculiar Cravings--Tendency
to Constipation Aggravated by Pregnancy--Dietary Measures in
Constipation--Rectal Injections in Constipation--Laxatives--
Cause of Frequent Desire to Urinate During First Two or Three
and Last Months of Pregnancy--Treatment of Frequent Urination--
Cause of Piles During Pregnancy and Their Treatment--Cause of
Itching of External Genitals During Pregnancy and Treatment--
Cause of Varicose Veins and Treatment--Liver Spots.
XII. WHEN TO ENGAGE A PHYSICIAN 102
Necessity for the Pregnant Woman Immediately Placing Herself
Under Care of Physician and Remaining Under His Care During
Entire Period.
XIII. THE SIZE OF THE FETUS 105
Approximately Correct Measurements and Weight of Fetus at End
of Each Month of Pregnancy.
XIV. THE AFTERBIRTH (PLACENTA) AND CORD 108
How the Afterbirth Develops--Bag of Waters--Umbilical Cord--The
Navel--Fetus Nourished by Absorption--Fetus Breathes by Aid
of Placenta--No Nervous Connection Between Mother and Child.
XV. LACTATION OR NURSING 110
No Perfect Substitute for Mother's Milk--When Nursing is
Injurious to Mother and Child--Modified Milk--Artificial
Foods--Care Essential in Selecting Wet Nurse--Suckling Child
Benefits Mother--Reciprocal Affection Strengthened by
Nursing--Sexual Feelings While Nursing--Alcoholics are
Injurious--Attention to Condition of Nipples During
Pregnancy Essential--Treatment of Sunken Nipples--Treatment
of Tender Nipples--Treatment of Cracked Nipples--How to Stop
the Secretion of Milk When Necessary--Menstruation While
Nursing--Pregnancy in the Nursing Woman.
XVI. ABORTION AND MISCARRIAGE 117
Definition of Word Abortion--Definition of Word Miscarriage--
Spontaneous Abortion--Induced Abortion--Therapeutic Abortion--
Criminal Abortion--Missed Abortion--Habitual Abortion--
Syphilis as Cause of Abortion and Miscarriage--Dangers of
Abortion--Abortion an Evil.
XVII. PRENATAL CARE 121
Meaning of the Term--Misleading Information by
Quasi-Scientists--Exaggerated Ideas Regarding Prenatal
Care--Nervous Connection Between Mother and Child--Cases
Under Author's Observation--Effects on Offspring--Advice to
Pregnant Women--Germ-plasm of Chronic Alcoholic--A Glass of
Wine and the Spermatozoa--False Statements--Cases of
Violence and Accidents During Pregnancy.
XVIII. THE MENOPAUSE, OR CHANGE OF LIFE 128
Time of Menopause--Cause of Suffering During Menopause--
Reproductive Function and Sexual Function Not Synonymous--
Increased Libido During Menopause--Change of Life in Men.
XIX. THE HABIT OF MASTURBATION 135
Definition of Masturbation--Its Injurious Effects in Girls as
Compared with Boys--Married Life of the Girl Masturbator--
Necessity for Change in Injurious Attitude of Parents who
Discover the Habit--Common-sense Treatment of the Habit--
How to Prevent Formation of Habit--Parents' Advice to
Children--Hot Baths as Factor in Masturbation--Other Physical
Factors--Mental Masturbation and Its Effects.
XX. LEUCORRHEA--THE WHITES 143
Misconception Regarding the Meaning of the Term "Leucorrhea"--A
Common Complaint--Severe Cases--Reasons for Resistance to
Treatment--Proper Local Treatment of the Disorder--Sterility
Due to Leucorrhea--Causes of Leucorrhea--Tonic
Medicines--Local Treatment--Formulæ for Douching.
XXI. THE VENEREAL DISEASES 149
Derivation of Word "Venereal"--Three Venereal Diseases--
Innocent Contraction of Syphilis Through Various Objects--
The Hygienic Elimination of Common Sources of Venereal
Infection--Measures for Prevention After Sexual Relations.
XXII. THE EXTENT OF VENEREAL DISEASE 151
Former Ban on Discussion of Venereal Disease and Its Evil
Results--Present Reprehensible Exaggerations of Extent of
Venereal Disease--Erroneous and Ridiculous Statements of
"Reformers"--Senseless Fear of Marriage in Girls Due to
Lurid Exaggerations--Study by Woman Psychologist Reveals
Harmful Results of Exaggerated Statements--Truth in Regard
to Percentage of Men Afflicted with Venereal Disease.
XXIII. GONORRHEA 158
Source of Gonorrhea--Mucous Membrane of Genital Organs and of
Eye Principal Seats of Disease--Symptoms in Men and in
Women--Vagina Seldom Attacked in Adults--Nobody Inherits
Gonorrhea--Ophthalmia Neonatorum--Differences of Course of
Disease in Men and Women--Gonorrhea Less Painful in
Women--Symptoms not Suspected by Woman--Necessity for the
Woman Consulting a Physician--Self-treatment When Woman
Cannot Consult Physician--Formulæ for Injections.
XXIV. VULVOVAGINITIS IN LITTLE GIRLS 164
Former Causes of Vulvovaginitis in Little Girls--Discharge
Chief Symptom--Evil Results of Vulvovaginitis--Psychic
Results of Treatment--Effects in Hastening Sexual
Maturity--Vulvovaginitis a Cause of Permanent
Sterility--Measures to Prevent the Disease--Toilet Seats and
Vulvovaginitis.
XXV. SYPHILIS 168
Syphilis Due to Germ--Syphilis a Constitutional Disease--
Primary Lesion--Incubation Period--Roseola--Primary
Stage--Secondary Stage--Mucous Patches--Tertiary
Stage--Gumma--Hereditary Nature of Syphilis--Milder Course
in Women Than in Men--Obscure Symptoms in Syphilis--
Necessity for Examination by Physician--Locomotor Ataxia--
Softening of the Brain--Chancroids.
XXVI. THE CURABILITY OF VENEREAL DISEASE 174
Gonorrhea May Be Practically Cured in Every Case in
Man--Extensive Gonorrheal Infection in Woman Difficult to
Cure--Positive Cure in Syphilis Impossible to Guarantee.
XXVII. VENEREAL PROPHYLAXIS 177
Necessity for Douching Before and After Suspicious
Intercourse--Formulæ for Douches--Precautions Against
Non-venereal Sources of Infection--Syphilis Transmitted by
Dentist's Instruments--Manicurists and Syphilis--Promiscuous
Kissing a Source of Syphilitic Infection.
XXIII. ALCOHOL, SEX AND VENEREAL DISEASE 181
Alcoholic Indulgence and Venereal Disease--A Champagne Dinner
and Syphilis--Percentage of Cases of Venereal Infection Due
to Alcohol--Artificial Stimulation of Sex Instinct in Man
and in Woman--Reckless Sexual Indulgence Due to
Alcohol--Alcohol as an Aid to Seduction.
XXIX. MARRIAGE AND GONORRHEA 187
Decision of Physician Regarding Marriage of Patients Infected
with Gonorrhea or Syphilis--Advisability of Certificate of
Freedom from Transmissible Disease--Premarital Examination
as a Universal Custom--When a Man Who Had Gonorrhea May Be
Allowed to Marry--When a Woman Who Had Gonorrhea May be
Allowed to Marry--Antisepsis Before Coitus--Question of
Sterility in the Man Who Has Had Gonorrhea Easily
Answered--Impossibility of Determining Whether the Woman is
Fertile or Not.
XXX. MARRIAGE AND SYPHILIS 195
Rules for Permitting a Syphilitic Patient to Marry--Rules More
Severe in Cases Where Children Are Desired--Where Both
Partners Are Syphilitic--Danger of Paresis in Some
Syphilitic Patients--A Case in the Author's Practice.
XXXI. WHO MAY AND WHO MAY NOT MARRY 200
The Physician Often Consulted as to Advisability of Marriage--
_Venereal Disease_ the Most Common Question--_Tuberculosis_--
Sexual Appetite of Tubercular Patients--Effect of Pregnancy
Contraceptive Knowledge for Tubercular Wife--_Heart Disease_--
Serious Bar to Marriage--Influence of Sexual Intercourse--
_Cancer_--Fear of Hereditary Transmission--_Exophthalmic
Goiter_--Most Frequent in Women--Simple Goiter--Exceptions
to Rule--_Obesity_--Family History--Obesity and Stoutness Not
Synonymous--_Arteriosclerosis_--Danger in Sexual Act--_Gout_--
Real Causes of Gout--_Mumps_--Parotid Glands and Sex Organs--
Mumps and Sterility--Oöphoritis Due to Mumps--_Hemophilia_--
Hemophilic Sons May Marry--Hemophilic Daughters May Not
Marry--_Anemia_--_Chlorosis_--_Epilepsy_--Hysteria--Symptoms
of Hysteria--Marriage of Hysterical Women--_Alcoholism_--
Effect on Offspring--Alcoholics and Impotence--
_Feeblemindedness_--Evil Effects on Offspring--Sterilization
of Feebleminded Only Preventive--_Insanity_--Functional
Insanity--Organic Insanity--Hereditary Transmissibility of
Insanity--Fear Resulting in Insanity--Environment versus
Heredity in Insanity--_Neurosis_--_Neurasthenia_--
_Psychasthenia_--_Neuropathy_--_Psychopathy_--Nervous
Conditions and Genius--Sexual Impotence and Genius--_Drug
Addiction_--External Causes--_Consanguineous Marriages_--When
Consanguineous Marriages are Advisable--Offspring of
Consanguineous Marriages--Homosexuality--Homosexuals Often
Ignorant of Their Condition--Sexual Repression and
Homosexuality--Sadism and Divorce--Masochism--Sexual Impotence
and Marriage--Effect Upon the Wife--Frigidity--Marital Relations
and Frigid Woman--Excessive Libido and Marriage--Excessive
Demands Upon Wife--Satyriasis--The Excessively Libidinous
Wife--Nymphomania--Treatment--Harelip--Myopia--Astigmatism--
Premature Baldness--Criminality--Crime as Result of
Environment--Legal and Moral Crime--Ancestral Criminality and
Marriage--Rules of Heredity--Pauperism--Difference Between
Pauperism and Poverty.
XXXII. BIRTH CONTROL OR THE LIMITATION OF OFFSPRING 244
Knowledge of Prevention of Conception Essential--Misapprehensions
Concerning Birth-control Propaganda--Modern Contraceptives Not
Injurious to Health--Imperfection of Contraceptive Measures
Due to Secrecy--Prevention of Conception and Abortion
Radically Different--More Marriages Consummated if Birth-control
Information were Legally Obtainable--Demand for Prostitution
Would be Curtailed--Venereal Disease Due to Lack of
Knowledge--Another Phase of the Birth-control Problem--Knowledge
of Contraceptive Methods Where There Was a Taint of Insanity,
and the Happy Results.
XXXIII. ADVICE TO GIRLS APPROACHING THE THRESHOLD OF WOMANHOOD 261
The Irresistible Attraction of the Young Girl for the Male--The
Unprotected Girl's Temptations--Some Men Who Will Pester the
Young Girl--Risk of Venereal Infection--Danger of
Impregnation--Use of Contraceptives by the Unmarried Woman
May Not Always Be Relied Upon--Nature of Men who Seduce
Girls--Exceptions--Illegitimate Motherhood--Difficulties in
the Way of Illegitimate Mother Who Must Earn Her Living--The
Child of the Foundling Asylum--Social Attitude Towards
Illegitimacy Responsible for Abortion Evil--Dangers of
Abortion--The Girl Who Has Lost Her Virginity.
XXXIV. ADVICE TO PARENTS OF UNFORTUNATE GIRLS 273
Attitude of Parents Towards Unfortunate Girl--The Case of Edith
and What Her Father Did--The Pitiful Cases of Mary B. and
Bridget C.
XXXV. SEXUAL RELATIONS DURING MENSTRUATION 279
Heightened Sexual Appetite of Many Women During Menstruation--
Sexual Intercourse During Menstrual Period--When Intercourse
May be Permitted--Injection Before Coitus During
Menstruation--Fallacy of Ancient Idea of Injuriousness.
XXXVI. SEXUAL INTERCOURSE DURING PREGNANCY 282
Complete Abstinence During Pregnancy--Bad Results of Complete
Abstinence--Intensity of Relations During First Four Months--
Intercourse During Fifth, Sixth and Seventh Months--
Intercourse During Eighth and Ninth Months--Abstinence
After Birth of Child.
XXXVII. SEXUAL INTERCOURSE FOR PROPAGATION ONLY 284
Belief in Sexual Intercourse for Propagation Only--What Such
Practice Would Lead to--Nature and the Sex-fanatics--Sexual
Desire in Woman After Menopause--Sex Instinct of Sterile Men
and Women--Sex Instinct Has Other High Purposes.
XXXVIII. VAGINISMUS 288
Vaginismus--Dyspareunia--Difference Between Vaginismus and
Dyspareunia--Adherent Clitoris a Cause of Masturbation and
Convulsions.
XXXIX. STERILITY 291
Definition of Sterility--Husband Should First be Examined--
One-child Sterility--The Fertile Woman--Salpingitis as a
Cause of Sterility--Leucorrhea and Sterility--Displacement
of Uterus and Sterility--Closure of Neck of Womb and
Sterility--Sterility and Constitutional Disease--Treatment
of Sterility.
XL. THE HYMEN 294
Difference Between Chastity and Virginity--Worship of Intact
Hymen--Sacrificing Hymen Sometimes Essential for Health of
the Girl--Certificate from Physician who has Ruptured Hymen.
XLI. IS THE ORGASM NECESSARY FOR IMPREGNATION? 297
Suppression of Orgasm by Woman to Prevent Impregnation--Bad
Results of Suppression by the Woman--Orgasm: Relation of to
Impregnation--A Hypothesis--A Fanciful Hypothesis--Why
Passionate Women Frequently Fail to Become Mothers--Advice
to Passionate Women who Desire to Conceive.
XLII. FRIGIDITY IN WOMEN 301
Meaning of Term Frigidity--Types of Frigidity--Large Percentage
of Frigid Women--Repression of Sexual Manifestations and
Frigidity--Frigidity and Masturbation--Frigidity and Sexual
Weakness of Husband--Frigidity and Dislike of Husband--Organic
Causes of Frigidity--A Frigid Woman May Become Passionate--
Treatment of Frigidity.
XLIII. ADVICE TO FRIGID WOMEN, PARTICULARLY WIVES 304
Advice to Frigid Women--Attitude of Different Men Towards
Frigid Wives--Orgasm a Subjective Feeling--A Justifiable
Innocent Deception--The Case of a Demi-Mondaine.
XLIV. RAPE 308
Definition of Rape--Age of Consent--Unanimous Opinion of
Experts--Exceptional Cases--False Accusation of Rape Due to
Perversion--Erotic Dreams Under Anesthesia Causing
Accusations Against Doctors and Dentists.
XLV. THE SINGLE STANDARD OF SEXUAL MORALITY 311
Chastity--Double Standard of Morality--Attempt to Abolish
Double Standard--Late Marriages and Chastity in Men--Harmful
Advice Given to Young Women--Chastity in Men Not Always Due
to Moral Principles--Chaste Men and Satisfactory Husbands--A
Statement by Professor Freud--A Statement by Professor
Michels--What a Girl has a Right to Demand of Her Future
Husband--Three Cases Showing Disastrous Effects of Wrong
Teachings.
XLVI. DIFFERENCE BETWEEN MAN'S AND WOMAN'S SEX AND LOVE LIFE 318
Seemingly Contradictory Statements--Faulty Interpretations of
Words Sexual Instinct and Love--Difference in Manifestations
of Male and Female Sexual Instincts--Man's Sex Instinct
Grosser Than Woman's--Awakening of Sexual Desire in the Boy
and in the Girl--Woman's Desire for Caresses--Man's Main
Desire for Sexual Relations--Normal Sex Relations as Means
of Holding a Man--A Physiological Reason Why Man is Held--Man
and Physical Love--Woman and Spiritual Love--Preliminaries of
Sexual Intercourse in Men and Women--Physical Attributes--
Mental and Spiritual Qualities--Difference Between Love and
"Being in Love"--Love as a Stimulus to Man--When the Man
Loves--When the Woman Loves--Man's More Engrossing
Interests--Lovemaking Irksome to Man--Man's Polygamous
Tendencies--Woman Single-affectioned in Her Sex and Love
Life--Man and Woman Biologically Different.
XLVII. MATERNAL IMPRESSIONS 327
Wide-spread Belief in Maternal Impressions--No Single
Well-authenticated Case of Maternal Impression--Birth of
Monstrosities--Ridiculous Examples Given by Physicians--
So-called Shock Often a Product of Mother's Imagination--
Four Cases of Alleged Maternal Impressions--Mother's
Health During Pregnancy May Have Effect Upon Child's
General Health.
XLVIII. ADVICE TO THE MARRIED AND THOSE ABOUT TO BE 336
Marriage as an Ideal Institution--Monogamic Marriage--Some
Reasons for Husbands' Deviations--Importance of First Few
Weeks of Married Life--Necessity for Understanding at
Beginning--Preventing and Breaking Habits--The Wife's
Individuality--Husbands Who are Childish, Not Vicious--
Wife's Interest in Husband's Affairs--The "Slob" Husband--
The Well-groomed Husband--Bad Odor from the Mouth--Odors
from Other Parts of the Body--Treatment for Bad Odor from
Perspiration--A Beneficial Powder--Advice Regarding
Flirting--Dainty Underwear--Fine External Clothes and Cheap
and Soiled Underwear--Delicate Adjustments of Sex Act
Required with Some Men--Wife Who Discusses Her Husband's
Foibles--A Professional Secret--A Case of Temporary
Impotence--The Wife's Indiscretion--The Disastrous Result--A
Big Stomach--The Wife's Attitude Towards the Marital
Relation--Behavior Preliminary to and During the Act--
Congenital Frigidity--Prudish and Vicious Ideas About the
Sex Act--Sexual Intercourse for Procreative Purposes
Only--Fear of Pregnancy on the Part of the Wife--The
Remedy--Other Causes--Wife who Makes too Frequent Demands--
Sacrificing the Future to the Present--Esthetic Considerations.
XLXIX. A RATIONAL DIVORCE SYSTEM 356
A Rational Divorce System--Storms and Squalls--Two Sides of the
Divorce Question--Outside Help and Marital Tangles--A
Husband who was a Paragon of Virtue--The Case of the Sweet
Wife--The Proper Untangling of Domestic Tangles.
L. WHAT IS LOVE? 361
Is Love Definable?--Raising a Corner of the Veil--Two Opinions
of Love--The First Opinion: Sexual Intercourse and Love--The
Second Opinion--The Grain of Truth in Each--The Truth
Concerning Love--Foundation of Love--Sexual Attraction and
Love--The Frigid Woman and Her Husband--Puzzling Cases of
Love--The Paradox--Blindness of Love and the Penetrating
Vision of Love--Limits of Homeliness--Physical Aversion and
Genesis of Love--Mating in the Animal Kingdom--Mating in Low
Races--Love in People of High Culture--Difference in Love of
Savage and Man of Culture--Distinctions Between
Loves--Varieties of Love and Varieties of Men--"Love"
Without Sexual Desire--Refraining and Wanting--Cause of
Love at First Sight--"Magnetic Forces" and Love at First
Sight--The Pathological Side--Differentiation of Phases of
Love--Infatuation--Difference Between "Infatuation" and
"Being in Love"--Sexual Satisfaction and Infatuation--Sexual
Satisfaction and Love--Infatuation Mistaken for Love--Love
the Most Mysterious of Human Emotions--Great Love and
Supreme Happiness.
LI. JEALOUSY AND HOW TO COMBAT IT 375
Jealousy the Most Painful of Human Emotions--Impairment of
Health--Mental Havoc--Jealousy as a Primitive Emotion--
Jealousy in the Advanced Thinker and in the Savage--Jealousy
in the Child--Feelings and Environmental Factors--Essential
Factors--Vanity--Anger--Pain--Envy--The Impotent Husband's
Jealousy--Anti-social Qualities--The Jealous and the
Unfaithful Husband--Means of Eradicating the Evil--Iwan
Bloch on the Question--Prof. Robert Michels' Statement--
Remark of Prof. Von Ehrenfels--Havelock Ellis on Variation
in Sexual Relationships--Advanced Ideas--Woman as Man's
Chattel--The Change and the Changer--Teaching the Children--
Casting Epithets at Jealousy--Free Unions and Jealousy--
Feelings, Actions and Public Opinion--The Adulterous Wife of
the Present Day--Jealousy Defeating Its Own Object--Jealousy
of Inanimate Objects.
LII. REMEDIES FOR JEALOUSY 395
Prevention and Cure--Prophylaxis of Jealousy--Fitting Remedy to
Circumstances--The Neglectful and Flirtatious Husband--No
Question of Love--Advice to the Wife of the Flirtatious
Man--An Efficient Though Vulgar Remedy--Jealousy Must Be
Experienced to Be Understood--Necessity for Freedom of
Association--Lines of Conduct for the Wife--Contempt for a
Certain Type of Wife and Husband--The Abandoned Lover--The
Effects of Unrequited Love--Sublimated Sexual Desire--
Replacing Unrequited Love--The Attitude of Goethe--
Simultaneous Loves Possible--Successive Loves Possible--
Eternal Loves--When Sex Relationships May Be Beneficial--
Purchasable Sex Relations and Their Value--The Broken
Engagement--The Terrible Effects on the Young Man--The
Young Streetwalker--Sex Relations with Fiancé--Inundating
Sense of Shame--Collapse--Attempts at Suicide--An Active Sex
Life--The Results--The Prevention of Jealousy.
LIII. CONCLUDING WORDS 409
WOMAN: HER SEX AND LOVE LIFE
CHAPTER ONE
THE PARAMOUNT NEED OF SEX KNOWLEDGE FOR GIRLS AND WOMEN
Why Sex Knowledge is of Paramount Importance to Girls and
Women--Reasons Why a Misstep in a Girl Has More Serious
Consequences than a Misstep in a Boy--The Place Love Occupies in
Woman's Life--Woman's Physical Disabilities.
All are agreed--I mean all who are capable of thinking and have given
the subject some thought--that for the welfare of the race and for his
own physical and mental welfare it is important that the boy be given
some sex instruction. All are not agreed as to the character of the
instruction, its extent, the age at which it should be begun and as to
who the teacher should be--the father, the family physician, the
school teacher or a specially prepared book--but as to the necessity
of sex knowledge for the boy there is now substantial agreement--among
the conservatives as well as among the radicals.
No such agreement exists concerning sex knowledge for the girl. Many
still are the men and women--and not among the conservatives only--who
are strongly opposed to girls receiving any instruction in sex
matters. Some say that such instruction--except a few hygienic rules
about menstruation--is unnecessary, because the sex instinct awakens
in girls comparatively late, and it is time enough for them to learn
about such matters after they are married. Others fear that sex
knowledge would destroy the mystery and romance of sex, and would rob
our maidens of their greatest charms--modesty and innocence. Still
others fear that sex instruction would tend to awaken the sex instinct
in our girls prematurely; would direct their thoughts to matters about
which they would not think otherwise; and they argue that the warnings
about venereal disease, prostitution, etc., which are an integral part
of sex instruction, tend to create a cynical, inimical attitude
towards the male sex, which may even result in hypochondriac ideas and
antagonism to marriage.
I do not deny that there is a grain of truth in all the above
objections. Sex instruction does cause _some_ girls to think of sex
matters earlier than they otherwise would, and some girls have been
made bitter and hypochondriac, and disgusted with the male sex. But it
would not be difficult to demonstrate that it was not sex instruction
_per se_ that was responsible for these deplorable results; it was the
_wrong_ kind of instruction that was to blame--it was the wrong
emphasis, the lurid exaggerations that caused the mischief, and not
the truth. In other words, it is not sex information, it is sex
misinformation, that is pernicious. And, of course, to this everybody
will agree: rather than false information, better no information at
all.
But if the information to be imparted be sane, honest and truthful,
without exaggerating the evils and without laying undue emphasis on
the dark shadows of our sex life, then the results can be only
beneficent. And the task I have put before myself in this book is to
give our girls and women sane, square and honest information about
their sex organs and sex nature, information absolutely free from
luridness, on the one hand, and maudlin sentimentality, on the other.
The female sex is in need of such information, much more so than is
the male sex. Yes, if boys, as is now universally agreed, are in need
of sex instruction, then girls are much more in need of it. Why? For
several important reasons.
The first reason why sex instruction is even more important for girls
than it is for boys is because a misstep in a girl has much more
disastrous consequences than it has in a boy. The disastrous results
of a misstep in a boy are only physical in character; the results of
the _same_ misstep in a girl may be physical, moral, social and
economic. To speak more plainly. If a boy, through ignorance, rashly
indulges in illicit sexual relations, the worst consequence to him may
be infection with a venereal disease. But he is not considered
immoral, he is not despised, he is not ostracized, he does not lose
his social standing in the slightest degree, and when he is cured of
his venereal disease he has no difficulty in getting married. He does
not even have to conceal his past sexual history from his wife. But if
a girl makes a misstep the consequences to her are terrible indeed; it
may not only cost her her health and social standing, she may have to
pay with her very life. She runs the risk of venereal infection the
same as the boy does, but in addition she runs the risk of becoming
pregnant, which in our present social system is a catastrophe indeed.
To save herself from the disgrace of an illegitimate child she may
have an abortion produced; the abortion may have no bad results, but
it may, if performed bunglingly, leave her an invalid for life, or it
may kill her outright. If she is so unfortunate as to be unable to get
anybody to produce an abortion, she gives birth to an illegitimate
child, which she is forced in most cases to put away in an institution
of some sort where she hopes and prays it may die soon--and, in
general, it does. If it does not die, she has for the rest of her life
a Damocles' sword hanging over her head, and she is in constant terror
lest her sin be found out. She does not permit herself to look for a
mate, but if she does get married, the specter of her antematrimonial
experience is constantly before her eyes. After years and years of
married life, the husband may divorce her if he finds out that she had
"sinned" before she knew him. And unless the husband is a broad-minded
man and loves her truly and unless she made a clean breast of
everything to him before marriage, her life is continuous torture. But
even if the girl escaped pregnancy, the mere finding out that she had
an illicit experience deprives her of social standing, or makes her a
social outcast and entirely destroys or greatly minimizes her chances
of ever marrying and establishing a home of her own. She must remain a
lonely wanderer to the end of her days.
The enormous difference in the results of a misstep in a boy and a
girl is clearly seen, and for this reason alone, if for no other, sex
instruction is of more importance to the girl than it is to the boy.
But there are other important reasons, and one of them is beautifully
and truthfully expressed by Byron in his two well-known lines.
Man's love is of man's life a thing apart,
'Tis woman's whole existence.
Yes, love is a woman's whole life.
Some modern women might object to this. They might say that this was
true of the woman of the past, who was excluded from all other avenues
of human activity. The woman of the present day has other interests
besides those of Love. But I claim that this is true of only a small
percentage of women; and in even this small minority of women, social,
scientific and artistic activities cannot take the place of love; no
matter how busy and successful these women may be, they will tell you
if you enjoy their confidence that they are unhappy, if their love
life is unsatisfactory. Nothing, nothing can fill the void made by the
lack of love. The various activities may help to cover up the void, to
protect it from strange eyes, they cannot fill it. For essentially
woman is made for love. Not exclusively, but essentially, and a woman
who has had no love in her life has been a failure. The few exceptions
that may be mentioned only emphasize the rule.
But not only psychically is a woman's love and sex life more important
than a man's, physically she is also much more cognizant of her sex
and much more hampered by the manifestation of her sex nature than
man is. To take but one function, menstruation. From the age 13 or 14
to the age of forty-five or fifty it is a monthly reminder to woman
that she is a woman, that she is a creature of sex; and, while to many
women this periodically recurring function is only a source of some
annoyance or discomfort, to a great number it is a cause of pain,
headache, suffering, or complete disability. Man has no such
phenomenon to annoy him practically his whole life.
But more important are the results of love-union, of sex relations. A
man after a sexual relation is just as free as he was before. A woman,
if the relation has resulted in a pregnancy, which is generally the
case, unless special pains are taken it should not so result, has nine
troublesome months before her, months of discomfort if not of actual
suffering; she then has an extremely trying and painful ordeal, that
of childbirth, and then there is another trying period, the period of
lactation or of nursing and of bringing up the baby. The penalty seems
almost too great.
And when the woman is on the point of ceasing to menstruate she does
not do so smoothly and comfortably. She has to go through a period
called the menopause, which may last one or two years and which may
bring discomforts and dangers of its own. Man does not have to go
through such a distinct period of demarcation separating his sexual
from his non-sexual life. Altogether it cannot be denied that woman is
much more a slave of her sex nature than man is of his. Yes, Nature
has handicapped woman much more heavily than she has man.
In short, both in view of the fact that sexual ignorance with its
possible missteps has much more disastrous consequences for the girl
than it has for the boy, and in view of the fact that the sex instinct
and its physical and psychic manifestations occupy a much more
important part in woman's life than they do in the life of man, we
consider the necessity of sex instruction much greater in the case of
woman than in the case of man. I do not wish to be misunderstood as
underestimating the need of sex instruction for the male--only I
consider the need even greater in the case of the female.
CHAPTER TWO
THE FEMALE SEX ORGANS: THEIR ANATOMY
The Internal Sex Organs--The Ovaries--The Fallopian Tubes--The
Uterus--The Divisions of the Uterus--Anteversion, Anteflexion,
Retroversion, Retroflexion, of the Uterus--Endometritis--The
Vagina--The Hymen--Imperforate Hymen--The External Genitals--The
Vulva, Labia Majora, Labia Minora, the Mons Veneris, the
Clitoris, the Urethra--The Breasts--The Pelvis--The Difference
Between the Male and Female Pelvis.
The organs which primarily distinguish one sex from the other are the
sex organs. It is by the aid of the sex organs that children are
begotten and brought into the world, that the race is _reproduced_ and
perpetuated. It is for this reason that the sex organs are also called
the Reproductive Organs.
The first thing we must do is to become familiar with the _structure_
and _location_ of the sex organs; in other words, we must get a fair
idea of their _Anatomy_.
The female sex organs, also called the reproductive or generative
organs, are divided into internal and external. The internal are the
most important and consist of: the ovaries, Fallopian tubes, uterus
or womb, and vagina. The external sex organs of the female are: the
vulva, hymen, and clitoris. Among the external organs are also
generally included the mons Veneris and the breasts or mammary glands.
SUBCHAPTER A
THE INTERNAL SEX ORGANS
[Illustration: OVARY.]
=The Ovaries.= The ovaries are the essential organs of reproduction.
For it is they that generate the eggs, or _ova_, or _ovules_, which,
after becoming _fertilized_ or _fecundated_ by the spermatozoa of the
male, develop into children. Without the ovaries of the female, the
same as without the testicles of the male (to which they correspond),
no children could be begotten, and the entire human race would quickly
disappear from our planet. The ovaries are two in number; they are
embedded in the _broad ligaments_ which support the womb in the
pelvis, one on each side of the womb. They are of a grayish or whitish
pink color, and are about an inch and a half long, three-quarters of
an inch wide, and one-third of an inch thick. They weigh from
one-eighth to one-quarter of an ounce. Their surface is either smooth
or rough and puckered. Think of a large blanched almond and you will
have a pretty fair idea of the size and shape of an ovary.
=The Fallopian Tubes.= The Fallopian tubes (so called from Fallopius,
a great anatomist, who discovered them; also called oviducts: egg
conductors, because they conduct the eggs from the ovary into the
uterus) are two very thin tubes, extending one from each upper angle
of the womb to the ovaries; but at their ovarian end they expand into
a fringed and trumpet-shaped extremity. The fringes are referred to as
_fimbria_. They are about five inches long and only about
one-sixteenth of an inch in diameter; the function of the tubes is to
catch the ova as they burst forth from the ovaries and to convey them
to the uterus. Taking into consideration the very narrow _lumen_, or
_caliber_, of the Fallopian tubes, it is easy to understand why even a
very slight inflammation is apt to clog them up, to seal their mouths
or openings, thus rendering the woman _sterile_, or incapable of
having children. For, if the Fallopian tubes are "clogged" up, the
eggs, or ova, have no way of reaching the uterus.
The Greek name for the Fallopian tube is salpinx (salpinx in Greek
means tube). An inflammation of the Fallopian tube is therefore called
salpingitis. (A salpingitis has the same effect in causing sterility
in the female as has an epididymitis in the male.) Salpingectomy is
the cutting away of the whole or of a piece of the Fallopian tube
(corresponds to vasectomy in the male).
=The Uterus.= The uterus or womb is the organ in which the fertilized
ovum, or egg, grows and develops into a child. It is a hollow muscular
organ, about the size of a pear, with thick walls, capable under the
influence of pregnancy of great expansion and growth. The broad part
of the pear is called the _body_ of the uterus; the lower narrow part
is called the _neck_ of the uterus, or _cervix_. The uterus in the
adult girl or woman is about three inches long, two inches broad in
its upper part and nearly an inch thick. It weighs from an ounce to an
ounce and a half. When the uterus is in a pregnant condition, it
increases enormously, both in size and in weight, as we will see in a
future chapter. The cavity of the uterus is somewhat triangular in
shape; at each upper angle is the small opening communicating with the
Fallopian tube; the upper portion of the uterus is called the fundus;
the external opening of the womb, situated in the center of the
cervix, is called the mouth of the womb, or the _os_, or external os.
[Illustration: 1. OPENINGS INTO THE FALLOPIAN TUBES. 2. MOUTH OF
THE WOMB.]
The uterus is situated in the center of the pelvis, between the
bladder and the rectum. It is supported by certain ligaments, the
chief of which are the broad ligaments; but, on account of general
weakness, too hard physical labor, or lifting heavy weights, the
ligaments may stretch, and the uterus may sink down low in the vagina,
and we then have the condition known as prolapse of the womb. Or, the
womb may turn forward, when we have a condition of _anteversion_. If
the womb is _bent_ (or _flexed_) forward on itself the condition is
called _anteflexion_. If the womb is turned backwards, the condition
is called _retroversion_; if it is bent or flexed backward upon itself
the condition is called _retroflexion_. An extreme degree of
anteversion or anteflexion, or retroversion or retroflexion, may
interfere with impregnation, as the spermatozoa may find it
difficult or impossible to reach the opening of the womb--the external
os.
[Illustration: (Female Reproductive Organs)]
The entire cavity of the uterus is lined by a mucous membrane;[1] this
mucous membrane is called the endometrium (endo--within;
metra--uterus). An inflammation of the endometrium is called
_endometritis_. It is the endometrium that is principally concerned in
menstruation--that is, it is from it that the monthly discharge of
blood comes.
=The Vagina= [vagina in Latin--a sheath]. The vagina is the tube or
canal which serves as a passage-way between the uterus and the outside
of the body. It extends from the external genitals or vulva to the
neck of the womb, embracing the latter for some distance. It is a
strong, fibromuscular canal, lined with mucous membrane. It is not
smooth inside, but arranged in folds, or _rugæ_, so that when
necessary, as during childbirth, it can stretch enormously and permit
the passage of a child's head. The length of the vaginal canal is
between three and five inches, but it is in general much more
capacious in women that have borne one or more children than in those
who have not borne any.
Near the vaginal entrance are situated two small glands; they are
about the size of a pea, and secrete mucus. They are called
Bartholin's glands; occasionally they become inflamed and give a good
deal of trouble.
[Illustration: ANTEVERSION OF THE UTERUS.]
[Illustration: ANTEFLEXION OF THE UTERUS.]
[Illustration: RETROVERSION OF THE UTERUS.]
[Illustration: RETROFLEXION OF THE UTERUS.]
=The Hymen= [hymen in Greek--a membrane]. The external opening of the
vagina, in virgins, that is, in girls or women who have not had sexual
intercourse, is almost entirely closed by a membrane called the hymen.
The vulgar name for hymen is "maidenhead." The hymen may be of various
shapes, and of different consistency. In some girls it is a very thin
membrane, which tears very readily; in others it is quite tough. On
the upper margin or in the center of the hymen there is an opening
which permits any secretion from the vagina and the blood from the
uterus to come through. In rare cases there is no opening in the
hymen, that is, the vagina is entirely closed. Such a hymen is called
_imperforate_ (not perforated). When the girl begins to menstruate,
the blood cannot come out and it accumulates in the vagina. In such
cases the hymen must be opened or slit by a doctor. In some cases the
hymen is congenitally absent; that is, the girl is born without any
hymen. While the hymen is usually ruptured during the first
intercourse, it, in some cases, being elastic and stretchable,
persists untorn after sexual intercourse. It will therefore be seen
that just as the presence of the hymen is no absolute proof of
virginity, so is the absence of the hymen no absolute proof that the
girl has had sexual relations, She might have been born without any
hymen, or it might have been ruptured by vaginal examination, by a
vaginal douche, by scratching to relieve itching, or by some accident.
The remains of the hymen after it is ruptured shrink and form little
elevations which can be easily felt; they are known as caruncles.
[In Latin, _carunculæ myrtiformes_, which means in English
myrtleberry-shaped caruncles; caruncle is a small fleshy elevation;
derived from _caro_, which in Latin means flesh.]
SUBCHAPTER B
THE EXTERNAL GENITALS
=The Vulva.= The external genitals of the female are called the
_vulva_. The vulva consists of the labia majora (meaning the larger
lips), which are on the outside and which in the grown-up girl are
covered with hair, and the labia minora (the smaller lips), which are
on the inside and which are usually only seen when the labia majora
are taken apart.
[Vulva in Latin means folding-door. The ancients Were fond of giving
fancy names to things.]
=The Mons Veneris.= The elevation above the vulva, which during
puberty becomes covered with hair, is called by the fanciful name,
_mons Veneris_, or Venus' mountain. It is usually well padded with
fatty tissue.
=The Clitoris.= The clitoris is a small body about an inch in length,
situated beneath the mons Veneris and partly or entirely covered by
the upper borders of the labia minora.
=The Urethra.= Between the clitoris above and the opening of the
vagina below is situated the opening of the _urethra_, or the urinary
meatus, through which the urine passes. Many women are so ignorant,
or, let us say innocent, that they think the urine passes out through
the vagina. This is not so. The vagina has nothing to do with the
process of urination.
Again enumerating the female sex organs, but in the reverse order,
from before backward, or from out inward, we have: The mons Veneris
and the labia majora, or the external lips of the vulva; these are the
plainly visible parts of the female genital organs. When the labia
majora are taken apart we see the labia minora; when the labia majora
and minora are taken apart we can see or feel the clitoris and the
hymen, or the remains of the hymen. We then have the vagina, a large,
stretchable musculo-membranous canal, in the upper portion of which
the neck of the womb, or the cervix, can be seen (when a speculum is
used), or felt by the finger. Only the cervix, or neck of the womb,
can be seen, but the rest of the womb, the broader portion, can be
easily felt and examined by one hand in the vagina and the other hand
over the abdomen. Continuous with the uterus are the Fallopian tubes,
and below the trumpet-shaped ends of the Fallopian tubes are the
ovaries, embedded in the broad ligaments, one on each side.
=The Breasts.= The breasts, also called mammary glands, or mammæ
[mamma in Latin, breast], may be considered as accessory organs of
reproduction. They are of no importance in the male, in whom they are
usually rudimentary, but they are of great importance in the female.
They manufacture milk, which is necessary for the proper nutrition of
the infant, and they add a great deal to the beauty and attractiveness
of the woman. They are thus a help to the woman in getting a mate or a
husband. The projecting elevation of the breast, which the child takes
in his mouth when nursing, is called the nipple; the darker colored
area surrounding the nipple is called the areola.
[Illustration: THE PELVIS OF THE MALE.]
[Illustration: THE PELVIS OF THE FEMALE.]
SUBCHAPTER C
THE PELVIS
The internal sex organs are situated in the lower part of the
abdominal cavity, the part that is called the _pelvis_, or pelvic
cavity. The meaning of the word pelvis in Latin is basin. The pelvis,
also referred to as the pelvic girdle or pelvic arch, forms a bony
basin, and is composed of three powerful bones: the sacrum, consisting
of five vertebræ fused together and constituting the solid part of the
spine, or vertebral column, in the back, and the two hipbones, one on
each side. The two hipbones meet in front, forming the _pubic arch_.
The hipbones are called in Latin the ossa innominata (nameless bones)
and each hipbone is composed of three bones: the ilium, the ischium,
and the os pubis. The thighs are attached to the hipbones, and to the
hipbones are also attached the large _gluteal_ muscles, which form the
buttocks, or the "seat."
The pelvis of the female differs considerably from the pelvis of the
male. The female pelvis is shallower and wider, less massive, the
margins of the bones are more widely separated, thus giving greater
prominence to the hips; the sacrum is shorter and less curved, and the
pubic arch is wider and more rounded. All this is necessary in order
to permit the child's head to pass through. If the female pelvis were
exactly like the male pelvis, a full-term living child could never
pass through it. The two illustrations show the differences between
the male and female pelvis very clearly.
Note particularly the differences in the pubic arches: in the male
pelvis it is really more of an angle than an arch. Also note how much
longer and more solid the sacrum (with its attached bone, called the
coccyx[2]) is in the male pelvis. The differences in the pelves (the
plural of pelvis is pelves) of the male and female become fully marked
at puberty, but they are present as early as the fourth month of
intra-uterine life.
FOOTNOTES:
[1] Mucous membrane--briefly a membrane which secretes mucus or some
other fluid.
[2] The coccyx consists of three rudimentary vertebræ; it is the
vestige of an organ which we once possessed in common with many other
animals, namely--a tail.
CHAPTER THREE
THE PHYSIOLOGY OF THE FEMALE SEX ORGANS
Function of the Ovaries--Internal Secretion of the
Ovaries--Function of the Internal Secretion--Number of Ova in the
Ovaries--The Graafian Follicles--Ovulation--Corpora
Lutea--Function of the Fallopian Tubes--Function of the
Vagina--Functions of the Vulva, Clitoris and Mons
Veneris--Function of the Breasts--Besides Secreting Milk Breast
Has Sexual Function--The Orgasm--Pollutions in Women--Secondary
Sex Characters--Differences Between Woman and Man.
The importance of an organ depends upon its _function_, upon what it
does, and not so much upon what it is. It is important to know the
size, structure and location of an organ, but it is still more
important to know its function; in other words, for our purpose it is
more important to know the _physiology_ than the anatomy of the sex
organs.
SUBCHAPTER A
FUNCTION OF THE OVARIES
Like the testicles in man, so the ovaries in woman are the essential
sexual organs. They are the fundamental organs, without which the
other sexual organs are useless. Also like the testicles in man, the
ovaries have two distinct functions, manufacturing two distinct
substances. One function is to manufacture eggs; this, called the
oögenetic or egg-producing function, is its _racial_ function; without
it the race could not perpetuate itself. But the ovary has also an
_individual_ function. Besides the ova, the ovary manufactures what we
call an _internal_ secretion which is absorbed by the blood, and which
is of the greatest importance to the woman herself. While the
manufacture of ova begins only at puberty, with menstruation, and
closes at the menopause, the manufacture of the internal secretion
lasts throughout the woman's entire life. This secretion, which
consists of various chemical substances, has a tremendous influence
not only on the development of the woman's body, but also on her
feelings.
First of all it is necessary for the development of the woman's
special characteristics, or _secondary sexual characters_. Without
that internal secretion of the ovaries, a woman would look more or
less like a man; she would not develop her beautiful rounded form, her
pretty long hair, her breasts, her broad pelvis, her feminine voice,
etc. _Second_, the secretion is necessary to the proper development of
her other sexual organs; if the ovaries are cut out, then the uterus
and the vagina and even the vulva shrivel up. _Third_, it is that
internal secretion that excites in woman sexual desire and makes her
enjoy relations with the male sex. If the ovaries are cut away,
particularly if it is done early in life, the woman has no sexual
desire and no enjoyment. _Fourth_, it contributes to the general
health, wellbeing, energy, and mental alertness of the woman.
You see the importance of the internal ovarian secretion, and you will
readily understand why, when the ovaries are removed by operation, the
woman, particularly if she is young, undergoes such marked changes. It
is because we recognize now the great importance of the ovaries that
we always, when operating on diseased ovaries leave at least a small
piece of ovary, if at all possible.
=Number of Ova.= When the female infant is born, her ovaries contain
as many ova or eggs as they ever will contain. In fact, they contain
more than they will at puberty. For it is estimated that at birth each
ovary contains about 100,000 ova; the majority of these, however,
disappear so that at the age of puberty each ovary contains only about
30,000 ova. As only one ovum ripens each month from the time of
puberty to the time of the menopause (i.e., about 300 to 400 ova at
the utmost during a lifetime), and as only a dozen or two ova would
be necessary for the propagation of the race, it seems a
superabundance of ova, an unnecessary lavishness. But nature _is_
lavish where the propagation of the species is concerned. A portion of
an ovary or of both ovaries might become diseased, and thousands of
ova might become unfit for fertilization; nature therefore puts in an
extra reserve supply. We see a still more striking example of this
extreme extravagant lavishness in man; only one spermatozoön is
necessary to impregnate the ovum, and only one spermatozoön can
penetrate the ovum; nevertheless each normal ejaculation of semen
contains between a quarter and half a million spermatozoa.
=The Graafian Follicles.= Each primitive or primordial ovum[3] is
imbedded in a little vesicle or follicle, which is generally known as
_Graafian follicle_, and there are as many Graafian follicles as there
are ova. (The Graafian follicles were first described about 250 years
ago--in 1672--by a Delft physician named De Graaf, hence the name.)
Until puberty, that is the commencement of menstruation, the Graafian
follicles with the oöcytes or primitive ova are in a more or less
dormant condition. But with the onset of puberty there commences a
period of intense activity in the ovaries. This period of activity is
repeated regularly once a month, and it constitutes the process of
_ovulation_ and _menstruation_. The two processes are closely though
not causally connected. Ovulation consists in the monthly maturation
and extrusion of a ripe ovum; menstruation, which will be further
discussed in a separate chapter, consists in the monthly discharge of
blood, mixed with mucus from the inside lining of the uterus. Every
twenty-eight days, from the time of puberty to the time of the
menopause, a Graafian follicle bursts and an ovum is extruded from the
ovary. Before the follicle bursts, it swells and enlarges and reaches
the surface of the ovary; the whole follicle is congested with blood,
but at one point near the surface of the ovary it is pale and thin,
and here the rupture takes place.
[Illustration: SECTION OF OVARY.
1. Graafian follicle in the earliest stage. 2, 3, 4. Follicles in
more advanced stages. 5, 7. Almost mature follicle. 6. Follicle
from which the ovum has escaped. 8. Corpus luteum.]
=Corpora Lutea.= After the Graafian follicle has burst and the ovum
has been pushed out, the cavity that is left does not remain empty and
functionless; there is a further process going on there; there is a
growth of cells, of a yellowish color, and the follicle becomes filled
with a yellowish body, which on account of its color is called the
_corpus luteum_ (plural--corpora lutea; luteum in Latin--yellow,
corpus--body). This corpus luteum grows in size until it sometimes
occupies as much as one-third of the ovary. But there is considerable
difference between the corpora lutea of non-pregnant and pregnant
women. Up to the end of about a month the corpora lutea are the same,
but after that the corpus luteum of the non-pregnant woman begins to
get smaller, to shrink, so that at the end of two or three months it
is reduced to a small scar and later cannot be noticed at all. The
corpus luteum of the pregnant woman keeps on increasing until the end
of the second month, remains about the same size until the end of the
sixth month, and only then begins gradually to diminish. The corpus
luteum of the non-pregnant woman, that is, the one following
menstruation, is called false corpus luteum; the corpus luteum
following pregnancy is called a true corpus luteum. The corpus luteum
acts like a gland and elaborates a secretion which has an influence on
the circulation in the uterus and on menstruation. It probably
possesses other properties, with which we are not yet quite familiar.
The corpora lutea of various animals are now prepared in powder or
tablet form and used in medicine in the treatment of certain diseases
of women.
SUBCHAPTER B
FUNCTION OF THE OTHER GENITAL ORGANS
=Function of the Fallopian Tubes.= The function of the Fallopian tubes
or oviducts as they are sometimes called is to catch the ovum as it
bursts through the ovary and to conduct it from the ovary into the
uterus. It is while the ovum is in the narrow lumen of the tube that
the spermatozoön which has travelled up from the uterus usually finds
it, and it is in the tube, near its entrance to the womb, that
impregnation usually takes place. After the ovum is impregnated or
fecundated, it slowly moves down to the uterus, where it attaches
itself and remains and grows for nine months, until it is ready to
come out and start an independent life.
The uterus or womb is the house of the embryo almost from the moment
of conception to the moment of birth. Within the thick warm sheltered
walls of the uterus the child grows, develops, eats and breathes,
until all its organs and functions have reached such a stage of
perfection that it can live by itself and for itself. And this may be
said to be the sole function of the uterus, or at least its sole
useful function. For the other function of the uterus, menstruation,
cannot be said to be a necessary or a useful function. It is a normal
function because it occurs regularly in every healthy woman during her
child-bearing period, but not every normal function is a necessary or
useful function. Not everything that is is right or useful.
=Function of the Vagina.= The vagina is the canal in which sexual
intercourse takes place. It receives the male organ (penis) during the
sexual act, and serves as a temporary repository for the male semen.
After the spermatozoa have reached the uterus, the vagina has no
further function to perform.
=Functions of the Vulva, Clitoris=, and =Mons Veneris.= The vulva and
the clitoris have no special functions to perform; but in them, in the
clitoris particularly, but also in the labia minora, resides the
feeling of voluptuousness, the pleasurable sensation experienced
during the sexual act. Another seat of voluptuousness in the woman is
located in the cervix of the uterus.
The mons Veneris has no special physiological function to perform, but
it as well as the vulva serve as strong points of attraction for the
male sex. While the entire female body is attractive to the male, and
vice versa, there are certain zones which are especially attractive or
exciting. Such zones or areas are called _erogenous zones_--the word
erogenous means love-generating. The vulva and the mons Veneris are
the strongest erogenous zones; other erogenous zones are the lips, the
breasts, etc.
=Function of the Breasts.= The function of the breasts is to nurse or
suckle the young on the mother's milk until they are able to live on
other food. The other name for breasts is mammary gland (in Latin,
mamma--breast), and all animals who suckle their young are called
mammals or mammalia. Besides its milk secreting function, the breasts
constitute a strong erogenous zone; they are a point of strong
attraction for the male sex, many men being more attracted by
well-developed breasts than by a pretty face. There is a good
biological reason for this. Well developed breasts indicate that the
other sexual organs are well developed and that the woman will make a
satisfactory wife and satisfactory mother. Considering then the
importance of the breasts in attracting a husband and their function
in nursing the young, also their erogenous properties, it is perfectly
proper to class them among the reproductive organs.
SUBCHAPTER C
THE ORGASM
The culmination of the act of sexual intercourse is called the orgasm.
It is the moment at which the pleasurable sensation is at its highest
point, the body experiences a thrill, there is a spasmodic contraction
in the genital organs, and there is a secretion of fluid from the
genital glands and mucous membranes. This fluid in women is not a
vital fluid like the semen in man; it is merely mucus, and in some
women it is very slight in amount or altogether absent. Adult women
who live without sexual relations occasionally have sexual or erotic
dreams; that is, they dream that they are in the company of men,
playing or having relations with them. Such dreams are usually
accompanied by an orgasm or an orgastic feeling, and by a discharge of
mucus, the same as in sexual intercourse. Such a discharge of mucus
during sleep is called an emission or pollution.
In the male sex pollutions play an important rôle (see the author's
"Sex Knowledge for men"), because the semen is a vital fluid, and if
it is lost too frequently the system is put under a heavy drain. In
boys and men the pollutions or night losses may occur several times a
week or even every night, or several times a night. When they occur
with such frequency the man may become a wreck. Not so with women.
First, pollutions or night dreams in women are much more rare than
they are in men; and second, as just mentioned, the fluid secreted by
woman during intercourse or during an erotic dream is not of a vital
character, as the semen is in man; it is mucus, and the secretion of a
mucous fluid, even if somewhat excessive, does not constitute a drain
on the system. For this reason women can stand frequently repeated sex
relations and emissions or pollutions much better than men can.
SUBCHAPTER D
THE SECONDARY SEX CHARACTERS
The sex organs constitute the primary sex characters. It is they that
distinguish primarily one sex from another. But there are numerous
other sex characters or sex differences which while not so important
serve to differentiate the sexes, at the same time forming points of
attraction between one sex and another. For instance, the beard and
mustache are a distinct male characteristic and constitute one of the
secondary male sex characters. The secondary sex characters are very
numerous; one might say that each one of the billions of cells in the
body bears the impress of the sex to which it belongs.
First, the skeleton. The entire female skeleton differs from the male
skeleton; all the bones are smaller and more gracile; the pelvis, as
we have seen before, is shallower and wider. Then the muscles are
smaller and more rounded. The entire contour of the body is rounded
rather than angular as in man. The skin is finer, softer, more
delicate. The hair on the head is longer and of a finer texture, while
over the body the hair is also finer and less abundant. The voice is
finer, more pleasant, and of a higher pitch (soprano). The breasts are
well developed, and serve an important purpose, while in men they are
rudimentary. The breathing is also different; woman breathes
principally with the upper part of the chest, man with the lower. The
brain is smaller and its convolutions somewhat less complex in woman.
Woman differs considerably from man not only physically, as we have
seen, but also mentally and emotionally. But into this phase of the
subject we will not enter, except to remark that it is foolish to
speak of the superiority or inferiority of one sex to another. In some
respects man is greatly superior to woman, in others he is inferior;
on the whole the sexes balance one another pretty well, and while the
sexes are not and never will be exactly alike, we have no right to
speak of the inferiority of one sex to another. We recognize that the
sexes are different, but they complement one another, and the claim of
the reactionary and of the woman-hater that woman is an inferior
creature is just as senseless as is the claim made by some
ultra-militant feminists that woman is the superior and man the
inferior.
FOOTNOTES:
[3] The ovum is really the fully mature egg ready for fecundation;
before maturity it should not be called ovum but oöcyte; and in
advanced treatises it is so referred to. But here ovum will do for
both the unripe and ripe egg.
CHAPTER FOUR
THE SEX INSTINCT
Universality of the Sex Instinct--Not Responsible for Our Thoughts
and Feelings.
THE sex instinct, which runs all through nature from the lowest animal
to the highest, is the inborn impulse, craving or desire which one sex
has for the other: the male for the female and the female for the
male. This instinct, this desire for the opposite sex, which is born
with us and which manifests itself at a very early age, is not
anything to be ashamed of. There is nothing disgraceful, nothing
sinful in it. It is a normal, natural, healthy instinct, implanted in
us by nature for various reasons, and absolutely indispensable for the
perpetuation of the race. If there were anything to be ashamed of, it
would be the lack of this sex instinct, for without it the race would
quickly die out.
=Not Responsible for Thoughts and Feelings.= It is necessary to
impress this point, because many girls and women, whose minds have
been perverted by a vicious so-called morality, worry themselves to
illness, brood and become hypochondriac because they think they have
committed a grievous sin in experiencing a desire for sexual relations
or for the embrace of a certain man. Altogether it is necessary to
impress upon the growing girl, when the occasion presents itself, that
a thought or a feeling can never be sinful. An action may be, but a
thought or a feeling cannot. Why? Because we are not responsible for
our thoughts and feelings; they are not under our control. Though it
does not mean that when they do arise we are to give them full sway.
We should attempt to combat them and drive them away, but there is
nothing to be ashamed of, because for their origin we are not
responsible.
=Responsible for Actions.= Our actions are under our control, to a
certain extent at least, and if we do a bad or injurious act, we have
committed a sin and are morally responsible. The _desire_ for the
sexual act is no more sinful than the desire for food is when one is
hungry. But the performance of the act may, under certain
circumstances, be as sinful as the eating of food which the hungry man
obtained by robbing another fellow-being, just as poor as himself.
I am not preaching to you. But I am not an extremist nor a hypocrite.
I am advocating neither asceticism nor licentiousness. One is as bad,
or almost as bad, as the other.
What I am trying to do is to inculcate in your minds, if possible, a
sane, well-balanced view of all things sexual.
For I believe that wrong, perverted views of the physiology and
hygiene of the sex act and of sex morality, that is, the proper
relationship of the sexes, are responsible for untold misery, for
incalculable suffering. Both sexes suffer, but the female sex suffers
more. The woman always pays more. This is due to her natural
disabilities (menstruation, pregnancy, lactation), to her age-long
repression, to the fact that she must be sought but never seek, and to
her economic dependence.
For the above reasons, sex instruction is a matter of double
importance to woman--this fact has been emphasized in the first
chapter. But woman's disabilities impose upon us another duty:
_because_ she carries the heaviest burden, _because_ she always pays
more dearly than the man, it becomes incumbent upon man to treat her
with special consideration, with genuine kindness and chivalry.
CHAPTER FIVE
PUBERTY
Physical Changes in Puberty--Physical Changes in the Genital
Organs and in the Rest of the Body--Psychic Changes--Puberty and
Adolescence--Nubility.
Puberty is the most wonderful, the most significant period in a girl's
life. Important as it is in a boy's life and development, it is still
more so in a girl's. At this period there are often laid the
foundations which either make or mar the girl's future life.
The meaning of the word puberty is maturity. It is the period at which
the girl and the boy reach sexual maturity; in other words, the period
at which the sex glands of the boy begin to generate spermatozoa, and
the sex glands of the girl begin to mature and expel eggs or ova; with
the girl puberty is marked by an additional phenomenon, which has no
analogue in the boy, namely, menstruation.
=Physical Changes.= The word puberty is derived from the word _puber_,
which in Latin means mature, ripe. But the word puber is itself
derived from the word _pubes_, which in Latin means fine hair or
down. For at this period of maturity all mammals (that is animals
which have breasts and nurse their young) begin to develop a growth of
hair. You know that our entire body, with the exception of the palms
of the hands and the soles of the feet, is covered with innumerable
hair follicles, and from our birth our entire body, with the exception
named, is covered with fine hair. The hair may be too delicate to be
seen, but it is there, and with a magnifying glass you can see it
without any trouble. But at puberty the hair increases in thickness
and in quantity, and becomes abundant in places where it was hardly
noticeable before--the upper lip and face in boys, and the armpits and
lower part of the abdomen in both boys and girls.
And so the first apparent physical sign of puberty in a girl is the
gradual appearance of hair in the armpits, on the mons Veneris and the
labia majora. But all the genital organs are undergoing rapid
development; the vulva, the vagina, the uterus and the ovaries become
larger, and the ovaries which up to that time were elaborating an
internal secretion only, now also begin to manufacture ova; in other
words, the monthly process of ovulation is begun. Synchronously with
the process of ovulation, there commences the monthly function of
menstruation. The breasts also increase in size, assume the
characteristic contour, develop their glandular substance, and become
capable of secreting milk for the use of any possible offspring.
During this period of development they are often very sensitive to the
touch or feel painful without being touched.
But not only the genital organs undergo growth and development--the
entire body participates in the process. The growth in height is the
most rapid at this period; the greatest growth takes place in the
limbs--legs and arms. The pelvis becomes broader, and the chest or
thorax also becomes broader and larger. The muscles become larger and
rounder and finally give the girl the beautiful womanly form.
=Psychic Changes.= But the changes are not only physical; the changes
that take place in the girl's psychic sphere during the pubertal years
are also highly important. That is the period of the development of
the emotions; she is overflowing with emotion; she becomes sensitive;
in her relations with boys and men she becomes self-conscious.
Distinct sexual desire fortunately does not make its appearance in the
girl at this period, as it does in the boy, but she becomes filled
with vague undefined and undefinable longings. It is the period of
"crushes" when the girl is apt to bestow her overflowing emotion on a
girl friend. There is nothing reprehensible in these crushes--they
act as a safety valve--and only in rare cases are they apt to lead to
abnormal development. This is also the period of day-dreaming and of
romancing; the girl likes to read love-stories and novels in which she
identifies herself with the heroine. And it makes quite some
difference as to what the girl reads during this period, for
literature has a strong influence on the young in the most plastic
period of their lives; and it is important that older persons see to
it that those in their care spend their time on books of noble ideals
and high artistic value.
Girls of a highly sensitive or so-called "nervous" temperament,
especially if there is "nervousness" in the family, must be
particularly looked after. For it is during the years of puberty and
adolescence that any neurotic traits are apt to develop and become
emphasized. It is also the period when bad sexual habits
(masturbation) are apt to develop, and the careful mother will devote
special attention to her girls in their years of puberty, and guard
them as much as possible against physical and emotional shocks.
The age of puberty in girls is by many writers considered as
synonymous or synchronous with the onset of menstruation, which in
this country in the majority of cases occurs between the ages of
thirteen and fourteen. The year of gradual development before the
onset of menstruation is by some referred to as the pre-pubertal year;
and the first year after the onset of menstruation is the
post-pubertal year. The period from puberty to full sexual maturity is
called adolescence, and this term is applied generally to the period
between thirteen and eighteen. For at eighteen the boy and the girl
have reached full maturity. Mentally we acquire things as long as we
live, and even physically the body gets larger for some years after
eighteen. But sexually both boys and girls are fully mature at
eighteen, though in order to become parents it is best, for various
reasons, to wait to the ages of twenty or twenty-five.
=Nubility.= Nubility is the age or state when a boy or a girl is "fit"
for marriage. This is a vague and unsatisfactory term. At the age of
thirteen to fifteen boys and girls are physically "fit" for marriage,
that is at that age a boy is capable of begetting and a girl of having
children. But it does not mean that it would be advisable for them to
marry at such an early age. Neither their bodies nor their minds are
fully developed, and children begotten of such young parents are apt
to be weaklings, both mentally and physically. The youngest age for
girls to marry should be eighteen, and for boys twenty; but the
youngest age for becoming parents should be twenty to twenty-two for
the mother and twenty-three to twenty-five for the father.
CHAPTER SIX
MENSTRUATION
Definition of Menstruation--Where Menstrual Blood Comes From--Age
of Menstruation--Age of Cessation of
Menstruation--Duration--Amount--Regularity and Irregularity.
The first function with which the girl will be confronted, which will
impress upon her that she is a creature of sex, that she is decidedly
different from the boy, is _menstruation_. And this function we will
now proceed to study.
What is menstruation? Menstruation is a monthly discharge of blood.
The word is derived from the Latin word mensis, which means a month;
and menstruation is also frequently spoken of as _the menses_. It is
also called the catamenia or catamenia-flow (Greek, kata--by, men--a
month). Other terms are: the periods, courses, monthlies, turns,
monthly changes, monthly sickness, sickness, flowers, to be unwell, to
be regular. "Not to see anything" is a common term for having missed
the menses. This flow of blood recurs in most cases with remarkable
regularity once a month; not a calendar month, but once a lunar month,
i.e., once every twenty-eight days. And as there are thirteen lunar
months a year, a woman menstruates not twelve but thirteen times a
year.
Where does the menstrual blood come from? The menstrual blood comes
from the inside of the womb. Every month, for a few days prior to
menstruation, the inside lining of the womb (what we call the mucous
membrane or endometrium) becomes congested and its bloodvessels become
distended with blood. If the woman has sexual intercourse and
pregnancy happens to take place, then this extra blood is used to
nourish and develop the new child; but if no pregnancy takes place,
that extra blood exudes from the bloodvessels (some of the
bloodvessels rupture) and is discharged from the uterus into the
vagina, and from there to the outside, where it is caught on cotton,
sanitary napkins or some other pad.
=At what age does menstruation begin?= The usual age at which
menstruation begins in this country is thirteen or fourteen; in some
it may occur as early as twelve, in others as late as fifteen, sixteen
or even seventeen. For menstruation to begin earlier than twelve or
later than seventeen is in this country a rare exception. But in cold
northern climates the age of eighteen is not rare, and in the hot
southern climates menstruation often starts at the ages of ten or
eleven. Change of climate or of country will often have an influence
on the menses. In the early years of his medical practice, the author
had many Finnish girls as patients. It was a very common occurrence
for them to stop menstruating for the first few months or even for the
first year of their residence in this country.
=At what age does menstruation cease?= The age at which menstruation
ceases is called the _menopause_ or _climacteric_. It usually takes
place at the age of forty-eight or fifty. In some cases it does not
take place until the age of fifty-two, in others it takes place as
early as forty-five or forty-four. In general, it may be said that the
woman's menstruating period, during which she is able to have
children, lasts about thirty-five years. And if no restraint be taken,
and if no precautions be taken against conception, a woman could have
twenty or thirty children during her childbearing period.
=How many days does a woman menstruate?= The usual number of days is
from three to five; in some cases menstruation lasts only two days, in
others as long as seven. As a rule, the greatest amount of blood
passed is during the first two days.
=The amount of blood.= It is hard to estimate the exact amount of
blood passed by a woman during her menses, but it reaches about an
ounce and a half to three ounces. In some women the amount may reach
as much as four or five ounces and in exceptional cases as much as
eight ounces. Where it exceeds this amount, it is an abnormal
condition, requiring treatment. The usual statement that a normally
menstruating woman should not have to use more than three napkins
during the twenty-four hours is correct.
_The periodical regularity_ with which menstruation recurs in many
women is remarkable. I know a woman who has not missed her menses in
twenty years; during those twenty years the menses have started every
fourth Friday, almost always at the same hour. I know another one who
has her menses every fourth Wednesday, about seven in the morning. She
skipped her periods during her two pregnancies, then they were
irregular for a while, then they came back to Wednesday. Other women
have their menses on a certain day of the month, say the first or the
fifth, regardless of the number of days in the month (such cases are,
however, exceptional). And in some women the menses are irregular:
every three weeks, every five or six weeks, every six or seven weeks,
etc. Some women never know when they may expect their menses, so
irregular they are.
CHAPTER SEVEN
ABNORMALITIES OF MENSTRUATION
Disorders of Menstruation--Menorrhagia--Metrorrhagia--Amenorrhea--
Vicarious Menstruation--Dysmenorrhea of Organic and of Nervous
Origin.
In many girls and women menstruation is a perfectly normal,
physiological process. They suffer no discomfort whatever from it.
They suffer no pains, no headache, no irritability, they have no
admonition of its onset, until they feel the blood oozing or trickling
out. But, unfortunately, this is true only of a small percentage. The
majority of women have some unpleasant symptoms. Some have a headache
for a day or two, some complain of a dragging down sensation, some are
irritable, feel depressed or quarrelsome; some have no appetite, no
ambition, no desire for work or company, while some girls have such
severe pains and cramps that they are obliged to go to bed for a day
or two and call in medical aid.
When the menstruation is very profuse, resembling more a hemorrhage
than normal menstruation, it is called _menorrhagia_; if the
hemorrhage from the uterus occurs out of the regular menstrual
periods, it is called _metrorrhagia_. When the menses are skipped, or
when they are so scanty that you can hardly notice any blood, we use
the term _amenorrhea_. In a few rare cases the menstruation instead of
coming normally from the uterus, comes from some other part of the
body, for instance, the nose. Some women have a hemorrhage from the
nose every month. In some a bloody discharge may come from the
breasts. To such a substitute menstruation we apply the term
_vicarious menstruation_. Such cases, however, are rare, and are mere
curiosities.
=Dysmenorrhea.= I mentioned before that in some girls and women the
menses are accompanied by pains and cramps. This affliction, which is
the lot of millions of women, and from which men are entirely free, is
called _dysmenorrhea_. Dysmenorrhea means painful and difficult
menstruation. A slight pain or at least a feeling of discomfort is
present in most cases of menstruation. But in many cases the pain is
so severe, so _excruciating_, that the sufferer, girl or woman, is
incapacitated for any work, and must go to bed for a day or two. In
some cases the pain is so severe as to necessitate the use of
morphine, and as it is a very bad thing to have to give morphine every
three or four weeks, every endeavor should be made to find out the
cause of the trouble and to remove it. It is a mistake, however, to
think that all or even most cases of dysmenorrhea are due to some
local trouble, that is, to an inflammation of the ovaries, or a
displacement of the womb. Many cases of dysmenorrhea are of _nervous_
origin; the cause resides in the central nervous system, and not in
the genital organs themselves. It is, therefore, not advisable to
undertake any local treatment, unless a competent physician has made a
thorough examination and has decided that local treatment is
advisable.
As to the percentage of dysmenorrhea, a recent statistical examination
of 4,000 women showed that dysmenorrhea of some degree was present in
over one-half, namely, 52 per cent.
CHAPTER EIGHT
THE HYGIENE OF MENSTRUATION
Lack of Cleanliness During Menstrual Period--Superstitious
Beliefs--Hygiene of Menstruation.
The hygiene of menstruation can be expressed in two words: cleanliness
and rest. Common sense would suggest these two measures, and as far as
rest is concerned, many women do rest or take it easy while they are
unwell. Some are forced to do it, because, if they don't, their
dysmenorrhea is worse and the amount of blood they lose is
considerably increased. The same cannot be said of cleanliness. Due
undoubtedly to the superstitious opinions about menstruation, which
came over to us from the ages-of-long-ago, menstruation is still
considered a _noli-me-tangere_, and women are afraid to bathe, to
douche or even to wash during the periods. And if there is any period
when a woman needs a douche it is during menstruation. Any leucorrhea
that a woman may be suffering from becomes aggravated around the
periods; the menstrual blood of some women has a decided odor, and if
no cleansing douche is taken during four or five days, some of the
blood decomposes and acquires a decidedly offensive odor, which can be
noticed at some distance and to which some men and women are very
susceptible. There are some women who never take a vaginal douche.
Some consider it a useless and unnecessary luxury; while some orthodox
puritanical women consider it an ungodly procedure (forgetting that
cleanliness is next to godliness) fit only for women of gay and
questionable character. If these orthodox women knew what was good for
them--and for their health--they would take a douche at least during
menstruation, if at no other time.
=Cleanliness.= When the girl reaches the age of twelve or thirteen the
mother should explain to her the phenomenon of menstruation and the
likelihood of its making its appearance in a short time. Of course she
should be told that there is nothing shameful in it, that when it
makes its appearance she should at once tell her mother, who will
instruct her what to do. She should be shown the use of sanitary
napkins. Rags, unless recently washed and kept wrapped up and
protected from dust, should not be used. Unclean rags may lead to
infection. I have no doubt that many cases of leucorrhea date back
their origin to unwashed rags. Every morning and every evening the
girl should wash the external genitals with warm water, or plain soap
and water. Married women should also take a douche once a day--the
douche may consist of two quarts of water in which has been dissolved
a teaspoonful of common table salt, or a tablespoonful of borax or
boric acid. Such things like alum, potassium permanganate, carbolic
acid, lactic acid, or tincture of iodine should only be used when
there is leucorrhea present and generally only under a physician's
directions. Bathing is permissible, but it is safe to use only a
lukewarm bath. Cold tub baths, cold shower baths, as well as ocean and
river bathing are best avoided during the period; at least during the
first two days. I do not give this as an absolute rule; I know women
who bathe and swim in the ocean during their menstrual periods without
any injury to themselves, but they are exceptionally robust women;
advice in books is for the average person, and it is always best to be
on the safe side.
=Rest.= Rest is just as important during menstruation as cleanliness,
if not more so. Some women as mentioned before feel during their
menses just as well as they do at other times, and do not need any
special hygiene. But these are in the minority. Most girls and women
do feel somewhat below par during that period, and it is very
important that they take it easy, particularly during the first two
days. It is an outrage that many delicate, weak girls and women must
stay on their feet all day or work on a machine when they should be at
home in bed or lying down on a couch.
The womb is congested during the period, is larger and heavier than
normal, and it is then that there is often laid the foundation for
some future uterine disease, the well-known "womb trouble," or "female
disease." It is not necessary that work be given up altogether, but
there certainly should be less of it and there should be as much rest
as possible. For delicate and sensitive girls it is always best to
stay away from school during the first and second days. Speaking again
of the average and not the exception, it is best that dancing, bicycle
riding, horseback riding, rowing, and other athletic exercises be
given up altogether during the menses. Automobile riding and railroad
and carriage travelling prove injurious in some instances, greatly
increasing the flow of blood. But these are the exceptions at the
other extreme.
CHAPTER NINE
FECUNDATION OR FERTILIZATION
Fecundation or Fertilization--Process of Fecundation--When the
Ovum Matures--Fate of Ovum When no Intercourse Has Taken
Place--Entrance of Spermatozoa as Result of Intercourse--The
Spermatozoa in Search of the Ovum--Rapidity of Movements of
Spermatozoa--Absorption of Spermatozoön by Ovum--Activity of
Impregnated Ovum in Finding Place to Develop--Pregnancy in the
Fallopian Tube and Its Dangers--Twin Pregnancy--Passivity of Ovum
and Activity of Spermatozoön Foretell the Contrasting Rôles of
the Man and the Woman Throughout Life.
Fecundation and fertilization are important terms to remember. They
stand for the most important phenomenon in the living world. Without
it there would be no plants and no animals, excepting a few very low
forms of no importance, and of course no human beings.
=Fecundation= or fertilization is the process of union of the female
germ cell with the male germ cell; speaking of animals, it is the
process of union of the egg or ovum of the female with the
spermatozoön of the male. When a successful union of these two cells
takes place a new being is started. The process of fertilization or
fecundation is also known as impregnation and conception. We say, to
fertilize (chiefly, however, when speaking of plants) or to fecundate
an ovum, or to impregnate a female or woman, and to conceive a child.
We say the woman has become impregnated or has conceived.
_The Process._ The process of fecundation is briefly as follows. An
ovum becomes mature, breaks through its Graafian follicle in the ovary
and is set free. It is caught by the fimbriated or trumpet-shaped
extremity of the Fallopian tube and, moved by the wave-like motion of
the cilia[4] of the lining of the tube, it begins its travel towards
the uterus. If no sexual intercourse has taken place nothing happens.
The ovum dries up, or "dies," and either remains somewhere in the tube
or womb or is removed from the latter with the menstruation, or mucous
discharge. But if intercourse has taken place, thousands and thousands
of the male germ cells or spermatozoa enter the uterus through its
opening or external os, and begin to travel upward in search of the
ovum. The spermatozoa are capable of independent motion, and they
travel pretty fast. It is claimed that they can travel an inch in
seven minutes, which is pretty fast when you take into consideration
that a spermatozoön is only 1/300 of an inch long. Many of the
spermatozoa, weaker than the others, perish on the way, and only a few
continue the journey up through the uterus to the tube. When near the
little ovum, which remains passive, their movements become more and
more rapid, they seem to be attracted to it as if by a magnet, and
finally one spermatozoön--just one--the one that happens to be the
strongest or the nearest, makes a mad rush at it with its head,
perforates it, and is completely swallowed up by it. As soon as the
spermatozoön has been absorbed by the ovum, the opening through which
it got in becomes tightly sealed up--a coagulation takes place near
it--so that no other spermatozoa can enter the ovum. For if two or
more spermatozoa got into the same ovum a monstrosity would be apt to
be the result.
[Illustration: SPERMATOZOÖN PENETRATING THE OVUM.]
What becomes of all the other spermatozoa? They perish. Only one is
needed. But in the ovum that has been impregnated, and which is now
called an embryo, a feverish activity commences. First of all it looks
for a fixed place of abode. If the ovum happened to be in the uterus
when the spermatozoön met and entered it, it remains there. It becomes
attached to some spot in the lining of the womb and there it grows and
develops, until at the end of nine months it has reached its full
growth, and the womb opens and it comes out into the outside world. If
the ovum is in the Fallopian tube when the spermatozoön meets it, as
is usually the case, it travels down to the uterus, and fixes itself
there.
=Extra-Uterine Pregnancy.= The tube is a bad place for the ovum to
grow and develop, because the tube cannot stretch to such an extent as
the uterus can, nor can it furnish the embryo such good nourishment as
the uterus can. Occasionally, however, it happens that the impregnated
ovum remains in the tube and develops there; we then have a case of
what we call _extra-uterine_ (outside-of-the-uterus) or _tubal_
pregnancy. Extra-uterine pregnancy is also called _ectopic_ pregnancy,
or ectopic gestation. Unless diagnosed early and operated upon, the
woman may be in great danger, for after a few weeks or months the tube
generally ruptures.
From the moment the spermatozoön has entered the ovum, a process of
_division_ or _segmentation_ commences. The ovum, which consists of
one cell, divides into two, the two into four, the four into eight,
the eight into sixteen, these into thirty-two, these into sixty-four,
128, 256, 512, 1,024, until they can no longer be counted. This
mulberry mass of cells arranges itself into two layers, with a cavity
in between. And from these layers of cells there develop gradually all
organs and tissues, until a fully formed and perfect child is the
result. If two ova are impregnated at the same time by two
spermatozoa, the result is twins.[5]
I might mention here that the moment the ovum is impregnated, i.e.,
joined by a spermatozoön, it is called technically a zygote; it is
also called embryo, and this name is applied to it until the age of
five or six weeks. Some use the term embryo up to two or three months.
After that, until it is born, it is called fetus.
A study of the development of the embryo and the formation of the
various organs from one single cell, the ovum, vitalized or fecundated
by another single cell, the spermatozoön, is the most wonderful and
most fascinating of all studies. But that belongs to the domain of
Embryology, which is a separate science.
What we see in the process of fecundation is a foreshadowing of the
future man and woman. The ovum has no motion of its own, it is moved
along by the wave-like motions of the lining cells of the Fallopian
tube, and throughout the entire act it remains passive. The
spermatozoön, on the other hand, is in a state of continuous activity
from the moment it has been ejaculated by the male until it has
reached its goal--the ovum. And as the spermatozoa carry in them the
entire impress of the man, and the ova of the woman, they foretell us
the fates of the future boy and girl. The woman's rôle throughout life
is a passive and the man's an active one. And in choosing a mate the
man will always be the active factor or pursuer. So biology seems to
tell us. Whether education--using the word in its broadest sense--will
effect a radical change in the relation of man and woman remains to be
seen. A change putting the man and the woman on a footing of
_equality_ would be desirable; but whether biological differences
having their roots in the remotest antiquity can be obliterated, is a
question the answer of which lies in the distant future. As Geddes and
Thomson so well said: The differences [between the sexes] may be
exaggerated or lessened, but to obliterate them it would be necessary
to have all the evolution over again on a new basis. What was decided
among the prehistoric Protozoa cannot be annulled by act of
Parliament.
FOOTNOTES:
[4] Hair-like appendages.
[5] Each ovum has one germinal vesicle; occasionally one ovum may
contain two germinal vesicles; and from the impregnation of such an
ovum a twin pregnancy may result.
CHAPTER TEN
PREGNANCY
Period of Pregnancy in Human Female--Physiologic Process of
Pregnancy--Growth of Embryo from Moment of Conception--Pregnant
Woman Provides Nourishment for Two--Her Excreting Organs Must
Work for Two.
From the moment the ovum has been fertilized or fecundated by the
spermatozoön, the woman is said to be pregnant (or in French
_enceinte_. This term was used very frequently and is still used by
prudes, who seem to consider the word pregnant vulgar and
disgraceful). Pregnancy, or the period of gestation, lasts from the
moment of conception to the moment that the fetus or child is expelled
from the uterus. The period of pregnancy differs very widely in
different animals,[6] but in the human female it lasts nine calendar
months or ten lunar months--from about 274 to 280 days. We usually
count 280 days from the _first_ day of the _last_ menstruation. A
pregnant woman generally wants to know the day of the expected
confinement--for this purpose a table is appended to this chapter. If
you know the first day of your last menstruation, you will see at a
glance when the confinement may be expected. There may be a difference
of a few days--either before or after the expected date--but for
practical approximate purposes the tables serve very well.
A simple way is to count back three months and add seven days. For
instance, a woman's last menstruation occurred on April 4th; counting
back three months gives you January 4th; add seven days and you get
January 11th, the probable date of delivery. The first day of the last
menstruation was December 30th; counting back three months gives you
September 30th; add seven days and you get October 6th, the probable
date of delivery. The presence of a short month like February may be
disregarded, as the calculation is not absolutely, but only
approximately correct.
The period at which the child's movements begin to be felt by the
mother is termed Quickening. It usually occurs at the middle of the
pregnancy, between the 16th and 18th week.
Pregnancy is a normal physiological process; but every active
physiological process is apt to be accompanied by disturbances, and
there is certainly no process in the animal body in which greater
activity, greater changes, go on than during the process of pregnancy.
Just see what occurs in nine months. The uterus, at first the size of
a small pear, reaches a size larger than that of the head of a big
man; it does not merely stretch, as some think, but it actually grows
enormously in size, the muscular walls of a pregnant uterus being many
times thicker than those of a non-pregnant one. They have to be or
they would not have the strength to expel the child, when the proper
time comes. It is to be borne in mind that the child does not slip out
by itself; it is the powerful muscular contractions of the uterus that
push it out. If the uterus should refuse to work, if its walls were
too thin or too weak, the child could not come out, but would have to
be taken out with forceps. Still greater changes than in the uterus
take place in the child itself. At the moment of conception it is the
size of _the head of a pin_; at the moment of birth it weighs from
seven to ten pounds; at the moment of conception it is a minute,
undifferentiated mass of protoplasm, just a single fertilized cell; at
the moment of birth it consists of millions and millions of cells,
which have become differentiated into numerous harmoniously working
organs, and different tissues, such as brain and nerve tissue,
muscular tissue, connective tissue, bone, cartilage, etc., etc. A
truly wonderful process. And in the meantime this child, which is
biologically a parasite (though it is not a nice name to call it by)
draws its sustenance from the mother's blood, and the mother has to
provide nourishment for two. And, besides providing nourishment, her
excreting organs, her kidneys, must work for two, because her system
has also to get rid of the child's excretions. No wonder that the
pregnant woman, particularly under an artificial unhealthy mode of
living, is subject to many troubles and disturbances.
DR. ELY'S TABLE FOR CALCULATING THE DATE OF CONFINEMENT
---------+-----------------------------------------------
January | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OCTOBER | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 |NOV.
----------------------------------------------+-----
---------+-----------------------------------------------
February | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NOVEMBER | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 |
24 25 26 27 28 29 30 1 2 3 4 5 |DEC.
----------------------------------------------+-----
---------+-----------------------------------------------
March | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
DECEMBER | 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 |JAN.
----------------------------------------------+-----
---------+-----------------------------------------------
April | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
JANUARY | 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
22 23 24 25 26 27 28 29 30 31 1 2 3 4 |FEB.
----------------------------------------------+-----
---------+-----------------------------------------------
May | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
FEBRUARY | 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 |MAR.
----------------------------------------------+-----
---------+-----------------------------------------------
June | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
MARCH | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
24 25 26 27 28 29 30 31 1 2 3 4 5 6 |APRIL
----------------------------------------------+-----
---------+-----------------------------------------------
July | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
APRIL | 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 |MAY
----------------------------------------------+-----
---------+-----------------------------------------------
August | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
MAY | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 |JUN.
----------------------------------------------+-----
---------+-----------------------------------------------
September| 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
JUNE | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
24 25 26 27 28 29 30 1 2 3 4 5 6 7 |JULY
----------------------------------------------+-----
---------+-----------------------------------------------
October | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
JULY | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 |AUG.
----------------------------------------------+-----
---------+-----------------------------------------------
November | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
AUGUST | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
24 25 26 27 28 29 30 31 1 2 3 4 5 6 |SEPT.
----------------------------------------------+-----
---------+-----------------------------------------------
December | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
SEPTEMBER| 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
---------+-----------------------------------------------
----------------------------------------------+-----
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 |OCT.
----------------------------------------------+-----
EXPLANATION.--Find in top line the date of menstruation, the figure
below will indicate the date when confinement may be expected, _i.e._,
if date of menstruation is June 1st, confinement may be expected on
March 8th, or one day earlier if leap year.
FOOTNOTES:
[6] For instance, in rabbits one month, in dogs two months, in sheep
five months, in cows nine months, in horses eleven months.
CHAPTER ELEVEN
THE DISORDERS OF PREGNANCY
Smooth Course of Pregnancy in Some Women--Pregnancy and
Parturition May be Made Normal Processes Through Education in
True Hygiene--Morning Sickness and Its Treatment--Necessity for
Medical Advice in Pernicious Vomiting--Anorexia--Bulimia--Aversion
Towards Certain Foods--Peculiar Cravings--Tendency to Constipation
Aggravated by Pregnancy--Dietary Measures in Constipation--Rectal
Injections in Constipation--Laxatives--Cause of Frequent Desire to
Urinate During First Two or Three and Last Months of Pregnancy--
Treatment of Frequent Urination--Cause of Piles During Pregnancy
and Their Treatment--Cause of Itching of External Genitals During
Pregnancy and Treatment--Cause of Varicose Veins and Treatment--
Liver Spots.
We saw that in some women menstruation runs a perfectly smooth course,
free from any disagreeable symptoms. The same is true of pregnancy. It
is remarkable how smooth and easy the entire course is with some
women. Many women know that they are pregnant only because of the
non-appearance of the monthly periods; and even in the later months
they feel no discomfort, attending to all their work and pleasures as
usual; and even childbirth is a trifling matter with them.
Unfortunately the number of such women is not very large, and,
because of our confined, unnatural, often exhausting way of living,
is becoming smaller and smaller. There is no question that the
civilized, refined woman has a harder ordeal in pregnancy and
childbirth than has her primitive sister. We confidently hope that
this will not be so in the future; we expect the time to come when
true hygiene will be an integral part of the education and the life of
every girl, and then pregnancy and parturition may become even easier
processes than they are in the primitive races. But the time is not
yet; and in the meantime our young women have a good deal to go
through.
=Morning Sickness.= One of the commonest disorders of pregnancy is the
so-called morning sickness. This consists in a feeling of nausea and
vomiting, which comes on soon after getting up. The morning sickness
makes its first appearance in the third, fourth or fifth week of
pregnancy and lasts usually until the end of the third or fourth
month. In some women, however, the morning sickness comes on in a few
days after impregnation has taken place, and those women diagnose
their condition unmistakably by the feeling of slight nausea which
they experience on getting up. Medicines are as a rule of little use
in treating morning sickness. The "disease" can be relieved but not
cured. The patient should stay in bed later than usual, should have
her breakfast in bed, and then not get up for about half an hour
afterward. If the patient is anemic, a good iron preparation may prove
useful.
=Pernicious Vomiting.= The vomiting of pregnancy sometimes becomes so
severe and uncontrollable that it has been given the name pernicious.
The patient is unable to retain any kind of food, not even liquids,
vomits almost incessantly, and may become very much run down and
exhausted. The vomited matter may contain blood. For this condition a
competent physician must be consulted, for in some cases the patient's
life may be in danger and an abortion has to be performed.
=Capricious Appetite.= A capricious appetite is very common in
pregnancy. The capriciousness may express itself in four different
directions: (1) The patient may lose her appetite, almost altogether,
partaking only of very little food, and that with effort. This
condition of loss of appetite is called anorexia. (2) The patient may
develop an enormous appetite--what we call bulimia--eating several
times as much as she does ordinarily. (3) She may develop an aversion
towards certain articles of food. Thus many women develop an aversion
towards meat, the mere sight of or talk about meat causing in them a
sensation of nausea. (4) She may show a craving for the most peculiar
articles of food and for articles which are not food at all. The
craving for sour pickles or sour cabbage is well-known; but some women
will eat chalk, sand, and even more peculiar things (for the chalk
there may be a reason: the system needs an extra amount of lime and
chalk is carbonate of lime).
=Constipation.= Constipation is very common among women in the
non-pregnant condition; but in the pregnant it is much more common and
much more aggravated. Constipation must be guarded against, but the
measures must be of a mild nature. If we can relieve the constipation
by dietary measures alone, so much the better. The dietary measures
should consist in eating plenty of fruit--prunes, apples, figs, dates,
etc., and coarse bread and bran. Constipating articles, such as cheese
or coffee, should be eliminated. Where dietary measures alone are
insufficient, the patient should take an enema--a rectal
injection--twice or three times a week. The enema should consist of
about 8 ounces (half a pint) of cold or lukewarm water containing a
pinch of salt, and should be retained about ten minutes. Instead of
water, we may advise an occasional enema of two to four drams of
glycerin. Or instead of a glycerin enema, a glycerin suppository may
be used. If internal laxatives are to be used, only the mildest and
non-griping preparations should be employed The best are: a good
mineral oil--one or two tablespoonfuls on going to bed, or fluid
extract of cascara sagrada, one-half to one teaspoonful on going to
bed. It is very important, whatever we use, _not_ to use the same
thing for a long time. If the same drug or measure is used without any
change, the bowels get used to it and cease to respond and we have to
use larger and larger doses. In fighting constipation we must
therefore constantly change our weapons: one night we use mineral oil,
the next night cascara sagrada, the third night an enema, the fourth
night a glycerin injection or suppository, the fifth night perhaps
nothing at all, the sixth night a blue mass pill, the seventh morning
a Seidlitz powder, then a rest for a day or two, then a repetition of
the same measures. But always remember: first try to get along without
any drugs at all. Many cases can get relieved of their constipation by
a proper change in diet alone. And where this is impossible, then use
mild laxatives and use them interchangeably.
=Toothache= is not uncommon in pregnancy, and a pregnant woman should
have her teeth put in first-class condition.
=Difficulty in Urination.= Pregnant women often suffer with frequency
and urgency of urination. Some have to urinate, while they are on
their feet, every few minutes. This is due to the fact that during
the first two or three months of pregnancy the uterus is not only
enlarged but is also _anteverted_, that is _turned forward_ and
_presses down_ upon the bladder. When the woman is lying down the
pressure on the bladder is relieved, and she does not have to urinate
frequently. This pressure lasts only the first two or three months,
because after that the growing womb lifts itself out of the pelvis,
rising into the abdominal cavity; it is no longer anteverted and the
pressure on the bladder is relieved. During the last months of the
pregnancy there is again frequent urination, because then the heavy
uterus sinks again into the pelvic cavity and presses upon the
bladder. The treatment for this frequent urination consists in wearing
a well fitting abdominal belt or corset, which raises the uterus and
prevents pressure on the bladder. Sometimes a pessary which prevents
the anteversion is efficient. In all cases lying down and resting is
useful. In short, keeping off one's feet is the most efficient remedy
for the treatment of frequent urination in pregnant women.
=Hemorrhoids= (Piles). On account of the pressure of the womb on the
rectum, and also on account of the constipation which is so frequent
during pregnancy, hemorrhoids or piles are quite frequent among
pregnant women. The treatment of hemorrhoids consists in removing the
cause: wearing a well-fitting abdominal belt, and relieving the
constipation. Injecting into the rectum about half a pint of cold
water three times a day is very useful. For the intolerable itching
sometimes present in hemorrhoids the following ointment will be found
very grateful: menthol, 5 grains; calomel, 10 grains; bismuth
subnitrate, 30 grains; resorcin, 10 grains; oil of cade, 15 grains;
cold cream, one ounce. The piles (the hemorrhoids) are to be well
cleansed with hot water, and this ointment is to be well smeared over;
a little is pushed into the rectum, and a piece of cotton is put over
the anus. This protects the clothes from soiling and keeps the
medicine in place for a longer time. Instead of ointment a cocoa
butter suppository may be used. A suppository of the following
composition is good: powdered nutgalls, 3 grains; oil of cade, 3
drops; resorcin, 1 grain; bismuth subnitrate, 5 grains; cocoa butter,
20 grains. One such suppository to be inserted three times a day. The
ointment and the suppository given above, if used in conjunction with
the proper regulation of the bowels, will not only relieve but will
cure most cases of hemorrhoids caused by pregnancy.
=Itching of the Vulva. Pruritus Vulvæ.= Itching of the external
genitals during pregnancy is not uncommon. This may be due to the
fact that the vulva is generally congested and swollen during
pregnancy or it may be caused by an increased leucorrheal discharge.
The itching is sometimes very severe, and if the patient scratches
with her nails and produces bleeding, she may cause an infection of
the parts. The patient should be cautioned against scratching; she
should try simple measures to relieve the itching. A small towel or
gauze compress wrung out of boiling water and applied to the vulva
several times a day, followed by a free application of stearate of
zinc powder is often efficient. If it is not, the following salve may
be tried: carbolic acid, 10 grains; menthol, 5 grains; resorcin, 15
grains; zinc oxide, 1 dram; and white vaseline, one ounce. In very
severe cases the vulva should be painted with a solution of silver
nitrate, 25 grains to 1 ounce of distilled water.
=Varicose Veins.= In most women during pregnancy the veins in the legs
become somewhat enlarged. This is due to the pressure of the womb,
which interferes with the circulation. If the veins become very
prominent, swollen and tortuous, they are called varicose. This
condition should be prevented, because it often and to some degree
always persists permanently even after the pregnancy is over. The best
precautionary measure is for the woman to wear a well-fitting
abdominal belt or maternity corset, which supports the womb and does
not permit it to sink too low into the pelvis. If varicose veins have
been permitted to develop, the woman should wear well-fitting rubber
stockings, or at least have the legs bandaged with woven elastic
bandages. The bandage must be applied by a competent person, uniformly
and not too tightly. Constipation has also a bad effect in making
varicose veins worse; the bowels should therefore also be looked
after. In some severe cases all measures are of little value unless
the patient at the same time stays in bed or on a couch for a few
days, with the legs elevated.
Swelling of the feet should be at once attended to. It may be a
trifling matter due only to pressure of the womb; then again it may be
due to some kidney trouble. The physician will determine the true
cause and prescribe the appropriate treatment.
=Liver Spots. Chloasma.= In some cases irregular brownish patches or
splotches develop on the skin around the breasts, on the sides, or on
the face. These patches are known popularly as liver spots or in
medical language as _chloasma_. Nothing can be done for them, but they
generally disappear after the pregnancy is over. A few patches here
and there may remain permanently.
CHAPTER TWELVE
WHEN TO ENGAGE A PHYSICIAN
Necessity for the Pregnant Woman Immediately Placing Herself Under
Care of Physician and Remaining Under His Care During Entire
Period.
The disorders and disturbances described above are, with the exception
of pernicious vomiting, of a minor nature. They are annoying, may
cause considerable discomfort and suffering, but they do not endanger
the life of the woman or of the child. Occasionally, however,
fortunately not very often, the kidneys become affected, and for this
condition treatment by a physician is absolutely necessary. In fact,
the correct and safe thing for a woman to do is to consult a physician
as soon as she knows she is pregnant, and have him take care of her
during the entire pregnancy. Some women engage a physician during the
eighth or ninth month and this is decidedly wrong, because it may then
be too late to correct certain troubles which if taken at the outset
could have been easily cured; while many troubles in the hands of a
competent physician can be prevented altogether. I must therefore
reiterate: every woman should engage a physician from the beginning
of her pregnancy, or at least during the third or fourth and certainly
not later than the fifth month. He will examine the urine every month
and make sure that the kidneys are in order, he will make sure that
the child is in a normal position, and will prevent a host of other
ills.
[Illustration: POSITION OF THE CHILD IN THE WOMB.]
This is not a special treatise on the management of pregnancy, and
therefore minute details are out of place. Besides, to the details the
physician will attend. But some hints regarding diet and general
hygiene will prove useful.
If everything is satisfactory, if there is no severe vomiting, kidney
trouble, etc., the usual mixed diet may continue. The only changes I
would make are the following: Drink plenty of hot water during entire
course of pregnancy: a glass or two in the morning, two or three
glasses in the afternoon, the same at night. From six to twelve
glasses may be consumed. Also plenty of milk, buttermilk and fermented
milk. Plenty of fruit and vegetables. Meat only once a day. For the
tendency to constipation, whole wheat bread, rye bread, bread baked of
bran or bran with cream.
As to exercise, either extreme must be avoided. Some women think that
as soon as they become pregnant, they must not move a muscle; they are
to be put in a glass case, and kept there to the day of delivery.
Other women, on the other hand, of the ultramodern type, indulge in
strenuous exercise and go out on long fatiguing walks up to the last
day. Either extreme is injurious. The right way is moderate exercise,
and short, non-fatiguing walks.
Bathing may be kept up to the day of delivery. But warm baths,
particularly during the last two or three months, are preferable to
cold baths.
CHAPTER THIRTEEN
THE SIZE OF THE FETUS
Approximately Correct Measurements and Weight of Fetus at End of
Each Month of Pregnancy.
Men and women are always interested to know how large the fetus is and
how far it is developed during the various months of pregnancy.
Absolutely exact measurements cannot be given, but the following
approximate measurements are correct:
[Illustration: 1. EMBRYO BETWEEN ONE AND TWO WEEKS OLD.
2. EMBRYO ABOUT FOUR WEEKS OLD.
3. EMBRYO ABOUT SIX WEEKS OLD.
(Illustrations are double the actual size.)]
At the end of the first month (lunar) it is about the size of a
hazelnut. Weighs about 15 grains.
At the end of the second month it is the size of a small hen's egg.
The internal organs are partially formed, it begins to assume a human
shape, but the sex cannot yet be differentiated. Up to the fifth or
sixth week it does not differ much in appearance from the embryos of
other animals.
At the end of the third month it is the size of a large goose egg; it
is about two to three and a half inches long. Weighs about one ounce.
At the end of the fourth month the fetus is between six and seven
inches long and weighs about five ounces.
At the end of the fifth month the fetus is between seven and eleven
inches long, and weighs eight to ten ounces.
At the end of the sixth month it is eleven to thirteen inches long and
weighs one and one-half to two pounds. If born, is capable of living a
few minutes, and it is reported that some six months' children have
been incubated.
At the end of the seventh month the fetus is from thirteen to fifteen
or sixteen inches long and weighs about three pounds. Is capable of
independent life, but must be brought up with great care, usually in
an incubator.
At the end of the eighth month the length is from fifteen to
seventeen inches, and weight from three to five pounds.
At the end of the ninth month the length of the fetus is from sixteen
to seventeen and one-half inches, and weight from five to seven
pounds.
At the end of the tenth lunar month (at birth) the length of the child
is from seventeen to nineteen inches and the weight from six to twelve
pounds; the average is seven and a quarter, but there are full term
children weighing less than six pounds and more than twelve; but these
are exceptions.
CHAPTER FOURTEEN
THE AFTERBIRTH (PLACENTA) AND CORD
How the Afterbirth Develops--Bag of Waters--Umbilical Cord--The
Navel--Fetus Nourished by Absorption--Fetus Breathes by Aid of
Placenta--No Nervous Connection Between Mother and Child.
Whatever part of the womb the ovum attaches itself to is stimulated to
intense activity, to growth. Numerous bloodvessels begin to grow and
that part of the lining membrane with its numerous bloodvessels
constitute the placenta, or as it is commonly called _afterbirth_,
because it comes out _after_ the _birth_ of the child. From the
placenta there is also reflected a membrane over the ovum, so as to
give it additional protection. That membrane forms a complete bag over
the fetus; this bag becomes filled with liquid, so that the fetus
floats freely in a bag of waters; this bag bursts only during
childbirth. The fetus is not attached close to the placenta, but is,
so to say, suspended from it by a _cord_, which is called the
_umbilical cord_. When the child is born, the umbilical cord is cut,
and the scar or depression in the abdomen where the umbilical cord
was attached constitutes the navel or umbilicus (in slang
language--button or belly button). The umbilical cord consists of two
arteries and one vein embedded in a gelatin like substance and
enveloped by a membrane, and it is through the umbilical cord that the
blood from the placenta is brought to and carried from the fetus. The
blood of the fetus and the blood of the mother do not mix; the
bloodvessels are separated by thin walls, and it is through these thin
walls that the fetal blood receives the ingredients it needs from the
mother's blood. In other words, it receives its nourishment from the
mother by _absorption_ or _osmosis_. The blood from the placenta also
furnishes the fetal blood with oxygen, so that the fetus breathes by
the aid of the placenta, and not through its own lungs.
It is well to remember that there is absolutely no nervous connection
between mother and child. There are no nerves whatever in the
umbilical cord, so that the nervous systems of the fetus and of the
mother are entirely distinct and separate. And this will explain why
certain nervous impressions and shocks received by the mother are not
readily transmitted to the child. It is only through changes in the
mother's blood that the fetus can be influenced. As will be seen in a
later chapter we are skeptical about "maternal impressions."
CHAPTER FIFTEEN
LACTATION OR NURSING
No Perfect Substitute for Mother's Milk--When Nursing is Injurious
to Mother and Child--Modified Milk--Artificial Foods--Care
Essential in Selecting Wet Nurse--Suckling Child Benefits
Mother--Reciprocal Affection Strengthened by Nursing--Sexual
Feelings While Nursing--Alcoholics are Injurious--Attention to
Condition of Nipples During Pregnancy Essential--Treatment of
Sunken Nipples--Treatment of Tender Nipples--Treatment of Cracked
Nipples--How to Stop the Secretion of Milk When Necessary--
Menstruation While Nursing--Pregnancy in the Nursing Woman.
Every mother should nurse her child--if she can. There is no perfect
substitute for mother's milk. There is only one excuse for a mother
not nursing--that is when she has no milk, or when the quality of the
milk is so poor that the child does not thrive on it, or when the
mother is run down, is threatened with or is suffering with
tuberculosis, etc. In such cases the nursing would prove injurious to
both mother and child.
When the mother cannot nurse the child, it should be brought up
artificially on modified cow's milk. Formulas for modified milk have
been worked out for every month of the child's life, and if the
formulas are carefully followed, and the bottle and nipples are
properly sterilized, the child should have no trouble, but should
thrive and grow like on good mother's milk. If the child is sickly or
delicate and does not thrive on modified cow's milk or on the other
artificial foods, such as Horlick's malted milk, or Nestlé's food,
then a wet nurse may become necessary. But before engaging a wet nurse
great care should be taken to make sure that she is healthy, that the
age of her child is approximately the same as the age of the child
which she is about to nurse, and particularly that she is free from
any syphilitic taint. One, two or more Wassermann tests should be made
to settle the question definitely.
Mothers should bear in mind that suckling the child is good not only
for the child, but for the mother as well. Lactation helps the
_involution_ of the uterus: the uterus of a nursing mother returns
more quickly and more perfectly to its normal ante-pregnant condition
than the uterus of the mother who cannot or will not nurse her child.
It is asserted that the reciprocal affection between mother and child
is greater in cases in which the child suckled its mother's breast.
This is quite likely. It is also asserted that the nursing mother
transmits certain traits to its child, which the non-nursing mother
cannot. This is merely a hypothesis without any scientific proof.
On the other hand, the statement that many women experience decidedly
pleasurable sexual feelings while nursing seems to be well
substantiated.
That the mother who nurses her child should partake of sufficient
nourishment goes without saying. But the advice often given to nursing
mothers to partake of beer, ale or wine is a bad one. It is a question
if a mother partaking of considerable quantities of alcoholic
beverages may not transmit the taste for alcohol to her children. No,
alcoholics should be left alone, but milk, eggs, meat, fruit and
vegetables should be partaken of in abundance.
=Preparing the Nipples.= For the infant to be able to nurse properly
the nipples of the breast must be in good condition. If the nipples
are sunken, depressed, it is torture for the child to nurse. It uses
up a lot of energy uselessly, becomes exhausted, and gets very little
milk; while if the nipples be tender or cracked the process of nursing
is a torture for the mother.
It is therefore necessary to attend to the nipples in due time--to
begin at the fifth or sixth month is not too early. If the nipples are
sufficiently prominent, little need be done for them except to wash
them with a little boric acid solution (one teaspoonful of boric acid
to a glass of water) occasionally, and now and then to rub in a little
petrolatum, plain or borated. But if the nipples are sunken so that
they are below the surface of the breast, or if they are only slightly
above the surface of the breast, they must be treated. Gentle traction
must be made on them with the fingers three or four times a day. There
are only a few cases where persistent manipulation will not develop
the nipple and make it stand out prominently.
If the nipple is tender it should be washed two or three times a day
with a mixture of alcohol and water; one part of alcohol to three
parts of water is sufficient. In washing the nipple with this diluted
alcohol it should be dried and a little petrolatum or vaseline rubbed
in. This done two or three times a day during the last month or two of
the pregnancy will generally produce a good healthy nipple.
=The Treatment of Cracked Nipples.= If the care of the nipple has been
neglected, and it develops cracks or fissures so that the nursing of
the child causes the mother severe pain, the nursing should be done
through a nipple shield, and in the meantime between the nursings the
nipple should be rubbed with the following preparation, which is
excellent and which I can fully recommend: thymol iodide, ½ dram;
olive oil, ½ ounce. This should be applied every hour to the nipple
and covered with a little cotton; before each nursing, however, it
must be well washed off with warm water or warm boric acid solution.
When the nipples are cracked, the infant's lips should also before
nursing be carefully wiped out with boric acid solution. For the
baby's mouth contains bacteria which while harmless in themselves may
if they get into the cracks of the nipple set up an inflammation of
the breast or "mastitis" and cause an abscess. If the cracks are
excruciatingly painful, as they sometimes are, it is necessary to give
the one breast a rest for twenty-four hours and have the child nurse
at the other until the cracks have partially healed.
=When It Is Necessary to Dry Up the Breasts.= In case of the death of
the child, or if the mother for some other reason finds herself unable
to nurse, such as in cases where there is absolutely no nipple,
instead of the prominence of the nipple there being a deep depression,
it becomes necessary to stop the secretion of the milk, or as it is
said in common parlance, "to dry up the breasts." In former days, not
so very long ago, and the practice is still common enough to call
attention to it and to condemn it, the breasts used to be tightly
bandaged, or they used to be pumped every few hours. The first causes
unnecessary pain and trouble, while the second procedure, the pumping,
does exactly the reverse to what it is intended to do. Instead of
drying up the breasts it keeps up the secretion. The best thing to do
in a case like that is to leave the breasts alone, not to pump them,
but just gently support them with a bandage and then in three or four
days the secretion of the milk will gradually disappear. There is some
discomfort the first twenty-four or forty-eight hours, but if left
alone the discomfort is less than if the breasts are manipulated,
bandaged or pumped.
=Menstruation or Pregnancy While Nursing.= Many women do not
menstruate and do not become pregnant while they are nursing. Some
women will not conceive, no matter how long they may nurse the
child--a year or two or longer. And some women take advantage of this
fact, and in order to avoid another child they will keep up the
nursing as long as possible. In Egypt and other Oriental countries
where our means for the prevention of conception are unknown, it is no
rare sight to see a child three or four years old interrupting his
work or his play and running up to suckle his mother's breast. But not
all women have this good luck. Some women (about fifty per cent.)
begin to menstruate in the sixth month of lactation, while some become
pregnant even before they begin to menstruate. It only too often
happens that a woman considering lactation her safeguard omits to use
any precautions and finds herself, to her great discomfiture, in a
pregnant condition.
When a nursing woman discovers that she is pregnant she should give up
nursing at once. The milk is apt to become of poor quality, but even
where this is not the case, it is too much for a woman to feed one
child in the uterus and one at the breast.
CHAPTER SIXTEEN
ABORTION AND MISCARRIAGE
Definition of Word Abortion--Definition of Word Miscarriage--
Spontaneous Abortion--Induced Abortion--Therapeutic Abortion--
Criminal Abortion--Missed Abortion--Habitual Abortion--Syphilis
as Cause of Abortion and Miscarriage--Dangers of Abortion--
Abortion an Evil.
The word abortion, used somewhat loosely, signifies the premature
expulsion of the fetus; the expulsion of the fetus from the womb
before it is viable, i.e., before it is capable of living
independently. Used in a stricter sense, the word abortion is applied
to the expulsion of the fetus up to the end of the 16th week; to the
expulsion of the fetus between the 16th and the 28th week the term
miscarriage is applied; and when the expulsion of the fetus takes
place after the 28th week, but before full term, we use the term
premature labor. The laity does not like the term abortion, as it is
under the impression that the term always signifies criminal abortion;
it therefore prefers to use the term miscarriage ("miss"), regardless
of the time at which the expulsion of the fetus takes place.
When an abortion (or miscarriage) takes place by itself, without any
outside aid, we call it _spontaneous abortion_. When it is brought on
by artificial means, whether by the woman herself or by somebody else,
we call it _induced_ abortion. When an abortion is induced for the
purpose of saving the woman's life, we call it _therapeutic_ abortion;
this is considered perfectly legal and proper. But where an abortion
is induced merely to save an unmarried mother's reputation, or because
the married mother is too poor or too weak to have any more children,
or is reluctant to have any (or any more) for any other reason, it is
called _criminal_ or _illegal_ abortion, and, if discovered, subjects
the mother and the person who produced the abortion to severe
punishment.
When the fetus for some reason dies in its mother's womb, it is
generally expelled within a few hours or days. Sometimes this is not
the case, and the dead fetus is retained for several weeks, or months
or even years; to such a phenomenon we apply the term _missed_
abortion. Some women suffer from what might be called the abortion
habit; they can hardly ever carry a child to full term, but lose it in
the same month or even in the same week of gestation during each
pregnancy; we call this habitual abortion. And this habitual abortion
may be independent of disease, such, for instance, as syphilis. The
terms _threatened_, _imminent_ and _inevitable_ abortion require no
further explanation.
=The Causes of Abortion.= Outside of the abortion habit, which may be
due partly to heredity or be caused by a diseased condition of the
lining membrane of the uterus, the principal cause of abortion and
miscarriage is syphilis. And when a woman has had two or three or four
or more miscarriages in succession we generally assume the cause to be
syphilis, and in most cases the assumption will be correct.
When an abortion is performed by an experienced physician, with the
observance of the utmost cleanliness (asepsis and antisepsis), then
the abortion is accompanied with very little or no danger; but when
performed carelessly, by incompetent, non-conscientious physicians and
midwives, the operation is fraught with great danger to the patient's
health or to her very life. And abortion is a great cause of premature
death and chronic invalidism among women. And as long as the people
will remain ignorant of the proper means of regulating their
offspring, so long will abortion thrive.
While I recognize that there are cases in which the performance of an
abortion is perfectly justifiable from a moral standpoint, for
instance in cases of rape or where the mother is unmarried,
nevertheless abortion must be recognized as an evil, a necessary evil
now and then, but an evil, nevertheless. It is never to be undertaken
lightly, or to be considered in a frivolous spirit; and it is the duty
of all serious-minded and humanitarian men and women to do everything
in their power to remove those conditions which make abortion
necessary and unavoidable.
CHAPTER SEVENTEEN
PRENATAL CARE
Meaning of the Term--Misleading Information by Quasi-Scientists--
Exaggerated Ideas Regarding Prenatal Care--Nervous Connection
Between Mother and Child--Cases Under Author's Observation--Effects
on Offspring--Advice to Pregnant Women--Germ-plasm of Chronic
Alcoholic--A Glass of Wine and the Spermatozoa--False Statements--
Cases of Violence and Accidents During Pregnancy.
By prenatal care we understand the care taken during pregnancy before
the child is born. Used in a wider sense the term includes the care
which both parents should take of themselves even before the child is
conceived.
Of course the father and the mother should be in the best possible
physical and mental condition during the time of conception and even
before conception, and the mother should take the very best care of
herself--she should be in good health and as calm a spirit as possible
during the entire period of gestation. For the general health and
condition of the mother does influence the child.
And still I feel impelled to say something which may meet with violent
opposition in some quarters. The trouble is, there are too many
half-baked scientists in our midst. They spread misleading information
and the public at large is too apt to take every statement that has a
quasi-scientific seal for something absolute, for something positive,
for something that admits of no exceptions.
I have seen so much misery caused by wrong prenatal care teaching and
by the foolish, exaggerated ideas on the subject, that I consider it
my duty to say something in order to counteract those erroneous
notions. I consider it my special mission to destroy error, mysticism
and superstition. And the prenatal care teaching as imparted by some
unfortunately partakes of all three of the above.
Of course, I repeat, the mother should try to be in the best possible
condition while she is carrying the child. Nevertheless, it is foolish
to imagine if the mother is not quite well, or is worried about
something, or has a fit of anger, that it is invariably going to be
reflected on the child. The child, as we know, has no nervous
connection whatever with the mother, and it is only very violent or
prolonged shocks that are apt to have an injurious influence.
I know of children that were carried by their mothers in anger and in
anguish from the day of conception to the day of delivery. And still
they were born perfectly normal. I know of a child whose mother was
suffering the most hellish tortures of jealousy during the entire
period of pregnancy, and still the child was born perfectly healthy,
perfectly normal, and is now a splendid specimen of manhood. I know
children whose mothers went through severe attacks of pneumonia,
typhoid fever, etc., and still they were born perfectly healthy and
perfectly normal. I know children whose mothers were using every means
to abort them, took all kinds of internal medicines until they were
deathly sick, and still they were born perfectly healthy and normal. I
know children whose mothers tried to abort them by mechanical means,
who went to abortionists who made one or more attempts to induce the
abortion--I know even cases where the mothers bled as a result of such
attempts--and nevertheless, the children were born perfectly healthy,
developed normally physically and mentally.
Of course these are not things that I would advise women to do or to
undergo. I would not advise pregnant women to worry, to be sick, to
take poisonous medicines or to make attempts at abortion, but I merely
bring up these points to emphasize to my readers not to take the
necessity of prenatal care in too absolute a sense, and not to worry
themselves unnecessarily if the conditions during their pregnancy are
not all that could be desired. The child is not necessarily going to
be affected. The condition of the germ-plasms, i.e., the condition of
the ovum and the spermatozoa at the time of conception is more
important than all subsequent care during gestation.
As there are foolish people who possess a peculiar knack of
misinterpreting and misunderstanding everything, I wish to emphasize
that hygiene during pregnancy should not be neglected. Everything
possible should be done to put the mother in the best possible
physical and mental condition. All I want to say is that it is bad to
be insane on the subject, that it is bad to take things in an absolute
sense, and that it is bad to exaggerate.
You will often hear it said that a child that was conceived when the
father was in an exhilarated condition is apt to be epileptic, or
nervous, or insane, and what not. This is also to be taken with a
grain of salt. A chronic alcoholic has a defective germ-plasm, and his
children are apt to be defective. But a glass of wine at a wedding
banquet cannot affect the previously formed spermatozoa. And the
statements about children being born defective or developing
defectively because their fathers took an occasional glass of wine are
unworthy of serious consideration; are unworthy of any consideration.
In connection with the above the reports of some cases of _violence_
and _accidents_ during pregnancy which, in spite of their severity,
did not affect the children, will prove of interest.
A delicate little woman missed her periods. She was sure she couldn't
be more than two weeks over-due. And this is what she did. For five
nights in succession she took hot mustard baths and she took them so
hot that each time she nearly fainted and came out from them like a
broiled lobster. No effect. She then took a box of pills which cost
her two dollars. No effect except causing diarrhea. She then took two
boxes of capsules which upset her stomach and made her fearfully
nauseous. No other effect. She then ate one-half a colocynth, which
made her terribly sick, causing a bloody diarrhea. She had to stay in
bed for three or four days. She then took burning vaginal injections
with some ipecac in them. No effect except making her feel raw so that
she needed large amounts of cold cream. She then took secale cornutum
and radix gossypii. No effect except giving her a headache, making her
sick to her stomach and completely destroying her appetite, so that
within a very short time she lost nearly ten pounds. She was then told
that long walks might be efficient. She took walks of six and seven
miles at a time, coming home more dead than alive. No effect. She then
heard that jumping off a table is a very efficient means. She did it
a dozen times in succession so that she was completely fagged out and
out of breath. Eight and a half months later she gave birth to a
perfectly healthy, well-formed boy weighing eight pounds.
The following case was reported by Brillaud-Laujardiere. A farmer who
was responsible for the condition of a servant of his household
conceived the idea of riding horseback with her in order to bring
about an abortion, and pushing her off when the horse was running at
great speed. This he repeated several times. The woman gave birth to a
perfectly normal infant at full term.
Hofmann reports that another farmer, under similar circumstances,
brutally kicked the woman in the abdomen repeatedly until she lost
consciousness. The pregnancy continued to full term notwithstanding.
In another case of Hofmann's, a woman allowed a heavy door to fall
upon her, but the pregnancy was not affected.
Dr. Guibout relates that a German woman, living with her husband in
California, being pregnant, wished to return to Munich, her home-town,
to be delivered. The train in which she travelled through Panama
collided with another train. Threatened abortion required her to take
a rest. She took a steamer and after a very rough passage reached
Portsmouth. From there she went to Paris. Here she fell down a flight
of stairs in the hotel where she was stopping. Again she was
threatened with abortion, but after a rest was in good condition and
continued her journey. She finally reached home, and was delivered at
full term of a normal infant.
Vibert reports the case of a woman who was in a train accident which
injured her severely, killed two of her children, but did not affect
her pregnancy. She was delivered at the proper time of a normal baby.
CHAPTER EIGHTEEN
THE MENOPAUSE OR CHANGE OF LIFE
Time of Menopause--Cause of Suffering During Menopause--
Reproductive Function and Sexual Function Not Synonymous--
Increased Libido During Menopause--Change of Life in Men.
In the chapter on menstruation I referred briefly to the menopause. I
will consider it here somewhat more in detail.
The menopause, also called the climacteric, and in common language
"change of life," is the period at which woman ceases to menstruate.
The average age at which this occurs is about forty-eight. But while
some women continue to menstruate up to the age of fifty, fifty-two,
and even fifty-five, others cease to menstruate at the age of
forty-five or even forty-two. Between forty-four and fifty-two are the
normal limits. Anything before or beyond that is exceptional.
Just as the beginning of menstruation may set in without any trouble
of any kind, and just as some women have not the slightest unpleasant
symptoms during the entire period of their menstrual life, so the
menopause occurs in some women without any trouble, physical or
psychic. The periods between the menses become perhaps a little
longer, or a little irregular, the menstrual flow becomes more and
more scanty, then one or several periods may be skipped altogether,
and the menopause is permanently established. Many women, however, the
majority probably, suffer considerably during the transitional year or
years of the menopause. Symptoms are both of a physical and of a
psychic character, but the psychic symptoms predominate. There may be
headache, capricious appetite, or complete loss of appetite,
considerable loss of flesh, or on the contrary very sudden and rapid
putting on of fat, great irritability, insomnia, profuse perspiration;
hot flashes throughout the body, and particularly in the face, which
make the face "blushing" and congested, are particularly frequent.
Then the woman's character may be completely changed. From gentle and
submissive she may become pugnacious and quarrelsome. Jealousy without
any grounds for it may be one of the disagreeable symptoms, making
both the wife and the husband very unhappy. In some exceptional cases
a genuine neurosis or psychosis may develop.
=Cause of Suffering During Menopause.= It is my conviction, and I have
had this conviction for many years, that many, if not most, of the
distressing symptoms of the menopause are due, not to the menopause
itself, but to the wrong ideas about this period that have prevailed
for so many centuries. We know the influence of the mind over the
body, and the pernicious effect which wrong ideas may exercise over
our feelings. The generally prevalent opinion among women, and men for
that matter, and not only of the laity but unfortunately of the
medical profession as well, is that the menopause is the end of
woman's sexual life. Every woman is laboring under the erroneous
impression that with the establishment of the menopause, with the
cessation of the menses, she ceases to be a woman, and as she does not
become a man, she becomes something of a neuter being, neither woman
nor man. And she has the idea that after the menopause she can have no
further attraction for her husband or for other men. Naturally such an
idea has a very depressing effect on any human being. Any human being
fights to the last to retain all its human functions, especially the
function which is considered as important as is the sexual function.
=Reproductive Function and Sexual Function Not Synonymous.= Of course
with the permanent cessation of the menses the woman's _reproductive_
function is at an end. But the reproductive function is _not_
synonymous with the sexual function, I must insist again and again,
and naturally until this erroneous idea is dispelled much unnecessary
misery will be the lot of our women. If women in general will learn
that with the establishment of the menopause they do _not_ cease to be
women, if they will learn that the sexual desire in women lasts long
beyond the cessation of the menopause, many women being as passionate
at sixty as at thirty, if they will learn that their attractiveness or
non-attractiveness to the male sex does not depend upon the menopause,
but upon their general condition, if they will learn that many women
at fifty and sixty are much more attractive than some women at half
that age, they will not take the onset of the menopause so tragically
and they will thereby avoid the greater part of their mental and
emotional suffering.
The actual atrophy of the ovaries, uterus, external genitals and the
breasts can, of course, not be prevented, but that atrophy is a slow
and gradual process, and is not in itself the cause of the various
distressing symptoms that we have enumerated.
The treatment of the menopause, if the symptoms are at all
disagreeable, or distressing, should be in the hands of a competent
physician. A little wholesome advice may be more efficient than
gallons of medicine and bushels of pills. In general the woman should
try to lead as calm and peaceful a life as possible. Warm baths daily
are beneficial, constipation should be guarded against, hot vaginal
douches are often efficient against the disagreeable flushes, and
last, but not least, the husband should during this critical period be
doubly kind and doubly considerate of his wife. It is during the years
between forty-five and fifty-five that the wife is most in need of her
husband's sympathy and support.
=Increased Libido During Menopause.= There is one rather delicate
symptom which I must not pass unmentioned. Some women during the years
while the menopause is being established, and for some years after the
menopause, experience a greatly heightened sexual desire. In some
cases this increased libido is normal, that is, no other pathologic
symptoms or local conditions can be discovered. In some cases the
increased libido is distinctly due to local congestion, congestion of
the ovaries, the uterus, etc. In some cases, I can distinctly testify,
it is psychic or autosuggestive. Because the woman thinks, and
believes that other people think, that she is soon going to lose all
her sexuality, she unconsciously works herself up into a sexual
passion which sometimes may be of long duration and may even lead to
disastrous results.
What to do in such cases? Where the woman's libido is normal or near
normal, then naturally it should be normally gratified. But if the
libido seems to be abnormally strong and the demands for sexual
gratification are too frequent, then the woman should be treated and
sexual gratification should not be indulged in, because in such cases,
as a rule, sexual gratification only adds fuel to the fire, and the
woman's demands may become more and more frequent, more and more
insistent. In exceptional cases it may even reach the intensity of
nymphomania. In such cases the aid of a tactful physician is
indispensable.
Change of Life in Men
To people not familiar with the subject it sounds rather strange to
speak of "change of life" in men.
Man, possessing no menstrual function, cannot have any menopause, but
still sexologists and psychologists who have studied the subject
carefully are convinced that between the ages of forty-five and
fifty-five men also undergo a certain change which may be spoken of as
the change of life or the male climacteric.
They become irritable, capricious, very susceptible to feminine
charms, are apt to fall in love, and in many the sexual instinct is
greatly increased. As in women, this increase of the sexual desire is
sometimes due to pathologic causes, such as an inflamed prostate
gland--in other cases it is of psychic origin.
Just as a man should be particularly kind and considerate to his wife
during her menopause, so the wife, understanding that her husband is
going through a critical period, will also increase her tact, patience
and consideration.
CHAPTER NINETEEN
THE HABIT OF MASTURBATION
Definition of Masturbation--Its Injurious Effects in Girls as
Compared with Boys--Married Life of the Girl Masturbator--
Necessity for Change in Injurious Attitude of Parents who Discover
the Habit--Common-sense Treatment of the Habit--How to Prevent
Formation of Habit--Parents' Advice to Children--Hot Baths as
Factor in Masturbation--Other Physical Factors--Mental
Masturbation and Its Effects.
Masturbation or self-abuse is a term applied to a bad habit which
consists in handling and rubbing the genitals. It is a bad habit
because it is apt to injure the health and future development of the
girl. The more frequently it is practiced, the more injurious it is.
It is more injurious than when practiced by boys, because the effects
are usually more permanent. Girls who indulge in the habit of
masturbation to excess not only weaken themselves, become anemic and
get a dingy, pimply complexion, but they lose their desire for normal
sexual relations when they grow up, and are unable to derive any
pleasure from the sexual act when they get married. In fact, many
girls who masturbated excessively get a strong aversion to the normal
sexual act, and their married life is an unhappy one. Their husbands
often have to ask for a divorce. Fortunately, the habit is much less
widespread among girls than it is among boys. While about ninety per
cent. of all boys--nine out of every ten--masturbate more or less,
only about ten or at most twenty per cent. of girls are addicted to
this habit. But whatever the percentage may be, the habit is an
injurious one, and if you value your health, your beauty and proper
growth and mental development, you should not indulge in it. If you
are already indulging, if you are used to handling your genitals, if a
bad companion has initiated you into the habit, you should give it up.
And mothers should watch their children, guard them against developing
the habit, and do everything possible to cure them of it, if
prevention comes too late.
But while as you see I do not deny the evil effects of masturbation,
it is necessary to state that a great change has taken place in our
opinions on the subject, and it is but right that parents should know
of this change of opinion among the medical profession, particularly
among those who specialize in sexology.
=Wrong Behavior of Parents.= When parents make the "awful" discovery
that their child is fondling its genitals or is indulging in
masturbation, they feel as if a great calamity had befallen them.
They could not feel worse if they learned that the child was a thief
or a pyromaniac. Imbued with the medieval idea of the "sinfulness" of
the habit, as well as its injuriousness, they begin to scold the
child, to frighten it, to make it believe that it is doing something
terrible, that it has disgraced them and itself; and they try to
persuade it that, unless it stops immediately, the most direful
consequences are awaiting it. The results of this mode of procedure
are disastrous--much more so than is the masturbation itself.
Often the scolding and the exposure of the child are done in the
presence of others. This implants in the poor girl a sullen resentment
that only makes it more difficult for it to break the habit. When the
child is brought to the physician, you can see by its behavior, by its
downcast looks, by its sulkiness, by its attempt to refrain from
tears, and other signs, that it regards the physician in exactly the
same light as a youthful criminal regards the judge before whom he has
been brought for trial.
It is time, high time, that this silly and injurious attitude toward a
practice, which is very common, be radically changed. It is time that
parents and physicians learn that the injuriousness of the habit has
been greatly, grossly exaggerated. It is time that they know that the
vast majority of boys and girls get over the habit without being much,
or any, the worse for it. The knowledge of this fact will not only
save them and the children much needless anguish and suffering, but
will make it much easier to deal with the latter, make it much easier
to get them divorced from the habit.
If we look at the matter in a sensible, common-sense way, and do not
tell the child caught in the practice that it has done something
disgracefully vicious and criminal, but speak to it kindly and tell it
that it is doing something that may injure it greatly, that may
interfere with its future mental and physical health and development,
then we shall have far greater success in our endeavors to break the
boy or the girl of the habit of masturbation. As I have said in
another place:
"In my opinion, stigmatizing even the most moderate indulgence in
masturbation as a vice has a deleterious effect upon the people who so
indulge and makes it harder for them to break off the habit. Every
thinking physician and sexologist can tell you that picturing the
masturbatory habit in too lurid colors and stigmatizing it with too
strong epithets has, as a rule, the contrary effect to the one
expected. The victims of the habit consider themselves degraded,
irretrievably lost. They lose their self-respect, and it is, on
account of that, harder for them to break themselves of the habit."
We shall accomplish a good deal more with our youthful and older
patients if we leave alone, altogether, the moral side of the
question--if there be any moral side to it--and emphasize the physical
injuriousness of the habit. We do not want to diminish the
self-respect of our boys and girls, we want to increase it; and we can
not do this if we make them believe that a masturbator is a vicious
criminal. Inspire your patients with confidence, tell them that
indulgence in the habit jeopardizes their future growth, both physical
and mental, their health and happiness, and you will find them easier
to control.
I am not trying to minimize the danger of masturbation, for, if
indulged in from an early age and to great excess, the results _may_
be disastrous. But, even if I were to minimize the evil consequences,
that would be less of a sin than to exaggerate them the way it has
been done for so many years, by so many people in the profession and
out of it. The evil results of exaggerating the influence of
masturbation have been so great in the past that, if now the pendulum
were to swing to the other extreme, I am sure it would not be a bad
thing at all.
To deal with the subject of the _treatment_ of masturbation belongs to
a medical treatise. But, a few remarks on how to prevent children from
acquiring the habit of masturbation will not be out of place.
=Prevention of the Habit of Masturbation.= The keynote of preventing
the habit is, carefully to watch the child from its earliest infancy.
We know that not infrequently stupid or vicious nursemaids,
wet-nurses, and even governesses ignorantly or deliberately induce the
habit in children under their charge. This, of course, must be
prevented. Even children of the age of nine, ten, eleven years should
not be left alone, but always be under supervision. Too close
friendship between boys or girls, particularly of different ages,
should be looked upon with suspicion.
A number of girls never should sleep in the same room without
supervision by an older person.
The sleeping together of two in the same bed, whether it be two
children or a grown person and a child, should not be permitted under
any circumstances. I admit of no exceptions to this demand. It makes
no difference whether the other person is a mother, a father, a
brother or a sister. Leaving out of the question any _deliberate_
element, the thing is dangerous; for, very often, unintentionally,
unwittingly, masturbation is initiated by this intimate contact.
The child--boy or girl--should sleep alone, on a rather hard mattress.
The covering should be light. A coverlet may be put over the feet. The
child always should sleep with the arms out upon the cover or blanket,
never _under_ the same. If this is done from childhood on, it is very
easy to get used to this way of sleeping, and many a case of
masturbation will thus be obviated. The child should not be permitted
to loll in bed: it must be taught to get up as soon as it awakes in
the morning. The general bringing-up must be of a strengthening,
hardening character; and this applies both to the body and the will.
When the children reach the age of nine, ten, eleven, twelve or
thirteen years (we must use discrimination and judgment, for, some
children of nine are as developed as are others of thirteen), we must
tell them that it is bad and injurious to handle one's genitals, and
we must warn them to shun any companions who wish to initiate them
into any manipulations of these parts or who show an inclination to
talk about the sexual organs and sex matters.
Hot baths are very injurious for young children in their influence in
this direction. There is no question that a hot bath has a very
decided stimulating effect upon the sexual desire of adults as well as
of children, both male and female; in fact, I have had several
patients of either sex tell me that their first masturbatory act was
committed while they were in a hot bath. Of course, the sensation
having been pleasurable, they kept on repeating the experience.
Every factor liable to give rise to the habit should be removed. Thus,
for instance, eczema about the genitals, strongly acid urine,
seatworms, and the like, should be treated until cured. That anything
having a tendency prematurely to awaken the sexual instinct should be
rigorously avoided, goes without saying.
=Mental or Psychic Masturbation.= Some girls and women will abstain
from handling themselves with their hands (manual masturbation), but
will practice what we call mental masturbation. That is, they will
concentrate their minds on the opposite sex, will picture to
themselves various lascivious scenes, until they feel "satisfied."
This method is extremely injurious and exhausting and is very likely
to lead to neurasthenia and a nervous breakdown. You should break
yourself of it, by all means, if you can. For it is even more
injurious than the regular habit.
CHAPTER TWENTY
LEUCORRHEA--THE WHITES
Misconception Regarding the Meaning of the Term "Leucorrhea"--A
Common Complaint--Severe Cases--Reasons for Resistance to
Treatment--Proper Local Treatment of the Disorder--Sterility Due
to Leucorrhea--Causes of Leucorrhea--Tonic Medicines--Local
Treatment--Formulæ for Douching.
Leucorrhea means literally a "white running," and is applied by the
laity to any whitish discharge coming from the vagina. This is wrong,
because some white discharges may be of little importance; others may
be of a serious character, and not be leucorrhea at all.
Leucorrhea is one of the banes of the modern girl and woman. It is
very frequent. Probably at least twenty-five per cent, (some say fifty
or seventy-five per cent.) of all women suffer with it in a greater or
lesser degree. In some cases it is only an annoyance, necessitating
the frequent changing of napkins, but in others it causes a great deal
of weakness, backache, erosions, itching and burning. It is very
resistant to treatment, particularly in girls. The reason it is so
resistant to treatment is because the discharge, while coming from
the vagina, _does not usually originate_ in the vagina; it originates
in the neck of the womb, and the hundreds and hundreds of injections
that women take for their leucorrhea only reach the vagina; they
cannot penetrate into the womb. And it is only by treating the cavity
of the cervix, which can only be done by a physician, through a
speculum, that the root of the trouble can be reached. And, if any
erosion or ulcer is noticed, it can be directly touched up with the
necessary application. And it is for this reason that in girls
leucorrhea is so much more difficult to treat. For fear of having the
hymen ruptured the girl objects to a thorough examination and to local
treatment, and the leucorrhea is permitted to proceed until perhaps a
chronic inflammation of the womb and the Fallopian tubes is
established. There is no doubt that many cases of sterility or
childlessness in women are due to long-neglected leucorrhea in
girlhood.
=What Is the Cause of Leucorrhea?= We can answer simply: the cause of
leucorrhea is catarrh in any part of the female genital tract. But
this is no real answer. What are the causes of the catarrh? The causes
of catarrh are many: the most common cause is a cold. Wetting the feet
and getting chilled, particularly during the menses, may set up a
catarrh in the cervix. Long standing on one's feet, lifting and
carrying heavy bundles, dancing in overheated rooms and then going out
scantily clad in the chill night air, prolonged ungratified sexual
excitement, lack of cleanliness in the external genitals--all these
are factors in setting up a catarrh of the cervix with a resultant
leucorrhea. A general rundown condition, worry, overwork, too hard
study, lack of fresh air, and a general scrofulous condition also
favor the development of catarrh of the womb and leucorrhea. It will
therefore be seen that the treatment of leucorrhea to be successful
must be general and local.
=General Treatment.= The general treatment consists in general
hygienic measures and in common sense. The patient should not be on
her feet more than she can help, and she should not walk until
exhausted or fatigued. It is better to take several short walks than
one long one. The corset she wears, if she wears any at all, should be
of the modern kind: not one that presses the womb and the other
abdominal organs down, but one that supports the abdominal walls, and
rather raises the abdominal organs up. The lacing or buttoning must be
from below up, and not from above down. That it should not in any way
interfere with the freedom of respiration goes without saying.
Constipation if any, to be treated, must be treated intelligently, by
mild measures (see Constipation, in the chapter on pregnancy), and
care must be taken that the bowels move at regular hours. Where the
leucorrhea is due to or is aggravated by anemia and general weakness,
a good iron preparation, such as one Blaud's five-grain pill three
times a day, or a tonic of iron, quinine and strychnine, will do good.
A daily cold bath or cold sponge, followed by a brisk dry rubbing with
a rough towel, is also useful.
=Local Treatment.= Local measures consist of painting or swabbing the
vagina and cervix with various solutions, of tampons, suppositories
and douches. Local application to the vagina and uterus can be done
satisfactorily by the physician or nurse only. The insertion of a
suppository or douching can be easily done by the patient herself.
While it is always best and safest to consult a physician, and, while
self-medication is generally inadvisable, there are occasions when a
physician is not available; in some small places a woman may, _for
various reasons_, have a strong objection to gynecological examination
and treatment; and some women may be too poor to pay the doctor. In
such circumstances self-treatment is justified and there can be no
objection to it if the remedies are harmless and are sure to do some
good; that is, to improve the condition where they do not effect a
complete cure.
One of the simplest things is an alum tampon. You take a piece of
absorbent cotton, about the size of a fist, spread it out, put about a
tablespoonful of powdered alum on it, fold it up, tie a string around
the center, insert it in the vagina as far as it will go, and leave it
in for twenty-four hours. Then pull it gently by the string and
syringe yourself with a quart or two quarts of warm water. Such a
tampon may be inserted every other day or every third day, and I have
known many cases where this simple treatment alone produced a cure. In
some cases, however, douches work better and the two best things for
douching are: tincture of iodine and lactic acid. Buy, say, four
ounces of tincture of iodine, and use two teaspoonfuls in two quarts
of hot water in a douche bag. This injection should be used twice a
day, morning and night. Of the lactic acid you buy, say, a pint, and
use two tablespoonfuls to two quarts of water. The lactic acid has the
advantage over the tincture of iodine that it is colorless, while the
iodine is dark and stains whatever it comes in contact with. Sometimes
I order the use of the tincture of iodine and the lactic acid
alternately: for one douche the tincture of iodine, for the next the
lactic acid, and so on. When the condition improves, it is sufficient
to use one teaspoonful of the tincture of iodine and one tablespoonful
of the lactic acid to two quarts of water. These injections are quite
efficient and have the advantage of being perfectly harmless. One
point about the injections: they should be taken not in the standing
or squatting position (in which position the fluid comes right out),
but while lying down, over a douche pan. The douche bag should be only
about a foot above the bed, so that the irrigating fluid may come out
slowly; the patient, after each injection taken in the daytime, should
remain at least half an hour in bed (in the night time she stays all
night in bed). This gives the injection a better chance to come in
contact with all the parts of the vagina, and a portion of it comes in
contact with the cervix, where it exerts a healing effect. Avoid the
use of patent medicines.
CHAPTER TWENTY-ONE
THE VENEREAL DISEASES
Derivation of Word "Venereal"--Three Venereal Diseases--Innocent
Contraction of Syphilis Through Various Objects--The Hygienic
Elimination of Common Sources of Venereal Infection--Measures for
Prevention After Sexual Relations.
The word "venereal" means pertaining to sexual intercourse: venereal
excess--excess in sexual intercourse; venereal disease--a disease
acquired from sexual intercourse with an infected person. The word is
derived from Venus (genitive--veneris), the Roman goddess of spring,
flowers and Love.
There are three venereal diseases: gonorrhea, syphilis and chancroid.
Of these, gonorrhea is the most widespread, syphilis the most serious.
Chancroid is of comparatively little importance.
While by far the greatest amount of venereal diseases--probably ninety
per cent, of the total--is contracted from illicit[7] intercourse, it
is well to bear in mind that some of it is contracted innocently,
either from a kiss, or from using a sponge or a towel which has been
used by an infected person, etc. While the gonorrheal germ is
generally transmitted directly, the syphilitic poison may be
transmitted through various objects. Syphilis contracted not during
intercourse, but in an innocent manner, from a kiss, a towel, a
toothbrush, a razor, etc., is called syphilis of the innocent, or
syphilis insontium. In former years doctors would not very rarely
contract syphilis from examining syphilitic women with their bare
fingers. Now since gloves have come into use for examining purposes,
the number of infections has considerably diminished. And no doubt
that as the people become more familiar with the danger of venereal
infection from non-venereal sources, the number of innocent infections
will greatly diminish. The dangerous roller towel and the no less
dangerous common drinking cup are being gradually eliminated as
factors of _non-venereal_ infection; and we may confidently expect
that in a decade or two the amount of venereal disease from _venereal_
infection will be greatly lessened in all civilized countries. The
general increase in cleanliness in all strata of society and the
universal use of antiseptics after suspicious sexual relations will
constitute the chief factors in this diminution of venereal disease.
FOOTNOTES:
[7] Illicit--illegal, non-permissible, outside of marriage.
CHAPTER TWENTY-TWO
THE EXTENT OF VENEREAL DISEASE
Former Ban on Discussion of Venereal Disease and Its Evil
Results--Present Reprehensible Exaggerations of Extent of
Venereal Disease--Erroneous and Ridiculous Statements of
"Reformers"--Senseless Fear of Marriage in Girls Due to Lurid
Exaggerations--Study by Woman Psychologist Reveals Harmful
Results of Exaggerated Statements--Truth in Regard to Percentage
of Men Afflicted with Venereal Disease.
=Former Silence.= Only a very few years ago respectable women, by
which I mean all women outside of the women called "fallen," did not
know of the existence of venereal disease. It was considered a
prohibited, disgraceful subject, not to be mentioned or even hinted at
in conversation, in books or magazines, in lectures, or on the stage.
When I say that they did not know of the _existence_ of such a thing
as venereal disease, that the very words gonorrhea and syphilis were
unknown to them, I use these expressions not as figures of speech, but
in their literal meaning. All avenues of acquiring such knowledge
being closed to them--lay people don't usually now and they surely
didn't then purchase and read strictly medical works--where could they
obtain the information? The result was that when a woman was so
unfortunate as to contract a venereal disease from her husband, she
did not understand its character and did not suspect its source. Which
was a rather good thing--for the husband. Family peace was more
secure.
=Present Exaggerations.= Now a change has taken place in this respect,
and, as is often the case with recent changes, the pendulum has swung
to the other extreme. The silence of former days has given place to
shouting from the housetops. The last phrase is also used almost in
its literal sense. Many men and women, deeply stirred by the venereal
peril, and sincerely anxious to guard boys and girls from venereal
infection, have been indulging in very reprehensible exaggerations.
Particularly lurid have been the exaggerations as to the prevalence of
the disease in the male sex, with its consequent disastrous effects on
married women. A statement made by a Dr. Noeggerath (a German
physician who practiced at the time in New York), nearly half a
century ago, to the effect that 80 per cent, of all men have gonorrhea
and that 90 per cent. of these remain uncured and infect or are apt to
infect their wives, has been shown to be a ridiculously absurd
exaggeration. If it had been true, the race would now be at the point
of dying out. Nevertheless, this statement is copied from book to
book, as if it were gospel truth, as if it were a scientifically and
statistically established fact instead of a wild, sensational guess.
An esteemed New York physician, Dr. Prince A. Morrow, did excellent
pioneer work in calling attention to the dangers of venereal disease.
But, as is the case with so many "reformers," he permitted his zeal to
run away with him occasionally, and he made statements which caused
and are still causing the judicious to grieve. The statement, for
instance, that there is more venereal disease among innocent, virtuous
wives than among prostitutes is one to cause the real honest
investigator to weep (over the human tendency to exaggeration), or to
burst out in uproarious laughter. The ridiculousness of this statement
becomes especially evident when we recollect that the same gentleman
made the statement that every prostitute, without exception, was
diseased at one time or another. If venereal disease exists among
prostitutes to the extent of 100 per cent., then how can it exist to a
greater extent among innocent, virtuous wives? And to still further
emphasize the absurdity of the above statement, I will tell you that
the extent of venereal disease among married women is believed by
careful non-sensational venereologists not to exceed five per cent.!
Yes, the silence of former years has given place to the lurid
exaggeration of the present day. While on the whole the former was
worse than the latter, the latter is bad enough, because it makes many
girls unhappy, sowing in them the seeds of suspicion and cynicism,
tends to make them antagonistic to the entire male sex, and inoculates
them with a senseless fear of marriage. A study made by Miriam C.
Gould, of the department of psychology and philosophy in the
University of Pittsburg (_Social Hygiene_, April, 1916), corroborates
our remarks in a striking manner.
She has had confidential chats with 50 young girls, with whom she has
had some acquaintance; of these 50, 25 were college students and 25
were not. She asked them a number of questions, the purpose of which
was to find out what psychologic effect, if any, their knowledge of
prostitution and of venereal disease has had on them. She states in
her conclusions that "the histories reveal a large percentage of
harmful results, such as conditions bordering upon neurasthenia,
melancholia, pessimism and _sex antagonism_ (italics mine), directly
traceable to this knowledge. Eleven of the girls interviewed developed
a pronounced repulsion for men, although prior to their 'knowledge'
they had enjoyed men's company. They now avoid association with them,
and six have declared that they have totally lost faith in the moral
cleanness of men. Eight have already refused to marry, or intend to do
so, because of their belief that the risk of infection was too great.
If it were not for the existence of these diseases, they say they
would be glad to marry. All of these say their decision has rendered
them more or less unhappy."
In the laudable desire to keep our young women pure and to protect
them from infection, in the endeavor to make them demand one moral
standard for both sexes, our exaggerating reformers are condemning
them to lifelong celibacy, which in the case of women often means
lifelong neurasthenia and hypochondria.
=The Truth of the Matter.= Here is the Truth about venereal
disease--the truth as I know it, without concealment on the one hand
and without exaggeration on the other. Exact figures are, of course,
unobtainable anywhere; but results obtained from unbiased
investigations of _different_ classes of society, from hospital
reports, from questionnaires among students, etc., tell us that
probably about twenty per cent. of the adult male population are the
victims of gonorrhea at one time or another; that probably eight or
ten per cent. are not entirely cured when they enter matrimony; and
four or five per cent. (some would say two per cent.) of wives become
infected with gonorrhea. This, I say, is terrible enough, and makes
the greatest care and caution imperative; for, if you should be one of
the victims of the two or five per cent., it would be little
consolation to you that the other ninety-eight or ninety-five per
cent. of wives have escaped.
Of course the percentage of venereal disease among young men, and
afterwards among their wives, will vary greatly with the stratum of
society. Among the "lower" strata you may find fifty per cent. of
infection, with a very large percentage of those uncured. Not because
they are of a lower morality than the higher classes, but because the
cheap class of prostitutes that they are obliged to patronize are
frequently diseased and because they cannot afford expert treatment,
or any treatment at all. Among these classes you will naturally find a
much larger percentage of diseased wives. But then to counteract this
we must bear in mind that there are large classes of men in whom
gonorrhea exists only to the extent of five or ten per cent., and we
have large classes of wives among whom the victims of gonorrhea will
come up only to a fraction of one per cent.
The above figures, you see, differ materially from the statements
found in so many sex books that "80 per cent. of all married men in
New York have gonorrhea," and that "at least three out of every five
[60 per cent.!] married women in New York have gonorrhea." Whenever
you read or hear such a statement treat it with a smile--or with
contempt, as all false statements should be treated.
As to syphilis, the extent of the prevalence may be given as between
two and five per cent. Which percentage differs considerable from the
75, 50 or 25 per cent. given us by some sex lecturers, but which is
terrible enough as it is, without any exaggerations.
CHAPTER TWENTY-THREE
GONORRHEA
Source of Gonorrhea--Mucous Membrane of Genital Organs and of Eye
Principal Seats of Disease--Symptoms in Men and in Women--Vagina
Seldom Attacked in Adults--Nobody Inherits Gonorrhea--Ophthalmia
Neonatorum--Differences of Course of Disease in Men and Women--
Gonorrhea Less Painful in Women--Symptoms not Suspected by Woman--
Necessity for the Woman Consulting a Physician--Self-treatment
When Woman Cannot Consult Physician--Formulæ for Injections.
The subject of gonorrhea and syphilis is treated pretty fully, from a
layman's point of view, in the author's _Sex Knowledge for Men_. I do
not intend to devote much space to a discussion of the details of
these two diseases here, because the subject is not of such direct
interest to women. Respectable girls and women do not indulge in
illicit relations the same as respectable men and boys do, and their
danger of contracting a venereal disease is insignificant as compared
with men's liability. I will, therefore, touch upon only a few points,
particularly insofar as the diseases differ in their course from the
course pursued in men. Those, however, who are interested may read the
chapters on the subject in the author's _Sex Knowledge for Men_, and
if they want still fuller details, they may study the author's
_Treatment of Gonorrhea and Its Complications in Men and Women_.
[Illustration: GONORRHEAL GERMS.]
=Gonorrhea= is an inflammation caused by a germ called the gonococcus,
discovered by Dr. A. Neisser, of Breslau, Germany, in 1879. Any mucous
membrane may be the seat of gonorrhea, but it attacks by preference
the mucous membrane of the genital organs, and of one other organ--the
eye. Its principal symptoms are: inflammation, pain, burning and
discharge. In men, it attacks the urethra; in women it attacks the
cervix--the neck of the womb--the urethra, and the vulva. The vagina
is seldom attacked in adult women, because the mucous membrane of the
adult vagina is rather tough and does not offer a good soil for the
development of the gonococcus germ. The discharge that a woman has
when she has gonorrhea comes principally or exclusively from the neck
of the womb. In little girls, however, in whom the lining of the
vagina is tender, gonorrhea of the vagina and the vulva is common.
(See chapter Vulvovaginitis in Little Girls.) Gonorrhea is a local
disease. While in some cases, after the disease has lasted for some
time, a certain poison is generated by the germs which circulates in
the blood, and while the germs may occasionally wander into distant
organs, still in 98 per cent. of all cases gonorrhea is a local
disease, and if taken in time is cured without leaving any traces on
the general organism.
=Gonorrhea Not Hereditary.= Then, gonorrhea is not a hereditary
disease. Nobody ever _inherits_ gonorrhea. A child may be born with a
gonorrheal inflammation of the eyes (ophthalmia neonatorum), but this
inflammation is not inherited; it can only be acquired if the mother
is suffering with gonorrhea while the child is being born: some of the
pus in the mother's birth canal gets into the child's eyes while it
passes through the uterus and vagina. This is not heredity; this is
simple infection, and can be avoided by keeping the mother's birth
canal clean by antiseptic douches before childbirth. In short, I
repeat gonorrhea is essentially a local and not a constitutional
disease, and is not hereditary. In which two respects it differs from
syphilis, which is the most constitutional and most hereditary of all
diseases.
=Course of Gonorrhea in Men and Women.= Gonorrhea runs an entirely
different course in women than it does in men. When a man has
gonorrhea he knows it immediately; first, because the discharge tells
him that there is something the matter with him, for a man is not used
to having any discharge from the urethra unless there is something the
matter with him. Second, the urine becomes at once burning and
painful. In women the urethra is a separate canal from the vagina, and
the urethra is very frequently not affected in gonorrhea. The
infection generally starts in the cervix, and the disease may last for
considerable time before the woman becomes aware of it. In general,
gonorrhea is a less painful disease in woman, and this is a bad thing,
because she thus neglects treatment and loses valuable time,
permitting the disease to develop. Even when the urethra is affected
in women, it does not give as severe symptoms as inflammation of the
urethra in men. If the woman does have pains she often pays no
attention to them, because woman is used to pains; as we have seen
before, fifty per cent. of all women suffer more or less with
dysmenorrhea. Many of them have a leucorrheal discharge of greater or
lesser degree, and therefore if there is an increase in the pains, or
an increase in the discharge, little attention is paid to the matter.
In fact, a woman may have a chronic gonorrhea for months or years
without being aware that there is anything the matter with her. It is
important to teach women to seek medical aid as soon as they notice
any increase in the amount of the discharge, or change in color,
particularly if it becomes greenish, or if the odor becomes offensive,
or if there is chafing, burning, or irritation around the genitals,
and particularly if there is an increase in the frequency or urgency
of urination, or if there is a burning, scalding, or cutting sensation
during the act of urination. Also whenever the sexual act becomes
painful. If women consulted a physician as soon as they noticed any of
the symptoms referred to above, they would save months and years of
suffering and expense, because the disease would often be taken in
hand while still limited to the cervix, and not, as is now often the
case, after the inflammation has extended into the uterus and
Fallopian tubes.
=Self-treatment.= I do not believe in self-treatment because it is
generally unsatisfactory and may often even become dangerous, and I
decidedly advise every woman who suspects that she has contracted
gonorrhea to apply at once to a competent physician. But it happens
not infrequently that a woman is so situated that she cannot consult a
physician. And in the meantime there is danger of the gonorrhea
spreading further and further. In such cases it is advisable for the
woman to use an injection until such time when she can consult a
physician. The injection I am going to advise may in itself produce a
cure; and, if it does not produce a complete cure, it at any rate
improves the condition, prevents the extension of the disease, makes
subsequent treatment easier, and besides is perfectly harmless. The
best injection for self use in gonorrhea is tincture of iodine; the
proportion is two teaspoonfuls to a quart or two quarts of water. If
the case is very bad, such an injection may be taken twice a day. If
the case is not very bad, once a day is sufficient. After using the
tincture of iodine for five days to a week, it is good to change off
to lactic acid. Buy a pint or so of lactic acid in a drug store, and
use one tablespoonful to a quart of water. It is preferable to have
the water hot, about 100 deg., but where this is inconvenient it may
be used lukewarm. The lactic acid injection is used for three days,
then the iodine injection is resumed, then again the lactic acid, and
so on. I know of many cases that were cured by this treatment alone.
And I might mention that these injections are generally also very
efficient in leucorrhea, as stated in the chapter on Leucorrhea.
CHAPTER TWENTY-FOUR
VULVOVAGINITIS IN LITTLE GIRLS
Former Causes of Vulvovaginitis in Little Girls--Discharge Chief
Symptom--Evil Results of Vulvovaginitis--Psychic Results of
Treatment--Effects in Hastening Sexual Maturity--Vulvovaginitis a
Cause of Permanent Sterility--Measures to Prevent the
Disease--Toilet Seats and Vulvovaginitis.
The mucous membrane, or the lining of the vulva and vagina, in little
girls is very tender, and therefore very readily subject to infection.
An infection of the vulva and vagina due to the gonococcus or to some
other germ is very common in little girls. At least it used to be,
particularly among children of the poor, in in
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