THE HYGIENE OF MENSTRUATION

Lack of Cleanliness During Menstrual Period--Superst.i.tious 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 superst.i.tious 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 v.a.g.i.n.al douche.

Some consider it a useless and unnecessary luxury; while some orthodox puritanical women consider it an unG.o.dly procedure (forgetting that cleanliness is next to G.o.dliness) 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, pota.s.sium 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 Spermatozoon by Ovum--Activity of Impregnated Ovum in Finding Place to Develop--Pregnancy in the Fallopian Tube and Its Dangers--Twin Pregnancy--Pa.s.sivity of Ovum and Activity of Spermatozoon Foretell the Contrasting Roles 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 spermatozoon 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 s.e.xual 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 spermatozoon 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 pa.s.sive, their movements become more and more rapid, they seem to be attracted to it as if by a magnet, and finally one spermatozoon--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 spermatozoon 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.

[Ill.u.s.tration: SPERMATOZOoN 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 spermatozoon 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 spermatozoon 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 spermatozoon 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 ma.s.s 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 spermatozoon, 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 spermatozoon, 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 pa.s.sive. The spermatozoon, on the other hand, is in a state of continuous activity from the moment it has been e.j.a.c.u.l.a.t.ed 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 role throughout life is a pa.s.sive 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 s.e.xes] 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 spermatozoon, 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 ma.s.s 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 ----------------------------------------------+-----