look for their blood-money. The great difficulty, however, lies in the failure of the woman to appreciate the seriousness of her condition, and as a consequence she fails to understands why it should take so long to cure her. She loses confidence in her physician, she buys certain "cures" recommended to her by Mrs. Busybody and later tries other physicians and ends by losing faith in herself. Meantime she grows worse and worse. There are thousands such. It may be here stated without fear of contradiction that if the public in general would repose more confidence in the medical profession, there would be much less suffering, much less sorrow, fewer regrets, fewer irresponsible "isms,"

and cults, because there would be fewer disappointed individuals to support them. If the medical profession would condescend to employ the tactics and devices of those questionable, fashionable agencies that claim the power to cure human suffering, it could quickly reap the profit and the laudation that it now escapes because it keeps the faith.

The way to be cured of any disease, if it is curable, is to engage a reputable physician and follow his instructions implicitly. Let him understand you expect him to see you through your trouble and let him know you have confidence in him. There isn't one physician in a thousand who will cheat you under these circ.u.mstances.

MALFORMATION.--Under this heading are all those cases of sterility resulting from imperfect generative organs. These are products of a failure on the part of nature to furnish or develop the structures partic.i.p.ating in the propagation of the species. The entire generative organs are sometimes wanting. The womb may have failed for some reason to grow with the rest of the body, it remains (as it is known) as an "infantile womb." Occasionally the womb grows together, that is, it is solid instead of being a hollow organ. The mouth of the womb may be too small, representing what is called "a pin head opening." The natural opening is large enough to admit a lead pencil, a "pin head opening"

would not be larger than the lead in the pencil. The latter condition is quite a common cause of sterility and is readily amenable to treatment.

Most of the malformations which produce sterility are impossible to cure.

LACERATIONS OR TEARS IN MOUTH OF WOMB.--This subject is fully discussed on another page of this volume.

TUMOR.--A tumor may be so situated as to prevent conception, or it may involve the body of the womb const.i.tuting a reason in itself for sterility.

LEUCORRHEA.--Leucorrhea or "the whites" may be of such an acid character as to kill the spermatozoa in the v.a.g.i.n.a, or it may be of such volume as to render impregnation impossible. The treatment of this condition is discussed elsewhere.

PHYSICAL DEBILITY.--When the general health is bad, no matter from what cause, sterility usually exists. This lack of vitality may be due to chronic disease, or it may have been caused by a very severe acute illness, such as typhoid fever. One's mode of living, if unhygienic, may be responsible for continued bad health and a consequent sterility.

OBESITY.--Very fat women are usually barren. If a woman rapidly acc.u.mulates fat after marriage she as a rule does not have more than one or two children. Women often become stout immediately after the child bearing age ceases.

SPECIAL POISONS.--Certain special poisons in the blood cause sterility by producing miscarriage.

MISCARRIAGE

By the term "miscarriage" we mean that for some reason the progress of pregnancy has been interrupted and the fetus is expelled from the womb.

A miscarriage or abortion (both terms meaning the same--the difference between the two terms is a technical one and need not concern us here) can occur any time after conception up to approximately the seventh month, when, if labor takes place, the child may be born alive. The condition would then be termed a premature labor. A miscarriage or abortion is an immature labor and implies an immature or dead child.

The condition is a serious one no matter whether it is attended with grave symptoms or apparently no symptoms. If it occurs shortly after conception, during the first few months of married life it is serious, if not in its physical consequences, it is in its significance, because it establishes the tendency to miscarry,--a tendency that may result in great mental distress because of the worry and fear it engenders, and of sorrow and heartache because it may blast the hope of parentage. Such a miscarriage may take place at once after conception. If so, the following menstruation may be delayed for a week or so and is then a little more profuse than is customary. This will be the only indication that a life has been sacrificed that the young wife may have, and frequently the significance of such an occurrence is never understood, yet the tendency to miscarry is nevertheless established, and a seeming sterility is apparently the fate of the woman. It is, therefore, of the greatest importance that extreme care should be taken to bring the first pregnancy to a successful consummation. A young wife should realize that she is apt to become pregnant at any time. Her conduct therefore should be such at least as not to harm the life principle with which she has been entrusted. To this end any excessive s.e.xual activity should be strictly avoided.

CAUSES OF MISCARRIAGE.--Any strenuous physical effort must be guarded against. Included in such efforts may be the following: dancing, running, jumping, surf-bathing, sewing on a machine, sweeping, washing, house-cleaning, moving furniture, etc. Sometimes the primary cause of a miscarriage is to be found in some hygienic act, such as a hot bath, too prolonged or too many hot douches near the menstrual periods. A blow or a fall, even a fright or shock may cause a miscarriage. Anything that violently shakes or agitates the womb, which may at this time be irritable because of its condition, will be sufficient to excite it to contract and miscarry. Hence violent coughing or vomiting should be avoided if possible; horseback riding, jolting in a carriage, convulsions, hysterical crying, may also be the causative factors.

Displacement of the womb by limiting its tendency to grow when pregnant, may cause it to miscarry. Very severe general diseases such as small-pox, pneumonia, etc., will cause the womb to empty itself. Disease of the fetus or the presence of syphilis in either of the parents will also have the same result.

THE COURSE AND SYMPTOMS OF MISCARRIAGE.--The cause of a miscarriage or abortion is much the same as an ordinary labor at term. Whatever interrupts the pregnancy causes the death of the fetus. The dead fetus acts as a foreign body and excites the womb to contract as it does during an ordinary confinement. The contractions open up the mouth of the womb and the fetus is expelled together with its membranes and after-birth. The significant and the most important symptom of a miscarriage or abortion is hemorrhage or bleeding from the privates. The flow of blood may not amount to much or it may be excessive and alarming; it may not be constant, it may come from time to time in the form of clots.

The next significant and important symptom of miscarriage or abortion is pain. The pain, like the flow of blood, may be only slight or it may be very severe, sometimes it is absent in very early miscarriage. As a rule the pain is severe when the miscarriage occurs after pregnancy has lasted for a number of months.

A miscarriage or abortion is said to be "complete" when the fetus with its membranes and after-birth is expelled clean and whole, or in other words when the womb empties itself completely. A miscarriage or abortion is said to be "incomplete" when some part of the embryo is left in the womb.

WHAT TO DO WHEN A MISCARRIAGE IS THREATENED.--When a woman, who is pregnant, begins to flow she should at once go to bed and keep perfectly quiet and send for a physician. A miscarriage is a treacherous condition and is so regarded by all medical men. It may not amount to much or it may, on the other hand, develop into a serious situation. The immediate danger is from hemorrhage; the ultimate or remote danger is sepsis or blood poisoning. The condition is one that can only be taken in charge by a qualified physician in whose hands we can safely leave the conduct of the case.

As a general rule it is quite safe to a.s.sert that a woman will not bleed enough at the beginning of a miscarriage to do any permanent harm.

Consequently there is no occasion for unnecessary alarm. She must, however, as stated above, heed the warning and go to bed, keep perfectly quiet and send for a physician. If she fails to follow this advice it is quite possible that she may have a hemorrhage during the course of the miscarriage of a sufficiently serious character to endanger her life or from the effects of which she may suffer for the remainder of her life.

There is practically no danger during the course of or after a "complete" miscarriage. The danger which may ensue from an "incomplete"

miscarriage is hemorrhage and a form of poisoning caused by the absorption into the system of putrifying products of the part of the dead embryo left in the womb.

There are a large number of cases of criminal abortion in which septic poisoning occurs caused by the utensils or instruments used in inducing the abortion. All of these cases are operative cases which must be attended to promptly to save life.

TREATMENT OF THREATENED MISCARRIAGE.--Not all of the cases of beginning miscarriage end in miscarriage. If the physician is sent for in time he can very frequently give directions that will, if carried out faithfully, avert the disaster. Success is more likely to attend those cases in which the trouble has been caused by some accidental injury, as a fall, or blow, or extra exertion. This is more especially the case if the woman has previously borne children, is healthy and in good condition and whose womb is known not to be diseased. In these cases there is a partial separation of the fetus from the wall of the womb, which causes the bleeding. The physician will direct that the woman be put to bed, in a quiet, darkened room. He will instruct the nurse to sterilize the external genital region: a sterile gauze dressing is then left in place. Some form of prescription will be given to diminish the patient's nervous fear and to allay any tendency on the part of the womb to contract. It is always essential and very important to save everything that pa.s.ses from the womb during the course of a threatened miscarriage in order that the physician may know exactly just what the condition is. Each cloth, each clot of blood will have to be examined before the proper treatment can be pursued in safety.

When the miscarriage cannot be prevented it is called an "Inevitable miscarriage."

TREATMENT OF AN INEVITABLE MISCARRIAGE.--In these cases every precaution is taken, just as in a normal confinement, to avert blood poisoning. The hands, instruments, dressings, etc., are carefully rendered sterile and the whole field must be surgically clean. The physician will conduct the case as conditions justify and as the situation develops.

AFTER TREATMENT OF A MISCARRIAGE.--It is one of the many thankless tasks of a physician's life to insist on each patient staying in bed at least ten days after a miscarriage. The average woman and frequently the intelligent woman fails to appreciate the absolute necessity for this procedure. It is necessary and it is the physician's duty to insist on it being done in the interest of the woman. Many of the mult.i.tude of diseases of women are caused by disregarding advice on such occasions.

THE TENDENCY TO MISCARRY.--If a woman, for any reason, has had a miscarriage, her womb will tend to miscarry at the same period during a subsequent pregnancy. If the miscarriage should occur during her first pregnancy the tendency to miscarry will be greater than if acquired after she has had a baby.

This is one of the reasons why young wives often fail to have children.

They "get rid" of the first one or two, because they are not ready to have children, or because they want some enjoyment themselves before they are tied down with a family. Having established the habit their womb has been educated to abort, and it will keep this habit up, much to their astonishment and chagrin.

Young wives should therefore faithfully follow out all the rules of the Hygiene of Pregnancy laid down by their physician, and which are given in detail in this book.

[Ill.u.s.tration: _Courtesy of New York World_

AT WORK WITH THE CALIPERS

Watching carefully the physical development of the child month by month is one of those many little things which may result in disaster if neglected.

Abnormal development, or lack of development, should be promptly reported to the physician, as it may be a warning of serious trouble.

For the table of standards, mental and physical, adopted by the American Medical Society see page 271.]

THE BABY

CHAPTER XVI

HYGIENE AND DEVELOPMENT OF THE BABY

What to Prepare for the Coming Baby--Care of the Newly-born Baby--The First Bath--Dressing the Cord--Treatment After the Cord Falls off--A Pouting Navel--Bathing Baby--Clothing the Baby--Baby's Night Clothes--Care of the Eyes--Care of the Mouth and First Teeth--Care of the Skin--Care of the Genital Organs--Amusing Baby--Temperature in Children--The Teeth--The Permanent Teeth--Care of the Teeth--Dent.i.tion--Treatment of Teething--How to Weigh the Baby--Average Weight of a Male Baby--Average Weight of a Female Baby--Average Height of a Male Child--The Rate of Growth of a Child--Pulse Rate in Children--Infant Records, Why They Should be Kept--"Growing Pains."

WHAT TO PREPARE FOR THE COMING BABY.--The physician should instruct the young wife just what to provide for the coming baby. The following list will be found useful as a general guide.

An ordinary clothes basket, padded and lined, is quite sufficient for the first month; or, a baby crib, which may be cheap or expensive as the individual taste dictates. The Taylor crib is probably the handiest and best one on the market.

Pin cushion;

Puff-box and puff;

Soap box containing pure castile soap;

Hair brush and fine comb;