Preparing For Motherhood - A Guide For The Expectant - 4m6n6h

Bernarr Macfadden

Preparing for Motherhood

A Guide for the Expectant

Macfadden Publications, Inc. 1923 - New York City 1st Digital edition 2015

Preface

M OTHERHOOD is the crowning glory of a woman’s life. It is the fulfillment of all that has been promised to her. It gives life. A new meaning. In the heyday of youth its important is not recognized. It is put aside, deferred until a later date. And the mistakes resulting from this attitude bring harrowing tragedies into the lives of a myriad of women. The savage mother knows but little of those terrors that are so agonizing to the civilized mother. The body of the savage mother has been prepared for motherhood. It is strong, vital, splendid. The same can not be said of the civilized mother. This book attempts to bring the vitality and vigor of savage life to civilized life. Mothers should be vital, vigorous—splendid physical types, in order to go through the crisis of motherhood easily and safely. Motherhood can not be made absolutely painless. It is not natural that it should be so, but pains that serve a beneficent purpose, that are the result of the normal functioning of the organs, can not ultimately harm the mother. We believe that the crisis of motherhood can be relieved of practically all of its dangers—that the pains associated therewith can be reduced to a minimum, and that every mother can so develop and strengthen her body that her progeny will be possessed of the vitality and vigor that bring beauty and charm. A strong beautiful baby—what is such a gift worth to a mother?

And it lies with the mother. Her baby can be hardy, and a splendid specimen of babyhood in every way, if she has properly trained her own body—if she has prepared herself for motherhood. This book attempts to help in a very practical way toward this preparation, and also to suggest methods whereby the ailments commonly associated with motherhood can be prevented or relieved. In the birth of my own children I always engaged a midwife. My wife wanted to dictate how she was to be cared for, with my help, and because of her unusual strength she was unwilling to comply with the usual rule of lying in bed for a number of days after parturition. On ore cold winter’s night while the windows were wide open, she got out of bed and waited on herself in an emergency in which she should have had assistance. As a result of this rash experiment she was almost stiff from the cold during the whole night ; and the next morning, when I learned of the situation, I was seriously alarmed. The danger was averted, however, by a simple yet truly marvelous remedy. I refer to the exclusive milk diet. Warm milk, to the extent of an eight-ounce glassful every half hour, was taken by the patient, and the serious symptoms, stiffness, and soreness gradually began to abate, disappearing entirely in twenty our hours. On another occasion this same diet apparently saved her from blood poisoning. The womb had not entirely emptied itself. About twenty-four hours after the birth of the child very serious symptoms of weakness, approaching semiunconsciousness, appeared, and again the exclusive milk diet, to the extent of five to eight quarts per day, was used. In a few hours the patient gradually began to improve, and three or four days afterward the remnants of the afterbirth that had remained in the womb, the cause of the trouble, were expelled without difficulty. In serious emergencies of this nature the exclusive milk diet seems to be a truly marvelous means of helping the natural processes of the body to save life. More complete details of this and many other measures which have been found useful in the preparation for and the final crisis of motherhood have been plainly presented herein.

Various medical and literary experts have helped in the preparation of this material, with a view to making sure that it should be complete in every respect. The book is not presented as a substitute for the doctor or midwife. It is sent forth as a guide to married persons who want to learn more about the subject. The information it contains will undoubtedly be of use while the doctor and midwife are on the way, or when a sudden crisis arises. Sometimes expert help arrives too late. That is the object of this book. May it go forth with its message, bringing to our mothers and their children that strength and vitality without which we can have no national power or permanence.

Table of Contents

PREFACE

I. THE NEW MOTHERHOOD Not necessary to lose one’s figure. Why civilized women suffer more than women who live close to Nature. Every baby a prize baby. How number of stillbirths can be reduced. The status of the unmarried mother.

II. WHAT MOTHERS SHOULD KNOW ABOUT EUGENICS Influence of heredity. Cousin marriages. The phenomenon of twins. Don’t marry without a physical examination. How sterility is brought about. Health a question of vitality and pure blood. Eugenics largely a matter of good health and nutrition during pregnancy. Determining the sex of your child.

III. MAKING MOTHERHOOD SAFE AND EASY The easy labor of the Indian mother. We can lessen but not abolish pain. A safe birth more important than a painless birth. Exercise to keep the baby small. The status of “twilight sleep.”

IV. PREPARATION FOR CONCEPTION General hygienic measures. How to exercise. Strength is safety. Prenatal impression. Intelligent birth control.

V. THE SIGNS AND PROGRESS OF PREGNANCY The menstrual cycle and its meaning. The function of the ovaries. How the egg enters the uterus. The first symptoms of pregnancy. How the breasts change in pregnancy. Nausea and vomiting. Bladder symptoms. “Quickening.” How long does pregnancy continue? Table of pregnancy.

VI. DIET IN PREGNANCY The exacting food requirements of pregnant women. The importance of the mineral elements. Destruction of the tissues. Bone disease from deficient diet. Diet to overcome nausea. Avoid drugs and alcohol. The value of a limited fast.

VII. EXERCISE DURING PREGNANCY The foolishness of “false pride.” The correct way to walk. Strength-building exercises. “Innerbuilding” exercises. Importance of bodily carriage. Oiling the muscles of the abdomen. Relieve pressure by going on all fours. Massage and exercise for varicose veins. Planning your exercise time.

VIII. BATHING DURING PREGNANCY The function of the skin. The influence of the bath. Hot baths depressing. Stimulating effect of the cold bath. The internal bath. How to take an internal bath.

IX. THE IMPORTANCE OF REST Rest most important in last three months of pregnancy. Overwork should be studiously avoided. When the weight of the womb causes sleeplessness. Aids to

rest and proper relaxation. Sexual intercourse during pregnancy. Should a pregnant woman travel? The benefits of mental diversion.

X. GENERAL HYGIENIC CONSIDERATIONS Visit your dentist. Don’t neglect the hair and scalp. How to shampoo the hair. For the general health. Mineral oil tends to prevent hemorrhoids. Care of the nipples. Should pregnant women douche?

XI. SYMPTOMS AND ILLS OF PREGNANCY Knee-chest position to prevent nausea in pregnancy. The importance of guarding against kidney trouble. Uremia and its treatment. The emotional impulses of the expectant mother. Weeping spells. Varicose veins. To prevent varicose veins. How to prevent miscarriage. The present day treatment of abortion. Leg cramps.

XII. CLOTHING FOR PREGNANCY AND LACTATION The chief function of clothes is to keep the body warm. About the underwear. Taboo the corset. The outer garments. Footwear.

XIII. PREPARATION FOR CHILDBIRTH The orange diet. Exercise during the final weeks.

XIV. MAKING THE BIRTH EASY The processes of labor. Some detailed advice. Deep breathing a help. How to prevent a tear. To prevent hemorrhage. Most common irregularities of labor and their management. Retained afterbirth. First care of the asphyxiated child. Care of child in normal birth.

XV. DIET, GENERAL CARE, AND HYGIENE DURING “LYING IN” The milk diet. Need for sleep. Care of the breasts.

XVI. GETTING UP AFTER CONFINEMENT Civilized women not necessarily weak and delicate. The recuperating period not a period of sickness. The lochia. The process of repair. Cleanliness is essential. Should a woman sit up in bed? The abdominal bandage. Do not “slump over” when sitting up. What eminent physicians now advise. Posture after labor. The return of the menstrual flow. The return to normal weight.

XVII. EXERCISES FOR QUICK RECUPERATION FOLLOWING CONFINEMENT Exercising to increase milk supply. Exercise of the right kind the greatest aid. ive motion at first. Beginning exercises. More advanced exercises.

XVIII. AMAZING REMEDY FOR BLOOD POISON

XIX. GENERAL CARE AND HYGIENE FOLLOWING CONFINEMENT

XX. DOES MATERNITY MEAN THE LOSS OF YOUR FIGURE?

XXI. KEEPING THE BREASTS FIRM AFTER CHILD-BIRTH

Chapter I

The New Motherhood

M OTHERHOOD, today, has taken on a new meaning. The problems of eugenics are everywhere discussed, and thousands of intelligent women the world over have ed in the general movement for improving the human race through better motherhood and more perfect babies. “Preparedness” for motherhood must be the plan of the future. The oldfashioned, ignorant way in which a woman arrived at the most important function and crisis in her life, utterly without preparation, is out of date. The women of the future will fit themselves for maternity, just as men and women in any profession prepare themselves for their life work. The experience of bearing eleven children and burying nine is for the most part a thing of the past. But, unfortunately, much of the ignorance that made such conditions possible still prevails, and it is the duty of everyone to help in bringing to others the knowledge that makes for natural and healthy motherhood. The New Motherhood is the result of natural living, instead of the unnatural habits and conditions of life common in civilization. It is the result of intelligent and a right understanding of everything which concerns this glorious phase of a woman’s life, instead of ignorance and superstition. The New Motherhood, means that a woman is truly prepared in every way to live up to the sacred responsibilities that come with maternity.

Should not impair health

The first great truth about natural motherhood is that the weakness and invalidism following childbirth, and to a large extent the suffering incidental to it, are unnecessary in most cases. There is no real reason why maternity should leave a woman a physical wreck. It should not be regarded as a curse—an experience to be dreaded. On the contrary, it is to be regarded as merely a fulfillment of the highest function of which a woman is capable. And instead of impairing her health, it should only serve to bring about that condition of complete maturity, physical, mental and spiritual, to which no woman can attain who has not been a mother. Among the reasons most frequently put forward by women for shirking maternity has been the fear of “losing one’s figure.” This seems to be an even more important consideration in some cases than the supposed danger of losing physical vigor or health. But there is positively no reason why any woman should lose her “figure” through motherhood. If she really has a figure that is worth keeping, if she has the bodily development and strength that should be the possession and pride of every woman, there will be no loss of vitality or of bodily beauty as a result of this perfectly natural function. Animals do not suffer in this way. And neither do women in a normally vigorous condition. It is only when a woman is physically unprepared for the demands of child-bearing that she experiences any impairment of her figure. In other words, it is only the weakling—the woman who has reason to be ashamed of her physical condition—who is likely to suffer materially in this respect. I shall have something very important to say on this head in a later chapter. I do not mean to say that childbirth is not something of an ordeal, under the best conditions. It is an event of great importance, and is preceded and followed by physiological changes and processes of an extensive character. But at the same time, it is a purely natural function. In a healthy woman it should not occasion much inconvenience, and certainly should involve no loss of beauty.

Why civilized women suffer more than women who live close to nature

It is a widely known fact that the women of savage races have comparatively little trouble in childbirth. Civilized women, on the other hand, seem to have lost to some extent the capacity for normal parturition, as a result of our artificial standards and habits of lik. But women only seem to have lost this capacity, for with suitable care, training and physical preparation, the civilized woman is just as strong and healthy as any savage, and may have little or no trouble in confinement. In short, the new motherhood is really the old motherhood. It is a return in many respects to the natural conditions of our remote and primitive ancestors. The fact is that if a woman is able to through and survive this crisis, she should be able to recover the fullest degree of health and strength. If not, there has been something radically wrong with her past habits and her physical condition. There is no doubt that in most cases trouble of this kind is due to lack of preparedness for this particular phase of woman’s life. We know now that maternity does not necessarily mean the sacrifice of the mother for the sake of the child, as so many women used to think. Motherhood is not a sacrifice, but a fulfillment, a realization of a woman’s true destiny. More and more it is coming to be recognized by progressive and high-minded women as a divine privilege, and not as a punishment. Under proper conditions of physical health, and with healthy, normal children, it is not a trial, but a blessing. In only too many cases the childless woman learns, too late, what she has missed, and lives out her lonely, empty life with a heart that aches for the touch of little hands that might have been, but which she would never allow to come into the world. The one crowning sorrow of any true woman’s life is childlessness, and there is nothing in Heaven or on earth that can fill the void. Therefore, make no mistake, you who are young and have the fruitful part of your life still before you.

Every baby a prize baby

A healthy baby should not be a burden, but a joy, and there is no reason in this wide world why practically every baby should not be a prize baby. It is purely a matter of intelligent and successful motherhood. If one can through the crisis of getting into the outside world, and be born alive, then he should certainly be able to stay alive for the best part of a hundred years. If not, there is something wrong with his care, feeding and surrounding conditions, or with the influences that have had to do with his creation. It is, of course, true that there are cases in which a bad start in life can never be overcome. There is such a thing as the transmission through heredity of an unsound nervous or mental make-up, and there is also such a thing as a germcell so poisoned that healthy life can not possibly spring from it. Consideration of such conditions belongs to the field of eugenics, but in practically every ordinary case a baby secures a good start in life if the parents are healthy and capable of taking proper and intelligent care of their young. And it is to the average case that we must give our attention. There are a few who profess a certain scorn for modem hygienic methods of baby care, and who talk sentimentally about the virtues of the “good oldfashioned mother,” who brought a large family of children into the world and who loved them in the good old-fashioned way. Such persons, however, forget to mention the “old-fashioned” baby funerals which resulted from the system they ask us to ire. There has been much reduction in child mortality in recent years, but there are still too many sick babies, too many baby funerals, and far too much ignorance on the subject of infant care. The death-rate of infants in the United States is just about twice what it is in New Zealand, which shows that half of the babies that die each year in this country could be saved if our women were, on the average, even as well informed on these matters as are the women in New Zealand. And, without doubt, even there the infantile death-rate could be reduced by half, or perhaps nine-tenths, if every mother in the land could be physically fitted for

motherhood in the first place, and then prepared by education for the task of caring for her children in a way to ensure their health and vigor.

How still-births can be decreased

What can be done to reduce the deaths of newborn children by the application of a little intelligence to the problem is well illustrated by an experiment of the New York Milk Committee, the report of which is published under the timely caption, A Baby Saved Is a Citizen Gained. The experiment covered a period of four years, and during this period 3,145 expectant mothers were kept under supervision for approximately three and a half months before, and one month after, confinement. Each mother was visited in her home every ten days by a specially trained nurse, and whenever necessary by a physician. In addition every mother was examined for ab-formal conditions, and received treatment for any such as were discovered before her baby was born. Much attention was also given to co-ordinating the activities of the various agencies whose cooperation and services were needed for the health of the expectant mother and her family. Three thousand one hundred and ninety-two babies were born to 3,145 mothers. Of these 113 were still-births and 86 others died during the first month after birth. The still-births per thousand of these cases were 36 against 46 for the Borough of Manhattan as a whole, as shown by the figures of the Board of Health, a reduction of twenty-two per cent. The rate per thousand of deaths under one month was 28 against 39 for the Borough, or a reduction of twentyeight per cent. Out of the whole group of mothers only five died, giving a rate of 1.5 per thousand mothers, against a rate of 4.9 per thousand in the Borough at large, or a reduction in the maternal mortality rate of sixty-nine per cent. All over the world there is now an increasing recognition of the necessity for a better preparation for maternity.

“Motherhood Schools” are being established, in which information tending to fit the young mother, or the prospective mother, for her duties is imparted. In many of our most advanced colleges for women, the girls are even taught how to bathe and dress the young baby—a real, live baby being used for purposes of demonstration.

The status of the unmarried mother

It is also a splendid sign of the increasing liberality of the times that there is growing a gradual recognition of the rights of the unmarried mother to adeguate protection—both by the State and by society at large. In many of the European countries, at the present time, unmarried mothers are, by law, entitled to practical recognition as legal wives, and their children are recognized as “legitimate”— with full right to claim from the father, whether he be single or whether he be already the husband of another woman. Also, in this country such measures as the Sheppard-Towner Bill will make it easier for women—especially in the country districts, or in the sections remote from hospital facilities—to avail themselves of the skilled care of obstetricians in their hour of trial—and this at an expense that is practically negligible. The Sheppard-Towner Bill provides for a national appropriation, to meet an equal appropriation from the states, for the promotion of the hygiene of maternity and infancy. It will furnish for the women of the various communities lectures, publications, illustrations, and demonstrations concerning diet, hygiene, and activities of the pregnant woman, and these will be in charge of doctors and trained nurses. This service must necessarily react to the immense advantage of mother and child—and incidentally to the welfare of countless generations yet unborn. And anything that helps mothers and babies is of paramount important from a standpoint of economics, humanitarianism, and social welfare-on the biggest and

broadest possible scale.

Chapter II

What Mothers Should Know About Eugenics

E VERY woman is more or less interested in eugenics, or race improvement. For it is her natural desire that her children shall represent the very finest type of manhood and womanhood possible. A general understanding of the fundamental principles of this new science is therefore of advantage. There are two main aspects of eugenics. One of these has to do with the hereditary qualities transmitted. The other has to do with matters of health, vitality, and pure blood, so that, irrespective of questions of family and heredity, the most healthy and best possible babies will be brought into the world. Both sides of the question are important. For the woman who is already married, there is little use in discussing eugenics in relation to heredity, but for the young, unmarried woman, this is worth careful consideration. The practical and important thing for the young woman to know and to is that in choosing her husband she is selecting the father of her children. Also, she should know that not only must she expect his personal qualities to reappear in greater or less degree in her children, but that some of the qualities possessed by the other of his family will also be manifested in them. Even though the young man whom she thinks of marrying may not have any objectionable characteristics, yet if either of his parents are abnormal, or if his grandparents, brothers, sisters, aunts, or other of his family, are mentally defective in some way, or fundamentally abnormal, some of these

undesirable traits or characteristics may crop out in his children. The point is that it is not only the individual, but the family stock as well, that counts in heredity. As a husband and companion, you marry only the one man; but as a parental possibility, you practically marry his family. We used to be told that the surface qualities of an individual, resulting from education and environment, are not transmitted to his children, that the qualities with which he was born are the only ones handed down. In view of recent discoveries we may have to modify this view, but the family stock seems still to be the dominant factor in heredity. A man of good, sound inheritance and levelheadedness may have been deprived of educational opportunities, may be unable even to read or write, and yet, because he comes from good stock, may possibly be even more satisfactory as a parent than another with poorer natural endowments, but who has had the benefit of educational and other advantages. It is always well to investigate not only the parents, but the grandparents of your prospective mate, as well as your own, to observe the possibilities that may be expected to be realized in your own children.

Genius often borders on insanity

It is not always best to marry into a family characterized by genius. Ability and strong mentality are desired, but genius is often unbalanced. As a rule, the inheritance of strong nerves, vigorous health, and a good, hard-headed, practical intelligence is far better than the erratic and uncertain qualities of genius. The fact is that most people have satisfactory inheritance, and under the best conditions of health and vitality can expect to have formal, healthy, and vigorous children. It is only in the exceptional case that one will find insanity, epilepsy, imbecility, feeble mindedness, crime, .or congenital defects that make marriage inadvisable. Children of the same family usually differ materially, and sometimes widely, for the reason that they really are the product of a somewhat different heredity, in

spite of the fact that they have the same parents. This is due to the fact that there are four grandparents, eight great-grandparents, and so on, and that the various children of the same parents may derive their inherited makeup from different ancestors. In fact, children often resemble a grandparent more closely than either immediate parent. The explanation is somewhat technical, and would require a little study of biology.

Seek health in your mate

Therefore, seek health in your mate. Assure yourself that his or her family does not consist largely of who are confined in the insane asylum or the penitentiary. Or that they are not addicted to the excessive use of drugs, alcohol, or tobacco. Also that they are free from epilepsy, syphilis, and scrofula. See to it also that the one you are to marry is not actively tuberculous nor afflicted with kidney disease; it is difficult enough to live ideally in the married relation when both parties to the marriage are physically vigorous. And right here I want to say to all young women—never marry a drunkard, hoping or expecting to reform him. Make up your mind that if a man will not stop drinking for you before you are married, there isn’t one chance in a million that he will cease after you are legally bound to him. Always that there is nothing, except syphilis, that is so likely to blast the germ-cells and handicap the little new life that is struggling into existence as the influence of alcohol. Professor Stockard demonstrated that when guinea pigs were kept under the influence of alcohol for some time their procreative cells were harmfully affected. Males so poisoned begat defective offspring, even when mated with perfectly normal females. The chief effect noticed was in impaired vision, and so profound an impression had alcohol stamped on the diminutive piggies that this defect was transmitted through three generations. There were also many instances of matings followed by negative procreative results, or early abortions, still-born young, or defectives.

Other experiments proved that when half a dram of alcohol was given to guinea pigs during their period of pregnancy, the young, even though alive at birth— which occurred but rarely —invariably died within six hours after birth. Also, I want to say to women that the appetite for liquor implanted by the mother —who perhaps, even under a doctor’s direction, is taking ale or porter “to strengthen" her and increase her supply of milk—tends ultimately to make her child an inebriate—if he grows to man’s estate. Other things being equal, breast-fed infants, nursed by mothers who use alcohol, are more subject to convulsions, are more restless and irritable, than infants of non-drinking mothers—all of which symptoms clear up when the mother is induced to substitute pure milk for her alcoholic potion.

Cousin marriages

There has been a great deal of discussion as to whether or not it is expedient to marry a person to whom one is closely related. So great is the prejudice against these “consanguineous marriages," as they are called, that in many countries marriages of first cousins are forbidden by law, or entered into only after special dispensation or permission has been granted. The prejudice which exists against consanguineous marriages, according to Westermarck, Ellis, August Bebel, and other authorities on sociology and ethnology, is based upon an ancient feeling which has been developed in the evolution of the race. Among certain of the ancients, notably the Egyptians, brother and sister marriages were not at all uncommon. Marriage of uterine brother and sister—socalled because of the fact that both sprang from the same mother—was of frequent occurrence, indeed almost universal in the royal families. The Ptolemys, as Dr. Wm. J. Robinson points out, were neither sterile nor particularly shortlived ; they were not more subject to disease than would be

expected from their luxurious habits ; they were no more stupid than the generality of people—nay, some of them were singularly sharp-witted. Cleopatra, the daughter of a brother and sister, and a great-great-granddaughter of Berenice, who was both cousin and sister to her husband, might with advantage compare in astuteness with Catherine de Medici of . In the fullness of time, however, inter-tribal marriages, or marriages between of the same tribe or clan, became more or less taboo. This feeling resulted from the fact that dose affiliation from earliest childhood unconsciously produced in the growing boy and girl such a degree of familiarity with one another that the mysterious attraction essential to the development of the sex impulse was totally lacking. This, in point of fact, is the physical and psychological basis of our present antipathy to sexual intercourse with one who is a near relation. The violation of this instinct constitutes incest, ed one of the greatest crimes among civilized races. This feeling, however, should not exist in the case of cousins, even though they have been raised in the same household. With cousins, provided the blood strain is pure, there is absolutely no reason why marriage should not be consummated. Where the blood is pure their association in marriage can be productive only of good results, so far as bringing healthy, well-nourished children into the world, is concerned. In the event, however, that either party to the marriage may be diseased, or lacking in that robustness of constitution necessary to bringing the best and healthiest of children into the world, such a union is not to be condoned, because the intensification of faults and hereditary traits would be almost assured by the fact that on both sides there would be approximately the same physical difficulties. And if there is an abnormal tendency present in both parties to a cousin marriage, that abnormal tendency will be very greatly magnified in offspring. Broadly speaking, then, if both parties to the marriage are sound, healthy, and robust, there is no reason why they should not marry. If there is the slightest defect on either side, it might be best to forego the marriage.

The phenomenon of twins

There is considerable misapprehension on the part of women generally as regards the development and birth of twins. Just a word as to the physiological basis of this phenomenon may be of interest here. There are, in every normal woman, at the period of puberty, approximately 60,000 to 70,000 embryonic eggs. One of these matures every twenty-eight days in the ovaries, and is discharged through the Fallopian tubes into the uterus. If at this time the spermatozoon of the man be brought in with this egg, it immediately penetrates the gelatinous envelope of the latter, mingles with its substance, and forms a nucleus from which the future embryo will be built. On rare occasions two, three, or even more of these eggs may happen to mature at the same time, and find their way into the uterus. If, at this time, conception be brought about, each. One of these eggs is likely to be impregnated. This brings about the double, triple, or quadruple impregnation, as the case may be, resulting in twins, triplets, or quadruplets. This, I believe, will clear up the erroneous impressions that many women may have had regarding this marvelous function of multiple reproduction.

Don’t marry without a physical examination

One other point I wish to emphasize strongly —and this is of especial interest to women. Don’t, I beg of you, marry any man who is not willing to undergo a physical examination as to his fitness to be married. If he is clean and fit to become a father, he will not object to having your physician examine him so as to as sure you that your husband-to-be is not afflicted with some loathsome venereal disease that might not only ruin your life, but also might render you

absolutely sterile, or else blast your child from birth. Many people refer to these disorders as the “black plagues." In discussing this matter in her very helpful book, Herself, Dr. E. B. Lowry says: “By black plague we mean the two diseases spoken of by physicians as the venereal diseases, because they usually are contracted during sexual intercourse. The most common of these diseases is gonorrhea, or ‘clap,’ as it often is called by men. How common it is may be judged by a statement made by a professor to his class in the medical college that at least eighty per cent of the men in the world have contracted it some time during their lives. Even the most conservative give the estimate as sixty per cent. “The prevalent idea common among men that it is no worse than a cold—a mere annoyance that all men must expect and endure some time—is lamentable. The persistence of the disease in the deeper structures long after it outwardly is cured leads to unexpected communication of it to women, among whom may be the young wife. As a result, she enters upon a period of ill-health that ultimately may compel the mutilation of her body by a surgical operation to save her life. Much of the surgery performed upon the female organs has been rendered necessary by disease contracted from the husband. “A few little germs of this disease left on even the external organs may find their way up through the vagina to the uterus or womb. Here they may produce an inflammation of the lining of the womb, causing severe pain and other symptoms, such as profuse discharge. The germs may go farther, or the inflammation may extend from the uterus to the Fallopian tubes. When we consider that the age through the tubes is only about as large as a broom straw, we see what serious trouble may result. The tubes become enlarged and filled with pus. The opening from the tubes to the uterus becomes closed, so there is no way for the pus to escape. “The accumulation of pus, or the products of septic inflammation, stretch the walls of the tubes until the little nerves in the walls cry out in rebellion. The pain becomes so great and the reflex symptoms are so aggravated that finally the woman resorts to the only relief—an operation for the removal of the tubes.

How sterility is brought about

“When we consider that the ovule, the human egg, must travel through these tubes to reach the uterus, and, if the tubes are destroyed, has no other way of reaching the womb, and if it can not reach the womb and be impregnated, can not develop into the babe, then we realize how this disease is dooming women to childless liveswomen whose natural instincts and desires cry out for motherhood. When we consider the factors that promote rate suicide, we must not forget this important one. Even though the woman refuses an operation, or in a case in which the inflammation is not so severe and is reduced until she is nearly free from pain, the result may be the same, for the tubes may remain closed permanently. “The closure of the tubes is not the only result that may follow the course of this disease. The infection may extend into the peritoneal cavity, causing peritonitis, which so often results in the untimely death of the woman. “The other loathsome disease, syphilis, infects the blood, and therefore all parts of the body. While under proper treatment it is not dangerous to life in the earlier years, yet the possibilities of conveying the contagion are numerous. In the second stage, which lasts for a number of weeks, the mucous patches in the mouth are a source of danger. In this stage the disease may be conveyed by a kiss, or through the medium of the public drinking cup, towel, or anything that comes in with the virus. It may be contracted by a babe from a wetnurse, or the nurse may contract it from the babe. “The most serious results of this disease appear years after its initial appearance, when the individual has been lulled into a false sense of security by long freedom from its outward symptoms. Many of the obscure cases of stomach or nerve trouble may be traced to this disease. The results not only affect the man, but, should he marry and have children, his innocent babes may come into the would with an inherited taint. These children seldom live to reach adult life and their lives usually are burdensome and full of misery. They may be deformed, or be continually afflicted with ulcers or other horrible manifestations of the disease."

While it is my firm conviction that the loathsome and deforming results of syphilis are due almost entirely to the medical treatment for it, rather than the disease itself, I would urge you to take no chances with a man who is not physically sound and clean. The risks are too terrible. But that even if he is found infected, he can be cured, if only he will take appropriate treatment —for the proper length of time. And, if you and he but knew it, that treatment is as natural and harmless as is the treatment for any other disease.

Health a question of vitality and pure blood

However, assuming that there are no special taints in the family stock, eugenics then becomes really a question of vitality, pure blood, and vigorous health. The best heredity in the world is not satisfactory where vitality is lacking. You should not expect to reproduce unless you are fit to reproduce. This applies both to the father and the mother. Granted that the hereditary qualities on both side are satisfactory, it is essential that you should be at your best, physically, in order to produce superior children. This is a factor in eugenics of tremendous importance, and if such conditions could be secured, it would raise the human race, in two or three generations, to a level of strength, beauty, and intelligence such as has never been known in the history of the world. There are two chief considerations: first, the condition of both parents prior to conception; and second, the health and vitality of the mother during pregnancy. It is hard to say which is the more important. You can not expect the best children unless the germ-cell from each side is healthy and vital. This depends upon pure blood and vigorous health in both parents for some time previous to conception. It is a crime to bring a child into the world under any other conditions. Perhaps I do not need to say anything further just here about good health and satisfactory diet as a means of insuring pure blood before conception, but it is important to know of the effect of various poisons. The germ-cell is nourished and made vital if the blood is rich and pure.

It is not generally known that lead poisoning is particularly disastrous to the germ-cell, and, in many instances, the cause of weakened or mentally defective children. Those engaged in painting ( with lead paint), or in plumbing, to the extent of producing even slight lead poisoning, should not become parents. Such a man or woman should follow some other occupation for a time, perhaps a year, in order to free himself from the effect of this chronic poisoning, and attain a condition in which he or she may be the parent of healthy children.

Eugenics largely a matter of good health and nutrition during pregnancy

Now, granted that conception has taken place under favorable and satisfactory auspices, eugenics then becomes simply a matter of health and good nutrition during pregnancy. It is the purpose of this book to impart knowledge which, if put into practice, will insure satisfactory conditions of this kind, What I have said about alcoholic tonics and poisons generally, applies equally during pregnancy. Do not drink beer, malt, or tonics of any kind, on the theory that they will “build blood." They do nothing of the kind. Milk, if it is relished, fruits, green foods, and uncooked foods generally, will do infinitely more than any of these tonics could even pretend to accomplish. Such tonics are harmful in the highest degree, and tend to exaggerate the ordinary discomforts of pregnancy. Pure food and pure blood are of the greatest possible import. With these, and with a calco condition of mind, you need have no more fear or apprehension of the ordeal of childbirth than you have of any either normal function.

Determining the sex of your child

Much has been written on the subject of predetermining the sex of the child to

come. The oft-repeated question, “Will it be a boy or a girl?" is one that causes both parents profound consideration. As far back as 1672, according to Dr. E. Apert, a French physician collected two hundred and sixty-two different theories bearing on the determination of sex, all of which he considered to be absolutely without foundation. Ile then advanced a theory of his own, which time and experience have proved to be equally erroneous. I myself have given this matter much thought and study, and have investigated the reports of the various methods advanced for the pre-determination of sex. The theory which excited the greatest amount of interest in modern times was that of the late Dr. Schenck, of Vienna, who insisted that favorable conditions, particularly of nourishment and temperature, are likely to favor the birth of a daughter ; while under-feeding and hard work on the part of the mother tend to produce males. Needless to say, Dr. Schenck’s theory, when tested out on a considerable scale, was found to be fallacious; whatever favorable results appeared to develop from its application could invariably be ascribed to mere coincidence. And this was true with practically every other method. Some time ago, however, I became acquainted with the theory which several American physicians, among them Dr. Emile Reeber, claimed to have originated. A German scientist tested the theory on a most elaborate scale by tabulating the time when, during the war, soldier husbands would return home on furloughs. Families in which he was interested gave this doctor ample opportunity for testing. The secret is, like most really profound things, quite simple. The length of time elapsing between menstruation and conception determines the sex of the child. If, for instance, conception occurred in from one to five days after menstruation, the child was almost certain to be a girl. The longer the period between menstruation and conception, the stronger the tendency to produce a male child. I have strong reason for believing in the truth of this observation. I have gathered an immense amount of data on this particular phase of the subject, much of it

embodied in hundred of personal letters from those who have had successful experience with this plan of sex control. All this data I am sifting and collating, and I may submit the entire matter in a comprehensive book on the subject.

Chapter III

Making Motherhood Safe and Easy

I S it possible to avoid or to lessen the pain and suffering incidental to childbirth? And can maternity be made safe? These are questions of profound interest to every woman. Motherhood is almost universally dreaded, not only because of the pain commonly experienced, but also because of the serious injuries known to be suffered in some instances. There is even the element of danger to life itself. For, while the general mortality of childbirth has been reduced from ten per cent to a fraction over one and onehalf per cent—by improved technic, by the introduction of strict antiseptic precautions, and by the use of anesthetics to prevent the exhaustion and collapse accompanying extreme pain—it is still too high. So every man and woman in the world is anxious to see labor made easier and safer. Now, how can this best be accomplished? To what extent can the difficulties and dangers associated with this ordeal be overcome? There is no doubt in my mind that to a large extent the troubles experienced in connection with childbirth are due to the weakness and the physical unfitness of women living under the artificial conditions of civilized life. Safe and easy childbirth is largely a matter of satisfactory bodily condition, as is shown by the maternity experience of the women of savage races, as well as by the ease with which many of the rugged and healthy peasant women of Europe through this ordeal.

The easy labor of the indian mother

As a rule, the Indian mother thinks very little of the difficulties attending childbirth. According to many reports, it is not at all uncommon for a squaw, when the tribe is on the march, to stop by the way for a half-hour, deliver herself of her child, perhaps wash it in a near-by stream, and then, without concern, proceed to overtake her people if they have gone on ahead. Furthermore, it is quite the usual thing, not only among the Indians but among African tribes and savages in other parts, for a woman to take up her ordinary work immediately following parturition. The freedom from corsets and constricting clothing, the completely unhampered condition of the body, the muscular excellence and natural living, all are conducive to a state of physical health as well as strength and elasticity of body that makes motherhood scarcely more than a momentary inconvenience.

“civilized" babies have larger heads

There is one special reason often mentioned by medical writers why the women of civilized races may expect more difficulty than savage mothers, and that is because their babies as a rule have larger heads. This is all the more reason, however, why the civilized woman should exert every effort to make herself physically fit to perform the function of motherhood. But it appears that the small difference in the size of the head should not be sufficient to cause the great extremes of difficulty in childbirth experienced by some of our women as compared with the ordinary savage mother. Motherhood is a physical process, and the stronger you are, the easier the process, and the stronger your children will be. Rarely do parents give any thought to this. Also, the fact that many white women deliver their children easily shows that it

is possible for most women, even of the Northern races, to avoid serious trouble. The fact is that the average woman is more or less unfit for the ordeal. Her methods of dressing, her corsets, her muscular inactivity, her lack of physical development, her mistakes in diet, and her entire mode of living, have been of a nature to unfit her for this, the supreme experience of a woman’s life. She is not capable of what I would term a “natural" childbirth.

We can lessen but not abolish pain

Now, no one claims that an entirely painless childbirth can be brought about as a result of natural living and proper preparation. That would be expecting too much. The same results can not be accomplished in all cases. But at least it is possible to bring about such a lessening of the sufferings involved as would give almost any woman cause to be grateful. However, a safe conclusion and quick recuperation in nearly every case are possible as a result of following the natural methods of preparation advised in these chapters. And these are results worth working for. Surely it is worth while for a woman to avoid the mistakes that make this crisis difficult, dangerous, and even agonizing. It must be understood in the beginning that women differ considerably in build. In some women the construction of the pelvis is such as to make childbirth more than ordinarily difficult. The hips are narrow. The “conjugate diameter"—the width between the pelvic bones through which the child must on its way to the outer world—is less than normal. This is an anatomical condition. Nothing can be done for it. In fact, in extreme cases of this condition, which are indeed rare, women should be advised against pregnancy, or their lives may pay the penalty. Again, lack of elasticity and strength in the muscles and other tissues has a great deal to do with difficult, protracted labor. But while it is not possible to make any material change in the bony structure, at least the condition of the muscles,

ligaments, and other tissues can be satisfactorily influenced. So that even those women who are not so built as to permit of an easy and almost painless birth, may depend upon having a less severe experience as a result of suitable preparation. To a certain extent the age of a woman has a great deal to do with it. A young woman is more likely to have an easy and natural birth. If over thirty, and especially if over forty, when having he’s first child, a woman is far more likely to encounter difficulties, owing to the rigidity of the bones and the lack of elasticity in the tissues and muscles. But that youth is not a matter of years so much as of physical condition; some women are as young at forty as others are at twenty-five and thirty years. It depends largely upon one’s mode of life. Therefore, get in condition if you are to have a child, and keep so to the end.

A safe birth more important than a painless birth

After all, it is having a safe and normal birth that is important, even though it should not be a painless birth. And if this can be secured, the result will be of almost priceless value to any woman. A safe and normal birth with quick recuperation depends upon the health and elasticity of all the tissues, as well as the strength of the muscles. The great trouble is that the body of the average woman, like that of the average man, is choked with dead cells. The tissues are stiffened, unyielding, brittle. Live tissues made up of healthy, new, live cells will stretch; dead or half-dead tissues will tear or break. It is important, therefore, to live an active and healthy life that will enable you to keep all of your bodily structures and cells alive, fresh, and elastic. The methods outlined in these chapters should enable great numbers of women to go through childbirth with comparatively little suffering. Such results have been secured in thousands of cases of physical culture mothers. And it will mean lessened pain, even in the naturally difficult cases. But while we can not promise entire freedom from pain, every woman can be assured that preparation of this kind will mean a safe and quick recovery in practically every case. These methods will ordinarily insure against lacerations, even when the birth is of a

very difficult character, for the stronger and more elastic the tissues, the less danger there is of laceration (tearing) and the more rapid the recuperation. There are occasional instances in which a woman who has led an athletic life, and is therefore muscularly very vigorous, nevertheless suffers considerably in childbirth. But practically in every case of this kind there is compensation in the way of quick recovery. It is possible when one’s physical training has been carried to extremes, as in certain types of athletics, to develop muscles that are a little too powerful and rigid. In other words, while strength is imperative, it is an elastic strength that is required, rather than what might be termed a rigid and muscle-bound condition.

Exercise to keep the baby small

But one of the most important of all reasons for regular exercise is to keep your baby small. A fat baby at birth is usually an indication of a lazy mother during pregnancy. If you become inactive and lounge around, it is almost inevitable that your baby will be heavier and larger than it would otherwise be. And consequently your delivery will be more protracted and more painful than it would be otherwise. So your reward for being energetic, and for taking the proper exercises, which will be outlined very carefully for your guidance, is far greater than you have any present conception of—in the form of safety to yourself and your child, in the greater ease with which you will come through your labor, and in the quicker and more complete recovery that will follow.

The status of “twilight sleep"

In reward to the merits of the “twilight-sleep" treatment, we can not commend it. The doctors themselves disagree on this subject. In many American hospitals where the method has been tried it has been discontinued as unsatisfactory. There is no question, so the doctors claim, that it at least slightly adds to the dangers of both mother and child. There is more danger from hemorrhages, the flow of blood being often difficult to stop, owing, it is said, to the deadening effect of the verve-doping drugs used. Physicians maintain that the effect of scopolamm and morphine—which cause the “twilight sleep"—is so great that the physician or attendant must pay the greatest possible attention to the pulse-rate, respiration, and mental reactions. On the other hand, it may be possible that in some cases, especially with extremely nervous women, the “twilight sleep" may be advisable. But when a woman has properly prepared herself for this ordeal in accordance with the principles of physical culture, it is absolutely to be condemned. Let her depend on the natural laws that gave us life and growth, and which emanate from an Intelligence infinite in power.

Chapter IV

Preparation for Conception

IT is a fact, itted by all who are qualified to testify, that the bearing of healthy children depends not only upon the condition of the mother during pregnancy, but upon the condition of both parents previous to the time of conception. This is important, not only from the standpoint of the child, but from that of the mother herself, inasmuch as her relative comfort or distress during pregnancy will be determined largely by her physical condition before entering upon this period. The fact is that one’s whole life should be a preparation for parenthood. In the case of a woman especially, the possession of vigorous health and bodily strength when she is about to enter upon this new experience, is so important that it is madness to treat the matter with anything but the utmost seriousness. Conception should really never take place unless both parents are in a condition of readiness and physical fitness. If one’s whole life has not been of a nature to prepare one in this way, at least it is advisable to go into training for parenthood, so to speak, for a period of one or two years, if possible, in order to acquire the condition of pure blood, internal cleanliness, perfect nutrition, and all round vigor that will not only make for healthy children, but will enable the prospective mother to go through the experience without special difficulty. As I have already made clear, a healthy germplasm depends upon satisfactory nutrition, derived from the blood-stream of the parent, and also upon entire freedom from poisoning of any kind, whether from narcotics, minerals, disease, or the toxins which are formed in the body itself through the ordinary life processes, and which sometimes accumulate to a harmful extent if the eliminative functions are not sufficiently active.

In other words, what is required previous to conception is a course of general allround building up of the vital forces of the body.

Importance of fresh air

There can be no health without paying proper attention to the laws of hygiene. First among these is that the lungs shall be supplied with plenty of fresh air. The mother-to-be should spend at least two hours every day walking in the fresh air. She should try so to train herself that the state of the weather will make no material difference in this program. If the sun is shining, the “airing" should be all the more delightful. But if the weather is bad, you need merely to wrap up well—just as though you were going out of doors. Then open all the windows in the room, and exercise and walk. that the average person uses about four bushels of air a minute. Therefore your room should be constantly replenished with fresh air; otherwise the available oxygen will be quickly exhausted and you will be breathing large amounts of carbon dioxide—a deadly gas thrown off in the breath. It is this poisonous gas that causes the feeling of faintness, stuffiness, dizziness, nausea, and headache, in those who live in “dose" rooms, and makes them so pale and languid and so utterly lacking in ambition. Their blood becomes vitiated and impoverished, their appetite fails, and much of their natural power to resist disease is lost. It is probable that pure air quiets the nerves and brings about refreshing sleep better and more surely than any other agent. Only be sure that when you sleep with all the windows open you have plenty of warm covering. In this way, you will avoid any danger of “catching cold."

What exercise does for you

Take plenty of outdoor exercise, for it benefits not only the muscles, but all the organs of the body as well. It strengthens the heart ; therefore all the tissues receive a richer supply of oxygen. Exercise helps you digest and assimilate your food, and helps the bowels to get rid of the food debris. It stimulates the respiratory glands to throw off more of their secretion, and with it many virulent poisons that might otherwise remain in the body. It strengthens the muscles, clears the brain, strengthens the nerves, and brings about a better state of elasticity of the tissues, so that birth will be easier, safer, and quicker. It helps you to overcome weaknesses and irregularities. In fact, if you are a sufferer from any of the disorders peculiar to women, it is urgently necessary that you should include a rational system of exercise among any other strengthbuilding measures you may adopt as a preparation for conception. And these weaknesses and disorders are so widespread among civilized women everywhere that there are few who can afford to neglect such natural curative treatment.

Strength is safety

For the woman who has lived an athletic life, any strenuous training immediately preceding the approach to motherhood is not necessary. Unfortunately, however, the athletic type is the exception, and a serious condition of muscular weakness is the rule among women. If the physical activity of girlhood could be continued into the adult life of the average woman, there would be little need to say anything on this subject. But the average woman is characterized by a relaxed, flaccid, and more or less prolapsed condition of the abdominal and pelvic organs. She lacks muscle-tone.

In a large percentage of cases, women suffer from falling of the womb and other displacements, and in the average case there is no other single treatment for the building of strength so important as proper exercise. , the physically perfect mother is the best mother. Can any human being ever afford to be at anything less than his or her best, physically or mentally? Most of alt can the woman facing maternity afford to be physically at her worst, or indeed at anything less than her best ? that a course of strength-building means internal strength and internal cleanliness, as well as strength of the external muscles. Also, that a good milk supply depends upon general vitality and the health of the milksecreting glands. The weak woman lacks this vitality. Her circulation is weak, her blood more or less impoverished and impure. She can not be a good mother under such circumstances, but, through proper preparation and with proper attention to fundamental laws of hygiene, she may enter upon this experience, desired by every normal member of her sex, with confidence and pope.

Prenatal impressions

Many women are terribly worried at the time of conception, or in the early months of pregnancy, for fear that some thought, fear or fright, or something they may intensely desire, may “mark" their child. The theory of “maternal impressions," or prenatal influence, is much disputed. Most scientists now declare that there is nothing in it so far as mental impressions are concerned. Do not, therefore, take too seriously any alarming stories about the “marking" of babies through fright and unpleasant sights. The body of the child is really formed during the first two or three months of pregnancy, and after that it is a simple matter of growth, depending upon good food, oxygen, and health generally. Shocks, and the seeing of cripples or animals, would have no effect upon the unborn, but worrying or losing sleep over them through the fear of

marking would be greatly detrimental in respect to the health and vitality of both the mother and the future babe. The prenatal influences that do count tremendously are those concerned with food, fresh air, sleep, rest, and all factors that make for pure blood. In discussing this subject, Professor Albert Edward Wiggam says : “Prenatal influence can have no possible effect in marking the unborn child. The germcells from which children are born are not created by the parents at all. Parents do not create their children. God Almighty does that. He also creates the eggs and sperms from which the children are born. Ile creates the hereditary characters that are contained in these germ-cells. He doesn’t leave the great work of infinite creation to the hands of us poor, ignorant, weak, short-sighted, foolish human beings. If He did, we would make a mess of it in one generation and wreck the whole course of evolution." We all know that the only way that the mother’s mental impressions could travel through her body to that of the baby is by the pathway of the nerves. But no nerves whatsoever run from the mother’s body to that of the unborn babe. There is a small, hollow cord—the umbilical cordwhich is the sole connection between the mother and the child. But this has no more function than a hose-pipe. It is really a part, temporarily, of the circulatory system of the child. It does not, so far as modern science knows, convey fright, worry, or nervous impressions of any other kind. And such things do not travel in the blood, so far as has ever been found out, though we know that these things can poison the mother’s blood to such an extent as to produce severe illness. It is reasonable to suppose then that they can injure the developing child to some extent in this way. Obviously, God has placed the child safely away so nothing of this sort could ever directly touch it. God’s whole aim has been to prevent the mother’s desires, ambitions, dreams, hopes, disgusts, eccentric sympathies, or anything else, from ever reaching the unborn. Of course, it would look as if whatever was in the mother’s blood would necessarily circulate through the body of the child. But the mother’s blood does not flow through the placenta and into the arteries and veins of the child. The blood circulating into the child’s body is its own blood, distinct from that of the

mother. The placenta, which is the channel through which the unborn child secures nutrition and oxygen, and disposes of wastes, is in the nature of a great filter through the membranes of which nutrition and oxygen are ed, but which filters out almost everything that can possibly injure the child. At least, it filters out microbes, the one exception being that of syphilis, which apparently es through, and is, it seems, the only disease that can be so transmitted.

Can’t be done by telepathy

Although the expounders of the prenatal theory it that there are no nerves which carry the mother’s mental impressions to the child, I gather that they believe that this influence travels after the manner of telepathy. Many people believe this to be the case. The mother reads beautiful books, sings lovely songs, and gazes at wonderful pictures ; or perhaps she becomes frightened or angry, and in some mysterious telepathic manner the child receives the impression. I don’t know whether there is such a thing as telepathy or not. I would like to believe there is. Let us suppose the mother “telepaths" to the child. Very well, then, why couldn’t the father do the same thing? Why couldn’t the neighbors do the same ? They’d like very much to be able to do so. Why, also, couldn’t the mother telepath and mark the baby in the incubator? Why need it cease at birth? Why should she not go on telepathing after the child is born, and either mark it with deformities or give it good health and genius by wishing hard about such things? You are on the horns of a dilemma, my dear mother-friend. Do you not know that if the good Lord, or natural law, permitted the unborn babe to be even remotely touched by such contradictory influences, the little fellow, by the time he got into this world, would be nothing but a grotesque conglomeration of absurdities ? His own mother wouldn’t know him. So I think telepathy can also be ruled out. But we don’t know. Without doubt the mother and child are in more intimate physical relationship before the birth of the child than at any time later in that child’s life. Yet why is it that millions of mothers get frightened and worry for months about marking their

babies, and the little creatures come into the world in fine form, notwithstanding? In this connection the report of the Paris authorities who had charge of the babes of Paris during the most terrible year of the war (1918) is interesting.

War babies of

These Paris mothers lived in constant fear, for there was a bombing raid by the Germans about every moonlight night. Yet the report states that the babies born during that period were somewhat larger and fatter and generally more healthy than usual. Why? Because the mothers were put under military direction and properly fed. If they could have enjoyed mental repose at the same time, no doubt the results would have been better still, for mental states have a profound effect upon nutrition. The prenatal months should by all means be months of joy and happiness. The mother should be calm, free from worry and overwork. Such conditions certainly help to give the unborn child a proper start, and it is a pity that babies should ever be born without such a happy prenatal beginning. And while you probably can not influence the mental development of the life within you by the thoughts you think before its birth, you may in this way mold your own character and help to prepare an environment in which the faculties of your child, whatever they may be, will find full freedom for expression.

Intelligent birth control

I can not leave this important consideration of the proper preparation for conception without saying a word or two on birth control.

This is a subject which is occupying the minds of thousands of earnest women in these days, and which must shortly press for reconsideration in legislative chambers everywhere. Every true woman who enters the married state physically capable is desirous of motherhood. Sterility to her would be one of the greatest of tragedies. And yet there are numerous considerations which cause her to dread a too rapid or too great an increase in the family. A numerous family is likely to place a burden of debt upon all but the most affluent, and to bring ili health upon even the most robust. Again, there may be temporary or permanent physical conditions which unfit a woman for motherhood, endangering her life, or the life and health of her child. She may suffer from some malformation of the pelvis which would render impossible the natural birth of a child, but which would not preclude a very beautiful love life, without children. Or, she may be married to a drunkard, a dope fiend, or a man who has contracted some transmissible disease such as syphilis. To bring children into the world cursed with such parentage, is nothing short of criminal. Every child brought into the world has a right to be well born, free from mental or physical handicap. In order that he may be so born, both parents should be in perfect health, full of vigor and vitality. It is for these reasons, and not for any un-natural or unmotherly motives, that woman desires the privilege of determining when and under what circumstances she will bring children into the world. But the dissemination of information as to methods of preventing conception is forbidden by law. There is a penalty of five years’ imprisonment at hard labor for conviction of this so called “crime." Earnest students of sociology universally condemn this law as unjust and restrictive of the liberty that should belong to the individual. They urge that woman should be mistress of her own body, with an inalienable right to elect or refuse motherhood in accordance with her own judgment.

The objection is advanced by many opponents of intelligent birth control that the methods are ineffective. If they are ineffective, then these objectors surely have nothing to complain of. To the best of my information and belief, however, they are about ninety-five per cent, or more, effective, and that they are usually harmless is proved by the fact that millions of women are using them for conditions that have nothing to do with the prevention of conception. Were the knowledge of their use as contraceptives available to women in general it would, in my judgment, solve many of society’s most distressing problems. Also, it would do away with the crime of “abortion and with the terrible dangers that necessarily follow this injurious practice. It is to be hoped that the time will soon come when a knowledge of these enlightened measures will be part of the equipment of every mother in the world.

Chapter V

The Signs and Progress of Pregnancy

S TRANGE as it may seem, one of the most difficult questions that confronts a woman is to decide definitely just when she is pregnant. It is a fact well known that many women who have been repeatedly pregnant, whether they carry the child to term or not, can usually tell with an almost infallible certainty just when conception has taken place. There is a peculiar paroxysm—a strange psychical shock—often accompanied by slight convulsive seizure, which tells them that a spermatozoon has come in with a ripe egg from the oviduct (the little tube that leads from the ovaries to the womb) and has effected that union with it that settles its status as a potential living organism. This symptom, however, is not generally experienced. Millions of women become pregnant absolutely without any consciousness of the fact. And as the average woman knows but little of the functions of ovulation and menstruation a description of just what happens and just what may be looked for at this time is desirable.

The menstrual cycle and its meaning

Under normal and healthy conditions the menstrual flow, sometimes spoken of

as “the monthly" or “the period," occurs at intervals of twenty eight days, or once each lunar month. Once each twenty-eight days one germ-cell or egg (sometimes more than one) is ripened and discharged from the ovaries, being then carried to the womb, where, if fertilized by the sperm-cell, it may attach itself to the inner wall of this organ, securing there the nutrition needed for its continuous growth. The ovum may retain its capacity for impregnation for some time after its escape from the ovary, but if not fecundated it loses its vitality after a time and is finally carried away with the uterine secretions. During the swelling and bursting of the Graafian follicle which results in the discharge of the ovum from the ovary, the vessels of the ovaries and womb and particularly of the membrane lining the womb are congested with blood. This congestion results in the stretching and weakening of the walls of the capillaries and hence in hemorrhage. This is the cause of the monthly discharge of blood. The blood is mixed with a large amount of mucus, including the slightly acid mucus from the walls of the vagina. Therefore it does not normally coagulate, though clots may be formed when the discharge is very profuse. Minute particles of the membranous lining of the womb are also ed out. The duration of the flow varies according to the muscular and structural tonicity of the womb, the general habits of living, the constitutional strength, and even the climate. As soon as impregnation has taken place the menstrual discharge normally ceases, and all signs of it are usually absent during pregnancy and lactation.

The function of the ovaries

By ovulation we mean the development, ripening, and discharge of germinal cells or eggs in the woman. These minute human eggs, or ova, as they are called, are developed in the ovaries—two little almond-shaped organs placed in the lower part of the abdominal cavity and above the uterus, one to the right and one to the left. When fully matured the ova are about one one-hundred-and-twenty-fifth (1/125th) of

an inch in diameter. While still the future woman is an unborn baby girl, Nature places in her tiny ovaries about sixty thousand of these microscopic cells, any one of which, later in life, may furnish the nucleus for a new life. Although these eggs are present in the bodies of girl children from the moment they are born, none of them ripen until the girl is from twelve to fifteen years old —the age of puberty, as it is called. The process of ripening, once established, continues until the menopause, or “change of life," at which time the function gradually dies out and becomes completely inactive. This little egg under the microscope shows itself to be a tiny, round bag, made with a transparent membrane. It contains a nucleus surrounded by a small quantity of yolk. Unlike the eggs of birds, it has no shell, for the shell is not needed for its protection. Neither does it require the large yolk of the bird’s egg, for its nourishment is provided directly from the body of the mother.

How the egg enters the uterus

After the egg has matured it becomes detached from the ovary and enters a little fleshy tube about the size of a lead pencil, known as the Fallopian tube, or oviduct, the canal of which is smaller than the lead of a pencil. These tubes are two in number. Both enter the uterus—on opposite sides of that organ. The egg gravitates down to the tube which leads from the particular ovary in which it originated and matured. It is helped onward in its course down the tube to the uterus by what is known as the ciliary movement of little hair-like appendages that line the tube. If, however, the egg becomes fecundated by the male cell or spermatozoon

during its progress down the tube, it quickly gravitates to some point on the inner lining of the uterus, where it attaches itself. The original identity of both cells is lost and they become absolutely blended. The life of the unborn child has its beginning in this union of cells, familiarly called “conception."

The first symptom of pregnancy

The suspension of menstruation is generally regarded as one of the first signs of pregnancy, although there are apparent exceptions to the rule. A discharge of blood may appear once or twice, or more times, after conception, and there have been rare cases in which it has continued regularly after conception. Such a condition, however, almost always indicates an abnormal or unhealthy physical condition, or a disease of the uterus. In discussing this subject Dr. J. Morris Semans says : “It is doubtful whether menstruation ever continues after conception has taken place. Instances in which the menstrual function is believed to persist are not uncommon, and yet in all probability the discharge regarded as menstrual has a different origin. In most cases it should be interpreted as meaning that there is some danger of miscarriage. Since miscarriage often occurs about the time a menstrual period would ordinarily be expected, there is unusual opportunity for confusing the symptoms.

“At all events women err much more frequently in suspecting that they are pregnant than in overlooking the condition. Indeed, pregnancy is not likely to be overlooked unless menstruation has been irregular or suppressed for a month or more previous to conception. Thus, in the case of nursing mothers in whom menstruation is already suppressed and who are, moreover, deprived of certain evidence that the breasts give, pregnancy may sometimes advance several months before it is recognized."

Anemia, chlorosis ( green sickness ), tuberculosis and diabetes not infrequently cause a cessation of the menstrual discharge, which may lead some women to believe they are pregnant. Other conditions may also cause the failure of the usual monthly flow, among which may be mentioned catarrh of the neck of the womb, goitre, fibroid tumors, hysteria, chronic Bright’s disease and tuberculosis of the kidneys, obesity, ovarian cysts, pelvic adhesions, acute rheumatism, scarlet fever, and ulcer of the stomach. Another cause for delayed or lessened or even suppressed menstruation is a low diet. A woman may possibly eat too little to all physiological processes. She requires the blood that would be lost in the menstrual discharge, and Nature in her conservative way brings about a diminution or complete cessation of this regular loss. But we can not know just how much this discharge depends upon diet for its amount, or even for its continuation. A diet that is low yet within the body’s requirements may, if properly balanced and if consisting of natural and wholesome foods, bring about a natural reduction of the flow to the point where the woman will be almost unconscious of any at all. I recall one case in which the raw-food diet brought about a complete arrest of the monthly period. Fruits and nuts were the main articles of diet, but other uncooked foods were eaten at times. A return to a more nearly conventional diet re-established the period, which was again checked entirely by a resumption of the raw-food diet. Therefore, if a woman is for any reason living on low rations, or on raw food (also limited in quantity), she need not be surprised or alarmed, or suspicious of pregnancy, if there is a great reduction or even a total absence of the usual menstrual flow.

How the breasts change in pregnancy

One of the signs which make pregnancy most palpable to experienced women is a tingling, throbbing, or pricking feeling in the breasts, or else a feeling of fullness in the breasts. To many women this is the earliest intimation they have as to their condition. Some women will experience great tenderness in the breasts after conception. They are hardly able to bear the weight of the clothing upon them without wincing. But no absolute dependence can be placed even on these signs. However, at the end of the second month, the nipples begin to swell and deepen in color. The areola (the pigmented circle of skin surrounding the nipple) also assumes a darker hue. The color of this pigment varies with the complexion of the woman—brunettes developing deeper color than blondes. Finally, within this areolar circle, a number of little shot-like elevations develop. These are the milk glands, which are aroused into active function by pregnancy. After the second period has been missed the breasts usually increase in size and firmness, and the veins immediately under the skin may stand out quite prominently. Shortly after this a thin fluid can be squeezed from the nipples, which most people believe to be milk, but which in reality is colostrum. At first this is clear and white—but later in pregnancy it becomes cloudy and yellow in color. None of these breast-changes can be absolutely depended upon to establish the fast of pregnancy, especially in the case of a woman who may have recently nursed an infant. As a general rule, however, women who have never before been pregnant can be quite certain that they have conceived if they note these characteristic changes in the breast.

Nausea and vomiting

Shortly after conceiving most women suffer from nausea and vomiting,

especially on first getting up in the morning; “morning sickness" this is called, and very characteristic and uncomfortable it is. This is supposed to be called forth by “reflexes"—due to nerve irritations—or else to increased acidity. I shall have something very important to say in a later chapter as to how this condition may usually be relieved. This nausea and vomiting (frequently so persistent that physicians have found it necessary to perform an abortion to save the woman’s life) comes on usually after the menstrual period has been missed, and continues until about the third month, or even later. But even this symptom is not infallible. For nausea and vomiting may originate in a variety of causes that have nothing to do with pregnancy, while, on the other hand, many women will come through repeated pregnancies without experiencing any discomfort from stomach reflexes.

Bladder symptoms

Many women when pregnant experience great difficulty in urination. The bladder becomes extremely irritable, requiring to be emptied very frequently—at times every half-hour or so. This, symptom, however, may often be due to nervousness or other conditions, and can not be regarded as a definite sign of pregnancy. It is clear, though, that the gravid uterus naturally tends to tilt forward and press against the bladder, giving rise to the same symptoms of irritation as though the bladder were filled with urine waiting to be voided. With all these symptoms present it occasionally happens that a mistake is made in establishing a diagnosis of pregnancy. Baby clothes are prepared and all arrangements are set on foot, only to meet the disappointment of a “phantom tumor" or some other abnormal condition.

“quickening"

The earliest certain sign of pregnancy is the “quickening" (the movement of the child in the womb), which is usually noted about the eighteenth to the twentieth week. This motion has been compared to a tapping, or a quivering or fluttering of bird wings, and grows stronger as the baby develops—until sometimes the mother can hardly sleep at night, so restless is the child. Nevertheless these movements are welcome to most mothers, who now have certain and definite proof of the precious new life developing within their own bodies. So, to sum up, I would say to the woman who suspects that the condition under consideration has arisen: If you have missed a couple of periods, if your breasts are tender and enlarged, if you are “sick at the stomach" on arising, the presumption is that you are pregnant. But, if in addition to these symptoms you can feel the little life stirring—the little form twisting in your body—you can make your baby’s dainty clothes in satisfied assurance that all is well —and all tedi/ be well—with you.

When will pregnancy terminate?

One of the first questions that the mother wants answered is : “When may I expect my baby?" This can not be stated definitely. Even though she knows the exact date of conception, it can not be prognosticated just when the woman will come to term. There is a slight variation in the duration of the “period of gestation," as it is called. But ordinarily it may be said to continue for 273 days. This estimate is

based on calculations in thousands of cases. As the exact date of conception is not usually known, however, it is customary to reckon 280 days from the first day of the last menstrual period as the date of expected confinement. This is equivalent to nine calendar months, or to ten lunar months of four weeks each. I am printing on the preceding page a table which will give the prospective mother a “bird’s eye view" of the date of her expected confinement. , however, that these dates are only approximate. Your confinement may antedate the schedule by a few days or a week, though it is more likely to be a week or even a forthright later. But whenever it may come, welcome it with confidence and high courage, for great joy is to be your portion.

Chapter VI

Diet in Pregnancy

K NOWING that she is eating for two, every woman probably understands that she ought to be well fed during pregnancy. Most women, however, have an erroneous idea of the amount of food required. Although it is true that the new life that is forming calls for ample nourishment, yet the growth is slow and gradual and not of a character to demand “stuffing," or even a considerable increase in the food intake. It is not so much the quantity of the food that calls for special consideration as its quality. The unborn child is building new tissues. We know that to a certain extent the food requirements of a growing boy or girl differ from those of, adult life, inasmuch as the child requires food for growth, whereas the adult requires it simply to repair waste and supply energy. For the same reason the food requirement of the pregnant woman differs from that of other adults in quality as well as quantity. The food requirements of pregnancy are quite exacting. It is doubtless for this reason that many women at this time experience “cravings" for unusual articles of food and drink. I am convinced that these cravings are the result of some vital deficiency in the ordinary diet. For instant, the desire for picides would probably never arise if enough good fresh fruit were available. There is usually a craving for fruit and green salads during the early months, probably to supply the demand for the organic mineral salts.

We would say in a general way that inasmuch as these unusual cravings indicate special needs, they should be followed when the desire is for natural types of food. When they are abnormal, an attempt should be made to supply natural foods which will serve as a substitute for the articles craved.

Importance of the mineral elements

It is during pregnancy probably more than at any other time in life that one realizes the inadeguate and worthless character of many conventional foods. It is largely because of the unsuitability and inadequacy of the conventional diet that women’s teeth suffer so much at this time, and that the general health is often so greatly impaired. It is almost a commonplace among women that every child means the loss of one or possibly several teeth. Why? It is simply because the food supplied does not contain the elements needed to build the teeth and bones of the unborn, and consequently these elements are taken from the blood of the mother. She is actually and literally sacrificed in order that her child may have, as nearly as possible, a fair start in life. But this sacrifice is entirely unnecessary. If the mother’s food contains sufficient lime and other bone-forming elements, there is no reason why she should lose her teeth at this time any more than at any other period of her life. White bread is probably the greatest enemy of the health of the prospective mother. Not only is it constipating, but its use means that the woman’s system will be robbed of those elements contained in the whole wheat, but removed in the process of making white flour. White flour is bad enough at any time, but is particularly injurious in pregnancy. Again, in the cooking of vegetables, the most precious food elements are usually drained off and thrown away. The water in which these foods are cooked should be served with them in all cases. The use of canned foods instead of fresh vegetables is another common mistake. Whenever possible, use your vegetables fresh.

It is a fact well known in medical circles that a deficiency of lime salts in the diet leads directly to a water-logging of the tissues and a corresponding loss of tissuetone, rendering a woman just as unfit physically to undergo the ordeal of motherhood as an athlete would be rendered unfit by the same cause to undergo any test of stamina or endurance.

Destroying the tissues

Barr shows that a diet of white bread, biscuits, crackers, degerminated cornmeal, cornstarch, polished rice, refined breakfast foods, washed-out vegetables, refined sugars and table syrups, leads to a chronic acidosis which extracts the lime salts from the fibrous tissues, from the cartilages, and even from the bones. Loss of lime salts, says Barr, causes irritable weakness of the muscles. Under such a loss the muscles waste and contract readily. Neuralgic pains result from the extraction even of a very small amount of the lime of the verve tissue. “With the continued absorption of the lime the particular tissues swell, and there is effusion into the ts. The cartilages soon become involved, and this is followed by thinning and erosion. The lime and other bases are so necessary to the neutralization of the acids elaborated by the acidforming foods (meat, fish, cheese, sugars, and starches) that they surrender themselves, to the actual destruction of the tissues, in order that, as long as possible, the unnatural condition may be tolerable. “Even when all the bases are withdrawn from our food the phosphates and sulphates continue to appear in the urine, showing that the body has had to steal the alkaline bases from its own tissues in order to carry on life’s processes. “Surely no one is so blind as to assume that this stealing can go on continually without encountering disaster. The relative absence of lime and potassium in the refined foods of the poorer classes leads to a deficient motility of the stomach, and this in turn results in obstinate constipation, with acid fermentation. Foods from which the lime and potassium salts are largely removed will not provide the intake of these substances necessary to normal metabolic processes."

After recounting some experiments in which different groups of animals were fed on white flour and whole wheat respectively, Alfred McCann, well known as a fighter for natural foods, asks: “What’s the matter with white flour, that it should undermine and destroy the health and life of one growing animal while its brothers and sisters are thriving gloriously on whole wheat? “The matter is simply this : White flour has lost the building materials with which nature works in the normal construction of a young animal. Could an architect and a contractor, working together with a squad of helpers, add another story to a building after they had run out of raw materials? They could not—nor can Mother Nature! “White flour contains fuel for warmth and a portion of the nitrogenous content of the whole grain for tissue cells. “But it has lost its iron for the hemoglobin of the blood. It has lost the oxidizing assistance of iron which, in the form of manganese, performs so many important functions in the economy of life. It has lost its calcium for the coagulation of the blood on demand. It has lost its potassium for the stabilization of the body fluids. It has lost its fluorides for the enamel shell of the teeth. It has lost eight per cent of the total mineral contents of the whole wheat. It has lost its power to protect the body against disease. “It has lost its bone-building and nerve-nourishing properties. A young animal can not grow on white flour because there is nothing left in white flour that will growth." And it is the same with a young human.

Bone disease from deficient diet

There is a bone disease known as osteomalacia, which is simply a condition of softening of the bones, from which women who have borne many children in rapid succession sometimes suffer. It indicates clearly that an extensive drain has been made upon the bodily resources of the mother. This disorder is the result of

an inadeguate diet. Of course the bearing of many children at short intervals is not to be recommended ; but if a woman is perfectly nourished, she will never develop osteomalacia even as a result of frequently repeated pregnancies. Tuberculosis is another disease which may result from the abstraction of lime salts from the mother’s blood by the fetus. On this head Dr. Drennin writes:

“Inasmuch as gestation and lactation both deprive the mother of lime salts, there is consequently less lime for the process of calcification of the tubercular areas —nature’s method of cure in tuberculosis. “This therefore s for the frequent rapid rise of tuberculosis following maternity, increasing after every successive delivery, until the underfed mother generally succumbs after the third. “During the re-establishment of functional activity following wasting disease, a deficiency of these compounders of life—the mineral salts, bases, and vitamines of natural foods—means not only slow recovery but permanent injury, depending entirely upon the extent to which the refinement has been carried on."

Diet to overcome nausea

In the early months of pregnancy when one is inclined to suffer considerably from “morning sickness," or nausea, it is well to live largely on fresh fruits. There is no doubt that such a diet will lessen general acidity, and this lowering of acidity will tend to prevent vomiting. Such a diet, too, is said to greatly reduce the pains of parturition. On this subject Dr. R. Lincoln Graham writes : “On a strictly vegetable diet (tomato) I have seen a child born with absolutely no discomfort to the mother. On a rich diet of oranges and vegetables I have frequently seen mothers give birth to healthy children with but slight labor and

effort. I have seen mothers who had coma and Bright’s disease with former pregnancies thrive and give birth to healthy children on a diet of six oranges and some bananas, with a little brown sugar, every day. For painless childbirth the orange has no equal, unless it be the tornato eaten raw." The appetite should be followed closely in all cases. Never try to eat anything that does not appeal to you. If in an extreme case one can not relish anything but fruit, eat nothing other than plenty of fruit. The appetite for substantial food will then return very quickly. Do not eat eggs, meat, or any other rich food that you can not relish, simply from a sense of duty. The important thing is to develop an appetite for wholesome and substantial foods through healthful living and especially through outdoor life. Being outdoors is the best thing in the world for this purpose. If you can eat and enjoy one or two or more eggs a day, so much the better. If you can relish milk, it would be well to use plenty of it. It contains, in ideal proportions, the food elements needed by both mother and child. If you have been accustomed to using meat, you should continue to use it, but not oftener than once a day in the average case. Those vegetables that grow above the ground, and appetizing green foods of every description, should form an important part of the diet. The value of fruits I have already mentioned. It is not well, however, to use much sugar or candy. They tend to upset the stomach and give one a bad taste in the mouth in the morning. The natural sweets found in fruit are ideal. If you wish any concentrated sweets, honey is to be recommended. It is advisable to drink plenty of water. Hot Water drinking is to be highly commended. But if it aggravates the feeling of nausea, as it does in some instances, it should be avoided and moderately cold water used. Lemonade is usually an attractive drink.

Avoid drugs and alcohol

I would reiterate for the sake of emphasis what I have said in a previous chapter on the subject of drugs. Avoid tonics and alcoholic beverages of all kinds. that the forming tissues of the unborn child are much more delicate and sensitive than in later life, and are especially more easily affected by drugs and poisons of any kind. The delicate cells of the nerve and brain structures are especially subject to the destructive effect of alcohol and other poisons. On this the pregnant mother should even avoid tea and coffee. For, though these are comparatively mild stimulants, they are detrimental to the nerve tissues, and should be avoided for the sake of the welfare of the child.

The valve of a limited fast

In cases of illness during pregnancy the question of the advisability of fasting may present itself. Since full nutrition is important at this time, a prolonged fast should not be undertaken ; but a brief one may interfere less with nutrition than other treatment. What is wanted under such conditions is to restore the purity of the blood, and fasting may be the quickest way of bringing this about. If the appetite is lost a fast of a day or two is always desirable. In some cases the exclusive milk diet will be found to be the ideal regimen. “Heartburn," or stomach acidity, is usually overcome by the bland effect of the milk. Too much care and attention can not be given this subject of diet. I do not mean that a woman should be so morbidly anxious about her food that she is afraid to eat anything, but that she should intelligently select the sort of foods that contain the elements needed for her own nutrition and that of her child. If she does this, there will be no occasion for fussing and anxiety about details.

Chapter VII

Exercise During Pregnancy

M OTHERHOOD is a natural function of the female, but it is nevertheless a tremendous ordeal, and one which severely taxes the physical resources of even a vigorous woman. Therefore, if right living is ever more necessary at one time than at another, it is during pregnancy. Even though the mother is in the pink of physical condition before conception, she should do her utmost to preserve her health and increase her vigor during the period of gestation, not only for her own sake but for that of the new life which is forming within her. It is important that one should begin this program of exercises and healthbuilding as early as possible, for the burdens of pregnancy increase rather than diminish during its term. Appropriate strength-building methods put into practice during the first three or four months may give one the vigor that will make it possible to continue the program during the later months. There are two special types of exercises to be considered. The first is what we call constitutional or health-building exercise, of which walking is the best example. The second is strengthbuilding exercise. Both types are needed. We will first consider constitutional exercise. I believe that every woman should walk from two to four miles every day during pregnancy. While it is true that a hike of four miles would be too much to expect in the beginning from those who are not accustomed to it, yet by starting in with a daily walk, carried to the point of slight fatigue, one will soon make such an improvement in endurance that one can cover the three or four miles without inconvenient and perhaps continue the

practice to within a few days of confinement.

The foolishness of “false pride"

Unfortunately, many women adopt the very foolish policy of staying indoors at this time, owing to a feeling of reluctance to “being seen." There could not possibly be a greater mistake, for outdoor life is a necessity, not only for general health reasons, but as a means of avoiding many of the unpleasant symptoms of pregnancy. There is a very peculiar arrangement of the fetal circulation, as a result of which the blood supply to the lower part of the body is never entirely fresh, but consists of a mixture of arterial and venous blood. If the air supply is poor, this part of the body receives but little oxygen, and growth is greatly impeded ; whereas, if the mother has plenty of fresh air, there will be a sufficiency of oxygen to cover these unusual requirements. Dora be ashamed of being seen out-of-doors. that motherhood is something to be proud of, and that pregnancy is a condition to be honored. , also, your duty not only to yourself but to the new life for which you are responsible. Spend as much time out-of-doors as possible. Apart from your walks, which should be regular, both motoring and sitting outdoors on the porch or on the lawn, whenever possible, are to be recommended. , also, in taking your walks, that you should not “poke" too much. Slow walking will stifler and exhaust one. A brisk pace, however, will stimulate the circulation and have a strengthening and invigorating effect. The important and value of walking are so great that I have sometimes said that no human being could be in perfect physical condition unless he or she did at least one or two hours of walking in every twenty-four hours, this naturally in addition to other exercises, either of a special or recreative nature. As a rule, if one walks a great deal, a proper position of the body will naturally be maintained, but the average woman is not enough of a pedestrian to make a correct method of walking a habit. There is a right way to walk, just as there is a

right way to do anything. No matter how you walk, a certain amount of vigor will be secured from the exercise ; but if you move in a slipshod manner, if your movements are not harmonious, you will tire quickly and fail to secure the benefits that are easily within your reach. Even those who possess more than the average strength will become exhausted after walking a few miles, if they do not understand the secret of the proper method.

GENERAL DEVELOPMENT EXERCISES. No. 1

Breathing and Chest Exercise.—Cross arms in front, bringing them as far across each other as possible and expelling as much breath as possible. Then continuing exercise, bring arms outward and backward as far as possible, at the same time inhaling deeply. Repeat this exercise, contracting and expanding alternately until slightly fatigued. This is excellent also for use in conjunction with exercises in Chapter XXI for improving contour of bust.

GENERAL DEVELOPMENT EXERCISES. No. 2

Exercise for Strengthening Waist and Abdomen.—Assume kneeling position on a cushion, and with hands interlaced behind neck describe a circle by moving the upper body at the waist to the left, front, right, and back, in one movement.

The correct way to walk

It is only within the last decade that I have really learned how to walk. In order to do so one must acquire an easy gait, every movement must be rhythmic, and the position of the body must be such that you go forward with strides that are made almost without effort. When assuming the proper attitude, the pedestrian inclines his body well forward. For walking should be a continual fall forward, just as in running. Each step should save you from a fall, and the body should always be inclined far enough forward to insure a continuance of the movement. The entire form should always be erect, shoulders back, chest prominent, and head back, and, unless it is necessary to look to the ground in order to select your path, eyes looking straight to the front.

GENERAL DEVELOPMENT EXERCISES. No. 3. Exercise for Waist, Back and Abdomen.—Raise arms sideways, and, bending as illustrated, come as dose to floor as possible. Perform movement either to one side at a time, or from side to side, according to strength, until slightly fatigued. Body must be returned to erect position after each sideward bending.

Many are of the opinion that because an erect position is advised in walking, it is necessary to swing the body backward. This is a serious mistake. Position of shoulders and chest should not be forced too much. The body should be erect at a forward angle. Do not raise the shoulders high. They should be down and back. Every step must furnish a progressive propelling power, and if the body is not at a forward angle, this is impossible. If your body is held in this fashion during your walk, and every step appears to save you from falling on your face, then you will be able to walk without tiring, and you can rest assured that your gait will be commended by the professional pedestrian.

Of course it is not easy to break old habits, and dose attention to one’s carriage in walking may be necessary for some time; but if one is persistent in one’s efforts to reform, a correct gait will soon become natural.

GENERAL DEVELOPMENT EXERCISES. No. 4 Exercise for Hips, Thighs and Lower Abdomen.—Stand erect with arms at sides. Raise arms sideways, level with the shoulders, simultaneously raising left leg as high as possible and then bringing it backward and forward before returning to standing position. Repeat until slightly fatigued. Then perform same movement with other leg. Excellent for developing the suppleness and elasticity of body desirable for maternity.

Strength-building exercises

Now for the strength-building type of exercise. I would advise fairly energetic physical training for the first four or five months of pregnancy in order to build up a high degree of physical vigor. During the last three or four months, it will be well to be somewhat careful, but still to take enough exercise of the same type to retain the strength that has been gained. Simply that during the latter part of the period there should be no unusual physical strain. If the exercises begin to seem “too much like work," or require too much will-power, it may be well to discontinue part of them. It is bodily elasticity that one should strive for, rather than exceptional power, with possible rigidity. As a general thing, the athletic woman should not attempt any special strength-building work, inasmuch as she may already have developed a somewhat muscle-bound condition. The athletic woman, especially, should strive for elasticity, and even relaxation of tissues, at least during her first pregnancy. She needs little or no special training still further to strengthen the

pelvic region. But she should do a very large amount of walking. And in subsequent pregnancies she may need special training for strength as much as any other woman. However, inasmuch as the athletic woman is the great exception, and the average woman is characterized by a more or less weakened and flaccid condition of the body, often with prolapses of the various organs, I would emphasize the need for strength-building measures in practically all cases. A woman who has experienced any weakness of this sort need not fear becoming too strong. She needs all the strength that she can possibly develop, and she should exercise with that end in view. At the same time, horseback riding, hard rowing, bicycle riding, and violent exertion of any kind should be avoided. There should be no attempt at heavy lifting, either in exercise or housework. The illustrations of four exercises for general development presented in this chapter are intended merely to suggest the type of exercises suitable, and no attempt has been made to illustrate a complete series. All general strengthbuilding exercises are desirable early in pregnancy, but those for strengthening the abdominal region are particularly important at this time. You may continue these exercises with benefit until the fourth or possibly the fifth month of pregnancy, after which such strenuous movements should be taken with less vigor and in some cases altogether discontinued in the sixth or seventh months. Exercises for the hips, however, are especially advantageous for purposes of developing elasticity, and should be continued throughout the whole term.

“inner building" exercises

Another form of physical training of special value, at least in the early months of this period, is what I would call “inner strength-building" exercise. You must there are internal as well as external muscles. As you know, the stomach and many other organs are to a large extent muscular in character. The diaphragm, however, is the most important purely muscular internal structure,

and through training it may be made very powerful. Through special use of these muscular tissues, all the internal parts of the body can be exercised, massaged, and generally strengthened. These inner strength exercises, then, consist in momentarily contracting the diaphragm and other internal muscles, with a bearing-down impulse similar to that which one experiences in a mild form of diaphragmatic breathing. By concentrating your mind upon these muscles, bearing down internally in this way, and causing the expansion of the body at the waist line and in the abdomen, you will finally acquire such perfect control of them that you thus can exert considerable energy and greatly strengthen all of these parts. Alternating with the bearingdown impulse, you may draw these parts inward and upward as vigorously as possible, assisting the action with that of the external muscles. In other words, there should be an alternate pressing down and drawing up of these parts. You should practice this very persistently at all times. As pregnancy advances you should be more and more careful in the bearing-down exercises, and in the last months of the term these should be avoided altogether.

Importance of bodily carriage

In this connection the importance of good bodily carriage can not be overemphasized. With poor bodily posture there is always a tendency toward the displacement of the digestive and other organs. Corsets aggravate this condition, and in many cases the vital organs sag or fall several inches below their normal position, a condition which is highly detrimental in pregnancy. For this reason, stretching the arms full length above the head—repeating ten or twenty times at intervals throughout the day—is a most excellent exercise. There is an old superstition that raising the arms above the head causes the cord to become tangled around the baby’s neck, choking it. There is no foundation for this notion, for such a result could not possibly follow such a movement. On the contrary, it raises the chest and relieves the downward pressure of the stomach, liver, and other organs.

During the later months of pregnancy there is often a very marked sense of weight and bearing down. Sometimes this gives rise to aches and pains of a more or less distressing character. The crowding of the bladder, for instance, is often most uncomfortable. In all such cases reclining exercises, with the hips on a higher level than the shoulders, will be of great value. An ironing board with one end lifted upon the side of a bed, and securely placed to avoid accidents, will provide an ideal arrangement for this purpose, and all the movements used for correcting displacements of the womb can be highly recommended. The mere position of reclining on the back with the hips higher than the shoulders will often work like magic in relieving some of the pains and aches from which pregnant women suffer. The results will probably surprise you. Try it.

Oiling the muscles of the abdomen

The contents of the lower abdomen at this time, consisting of the fetus, the amniotic sack with its fluid, and a greatly enlarged uterus, produce a tremendous tension of the skin and external muscles of the abdominal wall, and this necessarily causes more or less pronounced discomfort during the latter months of pregnancy. Massage with olive oil, or some other lubricant, especially before retiring at night, is useful as a means of increasing the elasticity of the skin and the abdominal muscles. The scarring of the skin of the abdomen which so often results from this process of stretching may to a large extent be prevented in this way. The cold sitz-bath, taken daily for from one to four minutes, according to your recuperative power, not only helps to maintain the tone of the skin and muscles but energizes the whole central portion of the body. You should not stay in the water so long that you can not quickly recuperate with a feeling of comfortable warmth. The cold sitz-bath should be discontinued about a month before pregnancy terminates, and a hot sitz-bath substituted.

Relieve pressure by going on all fours

In advanced pregnancy there is naturally an extreme degree of crowding of the other organs by the greatly enlarged uterus. The large veins by which the blood supply of the legs is returned to the trunk and heart are especially pressed upon, and the flow of blood may be so obstructed that varicose veins result.

GRAVITY EXERCISES. No. 1.

These exercises are taken while lying on an inclined board, with the head at the lower end, a position in which the force of gravity relieves the downwarddragging tendency of the uterus, heavy with the weight of the developing fetus, and helps to restore all the organs of the pelvic and abdominal regions to a normal position. For this purpose a large board, perhaps an ironing board (preferably padded and covered with cloth), may be used, one end being placed upon the floor and the other upon a chair, the side of a bed, or other firm . Exercise No. 1 consists simply of resting in this inclined position, which not only gives temporary respite from the tendency to prolapses and the sense of weight, but also relieves congestion. It may be well to rest in this way several times each day, especially when the sense of downward pressure becomes burdensome.

GRAVITY EXERCISES. No. 2.

This looks like a neck exercise, but it is really an abdominal exercise. Simply raise head and shoulders a few inches. This will require only a moderate contraction of the abdominal muscles, as you will find. Do not strain. Do not attempt to lift the head too high, or to rise to the sitting position. Repeat many times.

GRAVITY EXERCISES. No. 3.

Lying face downward on inclined board, raise head and shoulders, and then twist the body from the hips, as illustrated, first to one side and then to the other, until moderately tired. Do not strain, but as you grow stronger, let the exercise be a little more vigorous—raising the body a little higher.

GRAVITY EXERCISES. No. 4.

Grasping the board at each side with the hands and keeping the knees straight, lift the feet in the nianner illustrated until the legs are perpendicular. If not strong, one should, in the beginning, just lift one leg at a time. Repeat until only slightly tired. This exercise may be varied by separating the legs when they are perpendicular and bringing them together again, repeating a number of times. These movements are valuable for building strength in the organs and muscles of the pelvic and abdominal regions.

GRAVITY EXERCISES. No. 5.

A “scissors" exercise for the legs. Bring the legs first to the perpendicular

position, spread them apart, and then cross them laterally, as shown in this photograph. With the second movement bring the left leg under instead of over the right, and continue alternating in this way.

GRAVITY EXERCISES. No. 6.

Lying chest downward upon the board, raise one leg as high as possible, keeping the knee straight, as illustrated. Repeat until slightly tired. Then execute the movement with the other leg. Good for lower abdomen and hips. Perform with reasonable vigor, but do not strain. The exercise may also be done by lifting the legs alternately. Massage with olive oil, or other lubricant, especially before retiring at night, is useful as a means of increasing the elasticity of the skin and the abdominal muscles.

The position on knees and elbows is extremely effective as a means of relief from the discomforts due to this cause. In this horizontal position, which is practically a return to the “allfours" position of quadrupedal life, the uterus is suspended downward and away from the other organs, so that the pressure upon them and upon the veins is temporarily relieved. Many vigorous women may not need to rest themselves in this way, but for the woman who feels heavily the burden of advanced pregnancy these measures offer a remarkable means of finding rest and relief. There are many pains that are stopped instantly by assuming this position. The common pressure upon the bladder is especially relieved in this way.

SPECIAL EXERCISE DURING PREGNANCY.

Walking about on “all fours"—an ideal exercise for the prospective mother. This position tends to relieve the strain and downward pressure often experienced; also the tendency to nausea.

A particularly good exercise that may be continued up to the last day of pregnancy consists in lying upon the back, with the knees bent and heels resting against the hips, then raising the hips off the floor as high as convenient. The effect of this exercise is in part the same as that of the reclining position already referred to.

Massage and exercise for varicose veins

When there is swelling of the feet or ankles, or other conditions showing imperfect circulation, massage is often of value. In the case of varicose veins in the legs, common with women who have already experienced a number of pregnancies, massage may be very helpful if applied with the subject lying on her back after swathing the affected parts in cold wet cloths, or immersing them in cold water. Each leg should be elevated considerably while being massaged. In this position the venous blood is naturally drained from the leg through the force of gravity, and the circulation is thereby greatly improved. Even to lift the legs in this fashion while lying down, without massage, will be found a means of relief when the veins are greatly distended. Aching feet will be relieved quickly by this simple expedient. In this event it is a good plan to have massage istered each evening, and in most cases this can be done by the husband after a little study of the general principles of massage.

Stroking toward the heart, kneading gently, especially with the heels of the hands, rolling of the muscles back and forth, and circular movements applied with the heel of the hand, are very simple and among the most satisfactory forms of massage to be applied by the amateur. Rubbing from the toes to the ankle and from the ankle to the knee, especially with the leg elevated, will often work wonders in reducing swollen feet and ankles. I would suggest the plan of doing the strengthbuilding exercises the first thing in the morning, taking a walk in the afternoon, and having the massage treatment at night, before going to bed. Besides benefiting the swollen blood vessels, it will help to induce restful sleep.

Avoid too much housework

A certain amount of housework is advisable and will be beneficial, but not such a large amount as would be exhausting to one of limited strength. A few hours of house-work a day are more than enough. what I have said about the necessity for sufficient rest. It will be a good plan in most cases to lie down for an hour or two in the early afternoon. Rest may seem out of the question to a woman with many household duties on her hands, but if she and those about her realize its important they may, by careful planning, secure for her many more periods of relaxation than at first could have been believed possible. All must her responsibility to the expected newcomer, as well as to the family she may already have. Massage for varicose veins given by an assistant. The prospective mother should lie on her back with legs raised several inches by means of pillows or cushions.

Chapter VIII

Bathing During Pregnancy

P REGNANCY is not a pathological condition. It is a physiological function of womanhood. Yet nature must accommodate herself greatly to meet the demands made upon her during the period of gestation, and in this accommodation she must not be hindered by artificial conditions. The kidneys, bowels, and skin of the mother have additional work to do in the elimination of the waste materials of both child and parent ; the lungs must supply extra oxygen to throw off more carbon dioxide ; the heart must pump a greater amount of blood through the body. All this requires some extra labor on the part of these organs, and the woman should do everything in her power to aid Nature.

The function of the skin

The skin is one of the four great organs of elimination, throwing off through its pores poisons and waste products that accumulate in the system. We are not conscious of the excretory function of the skin except when we see its manifestations in the form of sweat. The pores are always active; however ; and, if the skin is healthy, they may be almost as much so when the weather conditions a Cold pint of water, carrying with it various waste materials, is normally eliminated from the skin every day.

Therefore it is most important to keep the mouths of the small sweat glands free at all times from accumulations of waste material which must inevitably limit their extra amount of waste materials to be eliminated, but because the pressure of the gravid uterus during the later mouths on the lower abdominal regions renders the kidneys unfit to endure extra strain. Activity of the skin necessarily relieves the kidneys of part of their burden, and it is quite natural that Nature, during pregnancy, should often cause the woman to perspire more freely than at other times. Any attempt to check this perspiration is ill advised. The tendency to convulsions mentioned in Chapter XI as being often met with when the kidneys do not function properly, may, in many cases, be overcome by the encouragement of free perspiration.

The influence of the bath

By means of bathing the mouths of the sweat, glands are kept free from accumulations of grease, scarf-skin (the dead layers of outer skin), dust, and dried perspiration. Water also favors elimination by means of its osmotic action. By this is meant the tendency of two fluids separated by an animal membrane to through it and mingle with each other until the density on both sides is equal. Blood is heavier than water. Therefore when the body is immersed in water there is a movement of the two fluids, blood and water, through the skin. A full warm bath of twenty minutes, therefore, not only cleanses the pores, but helps to drain off the wastes of the body through osmosis. A thorough rub-down with a coarse towel after a cold bath produces a healthy, refreshing glow. A dry frictioning of the skin with the coarse towel is also valuable as a means of promoting its healthful action. For these reasons the prospective mother should bathe regularly. Soap is required to remove the surface accumulations, and at least three times a week she should

have a warm bath with plenty of soap. On other days a tub or shower bath may be taken without soap, or the body may be cleansed with a wet towel. The cleansing bath should be warm. It is not necessary to gauge its temperature accurately, but a degree of warmth between 85 and 95 is usually most agreeable. Such a bath is neither extremely stimulating nor depressing. It is employed merely for cleansing purposes, and it is not designed to cause any specific reaction.

Hot baths depressing

Extremely hot baths or prolonged hot baths are more or less exhausting. They draw the blood from the great vessels on the inside of the body to the surface, and are likely to disturb the circulation. When one is not strong enough, or when it is inconvenient to take the enema in the knee-chest position, it will then be best to take it lying on the left side. Vapor and steam baths, Russian and Turkish baths, have a similar effect, and should not be taken unless there is some specific reason in the way of threatened uremia, or some other mal-function of the kidneys.

The stimulus of the cold bath

Unless there is some specific reason which develops as a result of experience, those who have been used to taking cold baths may continue them during pregnancy. Towards the end of pregnancy it will be advisable, however, to temper the coldness of the water, so as to avoid too great a shock. For those who can stand it, the cold plunge or shower will be found most invigorating; but that the cold bath is essentially for the purpose of

stimulating and invigorating, rather than cleansing. A thorough rub-down with a coarse towel after the bath assists in sending the blood to the surface of the body, and promotes a healthy, refreshing glow that is decidedly tonic in its effects. It is currently believed that hot foot-baths are sometimes likely to cause miscarriage, but there is no foundation for this belief. Surf bathing should be engaged in with considerable care. Violent efforts are occasionally required in saving oneself from the heavy breakers, and these might cause a miscarriage.

The internal bath

Most important of all is that the pregnant woman should maintain as cleanly a condition as possible in the intestinal canal. First, for the reason that fecal accumulation in the intestinal „canal is a source of extreme danger at any time. And second, because of the fact that the accumulation within the bowel of any considerable .amount of fecal matter tends to increase the irritability of the bladder and the frequency of a desire to urinate. One of the best of all means of overcoming a sluggish condition of the intestinal canal is the internal bath. A bi-weekly cleansing of the colon with a quart and a half or two quarts of warm water, into which has been dissolved a liberal amount of pure castile soap, or some other bland, non-irritating lubricant, will be found to afford a degree of relief that can be obtained by perhaps no other one means. This is definitely better than depending upon drastic purgatives or laxatives, or irritating the alimentary canal with overdoses of bran or other foods containing a great amount of “roughage," which sometimes cause an irritated condition of the alimentary tract.

How to tabe an internal bath

To get the best results from the rectal injection it must be properly istered. Do not lie on the side or back. The folds of the rectum and sigmoid flexure form cup-like valves, which fall back when the knee-chest position is assumed and permit the water to flow freely into the upper colon, without the cramps from the distended rectum that other positions excite. The addition of two or three alkaline antiseptic tablets to a quart of water will often prove soothing from the resulting neutralization of the acids of the bowel content as well as through the lessening of fermentation within the bowel. A strict adherence to these simple rules will be a source of extreme comfort to the prospective mother, and will enable her to go through her lying-in period with greater ease and security, both to herself and to the child, though it might be added that if the prospective mother has the vigor and vitality of a young athlete, none of these suggestions is of special value. She has no special need for adjuncts of any sort. Her supreme vigor will take care of her practically in every emergency if natural processes are not interfered with poisoning is said to be responsible for miscarriage or premature labor in fifty per cent of the cases concerned. In a broad, general way, it may be stated that no pregnant woman should be employed in any occupation where she can not be free to rest and recuperate the very moment she commences to feel unduly tired. Therefore, it is obvious that women who enjoy the protection of a home—no matter how humble —are in a much better position to come safely through the period of pregnancy than are those who, by force of economic circumstances, are obliged to labor outside the home up to and immediately following their hour of delivery.

When the weight of the womb causes sleeplessness

During the first six or seven months pregnancy of itself does not produce insomnia. After this time, however, disagreeable symptoms sometimes develop which may interfere with sleep. For instant, in the latter months of pregnancy the weight of the womb and its contents require that the woman sleep on her side. For many women this position at first may be a little awkward, although as a matter of fact the habit of sleeping on the right side is a good one. Also the pressure of the womb upon the bladder causes a degree of irritation that may force the prospective mother to get up several times during the night to empty the bladder. Of course, there is no way by which this can be avoided, and the annoyance must be borne patiently.

Aids to rest and proper relaxation

To bring about sound sleep and quiet relaxation, you should always be sure that the room is properly ventilated—that plenty of pure air is itted to the bedchamber at all times. Also see to it that the mattress is comfortable, and that the bed-clothes are warm but not too heavy. One of the most important of all means of securing proper rest is to occupy a bed by yourself, where you can turn over without disturbing your husband or a child —or where their restless movements will not disturb you. As a matter of fact, every person should have his or her own bed. Besides favoring better sleep, it is more sanitary.

Sexual relationship during pregnancy

The question is often asked: “Should sexual relationship be discontinued during pregnancy?" This is a matter that is worthy of most serious consideration. For it may involve even more than the health of the prospective mother—it may involve her domestic happiness as well. With women there is at times an intense congestion of the ovaries and of the genital organs following pregnancy. In fact, physicians state that, among women who are normally somewhat frigid, there often develops after pregnancy what amounts sometimes almost to nymphomania. There may be a physical basis for this, but it is abnormal and orly of temporary duration, and in any case can be mentally controlled. Sexual indulgence after pregnancy has taken place has a tendency to bring about abortion or miscarriage, if there is an inclination in this direction, and the health of mother and child must be the ,determining factors in the matter. The woman should turn her attention to other matters and stop thinking about the sexual relationship. If physical energy is expended through other channels, there will usually be less sex energy. It is, as a rule, the inactive woman, accustomed to giving way to her appetites, who feels the sex urge most strongly. In cases in which the craving is very strong it may be quite effectively reduced by the use of the cold sitz-bath. If the wife does not permit too intimate fondling at this time it will be less difficult for both the woman and the man to control the sexual impulse. In fact, if there is not this fondling, there will probably not be the awakening of the impulse. The husband should at this time consider his wife less in the physical and more in the spiritual light, as the woman who is to bring into the world a new soul is closely akin to the divine. We believe that the more nearly continence is maintained during pregnancy, the better ; but the question is one every couple must decide for themselves. The foregoing suggestions are intended to help them make their decision intelligently.

Should a pregnant woman travel?

Every once in a while you read about some woman suddenly come to labor in a railroad train, or some other conveyance, necessitating her delivery under most embarrassing conditions, and endangering her life and the life of her child because of lack of proper sepsis and attention. Is this merely a coincidence, or is it premature labor brought on by the jarring or the excitement of the journey? This is a very difficult question to answer, because the effects of traveling depend very largely upon the period of the woman’s pregnancy, her general health and vigor, the character of the journey she plans to undertake, and her mental attitude while taking it. If she is terribly grieved by the death or worried by the ili health of some dear one, the journey is much more likely to have a bad effect on her than it would be if she were going on a vacation or some other pleasant errand. To be absolutely on the safe side the prudent mother, if she has had a miscarriage in a former pregnancy, should if possible avoid all traveling during pregnancy. On the other hand, women who are not subject to miscarriage may travel with comparative safety at any time, though there is most danger during the first sixteen weeks and the last four weeks of pregnancy. For the first four months there is some little danger of miscarriage, because traveling may cause a separation of the relatively loose attachment of the ovum to the womb. In the last month the muscle fibers of the uterus are quite irritable. The rolling of a ship, or the jarring and jolting of a car or a motor, may set up painful contractions, which often bring about premature labor. And premature labor is to be avoided under any circumstances, if for no other reason than the fact that a lack of preparation and proper attendance places the woman at a decided disadvantage. As a rule there is the least risk of accident between the eighteenth and thirtysecond weeks, although even then pregnant women should try, as much as possible, not to travel at a time when their menstrual periods would ordinarily be

expected—for reasons already explained. Of course, the strength of the prospective mother, the length of the journey, and the ease with which it can be accomplished, are important factors. Naturally, there is less danger of unwelcome developments in a short trip than there is in a long, fatiguing journey. A comfortable berth in a Pullman is safer and less likely to produce harmful results than is a bolting seat in a day coach. Traveling by boat is less tiresome, unless it is an ocean voyage, and then the woman must be a good “sailor." But long auto tours are always attended with a risk of miscarriage, and should be discontinued during pregnancy.

The benefits of mental diversion

Mental diversion during pregnancy is very important, however, for it keeps the mind busy and happily occupied and prevents the woman from analyzing too closely every little sensation which in her normal condition would unnoticed. Many women, especially when carrying their first child, are made perfectly miserable by magnifying their disagreeable symptoms. They become anxious and timid, fearful of results, and constantly apprehensive of some danger to themselves or child. This state of mind interferes with proper nutrition, and all makes it almost impossible for the woman to get the restful sleep she should have. As Walton says, in his very helpful work, Why Worry?: “It is futile to expect that a fretful, impatient, and overanxious frame of mind, continuing throughout the day, and every day, will be suddenly replaced at night by the placid and comfortable mental state which shall insure restful sleep."

There is very little use in trying to control a condition like this by the mere exercise of willpower. The best thing for the mother-to-be to do if she finds herself inclined to worry over the coming ordeal is to keep herself so continuously occupied with pleasant activities that she has no time for anxious forebodings. If she still finds herself unable to sleep, there are a number of simple measures which may be used. For instance, a warm bath just before retiring, or a hot-water bottle against the feet, may help to equalize the circulation and draw the blood away from the brain into the big blood vessels of the abdomen. Often a glass of warm milk or other liquid nourishment, taken just before going to bed, will serve to draw the excess blood from the blood vessels of the brain to the blood vessels of the stomach, and thereby help the “Drowsy God" in his effort to establish himself. But whatever you do, do not get into the habit of depending upon hypnotics or narcotics in order to bring about sleep, or to quiet your nerves. For there is hardly anything else you could do that would have a more harmful effect on the developing life for which you are responsible. Use natural methods only. And if these fail-which they rarely will, if only you will persevere —rest and relax anyhow. Say to yourself : “I don’t care whether I sleep or not. I rest anyway." Thus you can make up your mind that you will relax whether you sleep or whether you don’t. And then you are far more likely to find the ability to sleep within yourself. Sleep is like happiness. If you seek it directly, it evades you, but if you stop worrying about it and think of something else, it may come to you unawares! And thus, in quiet confidence, you will await your wonderful time, with courage and joyous anticipation mounting with the age of the months.

Chapter IX

The Importance of Rest

P ROPER rest during pregnancy is quite as much a factor for insuring the comfort and safety of both mother and child as is proper exercise. It is tremendously important, especially in the case of those women who are habitually overworked, either physically or mentally. that during pregnancy your energy is to a very large extent diverted into another channel, and you are therefore not in a position to go to extremes in the way of either mental or physical work. Overwork of any kind always tends to produce an accumulation of fatiguepoisons in the system. This is not only detrimental to the welfare of the mother, but is also antagonistic to the growth and vitality of the unborn.

Rest most important in last three months of pregnancy

During the last three months of pregnancy this question of rest is of extraordinary importance. It does not seem to count for quite so much during the early months. It has been found in England that among mothers who work in factories up to the time of confinement, there is a large percentage of premature births, followed by an extremely high child-mortality during the first few months

of infancy. Among women who have sufficient rest, on the other hand, pregnancy commonly goes on to full term, with a great reduction in the infant death-rate.

Why women tire out quickly in the early months of pregnancy

During the early months of pregnancy many women complain that they lack energy, that they feel “lazy," and that they tire out quickly when they try to do many things they formerly did with ease. This experience is so general that it is practically accepted everywhere as the most natural one, and is probably due to a wise provision of good old Mother Nature, who tries her best to keep the woman quiet at a time when the attachment of the fertilized ovum in the womb is relatively insecure and is most liable to be jeopardized by any extra exertion. The woman should heed these onitions of Nature, and let herself rest when these periods of lassitude come upon her. Especially important is it to be guided by these warnings at a, time when the menstrual period would ordinarily be due, as the tendency toward miscarriage is son much more acute at this time. After the fourth month the attachment is usually thoroughly secure, and one may allow oneself a little more latitude. Toward the end of pregnancy great care not to overdo will again become specially necessary, because of the possibility causing premature labor, and also because of the annoying shortness of breath from which many women suffer during the last months of pregnancy.

Study to avoid unnecessary steps

For these reasons it would be wise for the mother to map out her work for each day carefully, and to include in her schedule periods for relaxation and rest. Avoid all violent or even difficult activities. Take great care never to exhaust yourself in anything. Stop when you begin to tire. When ascending and descending stairs, avoid jars or strains. In the morning, as you do your housework, stop at intervals, if it is fatiguing, and lie down on a couch and rest—even if only for a few moments. After lunch, if you are not over-strong, and you can possibly plan to do so, undress and go to bed for an hour or more. Even though you do not fall asleep, the relaxation is excellent for the general condition. Do not be afraid that a little nap in the afternoon will interfere with your sleeping at night particularly if you have taken a liberal amount of exercise during the day. In fact, you will sleep much better at night if you do not become overtired.

Dangers of idleness

However, there is no one thing more liable to influence the health unfavorably in pregnancy than is idleness, and by tending to produce a fat baby, it is likely, as I have mentioned in a previous chapter, to add to the difficulties of birth. A moderate amount of congenial work is good for body and mind. Physical exercises, too, if they are properly chosen and one is reasonably careful, are stimulating and invigorating, instead of exhausting. The thing to be avoided is work that involves severe muscular strain, or induces debilitating fatigue. Housework is likely to do both. It is not physical culture in any sense of the word. It cramps the chest, draws the shoulders forward bends the back, and is in many ways antagonistic to the best body training. I would not be understood as saying that housework should be abandoned. If you are a housekeeper, by all means continue your domestic duties, but do not go to extremes. Your work must not be exhausting. You may continue to do everything

that may be required about the house, if your strength is equal to it, without undue fatigue. The point is that you must not overstrain. Some women are so strong that they can stand almost any form of exertion up to the last day, but it may be dangerous to assume that one belongs to that class. Some household duties are too laborious for the average pregnant woman, and should, if possible, be turned over to some one else. These duties include every form of exertion that would be termed violent or straining to the prospective mother. Sweeping, scrubbing, laundry work, lifting of heavy furniture, or too much running up and down stairs, should be undertaken only by those who have good grounds for believing themselves strong enough for such exertion, and even then reasonable precaution should be used. The question of running a sewing machine at this time is one upon which many women desire information. Because of the need for baby clothes, this is just the time when a woman will want to do a great deal of sewing. The running of a sewing machine has been generally condemned, and there is no doubt good reason for this, in the case of extremely delicate women, during the advanced stage of pregnancy. If a woman is physically robust, however, and finds that no discomfort or inconvenience results from running a machine, there is no reason why she should not do so, at least to a moderate extent. It depends entirely upon the individual. When the mother-to-be is debilitated and run down, it will be a very sensible precaution, during these critical months, either to do all sewing by hand, or else to fit the machine with a hand attachment or a motor.

A great deal depends upon what the woman has been accustomed to

In a general way, the amount of work any woman should undertake to do during pregnancy should depend upon what she has always been accustomed to. In

many cases she can continue her usual activities to the last without harmful results. The following incident is a case in point: A professional “strong" woman was doing an “act requiring her to lift her husband, who weighed nearly one hundred and fifty pounds. She performed this feat in various ways, one of which was to elevate him above her head with one hand. When she became pregnant she continued her act daily up to the night when she went to the hospital to give birth to her child. Mothers accustomed to caring for a large household often continue their occupations until the very last months of pregnancy without any harmful consequences. They are strong enough to bear the burden—that’s the answer. But be sure you are strong enough before you take any such risk. Statistics show that in the majority of cases such practices are dangerous. Miscarriage and premature labor are much more common among women of the working classes than among the well-to-do. Also the average birth-weight of full-term infants whose mothers remained at work during the months of pregnancy has been found to be ten per cent less than that of infants among the leisure class, though all may still be considered within normal weight limits.

How various countries regulate the employment of pregnant women

The employment of women during and immediately following pregnancy is a matter that is closely regulated by law in countries which take an active, humane interest in the lives and health of their citizens. In our country, unfortunately, we devote nearly all such constructive efforts to conserving the lives of chickens, calves, and little pigs. In Holland, , Belgium, England, Portugal, and Austria, the employment of women in factories is prohibited during the last four weeks of pregnancy and the first four weeks following childbirth. In and Norway there is no legal restriction against the employment of

pregnant women; yet the laws of both countries forbid women to return to work until the sixth week after they have been delivered. Among all civilized nations, the United States, Turkey, and Spain lead in ignoring the rights of pregnant women to legislative protection, and the right of the coming generation to be well born. We should agitate for a reform in the present laws governing the employment of women, making it mandatory that no pregnant woman shall be permitted to work outside the home for a specified period before and after confinement, or be employed at all in certain metal industries, such as those requiring the handling of lead. Metal poisoning is said to be responsible for miscarriage or premature labor in fifty per cent of the cases concerned. In a broad, general way, it may be stated that no pregnant woman should be employed in any occupation where she can not be free to rest and recuperate the very moment she commences to feel unduly tired. Therefore, it is obvious that women who enjoy the protection of a home—no matter how humble —are in a much better position to come safely through the period of pregnancy than are those who, by force of economic circumstances, are obliged to labor outside the home up to and immediately following their hour of delivery.

When the weight of the womb causes sleeplessness

During the first six or seven months pregnancy of itself does not produce insomnia. After this time, however, disagreeable symptoms sometimes develop which may interfere with sleep. For instance, in the latter months of pregnancy the weight of the womb and its contents require that the woman sleep on her side. For many women this position at first may be a little awkward, although as a matter of fact the habit of sleeping

on the right side is a good one. Also the pressure of the womb upon the bladder causes a degree of irritation that may force the prospective mother to get up several times during the night to empty the bladder. Of course, there is no way by which this can be avoided, and the annoyance must be borne patiently.

Aids to rest and proper relaxation

To bring about sound sleep and quiet relaxation, you should always be sure that the room is properly ventilated—that plenty of pure air is itted to the bedchamber at all times. Also see to it that the mattress is comfortable, and that the bed-clothes are warm but not too heavy. One of the most important of all means of securing proper rest is to occupy a bed by yourself, where you can turn over without disturbing your husband or a child —or where their restless movements will not disturb you. As a matter of fact, every person should have his or her own bed. Besides favoring better sleep, it is more sanitary.

Sexual relationship during pregnancy

The question is often asked: “Should sexual relationship be discontinued during pregnancy?" This is a matter that is worthy of most serious consideration. For it may involve even more than the health of the prospective mother—it may involve her domestic happiness as well. With women there is at times an intense congestion of the ovaries and of the genital organs following pregnancy. In fact, physicians state that, among women who are normally somewhat frigid, there often develops after pregnancy what

amounts sometimes almost to nymphomania. There may be a physical basis for this, but it is abnormal and only of temporary duration, and in any case can be mentally controlled. Sexual indulgence after pregnancy has taken place has a tendency to bring about abortion or miscarriage, if there is an inclination in this direction, and the health of mother and child must be the determining factors in the matter. The woman should turn her attention to other matters and stop thinking about the sexual relationship. If physical energy is expended through other channels, there will usually be less sex energy. It is, as a rule, the inactive woman, accustomed to giving way to her appetites, who feels the sex urge most strongly. In cases in which the craving is very strong it may be quite effectively reduced by the use of the cold sitz-bath. If the wife does not permit too intimate fondling at this time it will be less difficult for both the woman and the man to control the sexual impulse. In fact, if there is not this fondling, there will probably not be the awakening of the impulse. The husband should at this time consider his wife less in the physical and more in the spiritual light, as the woman who is to bring into the world a new soul is closely akin to the divine. We believe that the more nearly continence is maintained during pregnancy, the better ; but the question is one every couple must decide for themselves. The foregoing suggestions are intended to help them make their decision intelligently.

Should a pregnant woman travel?

Every once in a while you read about some woman suddenly come to labor in a railroad train, or some other conveyance, necessitating her delivery under most embarrassing conditions, and endangering her life and the life of her child because of lack of proper asepsis and attention. Is this merely a coincidence, or is it premature labor brought on by the jarring or

the excitement of the journey? This is a very difficult question to answer, because the effects of traveling depend very largely upon the period of the woman’s pregnancy, her general health and vigor, the character of the journey she plans to undertake, and her mental attitude while taking it. If she is terribly grieved by the death or worried by the ili health of some dear one, the journey is much more likely to have a bad effect on her than it would be if she were going orr a vacation or some other pleasant errand. To be absolutely on the safe side the prudent mother, if she has had a miscarriage in a former pregnancy, should if possible avoid all traveling during pregnancy. On the other hand, women who are not subject to miscarriage may travel with comparative safety at any time, though there is most danger during the first sixteen weeks and the last four weeks of pregnancy. For the first four months there is some little danger of miscarriage, because traveling may cause a separation of the relatively loose attachment of the ovum to the womb. In the last month the muscle fibers of the uterus are quite irritable. The rolling of a ship, or the jarring and jolting of a car or a motor, may set up painful contractions, which often bring about premature labor. And premature labor is to be avoided under any circumstances, if for no other reason than the fact that a lack of preparation and proper attendance places the woman at a decided disadvantage. As a rule there is the least risk of accident between the eighteenth and thirtysecond weeks, although even then pregnant women should try, as much as possible, not to travel at a time when their menstrual periods would ordinarily be expected—for reasons already explained. Of course, the strength of the prospective mother, the length of the journey, and the ease with which it can be accomplished, are important factors. Naturally, there is less danger of unwelcome developments in a short trip than there is in a long, fatiguing journey. A comfortable berth in a Pullman is safer and less likely to produce harmful

results than is a jolting seat in a day coach. Traveling by boat is less tiresome, unless it is an ocean voyage, and then the woman must be a good “sailor." But long auto tours are always attended with a risk of miscarriage, and should be discontinued during pregnancy.

The benefits of mental diversion

Mental diversion during pregnancy is very important, however, for it keeps the mind busy and tappily occupied and prevents the woman from analyzing too closely every little sensation which in her normal condition would unnoticed. Many women, especially when carrying their first child, are made perfectly miserable by magnifying their disagreeable symptoms. They become anxious and timid, fearful of results, and constantly apprehensive of some danger to themselves or child. This state of mind interferes with proper nutrition, and also makes it almost impossible for the women to get the restful sleep she should have. As Walton says, in his very helpful work, Why Worry?: “It is futile to expect that a fretful, impatient, and overanxious frame of mind, continuing throughout the day, and every day, will be suddenly replaced at night by the placid and comfortable mental state which shall insure restful sleep." There is very little use in trying to control a condition like this by the mere exercise of willpower. The best thing for the mother-to-be to do if she finds herself inclined to worry over the coming ordeal is to keep herself so continuously occupied with pleasant activities that she has no time for anxious forebodings. If she still finds herself unable to sleep, there are a number of simple measures which may be used. For instance, a warm bath just before retiring, or a hot-water bottle against the feet, may help to equalize the

circulation and draw the blood away from the brain into the big blood vessels of the abdomen. Often a glass of warm milk or other liquid nourishment, taken just before going to bed, will serve to draw the excess blood from the blood vessels of the brain to the blood vessels of the stomach, and thereby help the “Drowsy God" in his effort to establish himself. But whatever you do, do not get into the habit of depending upon hypnotics or narcotics in order to bring about sleep, or to quiet your nerves. For there is hardly anything else you could do that would have a more harmful effect on the developing life for which you are responsible. Use natural methods only. And if these fail which they rarely will, if only you will persevere —rest and relax anyhow. Say to yourself : “I don’t care whether I sleep or not. I rest anyway." Thus you can make up your mind that you will relax whether you sleep or whether you don’t. And then you are far more likely to find the ability to sleep within yourself. Sleep is like happiness. If you seek it directly, it evades you, but if you stop worrying about it and think of something else, it may come to you unawares! And thus, in quiet confidence, you will await your wonderful time, with courage and joyous anticipation mounting with the age of the months.

Chapter X

General Hygienic Considerations

A S already stated, loss of, or injury to, the teeth is a frequent but quite unnecessary accompaniment of pregnancy. It is due to the abstraction of lime salts from these parts to supply the demand of the fetus when it cannot otherwise obtain what it needs. The remedy is a diet so rich in mineral salts that there will be no encroachment upon the body of the mother. With the right kind of diet the teeth should not suffer any more during pregnancy than at any other time. At the same time the prospettive mother should take every other precaution to protect them.

Visit your dentist

One of the first things a woman should do on discovering that she is pregnant is to visit her dentist and have all her teeth put in the best possible condition. Many women hesitate to have dental work done at this time, and many dentists have even advised against anything except the most vitally necessary work.

It used to be thought that the extraction of teeth, or the infliction of any unusual amount of pain, would inevitably result in a miscarriage. I do not think there is much danger of this. I have known many pregnant women who had all sorts of dental work done and without the slightest untoward effect. Still it might be well to avoid work likely to cause a severe shock. Needless to say, the teeth during pregnancy should be brushed even more carefully than at any other time. Particles of food lodged in the crevices between the teeth should be removed, so as to prevent their decomposing and generating acids which attack the enamel. The greatest care is needed just before retiring, because it is during the night, when the tongue is at rest and the secretions of the mouth are lessened, that the teeth suffer most. If there is any pyorrhea or inflammation of the gum margins present, the necks of the teeth should be carefully scaled—all tartan and other irritating debris removed—and a good antiseptic applied to the gums. These precautions may seem burdensome, but they will pay. Many injuries to the body can be repaired, but a lost tooth can not be replaced. The best repairs in this case can only take the form of skillful mending.

Don’t neglect the hair and scalp

The hair, too, often suffers in pregnancy, and should be well cared for at this time if at no other. The importance of brushing the hair regularly can hardly be emphasized too strongly. Brushing polishes the hair and will tend to increase its lustre very greatly. But the principal value of the brush lies in the influence of its proper use upon the scalp. The hair should be brushed once or twice a day, special care being taken at first, if the scalp is tender, to avoid too much vigor. Later on there will be little danger of irritating the scalp.

Some women prefer to use a brush with stiff bristles for removing dandruff, and then use a soft one for polishing and arranging the hair. To maintain the scalp in the best condition of cleanliness, it is not necessary to wash or shampoo the hair too frequently. Shampooing twice a week may often cause a dry, brittle condition of the hair—the very thing that should be avoided. Shampoos—especially if the shampoo happens to contain too much alkali—have a tendency to remove the natural oil from the hair. This removes at the same time the lustre and elasticity.

Therefore, if the hair is naturally inclined to be dry, these repeated shampoos will often make its condition worse. But the addition of a very small amount of olive oil or vaseline to the roots, after it is fully dry, will prevent undue dryness of and injury to the hair.

How to shampoo the hair

Unless there are some special reasons why the hair should be shampooed more frequently, it is not advisable for women to wash their hair oftener than once every week or ten days. If, however, the hair is very oily, it may be found necessary to wash it more frequently. For additional cleansings, daily brushing, and a cleansing of the scalp with a soft cloth, should suffice. Pure castile soap makes an excellent base for a shampoo. Sometimes the addition of the yolk of an egg to castile jelly, made by boiling the soap shavings in water, is excellent. As a general rule it is best to wet the hair with only a little water, then to apply the shampoo. This should be rubbed thoroughly into the scalp, from time to time adding more water, so as to make a good lather. Part the hair so that the scalp is exposed, and rub the shampoo thoroughly over the scalp with the finger tips.

After the scalp has been gone over in this way, it should be rinsed several times, until the soap is thoroughly removed. The washing water should be warm, as should the first rinsing waters—until all the soap has been removed, when it may be used cool; the final rinsing water, unless it causes discomfort, should be cold, so as to dose the pores. Be particularly careful, in drying the hair, to get all possible moisture out of it, and, if opportunity offers, finish the drying by exposing the hair to the fresh air and the sunshine. If the hair is naturally curly, it should never be brushed immediately after shampooing, as this has a tendency to make it straight and stringy. If it is straight, wait until it is nearly dryusing warm towels assiduously in the meantime. Then pull it slightly all over the scalp, and, if it is short, rub in circles. This will impart a natural fluffiness to the hair, and entourage any tendency that it has to curl. Comb it with a wide-spaced comb, after it is dry or practically so.

For the general health

Everything possible should be done to build up the most robust state of health during pregnancy—both for the sake of the mother and the baby that is coming. Diet, bathing, exercise, rest and recreation-everything should be considered in respect to its effect upon nutrition and increased well-being. Constipation is particularly to be avoided. The proper balance of fruit and vegetable diet will help overcome intestine and liver torpor. The use of mineral oil has given splendid results. Mineral oil, it must be ed, is in no sense a drug or a medicine. It is merely a lubricant, softening the hardened feces and facilitating their age through the intestinal canal.

From a teaspoonful to a tablespoonful may be used morning and evening, if needed.

Mineral, oil tends to prevent hemorrhoids

The regular use of mineral oil in lubricating the age for the feces, and thereby preventing undue strain upon the hemorrhoidal veins and the mucous membranes of the lower bowel, tends markedly to reduce the chances of developing hemorrhoids during pregnancy. In severe cases it would be advisable to take a limited fast for two or three days, and then live on oranges and other fruit for a few more days. If the hemorrhoids protrude, the inflammation and swelling can be reduced, either with a hot compress, or by the use of an ice bag, after which they can be annointed with vaseline and gently replaced. Hemorrhoids frequently grow worse as pregnancy progresses, and are often aggravated by the birth of the child. Yet they usually disappear within a few weeks after delivery—following the removal of tension upon the circulation of the portal veins. In many cases a vibrator will be beneficial, using the rectal attachment usually supplied with these instruments. But be sure that its use will have no ili effects on the unborn child. The knee-chest position will frequently be helpful in reducing hemorrhoids.

Care of the nipples

Before the sixth month it is not necessary to give the nourishment of the prospective child much consideration, but with the sixth month, the care of the mother’s breasts, to aid milk production, should have attention. All tight clothing

about the breasts must be avoided, for pressure prevents increased circulation and development. When it is advisable not to nurse the child, as with anemie, malarial, or tubercular in others, then it is well to maintain snug pressure in this region to prevent the development of the glands. Massage of the breasts is a delicate procedure. They are sensitive and easily bruised. Furthermore, any undue amount of force applied to them has a tendency to cause sexual excitation, and might possibly produce an orgasm. This is decidedly to be avoided, for the reason that any violent contraction of the womb might bring on a miscarriage. The breast is like a bunch of grapes, covered by fat and skin, the grapes representing the milk glands and the stems representing the milk ducts. These ducts have not been used, or not for many months, and require distention so that they may afford the milk opportunity to flow to the nipples, and the glands must be stimulated. The purpose of the massage is to facilitate these changes. To apply it, proceed as follows: Assume an all-fours position so that the breast is pendent. Cover it with a towel dripping with water for two minutes. This will lessen the blood supply through osmosis. Then for five minutes stroke the breast, using gentle pressure, from its insertion on the chest wall toward the nipple. A daily manipulation will do much to insure normal functioning of the breasts. The massage should always be given in the position mentioned, with the breast hanging at right angles to the body. An incidental advantage of this position is that it affords rest to the ligaments that the breast. Sometimes a little olive oil rubbed on the nipples tends to make them more resistant to fissure and cracking.

Should pregnant women douche ?

Many women, accustomed to regular douching as a toilette necessity, continue the use of the douche through pregnancy.

This is usually a mistake. For, while the walls of the vagina closely resemble the skin, yet, unlike the skin, they do not contain glands. Nor do they excrete any waste products from the system. The secretion which comes from the vagina has its origin in the small glands around the mouth of the uterus, and serves to keep the birth canal free from pathogenic bacteria. Repeated examinations have proved that under normal conditions there are no disease-producing bacteria in the vagina of a pregnant woman. In this respect it is even cleaner than the skin, on which bacteria are always present. Therefore, the naturally aseptic condition of the vaginal canal should not, unless there is excellent reason for it, be disturbed during pregnancy. Regular bathing is usually sufficient to insure external cleanliness, and, if there is any smarting or itching due to leucorrheal discharge or other cause, the cold sitz-bath will afford relief. It is excellent when there is any congestion, or pressure from enlarged hemorrhoidal veins. Close attention to all these matters will go far toward increasing the comfort and happiness of the mother and bringing about a successful termination of her labor.

Chapter XI

Symptoms and Ills of Pregnancy

W HILE the morning vomiting which occurs in many cases of pregnancy is regarded as natural, it can be greatly relieved by insuring regular daily evacuations of the bowels, and by proper flushing out of the stomach with copious drafts of hot water. This complaint is often caused, or at least greatly aggravated, by sexual intercourse during pregnancy. While a moderate amount of sexual indulgence for the first four or five months of this period is sometimes said to be beneficial, I am inclined to question the correctness of this conclusion. The only absolutely safe course is to adhere to a program of absolute continence after the existence of a state of pregnancy has been established. It is usually better in cases of nausea to eat your heartiest meal at noon, and use fruits or green salads at night. Heavy foods are best avoided altogether, and of course one should be careful not to overeat. At times a meal of acid fruits alone may be best for the evening. This will insure a good appetite for breakfast the next morning. And here is a suggestion which may prove useful: Before arising take a bit of dry bread, a few prunes, or a very small quantity of any food you think you can relish and which can conveniently be eaten in bed. In many cases this will immediately counteract any tendency to morning sickness. A fast now and then, followed by a restricted diet for a day or two, with a

gradual return to the full diet, will be very efficient. Washings of the body with cool water, and a general invigorating regime, will often prove beneficial.

Knee-chest position to prevent nausea in pregnancy

Physicians believe that the erect posture assumed by the human animal puts direct downward pressure upon the pelvic organs. For this reason it is imperative that these organs rise above the pelvis, to have ample opportunity for healthy development. From the very beginning of conception and through the early months of pregnancy, a woman, if not over-strong, should make a practice of assuming the knee-chest position several times during the day. Let her kneel on the bed, lower her face and shoulders to the mattress, and rest in this position for at least five minutes.

The morning vomiting of early pregnancy usually comes on as the expectant mother leaves the bed and assumes the erect posture. This causes the pelvic contents to crowd the rectum, and indicates how ‘very imperative it is to encourage the pelvic organs to remain as high as possible in the pelvis. The pressure on the pelvis can also be relieved by the evening enema. The emptying of the bowel will, naturally, give more space to the uterus, in addition to relieving the bowel itself. Upon rising, the pregnant woman should drink at least one large glass of cool water, provided it does not aggravate the symptoms of nausea. Cool water on the empty stomach is very effettive as a laxative. If the diet is satisfactory, this practice usually results after a few days in copious natural stools, but pending this action, the rectal irrigation is advisable. Let me repeat again that during pregnancy all medication should be religiously avoided except in extreme conditions. Most medicines are eliminated from the body by the kidneys, and these are the organs that are most taxed by pregnancy.

Owing to the unusual demands upon the kidneys during pregnancy, these organs are sometimes overtaxed. This result is manifested in part by a dropsical condition, especially by an unusual swelling of the feet, ankles, and legs. Swellings of this kind in moderate degree are very common during pregnancy, but symptoms of this kind should be very carefully watched. In addition there should be made early in the period, and from time to time thereafter, an analysis of the urine. Most physicians now insist on this for the reason that pronounced kidney trouble may exist with no external symptoms, and an apparently healthy woman may suddenly be seized with the convulsions of eclampsia. This grave condition usually occurs during the last few months of pregnancy, and heroic treatment may be required to save the woman’s life. Pregnancy in such cases is frequently terminated by the extraction of the fetus.

How to deal with sidney trouble

Proper precautions will usually prevent sudi a catastrophe. One should, therefore, know what precautions to take against abnormal kidney conditions and how to deal with them when they arise. The slightest trace of albumen in the urine should be treated as a matter of grave import. Medicinal treatment is of little value, and the kidneys should be relieved by the hot bathing already mentioned, and by an appropriate diet. The full milk diet, together with prolonged neutral baths, will not only prevent serious disturbance of these organs, but, in many cases, has corrected the trouble when well advanced. A low protein diet will usually answer all requirements in cases of this kind. In other words, where any kidney trouble is suspected, it is well to use practically no meat or eggs, also to avoid baked beans and dried peas. Plenty of fresh vegetables, green salads and fruits, together with whole-wheat bread and such milk as may be desired, would form a satisfactory diet in practically all such cases. But where there are signs of serious kidney disease an exclusive milk diet is usually the most satisfactory of all diets. The milk usually should be cool. When there is poor circulation and slow digestion, or during cold weather, the milk may be warmed to body temperature. It should never be boiled and never heated over 110 degrees.

The ideal amount is between four and six quarts daily for a person of average weight. Add about a pint for every additional ten or twelve pounds of body weight and deduct a pint for every ten or twelve pounds under average weight. The safe rule is to take as much as can be comfortably digested, but the stomach should be kept working to its highest capacity during the milkdrinking hours. If no milk is taken during the night, there is usually a morning hunger, and the milk is relished. Don’t drink milk as you would water. Sip it slowly, or, better still, dose the lips so tightly over the edges of the glass that you have to suck, draw in the milk, just as a baby would who is sucking the nipple of a baby bottle. Irrespective of other dietetic requirements, it is always well to adopt a low protein diet (largely avoiding lean meats, beans, peas, etc.) during the last two weeks of the term. It will serve as a safeguard in any case against complications of unsuspected kidney trouble.

Uremia and its treatment

Uremia is a form of blood poisoning due to inability on the part of the kidneys to excrete the liquid waste material. This derangement may be due to chronic or acute inflammation of the kidneys. It is one of the most dangerous symptoms accompanying pregnancy. The characteristic symptoms include a considerable diminution or a complete cessation of the flow of urine, severe headache and restlessness, loss of appetite, nausea and vomiting, vertigo, muscular spasms and convulsions, sometimes ending in coma and death. The keynote of the treatment of this grave disease is body-poison elimination, supplemented by such vitality-building measures as will restore the vigor of the kidneys and give tone to the organs of the body in general. In the case of uremic convulsions, indicating an extreme crisis of the disease, stringent measures must be adopted. A hot bath of 11.5 degrees Fahrenheit, or a

hot blanket pack, is often recommended. In the latter case the feet must be warmed by hot-water bottles, while cold packs may be applied to the head. The patient should also drink profusely of hot water. A full hot enema may be used at 115 degrees Fahrenheit, this having special value in stimulating the activity of the kidneys and in cleansing the alimentary canal. No nourishment should be given until the convulsions have ceased. It is needless to say that the patient must have as much fresh air as possible at all times. General constitutional treatment is absolutely necessary. S team baths once or twice a week are sometimes advised, and if they can not be had, then a moderately hot bath, at a temperature of 105 to 108 degrees, three times a week, may prove satisfactory. Every other day and alternating with the hot-water or steam bath, a cold wet-sheet pack should be given in the morning and a hot sitzbath in the evening. In the latter instance it is well to sponge immediately after with cool water, or use a cool sitz-bath for a half minute, more or less. A hot abdominal pack may be used in place of the hot sitz-bath, in which case a cold abdominal pack should follow, to remain until dry, or until morning—this treatment being taken immediately before retiring. Care must be taken, however, to insure reaction to warmth immediately after applying the pack. The free drinking of water is to be recommended. In all cases the patient should fast until the symptoms have disappeared. When nourishment is needed, the safest thing is milk. During this milk diet only neutral baths should be taken each day. Any needed exercises should be taken in the morning before beginning the use of the milk. Outdoor air, air-baths, dry friction baths, and sun-baths, together with all other measures helpful to promote elimination and activity of the skin, are to be insisted upon. A general vitalitybuilding regimen should be followed, with walks that should be just long enough to induce a moderate degree of fatigue, increasing daily until a long distance can be covered without inconvenience.

The emotional impulses of the mother

A young woman in her first pregnancy is likely to be filled with undue anxiety about her state, but much can be done to keep up her spirits by surrounding her with an atmosphere of confidence. The too anxious husband may be, and often is, a great detriment to the welfare of his wife and child. There is nothing strange or fearful in pregnancy, and most physicians are well trained in obstetrics. So there is no reason for not treating the conception of the wife as an ordinary, everyday incident, and such an attitude will do much to prevent depressing emotions at this time. With his strong sense of gallantry, the average American husband is too apt to put a serious construction on little incidents which offer no real menace to his wife’s health. During the early months of pregnancy there is seldom any reason why a woman should not dance and swim and walk, or even run, play golf or tennis, or take any exercise to which she has previously been accustomed. It is natural for some pregnant women to have their weeping spells. They should not be denied the privilege of indulging in them, for they afford sedative reaction. Husbands, if your wives enjoy a quiet, inoffensive weep, don’t interfere with their enjoyment. Many a woman has become a selfindulgent hysterical wreck simply because the anxious husband insisted upon cajoling her into smiles when tears would have quieted her much more satisfactorily. In fact, it is imperative that the husband as well as the wife be instructed in the matter of emotional disturbances. While the husband need not be stern or distant, yet he should learn not to take these outbursts of sentiment too seriously.

Varicose veins

Varicose veins are not peculiar to pregnancy. Tight clothing tends to produce

them, and anyone who stands much, or who does a great deal of walking, is liable to suffer in this way. Varicose veins are not peculiar to pregnancy. Tight clothing tends to produce them, and anyone who stands much, or who does a great deal of walking, is liable to suffer in this way. But pregnancy emphasizes any tendency in this direction which may exist, and with each recurrence of the condition the tendency becomes progressively greater. The right leg is generally the first to be affected, because the position of the child in the womb is such as to bring the greatest amount of pressure to bear on the blood vessels of the right side. In the event that both legs are affected, the right leg is usually the worse of the two. Varicosity is relieved spontaneously, in the majority of cases, after the birth of the child. If you can keep off your feet for a while after delivery, you will be almost sure to clear up the condition, and see the veins return to their normal calibre once more. Once the blood vessels have been distended, however, they are always more susceptible to any increased strain than they would otherwise have been, and in the next pregnancy a more serious condition may develop. Pains should therefore be taken to avoid the trouble. If a varicose condition is in any way threatened, prolonged baths should be taken, so as to relieve the distension of the veins through the osmotic action of water. A half-hour’s immersion in a neutral warm bath before retiring will usually meet all requirements during the first six months of pregnancy, but during the remaining three months a mid-day immersion in addition may be desirable. When actual ulceration of the veins has occurred the bath should be considerably prolonged. If the baths fail to control the condition, the patient must keep off her feet all she possibly can, and in extreme cases may have to go to bed.

Do not use a unless it can not be avoided. always ultimately weakens the tissues thus aided. If you must use one, a flannel bandage wound snugly around the leg, from toes to knee, or even higher—if the veins of the thigh are swollen—possibly gives the very best , although an elastic bandage is preferred by many. The bandage .should be removed at night, or when you are in a recumbent position, so as to afford the veins an opportunity to contract normally. If a vein should burst, it will be easy to check the hemorrhage by making firm pressure over the bleeding point with a clean handkerchief. Then apply a cold compress or a piece of ice. In most cases the bleeding will be checked by these measures.

To prevent varicose veins

Lying on the back with the legs elevated for a fairly prolonged period will often be of value in relieving the pressure on these blood vessels. It can be readily understood that constricting clothing should be avoided. It is estimated that about one out of eight pregnancies does not go on to term, but ends in a premature expulsion of the immature fetus. When this occurs at any time before the end of the third month, we speal of an abortion; between the end of the third and the beginning of the seventh months it is called miscarriage, and, later on, premature labor.

The causes of abortion

The causes of abortion are various. In some excitable women the uterus is so irritable that the slightest disturbance, whether mental or mechanical, will

produce an abortion. Usually, however, death of the ovum precedes, and is the cause of, abortion. The death may be due to a disease of the father ( for instance, syphilis) ; to disease of the mother ; to disease of the fetal membranes ; or to accident. Abortion manifests itself by severe pain in the abdomen, which is followed by more or less severe hemorrhage. The blood usually appears in clots, and may contain particles of the embryo, or the embryo is expelled as a whole. As soon as the embryo has been expelled, hemorrhage and pain cease and the woman usually recovers rapidly. To prevent abortion the woman should avoid all excitement and all physical exercise which exposes her to danger of sudden jolts or jars, or which causes an increase of abdominal pressure, as in lifting heavy weights. Either miscarriage or abortion can sometimes be prevented if cold sitz-baths of one to three minutes duration are taken two or three times daily when the very first symptoms of the condition are noted. They are of no value unless taken in the very beginning. When abortion has set in, rest is of no value. On the contrary, the woman should be encouraged to be up and about, unless the hemorrhage is too copious. Usually abortion terminates favorably without any interference. Sometimes, however, when bleeding is protracted or severe, surgical treatment is necessary.

The present-day treatment of abortion

In discussing this very important subject, Dr. William J. Robinson, Editor of the Critic and Guide, says : “As we all know, too much meddlesomeness in the treatment of abortion, as well as in the treatment of normal labor, is DOW frowned upon. It is considered almost equivalent to malpractice. Even cases of septic abortion, we are told, should receive no local treatment until they are at least five days free from fever, the only exception being made in cases of hemorrhage which actually threatens life.

“It is stated that this period of non-treatment converts a septic case into a socalled non-septic one, and results in fewer days of fever, fewer complications, shorter convalescence, and a lower mortality. It is only in the non-septic cases that curettage is still advised by some. “What a change from twenty years ago! At that time, the procedure was curetting, irrigating, packing, and again curetting and packing, etc. “I recollect a little incident in one of our medical societies in which a paper was read on The Treatment of Abortion, Septic and Non-Septic. Very radical and energetic measures were recommended. One doctor got up and timidly asked if it would not be better not to be so meddlesome and energetic and to give Nature a chance. “He was the only one among all those who discussed the paper who made such a suggestion, and he was pooh-poohed, sniffed at, and some as much as hinted that he was not to be taken seriously at any time. But the procedure recommended at that time, namely, to leave the patient alone, give Nature a chance, and interfere only when indications are clear and unmistakable, is the accepted practice of today." The pregnant uterus presses on nerves as well as blood vessels. This pressure often causes a great deal of pain. Sometimes the pain is localized in the area of the nerve pressed upon, at which time it is usually felt in the lower part of the back. On the other hand, the pain sometimes is felt in the area in which the nerve ends. This explains why pain, numbness, and disagreeable tingling sensations may be felt in the leg or foot —far remote from the actual seat of trouble. Needless to say, these troubles are difficult to relieve, until the pressure of the pregnant uterus is removed by the birth of the child. Meantime, brisk massage to the aching or tingling areas, applied by the nurse or by the husband, gives great relief, and may be repeated as frequently as the necessity arises.

Chapter XII

Clothing for Pregnancy and Lactation

T HE question of clothing during pregnancy is a very important one, for not only should it satisfy the demands of health, but it should be so designed as to help a woman over the embarrassment which many feel when obliged to appear in an obviously pregnant condition. It should be unnecessary to say that during this period all constriction of the waist by corsets, waist-bands, or strings, should be sedulously avoided. Such things should not be worn at any time, but during pregnancy they are particularly injurious. All clothing should hang from the shoulders. The waist-line is a monstrosity artistically and hygienically. There is no such thing as a waistline in the anatomy of the human body. When a girdle is desired, the proper place for it is directly underneath the bust. This is where the beautyloving Greeks placed it, allowing for the free and beautiful flow of drapery below this point. For those who love the lines of drapery, it should be evident that there is no opportunity for such satisfaction in a skirt which is pulled tightly around the waist. Fortunately, clothing that hangs from the shoulders is now fashionable, and one can buy it in the shops ready-made, instead of making it or having it made for oneself, as was the case only a few years ago.

The chief function of clothes is to keep the body warm

The basic reason for wearing clothes is to keep the body warm. The clothing, you , confines a cushion of air that prevents the escape of heat that radiates from your body. Since dry air conducts heat less effectually than does moist air, the underclothes should be made of a material that will absorb the perspiration. If they are not, the heat generated by the body is radiated and lost. In warm weather, silk, linen, or cotton, may be worn, as the purse permits. In cool or cold weather, light-weight woolen garments should always be worn, but preferably with linen next the skin, because linen absorbs moisture much more quickly than any other material. In cold weather the kidneys will not remove their share of poison from the body, unless it is kept warm; and as pregnancy, as already mentioned, places an extra strain on these organs, often with serious results, the important of keeping the sweat glands active during this period cannot be emphasized too strongly. Do not coddle yourself, but, on the other hand, do not take any risks.

About the underwear

In the way of underwear, combination garments may be bought in various attractive models. There is the “step-in," the princess slip, the combination vest and drawers, and so forth. There is also the standard union suit, covering the body from the neck to the feet, thus maintaining warmth with a minimum of weight and pressure. One of the most desirable garments for comfort, convenience, and fit is an athletically designed garment called “Sealpax," similar to a “step-in." With a foundation of this kind it is easy to eliminate the waist-band and waistline in external garments. In buying underwear it is well to select garments larger than those usually worn, to allow for the enlargement of the body, and especially the increase in the

distance from the neck down. Common sense should teach us that corsets, undesirable at any time, are doubly so during pregnancy. When worn for the purpose of compressing the abdomen, so as to render the condition less noticeable, they are not only an instrument of torture, but a great danger to both mother and child.

Effect of the corset

Corsets, or tight clothing, worn during the enceinte period, interfere with the proper breathing movements. They also impede the normal action of the heart, interfere with the digestive processes, and often, by their pressure, cause the child to assume an unfavorable position within the uterus. When discarding corsets, do not seek a substitute, since any real substitute for such a needless and injurious device is likely to be as objectionable as the corsets themselves. It is better to avoid anything that even remotely suggests the corset, but if one feels one must have something of the kind to the hose and other garments, a corset-waist without steels or whale-bone may be used. This corset-waist is buttoned down the front and laced at the sides, so as to permit of indefinite enlargement to conform to the growth of the body, and the garters are suspended from the sides and front. It should fit loosely. In the absence of such a garment, the only form of hose-er permissible is one that hangs from the shoulders. This may be made very readily by any moderately skillful woman from a piece of webbing one-inch wide, with ordinary elastic hose-ers attached halfway down. The best plan is simply to place the webbing upon and around the shoulders and pin it to fit, after which it may be sewed. Another possible choice is the combination brassiere and hoseer which may be purchased at any large department store.

The outer garments

The negligee in its various forms may be commended as an appropriate house garment during pregnancy. More ceremonious gowns should be built on the onepiece principle, avoiding the waist-line. A Greek effect may be commended, with something in the nature of a girdle dose up under the breasts, the material falling from that point straight downward. In all dresses and coats, it is always well to provide a fairly large collar to balance the figure at the top. The Jack of a collar gives the undesired “barrel shape." “Maternity gowns," so constructed that they conceal much, without at the same time bringing injurious pressure to bear on the body, may be bought in the shops. If one wants to follow the fashion which calls for separate blouses and skirts, it can be done by attaching the skirt to an under-waist fitting perfectly but not tightly. This should be finished with a stout tape or band to which the skirt is buttoned. The blouses designed to be worn outside the skirt are well adapted to the needs of this period, as they hang loose from the shoulders and conceal the outlines of the figure.

Footwear

The shoes to be worn during pregnancy should be ample and comfortable, whether there is any swelling of the feet and ankles or not. High heels, an abomination at any time, are especially injurious during this period, inasmuch as they disturb the normal poise of the body, and involve an unnecessary strain. The flatter the heels and the nearer one comes to the natural position of the foot the better. In addition to being a prevalent cause of backache, high heels are extremely dangerous, as they are likely to be the cause of a fall or stumble, and such might be fraught with serious consequences at this time. A broad-soled, low-heeled shoeaffording ample protection against weak ankles, and a firm foundation for

your increasing weight —is the only thing to wear during these momentous months. The sandal or house-slipper may be worn with benefit about the house.

Chapter XIII

Preparation for Childbirth

W E now come to one of the most important phases of our subject. What should be done when labor is imminent in preparation for this important event? In the first place, a person well versed in the management of such cases should be engaged in ample time. Of course, we would recommend a practitioner who is a believer in natural methods, but where such is not obtainable, a ed midwife or physician must by all means be engaged. Having done this, the woman will naturally turn her attention to the preparation of the various articles needed in labor. The following list, representing the minimum of supplies required, will serve as a guide:

- Vinegar (4 ozs.)

- Soft rubber catheter

- Tincture of green soap

- One pound of absorbent (4 ozs.) cotton

- Boracic acid

- Small bottle of carbolized

- One new large coarse sponge vaseline

- A fountain syringe (sterilized by boiling)

- One dozen towels

- Large rubber cloth (one Yard square)

- Bed pan, new

- Unbleached muslin for abdominal binder (2 yards)

- Cheesecloth (20 yards)

- Plenty of old clean linen, sterilized by baking in oven

- Large and small safety pins (2 doz. each)

- Fine soft sponge

- Talcum powder

- Castile soap

- Several changes of baby’s clothes

- Soft pillows

- Two flannel bands for baby

- Diapers (4 dozen)

The cheesecloth and cotton will serve for the making of two or three large absorbent pads and several small occlusive pads. The large pad consists of several layers of cotton, two or three feet square and two to four inches thick, covered by cheesecloth and loosely quilted. The occlusive bandage is made by enclosing two thicknesses of cotton seven or eight inches long, and four or five inches wide, in one-fourth yard of cheesecloth so folded as to make a pad sixteen or eighteen inches long and four or five inches wide, the edges being stitched. All pads are wrapped up in plain paper, baked, and kept sterile until required.

As soon as lightening is felt, or, in other words, when the mother experiences a general sense of the child’s having gone downward, usually about ten days before the delivery, special attention should be given to obtain normal, easy delivery. The child must go through the pelvis, and the pelvis has no room for anything else. The stool should never be allowed to lodge in the rectum or lower bowel. Once or twice daily, if the bowels are sluggish, the high colon irrigation should be used. On the knees with the face to the floor, three pints of warm water (or antiseptic solution if needed) should be permitted to flow into the rectum and transverse colon. In this position the water enters the ascending as well as the descending colon, and secures a complete evacuation of the bowel. If you are not unusually vigorous, the mere fact that the need for a stool is not felt, offers no excuse for failure to follow this routine, for gas may distend the rectum and occupy space necessary for the age of the child’s head into the pelvic canal. Eat two or three oranges at each meal, merely scraping off the yellow surface skin, and eating the white pulp with the juicy part. This practice is of the greatest possible value in keeping the bowels open and active.

The orange diet

A diet of oranges during the last ten days of pregnancy—to the extent of two or three meals daily—will, as a rule, greatly reduce the distress and dangers of confinement. Distilled water at this time is also useful, as it helps to eliminate the lime salts and the urates. Most women like the orange diet, and .will accept the partial or entire restriction to oranges and distilled water readily when convinced that labor will thereby be shortened, its pains reduced to a minimum, and danger of laceration materially lessened. Under the orange diet many cases in which confinement was practically painless and of very short duration have been recorded. Dr. Biel advises the free use of pineapple to supplement the oranges. This, if desired, should be beneficial. In

one case a patient lived on strawberries for the last ten days, and had a complete expulsion inside of three hours with but mild discomfort. The salicylic acid of the strawberries will dissolve the urates more efficiently than the citric acid of the orange, but it is not so mild, and the strawberry is not so nourishing as the orange, containing as it does a smaller amount of digestible sugar. If they are particularly craved, however, the berries may be taken. A prolonged warm sitz-bath, taken after labor pains begin, is of much value in producing relaxation, and thus promoting elasticity of the tissues during childbirth. The question of exercise during the final weeks offers some grounds for discussion. Walking, if it does not cause discomfort, is to be encouraged. Otherwise, appropriate movements of the arms and legs when lying on the bath with the windows open will encourage the intake of oxygen.

Value of the sitz-bath

After labor pains begin and until the bag of water breaks, it is of value to sit in a warm sitz-bath. By its osmotic action the water relaxes the perineum, and lessens the dangers of a tear. The early stages of labor are usually much modified by these long sitz-baths. The draining of the tissues about the genitals lessens their resistance and affords much assistance to the birth, while the warm water is soothing in its action. No set form of position is of any value. That in which the in other is most comfortable is the one to assume. The sitz-bath may be taken in an ordinary galvanized iron tub, as in illustration on opposite page, or in the special home sitz-tub shown above, which is especially made for this kind of bath. Try to avoid a fussy or a gloomy nurse. The same is true of the physician. , a hearty laugh has great therapeutic value. Many experienced doctors have a fund of funny incidents to relate during the critical period, and such gleams of humor help to keep up the spirits of everyone in the lying-in chamber.

Encourage the doctor to be patient. Nature must take her time, and patience with her is always richly rewarded. With the first sign of approaching labor the physician is summoned, and when it seems likely that parturition is about to begin a rectal enema of one pint of salt water is usually given, though great caution should be used, as many women who have borne children have a labor completed in a remarkably short time. If there be time the woman takes a warm bath with soap. In any case, her external genitals are thoroughly washed. She may now remain on her feet and walk about comfortably dressed, resting occasionally and taking light nourishment. Meanwhile, the bed is prepared by the attending nurse. The bed should preferably be narrow and high, with a firm mattress. It is better placed so that it can be approached from all sides. The rubber sheet is stretched over the mattress, fastened with safety pins, and covered with a sheet tucked well around and under the mattress. This constitutes the permanent bed. The temporary bed consists of a draw sheet and the small rubber sheet underneath. On top of the small rubber sheet and draw sheet is placed a large absorbent pad. A soft flat pillow at the head, and a sheet or an old but clean blanket to cover the patient, completes the outfit. A chair is placed at the foot of the bed. On the floor, which is covered with oil-cloth or thick paper, a bucket is placed to receive the waste. On a small table within easy reach is placed a bottle of vaseline, half a dozen towels, a large sponge, a pair of sterile scissors, sterile silk tape, and a basin containing several dozen pledges of cotton in a solution of boric acid. And so all is in readiness. Just be calm and confident of a successful outcome, and you’ll soon hold your baby in your arms.

Chapter XIV

Making the Birth Easy

A BOUT forty weeks or, less exactly, asine solar months from the time of conception, the fetus reaches full maturity, and labor begins. Labor is usually divided into three stages. During the first stage, the neck of the womb becomes slowly and gradually distended, and its mouth opens wide. When these changes have about reached their fullest degree, the fetal membranes burst and the amniotic fluid surrounding the fetus escapes. This ends the first stage. During the second stage the baby is born. After birth the placenta is expelled from the uterine cavity. This constitutes the third stage of labor. The first stage is usually ushered in by a sensation of more or less sharp, radiating pains in the abdomen, accompanied by a dull pain in the small of the back and a drawing pain in the thighs. Women giving birth to their first baby may feel these pains weeks in advance of the actual onset of labor. They are at first very short in duration and occur at long intervals, but gradually become prolonged and frequent; we speak of good pains, when each lasts about onehalf to one minute and when they occur at intervals of about three to five minutes. The pains are due to a cramp-like contraction of the muscular body and upper part (fundus) of the womb, forcing its contents downward. As the contents are in great part liquid, the effect is similar to that produced by pressure upon a rubber bag filled with fluid; the parts not subject to pressure distend to their limit. Thus the walls of the neck of the uterus become thinner and thinner ; first the inner and then the outer orifice of the neck opens, and the fetal membranes protrude through the external orifice. Finally, as these membranes can not

withstand the pressure of the amniotic fluid any longer, they rupture. The liquid escapes, and the part of the fetus nearest the orifice, usually the head, enters it. The average duration of the first stage of labor is six hours, but it may be twentyfour hours or longer, depending on the muscular action and upon the rigidity of the cervix; or it may also be one or two hours only.

The processes of labor

During the last few months of pregnancy, the fetus has assumed a fairly permanent position. Owing to its floating in a liquid medium it usually settles with its heaviest part (head) downward, and when the membranes burst at the end of the first stage of labor, this part naturally enters the orifice. It is said to have “engaged" in the orifice. Now the contractions of the womb become even more intense, and the head is forced out of the womb into the bony canal of the pelvis, lined by the vagina, toward the vulva. As the head proceeds on its course, it begins to press on the rectum, causing a desire to defecate. The external muscles of the abdomen now come into play, and by contracting help to expel the fetus. Each of these contractions is accompanied by pain. Soon the fetal head (scalp ) begins to show, with each pain, in the entrance of the vagina. The onmoving head now rests on the soft tissues between rectum and vulva (the perineum). The latter stretches under the enormous and steady pressure ; at the same time the head slowly turns upward, and after a few stronger pains the largest diameter of the sealp enters the vulva, the face resting now on the perineum. With the next pain the perineum slips backward over the face and the head is born. After another minute or two the rest of the body follows. The new-born babe is still connected with its mother by a pulsating cord, but under the stimulation of the cold air it begins to breathe, and the pulsation of the cord ceases. The cord is now tied and cut. This ends the second stage of labor. It usually lasts about two hours.

In a normal case of labor, the womb now contracts into a round, hard mass. An interval of rest lasting about one-half hour follows, during which the woman partly recuperates her forces. Meanwhile the placenta becomes detached, and when the pains set in again a few contractions usually suffice to expel it with all the membranes. This terminates labor. The woman now sinks into a deep, wholesome sleep, from which she wakes refreshed a few hours later.

Some detailed advice

Let us now return and go carefully over the actual procedure in the birth chamber. At the first symptoms of any labor pain, the bowels should be thoroughly emptied by an enema. This is for the obvious reason of giving the descending fetus all the room possible, and to avoid any soiling of the bed, with the attendant possibility of infection. Even though the pains are occurring with some little regularity, the woman is usually encouraged to remain on her feet until the external orifice of the cervix has dilated to about the size of a silver donar. When the pains are not strong, it may be to her benefit to stay up longer. As soon as, in the judgment of the attending physician, the bag of water threatens to rupture, the patient is placed in bed. A premature rupture of the fetal membranes must be guarded against, as an escape of liquid at an early stage means a difficult and prolonged labor, commonly known as “dry labor." Usually the membranes burst when the orifice is fully dilated; the large sponge is held in readiness to catch the outflowing liquid. During the second stage of labor the patient must by all means remain in bed; and during the latter part of this stage she is uncovered. The pains now change in character from cramp-like drawing pains in abdomen, back, and thighs to bearing-down pains.

Deep breathing a help

One of the most important aids to easy delivery is frequently ignored. With the onset of each pain during this stage of labor, the lungs should be filled to their greatest capacity. Draw in as much breath as you possibly can with each inhalation. This one thing will greatly increase your ability to “bear down," and thus insure an earlier delivery. The air is suddenly expelled, and after a deep inspiration the pressing down is again resumed, to be continued until the pain ceases. This is repeated with each pain. There is some advantage in letting the patient pull on a roller towel tied to the foot of the bed during the pains. The fetal head now descends lower in the pelvis and presses on the rectum. An intense desire to empty the bowel is felt by the woman. Under no condition must she now be permitted to leave the bed in order to gratify this desire. If any pieces of fecal matter appear at the anus, they are wiped away by a pledget of cotton and thrown into the waste pail. Soon the vulva begins to gape, and the scalp of the fetus begins to show. This occurs with each pain, but gradually more of the scalp appears. After about thirty minutes, more or less, the perineum appears stretched to its utmost, and the scalp becomes fixed in the vulva. Great care must now be exercised to avoid a serious tear of the perineum. A small laceration almost always occurs. This is not the case among savage women. With them the perineum is more elastic and resilient, while the baby’s head is proportionately smaller. But even with a less elastic perineum, and in spite of the larger brain and head of the baby under civilized conditions, a serious tear can be avoided, provided the woman has ed through a normal pregnancy and expert help is present at her bedside during labor.

How to prevent a tear

A tear of the perineum usually occurs because the head advances too rapidly and the perineum has no time to stretch to its maximum. It can, therefore, almost always be prevented, if at the critical moment the woman is warned not to press, and the head is held back for a pain or two by the pressure of the hand of the physician or attendance. Simultaneously the other hand rests on the perineum and pushes the head forward and upward in the direction of the pubic symphysis. This procedure, which relieves the perineum of much pressure, is usually called “ing the perineum." With proper of the perineum the head is born with but slight or no laceration. At first pale, the new-born head soon turns blue and almost livid. Nevertheless, there is no immediate danger to the fetus, and it is best not to interfere with the further natural progress of labor. Slowly the head turns with its face toward one of the thighs. With the next pain, the neck and shoulder nearest the symphysis appear, then the shoulder resting on the perineum rolls out and is immediately followed by the rest of the body. The new-born baby usually announces its arrival with a lusty cry. It is placed on the right side, with its face turned away from the mother, care being taken that the cord is not stretched tight. As soon as the cord stops pulsating it is tied securely about two inches away from the baby’s abdomen and cut a little above the ligature. The other end of the cord need not be tied. The baby is now wrapped in a warm blanket and put in its crib to await further attention. Immediately after the baby is born, the attendant places his hand on the woman’s abdomen and compresses the womb, kneading and rubbing it occasionally in order to secure complete contraction and to prevent hemorrhage. About one half hour after completion of the second stage of labor, pains usually set in again, and after a few minutes the placenta is expelled. This completes labor. The woman’s genitals should now be washed with clean, sterile water and covered with an occlusive bandage. The temporary bed is removed, the large absorbent pad is placed over the external genitals, and the binder adjusted about the abdomen.

Most common irregularities of labor and their management

In some rare cases labor does not tale the natural course, described above, but is in one or more respects irregular. Of all irregularities, a protracted labor, due to deficient contractions of the uterus, is the most important and the most common. While the usual duration of labor is from six to eighteen hours, it may in such cases be prolonged to twentyfour or even forty-eight hours, and will sometimes require surgical interference for its elimination. Inadeguate uterine contractions are more likely to occur in women who have given birth to several children in rapid succession than in young women during their first childbirth. The condition is the result of a weakening of the uterine musculature, but may sometimes be simply the expression of nervous excitement. The best possible preventive is a regular life during pregnancy. When the pains which result from the contractions fail to occur, a complete rest and the assuring of the patient that there is no cause for anxiety will often help. In extreme cases, the use of the forceps becomes necessary.

Deformities of the pelvis

Labor is sometimes delayed by a lack of proportion between the dimensions of the child’s head and those of the parturient canal; i.e., either the canal is too narrow or the head too large. Of the two, the first abnormality is more common. Not infrequently we have to deal with some deformity of the pelvis. This may be due to a general underdevelopment of the woman’s skeleton; more often it is the result of a disease of the bones of the pelvis (rachitis, osteomalcia), or of the hipt. Some of the most severe cases of pelvic deformity are the result of mineral starvation during the term of pregnancy.

The management of labor in a case of contracted pelvis is very difficult. When the child is of normal size, or perhaps slightly undersized, and the deformity slight, natural birth will often take place in spite of the deformity. In more serious cases, the physician will usually be obliged to help the natural forces either by applying the forceps or by performing version. The first operation consists in introducing a twobladed instrument (the forceps) into the uterine cavity, grasping the head between the blades of the instrument, and pulling at it until it is born. Naturally, the application of the instrument as well as the method of extraction require considerable skill. The operation of version consists in introducing the sterile hand into the uterine cavity, turning the child to a more favorable position, and then extracting it. In rare cases it is necessary to remove the child by operation through the abdomen.

Retained afterbirth

During the third stage of labor we sometimes encounter cases where the womb shows some sluggishness in its contractions and retains the afterbirth. It is usually possible to assist the woman in such cases by external manipulations ; the attendant grasps the womb in his hands through the abdominal wall, and by compressing it steadily or ryhthmically, while frequently testing the attachment of the placenta by extremely gentle traction upon the cord, is able to express the former. Sometimes, however, the attachment of the placenta to the inner wall is so dose that this method will not suffice to express it. In such case the physician must introduce his hand into the uterine cavity, and, by gentle manipulations with the fingers, sever all adhesions, when he should be able to remove the entire placenta. As to the degree of infection that may result from a retained placenta, much depends upon the general health of the woman, and upon the nature of the pregnancy and delivery. But usually degenerative changes will begin within a few hours, and within twenty-four hours there may be a more or less serious degree of degeneration of the placenta and uterine mucous membrane, with

absorption into the blood of the abnormal substances produced, and symptoms of infection. For this reason it is well to have the entire placenta discharged as soon as possible. This is usually accomplished within thirty minutes to one hour. When the afterbirth is removed it is well to examine it to see that it has all come away, for if considerable of it has been retained it may be advisable to attempt to remove this portion by manual manipulation, as described above. If only a small portion has remained no particular attention need be given to it, as it will usually be expelled naturally within twenty-four to thirty-six hours. After the uterus has been emptied of all its contents, it usually contracts firmly into a solid, hard, round mass. Sometimes, however, the muscle remains flaccid and, as a result, a dangerous hemorrhage is very apt to take place. The way to prevent this is to stimulate the uterine muscle by friction, rhythmic compression of the organ through the abdominal wall, and cold applications over the abdomen. Where this has no effect, the womb is sometimes packed with sterile gauze for twelve to twenty-four hours. Proper observance of the laws of health during pregnancy will prevent the development of these more or less alarming conditions.

First care of the asphyxiated child

It sometimes happens that the new-born child does not breathe. Quick action is then required. The assistant takes the physician’s place at the mother’s bedside, that the latter may devote his attention to the child. He lifts the baby by its feet to facilitate the escape of mucous, attempting to remove this with his little finger, if necessary, and then tries to resuscitate it by a few sharp taps on shoulder and buttocks. If unsuccessful, he at once begins artificial respiration, which is continued several minutes. Next, if required, the child is placed in a basin of warm water and a small stream of cool or cold water quickly thrown on its chest. If necessary, the water spray is repeated several times.

Care of child in normal birth

The physician, having delivered the woman of her placenta, returns to the baby. He first examines the cord, and, if necessary, reties it. Next, the baby’s entire body is wiped with a soft sponge dipped in warm olive oil. This is usually done by the nurse or attendant. The child is then thoroughly examined to ascertain the presence of any injuries or deformities which might require immediate treatment. A drop of one per cent solution of silver nitrate should be dropped in each of the baby’s eyes as a protection against possible blindness from venereal infection. Do not take any risk. This should always be done. Blindness is a terrible thing, and the above procedure is an absolute protection against loss of vision from this cause. The cord is now wrapped up in sterile gauze and an abdominal binder adjusted loosely around the abdomen, after which the child is diapered and dressed. It is obvious that the best thing for both mother and child to do after their ordeal is to rest. While childbirth is a normal process rather than a pathological or disease process, it is, even under the best conditions, the most severe and trying of natural processes, and after hard labor of any kind the normal, natural thing to do is to rest. In closing this chapter let us give the perturbed husband a word of cheer. The irritable emotional changes of pregnancy will soon give way to the collected, careful state of motherhood. The resentment of the distressed pregnant wife will be a thing of the past, and you both will forget your individual failings in the wonders of your child. True, you will assume the ordinary duties of fatherhood; your wife the devotions of motherhood. But you are now more than her lover you are the father of her child.

Chapter XV.

Diet, General Care, and Hygiene During “Lying In"

FOLLOWING the birth lime salts and nitrogen must be furnished to the mother to encourage tissue growth. Meat (preferably beef, mutton, or chicken), eggs, fish, and nitrogenous vegetables like the pea and bean may be taken regularly, but in moderation, and vegetable salads should be liberally used. In most cases the mother’s appetite should largely guide in the selection of foods. If she has lived rationally up to this time , she will usually crave foods she most needs. It is a mistake for mothers to think that during the early weeks of nursing they must eat a large quantity of “nourishing" food. that overeating is the most frequent of all causes of indigestion, and do not take any more food into the system than can be readily digested and assimilated. For indigestion will produce disturbances in the milk—assuming that the mother is nursing her baby which may, in turn, produce digestive troubles in the infant. Your diet need not be appreciably different from what you were previously accustomed to. Only the necessity of being thoroughly nourished. Usually one can not fast or go on a limited diet at this time without the baby’s being affected thereby. I might add, however, that on one occasion when my own wife was nursing a three-months old baby she exhibited all the symptoms of pneumonia. She fasted for one week absolutely, and nursed the baby during this entire period. She drank plenty of water and had plenty of milk, but it had too little nourishment in it, for the baby thinned noticeably. It quickly gained weight, however, when the mother began to eat. It is best to use a light, mixed diet at first, consisting of milk, gruels, soups,

vegetables, wholewheat bread, and a little meat. Vary the menu from day to day, so that the appetite will not become wearied by monotony in the diet. In the larger sense, all food is milk-forming food—for milk contains all the elements required for the perfect nutrition of the babe, and the body takes these elements from all classes of food in the formation of milk. And be very certain to drink plenty of water. For water forms almost ninety per cent of the milk supplied to the infant, as well as furnishing the proper diluent for the mother’s blood, and the normal stimulus for the excretion of toxic products from the kidneys and bowels.

The milk diet

It is almost needless to say that milk should form a very large part of the mother’s diet. This is for the reason that it contains the elements required for best nutrition, is most easily digested and assimilated, and forms the least harmful waste products. A strong, vigorous woman who has had no troubles during pregnancy, or at the time of childbirth, does not require as much milk in her diet as does a delicate one. But even such a woman should use this food liberally, for it will usually insure not only an abundant supply of milk for her baby, but one containing all the elements necessary to the perfect nutrition of the infant—with no elements that will tend to disturb its digestion. For the best health of mother and babe, in the majority of cases, the diet should be fruit, milk, and possibly nuts, for one or two meals a day; with vegetables, whole grains, and milk for the other one or two meals. When the woman is overweight and inclined to toxicity, and when her exercise habits have been lax, milk should form a considerable part of the diet, the entire diet being kept to a minimum that will weight and strength and supply sufficient milk in her own breasts. In these cases the woman’s diet should be

mainly milk, fresh fruits, and green vegetables. These women must be particularly careful to avoid overeating and accumulation of waste in the intestinal tract, as the absorbed toxins will prove harmful or disastrous to the baby. The milk and fruit diet will be especially beneficial in supplying the required nourishment without harmful by-products of digestion. In case such a woman is not nursing her baby, a fast or limited diet should shortly follow childbirth, and a fruit and limited milk diet should be taken later. Mothers who are underweight, anemie, and inclined to weakness, should make milk their main food. In these cases the full milk diet is to be recommended. One or two oranges should be taken daily with the milk, and occasionally the juice of small sections of lemon. This is especially true if pasteurized milk is used, for these fruits are rich in the antiscorbutic vitamin, which is injuriously affected in milk by the heat of the pasteurization process. Four to five and a half quarts of milk, with the fruit as mentioned, would not only give the baby sufficient milk from the mother’s breasts, in most cases, but would also allow the mother to build up rapidly in every way. Later, or in case the full milk diet can not be taken, the following program can be followed: Milk and fruit (both sweet and acid) for one meal; milk, whole-grain cereals, and sweet or sub-acid fruits for the second meal; vegetable soups, vegetables, salads, eggs, nuts or meat, and whole-grain bread and butter for the third meal. There are few conditions of the nursing mother, or even of the new mother who is not nursing her babe, in which the diet can not be improved by the addition of milk and fruits. I believe that in practically every instance one meal a day should consist of fruit and milk. The mother desires to build up as soon as possible to her original degree of health, or even to better health than she enjoyed before the birth of her baby; she wants to give the baby the very best physical start in life that she can. No factor is more important in accomplishing this than diet, and there are no articles of diet which will help her to do these things better than, or even in as satisfactory a manner as, milk and fruits.

Need for sleep

There is no one factor more important to a woman recuperating from childbirth than sleep and rest. She often finds that she needs more sleep than during the ordinary course of her life. All conditions in the home should be so arranged that she may be able to enjoy the sleep that Nature calls for. Visitors in the evening who have not sufficient sense to go home at a reasonable hour should not be tolerated. There are “stay-lates" of this kind in every community, and they should be told early in the evening, frankly and courteously, that the doctor has named such and such an hour as bedtime, on of the health of the wife and mother. All excitement, and everything that would tend to disturb sleep, must be avoided. The baby should be trained from the very first to regularity in its feeding habits, so that the mother’s rest may be broken as little as possible during the weeks following confinement. If, however, the baby, in spite of all efforts at training, persists in turning night into day, and thereby disturbs its mother’s sleep, supplement its night feeding with a good milk modification (see my book on the Care of the Baby for details) to the end that the mother may get more rest and sleep, and thereby conserve the quality and quantity of her milk.

Care of the breasts

The care of the breasts should, as already intimated, begin during pregnancy. After the infant begins to suckle, its efforts may have a tendency to injure the skin covering the nipples.

A little cocoa butter, or olive oil, rubbed carefully into the breast and nipple tissue, will usually overcome this tenderness in a short time. Shortly after delivery the breasts may become so distended with milk as to become hard and painful. This trouble usually corrects itself as the supply of milk becomes adjusted to the demand. Occasionally, however, it may be necessary to draw off the surplus milk with a milk pump. It is best to avoid manipulation of the breasts whenever possible, as this tends to increase the supply of milk and aggravate the condition. Sometimes, the mere application of hot or even cold cloths gives all the relief necessary.

Chapter XVI

Getting Up After Confinement

H OW long should the mother remain in bed after confinement ? Most physicians try to keep her there for ten days, or even two weeks. But is this justified ? Perhaps it is necessary in some cases. The practice of long confinement in bed following childbirth was no doubt due to the experience that physicians have had a t -times with extremely delicate women, or with those who had been badly torn. When there are serious lacerations, it is undoubtedly necessary to remain in bed and be extremely quiet, as in the case of any other serious injury. But when the mother has been able to through the ordeal in a normal way, without any lacerations, it is not only unnecessary but extremely inadvisable from every standpoint to remain in bed long. It is a common practice among savage races for the mother to be up and about her work immediately following parturition. In fact there are tribes in which the father goes to bed for two or three weeks at this time, while the mother does all the work. George Wharton James, who lived for many years among the Indians of the American Southwest, has known a woman to walk a halfmile to the creek immediately after childbirth, wash herself and baby in the cold water, and then return to her camp and to her work as if nothing had happened. He tells of other similar cases. This is not surprising, however, inasmuch as many European peasant women do practically the same thing. I have heard of cases of Polish women in the United States being up and doing a large day’s washing the day after childbirth.

This may appear to be something of a feat, but I have also known of women following literary and artistic pursuits who have done practically the same thing as a result of bodily preparation and fitness for motherhood.

Civilized women not necessarily weak and delicate

It may be contended that the highy civilized woman must remain in bed because she is physically weak and delicate. In many instances this may be true, although there is no reason why civilization should mean weakness. On the other hand, I am convinced that the weakness following maternity is in many cases a result of lying in bed too long. The extreme debility experienced by many women in the first few weeks after confinement could not possibly result from the effort and suffering involved in the birth itself. It is true that it is a strenuous experience, but if a woman comes through it normally, she should suffer only temporary exhaustion, similar to that felt by a man after an exhausting wrestling bout or Marathon run. To remain in bed for ten days or two weeks, however, must of itself cause a serious loss of strength. The strongest man, in perfect health, compelled to remain in bed and inactive for the same length of time, would find himself amazingly weakened and wasted.

The recuperating period not a period of sickness

It should be ed that the recuperation period is not a period of sickness —merely an interval during which Nature is trying to restore the generative organs to a condition somewhat similar to that which existed before pregnancy took place.

Immediately after confinement the womb measures some eight inches in length, five in breadth, and four in thickness, and weighs about two pounds. It now has to contract to its previous size, with a weight of two ounces. This process is called “involution of the uterus," and is brought about by the shriveling of the muscular fibres of which it is made up. It begins a few days after delivery and continues for about six weeks. Naturally it goes on faster when the tissue is healthy than when it is weak and flabby. A very important stimulus to contraction, which is not generally known, is manipulation of the breasts. Therefore nothing is more useful in forwarding the process than nursing the child. There is an intimate connection between the uterus and the breasts, so much so that women who become pregnant while nursing frequently abort because of the uterine contractions brought about by reflex action from the breasts. Subinvolution is a condition in which the reduction process has been arrested. Its existence is ascertained by feeling the fundus of the organ through the wall of the abdomen above the level of the pubic bones. Occasional bleeding, continuing perhaps for a few weeks, may be a symptom of the condition. Among its causes are retention of parts of the placenta, displacements of the uterus, adhesions, premature resumption of sexual intercourse, abstaining from nursing, inflammatory conditions, or fibroid tumors. It will readily be seen that most of these are not to be expected in a healthy woman. It is also said to be due in some cases to premature rising from childbed, but no woman of normal strength and muscular development need be alarmed over the prospect. The treatment, of course, depends on the cause. Tendencies to displacement should be corrected by methods given elsewhere in this book. Strict continence is usually essential, and everything possible should be done to improve the general health. In case of inflammation, retention of placenta, or other diseased conditions, a fast of from five to ten days will almost invariably set matters right. Cold hip baths are sometimes valuable.

The Lochia

Not only must the uterus contract to its former size, but the inner surface must heal. The mucous membrane of the womb has practically all come away during childbirth, leaving a raw surface from which at first blood oozes steadily. The cervix and vagina, greatly distended, partly mangled, and in places lacerated, produce a discharge of their own, which mingles with the uterine flow. Thus there is a steady flow from the mother’s genitals sufficient at first to call for several changes of napkins in twenty-four hours, but diminishing in quantity and changing in character as the repairing process goes on. At first bloody, the discharge become serous on the fifth or sixth day, and white (healthy pus) two days later. It should never have an offensive odor. While most of the blood flows away, a considerable quantity sometimes collects in the cavity of the uterus, or in the vagina, where it clots and may not be expelled for several days. The appearance of these clots should not occasion alarm, and no attempt should be made to douche them out, as this might carry infective material up into the body of the uterus. Merely wash them away as they appear at the orifice of the vagina.

The process of repair

The whole process of repair takes about six weeks. At the end of that time the healthy mother who has been properly treated should be “as good as new." But prolonged lying in bed will hinder rather than hasten the process. It has a serious effect upon the appetite and general functional activity, and among other things interferes with the, mother’s ability to nurse her child, since the quantity and quality of her milk depend upon her vitality. Without doubt the prevalent inability of American mothers to nurse their children is due in part to the protracted confinement usually thought necessary.

Cleanliness is essential

Cleanliness is most essential in the management of a newly-made mother. Her body should be bathed daily. Her external genitals should be bathed several times daily, with sterile water, the hands of the nurse being previously sterilized. There may sometimes be experienced some difficulty in emptying the bladder. Hot poultices over the bladder may induce urination. If necessary, the woman is catheterized twenty-four hours or so after delivery. Two days after delivery, if the bowels have not moved, an enema should be given. After this any tendency to constipation is combated by the methods already given. The influence of previous physical training naturally has a great deal to do with the ability to be up and about in a short time. The muscularly vigorous woman can do what the delicate woman with relaxed and weakened tissues can not attempt. We are assuming that the mother who attempts to follow these suggestions will have prepared herself for maternity by means of the exercise and healthful life advised in the preceding chapters. Do not, however, be reckless. We do not advise getting up or sitting up the first day under any conditions, even though there are some women as capable of it as the Indians mentioned. The great danger of the first day is hemorrhage, and for the same reason there is danger of overactivity up to the time that the locheal flow ceases. If a woman is torr it may be necessary for her to remain in bed for a considerable period, depending on the extent of the injuries. In the normal case, a woman of vigorous health and good muscular condition should be able to be up and about, to some extent, three or four days after confinement. With women of delicate physique it might be better not to attempt to be up until some days later, although in such cases it would be well on the second day to commence the exercises for quick recuperation, to be performed in bed, which are given in detail in the next chapter. To a great extent, a woman’s instinct will teli her when she is ready to get up. All animals and savage women are governed by their feelings and instincts in this respect. When there is a feeling of tenderness and weakness she will feel disposed to remain in bed, but when she feels the impulse and the strength to be about, then she will usually be justified in following this impulse—of course observing due caution. She should attempt to be up only a very all time at first, but however short the period it will aid her in recovering her strength.

Should a woman sit up in bed?

“Sitting up in bed" is not advisable. It is far better to stand up on one’s feet, in a good, erect attitude, than to assume the awkward and unhealthful position involved in sitting up in bed. The average physician makes a mistake in allowing the patient to sit up some days before he permits her to “get up." Sitting in bed involves a crowded and cramped position of the abdomen, with downward pressure upon the pelvic organs. A very little study of correct posture will show you how detrimental this must be immediately after childbirth. It is far better to stand up, especially in the erect, military attitude, holding the head up and carrying the chest high. For, in this way, the digestive and other organs are drawn well upward, and the abdomen is ed in such a way that there is no downward pressure upon the pelvic structures. Such a position is conducive to muscular tone and freedom from strain, whereas the “humped over" attitude of sitting in bed has the contrary effect. This question of correct posture upon getting up is most important.

The abdominal bandage

The question of abdominal bindings or bandages is one that must be answered in accordance with the muscular vigor of the individual. If the body is soft, flaccid, and relaxed, there is no doubt that suitable abdominal in the way of bindings will be advantageous when first getting up, although it will be less needed if proper posture is maintained. A woman who is muscularly strong and vigorous, however, should need no such artificial help. As previously stated, it takes about six weeks for the uterus to contract to its normal dimensions and to resume its original position. It should be ed that this organ is a muscular structure, and by the end of the term of pregnancy is

tremendously enlarged and supplied with an extraordinary group of blood vessels. The change from this size and condition back to the original small and compact form is a rather remarkable one, and you will see that before this change is completed, or when the organ is still very much enlarged, it is very easy for it to be doubled over or otherwise displaced, and that this displacement might easily become permanent. On this it should not be subjected to unnecessary pressure or strain. If this end can be attained through correct bodily carriage, so much the better. If not, the abdominal bandage should be used. In some cases a properly fitted elastic bandage of a porous character may be advantageous. One principal reason for the use of the bandage is to give the ligaments that the womb a little aid. For after the womb has been emptied of its contents these ligaments hang loosely from the side of the organ, affording practically none of the which they ordinarily give. In a physically healthy woman the cords soon shorten and tighten, and once more hold the womb in its proper position. In one who is not strong, readjustment is slower, and meantime artificial is useful. However, it is very necessary to see to it that no undue pressure is exerted on the uterus by means of an overtight bandage—as this has a tendency to push the uterus backwards, and eventually to cause what is known as a retroversion, or a displacement backward, of the womb. Indeed, in many large maternity clinics it has been noted that women who are tightly bandaged are always more liable to displacements than these who are not. With the return of the womb to its normal size, it is imperative, when the mother is not unusually vigorous, that abdominal massage be given. During the last months of pregnancy the abdominal contents have been ed by the enlarged womb and growing fetus; thus the ligaments of the abdominal organs have become weakened and the muscles of the abdomen stretched. Regular morning and evening massage helps to restore the tone of these parts. It may be istered by the mother herself, presward with a rotary stroke. Exercises to strengthen the abdominal muscles while reclining in the prone position are also useful.

Do not “slump over" when sitting up

In sitting up at any time during these first six weeks, one should not “slump over" in the chair. It will be a good plan to have a small pillow tied to the chairback at a point where it will fit the small of the back. This will preserve the natural lumbar curve of the spine and keep the chest well raised. The vital importance of the subject requires me again to emphasize the necessity for great caution in the matter of getting up. But no rules can be laid down. Each individual case must be decided according to the woman’s condition. She should not take risks, but, at the same time, she should not allow tradition to deter her from doing what she feels fully able to do. As previously stated, when there are no tears, it is seldom necessary for the woman to remain in bed for more than four or five days, while those who are very strong will often be able to be about in two or three days, thus avoiding any loss of strength as a result of the experience. Even among the of the medical profession the old-fashioned views in regard to keeping a woman in bed for a week and a half after confinement have been greatly modified. Physicians are temperamentally conservative, it seems. They are slow to take hold of new ideas. Yet the accepted theories in nearly all lines of medical practice are undergoing revolutionary changes.

What eminent physicians now advise

Shortly after writing the above sections, I came across the following very interesting editorial from a recent number of the Medical Summary, showing the new trend of medical thought in the direction of the views which I have expressed.

Posture after labor

“It is now the consensus of opinion that it is not always the wise thing to keep the parturient woman `fiat on her back for nine days or longer. If there are no pronounced contra-indications for so doing, the woman should assume a sitting posture for micturition and defecation. Drainage is thereby better effected and retained plots and debris expelled with greater facility. Many physicians even favor this procedure in septic peritonitis following labor. Drainage as a preventive of sepsis is one essential factor, and whatever measures accomplish this end, without otherwise proving detrimental to the patient, are commendable practice."

While the question of drainage is a very important one in connection with the prevention of puerperal fever, there are, of course, exceptional cases in which the sitting posture under any circumstarrces would be disadvantageous, and the instructions of your physician on this point should be closely followed. Another evident of the change in medical opinion along this line is the fact that many “twilight-sleep" mothers, not only in but in the United States, have been permitted and even encouraged to be up the fourth or fifth day, and sometimes sooner.

The return of the menstrual flow

One compensation for the pain of childbirth is the almost invariable absence of menstrual pains for some time afterwards. This is for the reason that the neck of the uterus has been so thoroughly dilated

by the age of the child that there rarely exists the contracted, rigid condition so frequently responsible for menstrual pains. If the woman nurses her infant, menstruation is not usually re-established as early as when bottlefeeding is resorted to. This is partly for the reason I have spoken of before—the marvellous contraction of the womb produced by the reflex from the breast. Also, nursing is believed to retard the development of ripe eggs in the ovary—in the complete absence of which there could be no natural menstrual discharge. If the infant is not suckled the menstrual function usually returns in from six to eight weeks after delivery. Otherwise, it may not re-appear for several months— or even for a year, if the infant is actively nursing during this period. A return to heavy household duties may hasten menstruation. Therefore, it would be well to avoid household work which is in any way exhausting for many months following confinement.

The return to normal weight

You may expect to lose considerable weight following childbirth. First and foremost, the child and the afterbirth, the extra blood and the amniotic fluid, all weigh considerable—on an average perhaps thirty pounds. But there is another loss—that of water from tissues that have become dropsical from pressure. The entire loss, therefore, is roughly about one twelfth of your weight at the conclusion of labor. Stout women lose more proportionately than slender ones, and all women may expect to lose a little more if they nurse their babies. When this loss is not desired, it can, however, usually be obviated by proper diet. But no reasonable loss of weight should concern a woman who has in her arms what nothing else in the world could compensate her for—her baby.

Chapter XVII

Exercises for Quick Recuperation. Following Confinement

I N the last chapter it was clearly shown that weakness following childbirth is unnecessary. Every woman should be as vigorous and vital after maternity as ever before, and a woman can least of all afford to lose her strength at such a time. The nursing of her child and her other duties as a mother make it imperative that she should maintain her health and vigor at their best. But she can not recuperate properly by inaction and stagnation. Therefore, it is advisable for her to be up and about as soon as strength will allow after confinement. One may, however, commence the process of building strength even before one is able to get up—within a day or two after confinement. Even when there have been lacerations it is possible to take exercises in bed that will involve no strain upon the injured or tender parts, yet will prevent loss of strength.

I agree with Dr. Arthur Still Craig, Editor of the Osteopathic Magazine, in this respect. He says: “We do not believe that there should be days or weeks of complete inactivity. As there are exercises which can be taken with the greatest benefit while the organs are stretching and the abdomen is enlarging, so there are exercises which may be taken, and which should be taken by all means, while the organs are contracting and the body is regaining its former shape.

“The abdominal muscles especially have been stretched and have been functioning while stretched. How can they be expected to regain their former shapes and activity without being called upon to perform any functions? “The mother should begin early to exercise the abdominal muscles. Of course this should not be vigorous or severe exercise, but should be graduated to the strength of the patient. A rhythmic retraction and protrusion of the abdominal walls, or, in other words, a raising and lowering of the abdomen, is one of the best exercises for causing the muscles to return to their former shape. These will restore the natural abdominal torse. On of the general inactivity and lying in bed, there is a tendency to constipation at this time. This tendency is combated by the exercises, while the circulation of all the organs of the abdominal and pelvic regions is improved at the same time.

Exercise to increase milk supply.

Lie upon the side and swing the upper arm forward while the leg, with knee straight, is moved backward. Then swing the arm backward and leg forward as far as possible, bringing the whole body into motion to get action in the spine. Then lie on the other side and perform the exercise with left arm and leg. Take the exercise very carefully, and avoid fatigue. “If the mother is deficient in milk supply, any exercises of the arms and shoulders tend to increase the blood supply to the breasts and therefore tend to increase milk secretion. “Lying upon either side and swinging the arm forward, while the leg, with knee straight, is moved backward, then the arm backward and the leg forward, being careful that there is sufficient motion of the whole body to get action in the spine, is a splendid exercise for this period, though of course it should be taken with great caution. None of the exercises should be too vigorous, and none of them should be continued till the patient is exhausted or even tired by them. “During the weeks before the birth of the child there is a softening of the ligaments that bind the large bones of the pelvis together. This is in order that the

pelvic arch may yield slightly, thus making the age of the child easier. A reasonable degree of exercise of the thigh and lower limbs after childbirth tends to bring blood to the ts and so to restore their tone and strength. One must use care in the exercise of the hip, however, and also as one begins to walk, that no unusual strain may, on of the relaxed ligaments, throw these ts slightly from their position."

Beginning Exercise No. 1.—While lying on the back, raise one leg with the knee doubled, and bring fairly well up over the abdomen, being careful that there is no sense of strain or discomfort. Do the same with the other leg. As improvement is noted, the knee can be brought gradually further back over the abdomen. At first the limbs should be lifted and the movements carried through by an assistant.

Beginning Exercise No. 3.—Lying on the back, simply raise the head from the pillow until the chin touches the chest. Do not attempt to raise the shoulders until later. Repeat several times, without straining.

Beginning Exercise No. 5.—Raise both legs at a time with the knees straight. Do not attempt this in the early period of convalescence without the assistance of your nurse.

Exercise of the right kind the greatest aid

Exercises of the right kind are of the greatest value after parturition. At the maternity hospital in Freiburg, —the home of the “twilight sleep" so much talked about—the physicians in charge have given a great deal of attention

to exercises of this type. We are told that many of the twilight-sleep mothers at this institution are able to be up in three or four days, which seems a remarkable state of affairs to the conservative mind. This result, however, is not due to the twilight sleep, but to the exercises which hasten recuperation, and also, doubtless, to the great vigor of the average German mother. Now such a rapid recovery from this natural experience should be the rule with every normal case, irrespective of twilight sleep. Particularly, it should be the rule with women who have followed the suggestions given in these pages, and who have built up the physical vigor required for this ordeal. In this chapter is presented a carefully designed system of exercise for promoting rapid recuperation. Do not attempt any of these exercises the first day. In every case extreme care should be taken not to subject any weakened or tender parts to stress or strain. This is especially true when there have been lacerations, but it will be found that even in such cases some of the simpler movements can be done without difficulty.

Beginning Exercise No. 6.— Lying on one side, raise the upper leg a few inches. It is not necessary that the leg should be straight in the beginning, though it should be later. Perform the same exercise while lying on the other side.

In the very beginning it might be well to have the foot of the bed elevated slightly, though this is not necessary in the case of a fairly vigorous woman. Very little exercise should be done at one time, to start with. In other words, it would be well to divide up the exercises into two or three installments daily. Beginning the morning of the second day, it might be well to attempt only the first three or four movements; then, on the evening of the second day, one might try two or three more, depending upon how one feels.

ive motion at first

In the beginning the exercises should be executed with the help of a nurse or physician. In short, the movements should at first be ive, so far as the mother is concerned. The nurse, for instance, will take hold of the patient’s limbs, and move them in the manner directed for the exercise. The patient at first should neither help nor resist.

Beginning Exercise No. 7.— Lying on the back, with both legs raised, in the beginning a short distance, but later to the perpendicular, separate them, at first only a few inches. Bring together again, and repeat. Within two or three days the legs can be separated more widely. Do not attempt this if any sense of tenderness or discomfort is produced. In the beginning this should be performed as a ive exercise, the limbs being manipulated by the nurse.

Advanced Exercise No. 10.—First raise both legs, with the knees straight, to the perpendicular, and then bring one farther up over the chest while moving the other farther down. Then reverse, bringing the other over the chest. Continue in this way—a “scissors" action of the two legs. Do not be too energetic at first. In the beginning this should be performed as a ive exercise, the limbs being raised and manipulated by the nurse.

But as soon as she feels instinctively that she is strong enough to do so, without discomfort and without straining herself, she may assist slightly in the movements, or perhaps resist them. After one or two days she will doubtless find it comfortable and desirable to execute the simpler movements without any help, and gradually to take up the more vigorous or advanced exercises. , however, that there should be no hurry and no strain.

It would be well to familiarize yourself with these exercises before confinement, so that you will know them thoroughly and have no difficulty in doing them when the time comes. It is important that these exercises should be kept up faithfully for a period of six weeks, which is the time required for complete involution, or the return of the uterus to its normal size and position. If this is done, future weakness of these parts need not be apprehended. Each movement should be repeated only a few times, and after the first two or three weeks others may be added to strengthen the abdominal region.

Advanced Exercise No. 11.—Having raised both legs to the perpendicular when lying on the back, bring them a little further forward and up, until the hips are slightly elevated or lifted. Be careful not to carry the movement so far as to cause strain. This should also be performed at first as a ive exercise, with the assistance of the nurse.

Advanced Exercise No. 12.— Lie on the back and draw the feet slightly apart up to a position directly under the knees. Then raise the hips from the bed only a few inches at first, but later, when stronger, as high as convenient.

Advanced Exercise No. 13.— This is simply taking a position on “all fours." Moving about in this position will afford mild exercise for the arms and legs, insuring the return of strength.

Beginning exercises

Let me again warn against taking any movement that will in any way interfere with the healing of any laceration there may have been. To begin :

1. While lying on the back raise one leg with the knee doubled and bring it fairly well up over the abdomen, being careful that there is no senso of strain or discomfort. At first the limb should be lifted and the movement carried through by an assistant. Same with the other leg. As improvement is noted, the knee can be brought gradually further back over the abdomen.

2. Both legs, knees doubled, should be brought up together. Do not try this alone at first.

3. Lying on the back, simply raise the head from the pillow until the chin touches the chest. Do not attempt to raise the shoulders as yet. Repeat several times without straining.

4. Raise one leg at a time as in No. 1, but with the knees straight, only as far as comfort will allow.

5. Raise both legs at a time with the knees straight. Do not attempt this without the assistance of your nurse for several days.

6. Lying on one side, raise the upper leg a few inches. It is not necessary that the leg should be straight in the beginning. The same on the other side.

7. Lying on the back with both legs raised to the perpendicular, separate them—

only a few inches at first. Bring together again, and repeat. Within two or three days they can be separated more widely. Do not attempt this if any sense of tenderness or discomfort is produced.

8. Lying on the back with knees together, press the knees against each other with only a very slight effort. The second day slightly more effort may be exerted. This exercise may be done with the knees doubled up or with legs extended, and as one gets stronger it may be executed with increasing vigor.

Advanced Exercise No. I4.--This exercise is intended to insure a correct poise, and consists simply in stretching the arms high above the head, thus raising the chest and drawing the abdomen inward and upward. Perform this exercise a great many times every day.

More advanced exercises

(Not to be attempted until the third or fourth day.)

9. Lying on the back, raise shoulders and head, but do not attempt to rise to the sitting position.

10. First raise both legs, with the knees straight, to the perpendicular, and then bring one farther up over the chest while moving the other farther down. Then reverse, bringing the other over the chest. Continue in this way—a “scissors"

action of the two legs. Do not be too energetic at first.

11. Having raised both legs to the perpendicular when lying on the back, bring the limbs a little further back and up, until the hips are slightly elevated or lifted. Do not strain, and be careful not to carry it too far.

Advanced Exercise No. 14 (in reclining position).— When lying down, the raising of the hands above the head or placing the hands back of the head will have the effect of drawing the digestive organs somewhat upward, and thus relieving pelvic pressure.

12. Lying on the back, draw the feet up to a position directly under the knees and with the feet slightly apart. Then raise the hips from the bed —only a few inches at first, but later, when stronger, as high as convenient. The exercise is really executed by the musdes of the back and hips, so there is not so much strain upon the pelvic region as you might suppose. Nevertheless, you should be careful. This is an ideal exercise to prevent falling of the womb at any time, and to overcome any bearirrg-down sensation. For this reason it is a splendid exercise for the period of pregnancy.

13. This is simply taking a position on “all fours." The four-footed animals have no difficulty in recuperating from parturition, partly for the reason that they have no large heads to, contend with, as has the human mother, but partly also from the fact of their horizontal position. that in the evolution of life on the earth the human race departed from the original horizontal and assumed an upright position. A temporary return to all fours, therefore, is natural and restful. This is the position of the creeping babe, and in most cases it will be found advantageous to the mother within a few days after confinement, the period

depending upon her recuperative strength. Moving about in this position will afford mild exercise for the arms and legs, insuring the return of strength.

14. This is a simple exercise of value after getting up. In the preceding chapter I emphasized the value of correct standing posture following childbirth to prevent any downward pressure upon the pelvic organs. This exercise is intended to insure a correct bodily poise and consists simply in stretching the arms high above the head, thus raising the chest and drawing the abdomen inward and upward. After getting up perform this exercise a great many times every day, or whenever you think of it. In fact, even when lying down, the raising of the hands above the head, or placing the hands back of the head, will have the effect of drawing the digestive organs somewhat upward and thus relieving pelvic pressure.

The persistent and conscientious performance of these simple exercises will do much to bring back vigor and strength. They will help more than any other one measure to restore girlhood charm and buoyancy to the little mother, who has “won through" so bravely and devotedly.

Chapter XVIII

Amazing Remedy for Blood Poison

T HE greatest danger of the lying-in period is puerperal sepsis, commonly known as blood poisoning. When this condition has developed, it will become necessary to institute general treatment. In the Preface I have briefly referred to an original treatment for the blood poisoning which so often results from childbirth. This discovery I believe to be one of the most important to childbearing women that has ever been made. The remedy is truly marvelous. Its very simplicity has doubtless had something to do with its attracting so little attention, since this very quality might deter women who are accustomed to relying on ultra-scientific methods of treatment from making use of it. Blood poisoning as a result of complications arising before, during, or immediately after delivery, is a serious condition. It may be caused by the absorption of ptomains (specific poisons) generated by putrefaction in the uterus or vagina —as a result of retained placenta (“afterbirth"), tears during delivery, or other injury. In fact, these are the most frequent causes. Other causes are inflammation of the tissues surrounding the uterus, vagina, bladder, or rectum, or of the tubes, peritoneum, veins about the uterus, or of bladder, kidneys, or rectum. Sometimes the inflammation is a result of erysipelas, malaria, or some other acute disease. The symptoms in the pelvis vary according to the degree of local infection. Among them may be a foul-smelling discharge, swelling of external or internal parts, pain and tenderness about the affected region, distention of the abdomen, inflammation of the tubes and ovaries, a large uterus, and possibly abscess

formation. Fever is present, as in all infections. By drinking a generous amount of liquids at such times, preferably hot or lukewarm, the infection can be checked in its progress or entirely remedied. Milk diluted with water, or an orangeade made like lemonade, sweetened or otherwise, as desired; water sweetened with honey; or any wholesome drink— can be recommended. The main idea of the treatment is to “drench" the internal system with liquids. Get the patient to take as much as she can. This will wash out the poisons. But in many cases when water or watery drinks are not effettive, milk, in large quantities, will prove to be an amazing remedy. There are several reasons for this. The large amount of liquid in milk dilutes the toxins and helps to carry them off through increased activity of the kidneys, skin, and bowels. The quantity of blood is greatly increased on the milk diet, and this brings about a more copious flushing of the diseased tissues. Food is a natural stimulant to the physiological processes, and during the intake of milk there is a quickening of every cell process. This helps the diseased cells to throw off their encumberance, and helps the normal cells to rid themselves of their seriously diseased neighbor cells. It is thought that the blood is able to take up directly from the milk certain cells which become white blood cells—the diseasefighting cells of the blood. At any rate, the milk diet greatly increases the number of these white blood cells, and this increase hastens recovery by destroying the disease elements. In these ways the milk produces its effectsand in a strictly natural, normal manner, without any resulting reaction, but with decided general physical improvement. But the quantity taken should be considerable. A half-pint every halfhour steadily throughout the day until six quarts or more are taken will be necessary to secure the greatest results in the shortest time—and haste is urgent in these cases. I feel confident that if this treatment is instituted at once, on the appearance of the slightest indications of impending septie infection, there will be no serious progress of the disturbance; and there will be no inflammation of any of the veins of the region (phlebitis), and no development of milk leg, or other acute or chronic inflammations. This treatment will also prevent a disturbance of the breasts and their secretion of mille, through the fever or other chemical changes

in the blood, or, by reflex action, through the irritation of the uterus or ovaries. Blood poisorring is one of the most serious dangers associated with childbirth, but I firmly believe it can be remedied in nearly every instance by adopting the full milk diet at once. In twenty-four hours after beginning the milk regimen, the most serious symptoms begin to abate, and within forty-eight hours thereafter the patient is usually normal. After a few days, the menacing dead tissue, the usual cause of the trouble, will be ejected from the womb naturally and painlessly. The only objection to the treatment is that the change back to a diet of solid food sometimes checks, to some extent, the secretion of milk by the mother. The mother’s life, however, is of prime importance, and the child can depend on cow’s milk for additional nourishment in case of need. When the emergency is past, proper diet and other hygienic measures will soon restore the normal milk flow. Sometimes the quantity of milk called for by the diet can not be taken. In such cases additional nourishment may be given in the form of an evening meal. In other words, milk can be taken up to one or two o’clock, and a regolar meal suitable to the appetite and requirements of the patient can be eaten in the evening. Or one may take milk in accordance with the rules of the diet up to nine or ten o’clock in the morning, following with an ordinary meal at noon and resuming the milk at four or five o’clock. In every case it is necessary to guard carefully against constipation. The abdominal pack is especially valuable in the relief of this condition. A cold wet towel is placed over abdomen and lower chest and covered with a sufficient thickness of flannel to induce fairly vigorous perspiration over the abdomen. After an hour or more of this perspiration the pack may be removed, and the parts sponged quickly in cold water. They should then be covered with ample light material to maintain complete warmth. This is one instant in which a mild saline laxative, given in sufficiently large dose to cleanse the intestinal tract, is very valuable; or the enema may be employed.

Chapter XIX

General Care and Hygiene Following Confinement

W HETHER the mother is vigorous or weak, she should not resume her usual activities in full for some time after parturition. She will recuperate more quickly if she does not over-exert herself, and it is better to err on the side of caution and conservatism than to take any risks. If she feels well, she is likely to be over-ambitious about returning to her household duties. It would be good policy, however, not to attempt any arduous household duties for three or four weeks following confinement—to insure against any possible danger of hemorrhage or prolapses; and when it can be afforded she should wait four to six weeks before taking full charge of her baby and her household. Many women have been made invalids for life by some injudicious exertion that might just as well have been avoided, as many others have been injured by deficient or delayed activity. Of course, the duration of her convalescence depends entirely upon the constitution of the woman, and upon her previous physical training. If there are stairs to go up and down, it would be well for the young mother not to go up and down too often for at least a couple of weeks. A daily period of relaxation should be arranged for whenever possible. This may be either at mid-forenoon, at noon, or at mid-afternoon, preferably the last, when the energies begin to wane—unless, of course, relaxation can be secured more

than once daily, which is to be preferred. The woman should lie in a comfortable position, and one which allows complete relaxation of all muscles. Social obligations should not be permitted to interfere with full recovery of the mother and normal development of the baby. As mentioned elsewhere, a proper diet is a most important feature of afterconfinement care. If a milk diet can be arranged for, the benefits to the mother will not only be tremendous, but those the baby will derive will be as great. This diet will help to restore quickly full strength and energy to the mother, at the same time helping to maintain formal breasts and to prevent their drooping later. Also, the breast milk tedi be greatly increased in amount and improved in quality, and this will help insure a steady, normal gain in the baby’s weight and its comparative freedom from the disturbances of infancy, which are not only weakening to the infant but wearing on the mother. If this milk diet is for any reason impracticable, then a natural diet of solid food should be adopted. This should consist of fresh and dried fruits ; fresh green vegetables, cooked and raw ; tuberous vegetables, as carrots, turnips, onions, potatoes, etc.; whole-grain cereal preparations, nuts, and an abundance of milk. Whether or not meats, fish, and eggs are used is unimportant, if sufficient of the foods already enumerated is consumed. Intestinal activity is most important with the pregnant woman and one who has recently given birth to a child. Sluggishness of the bowels may prevent the uterus from returning to normal size, and may also be responsible for prolapse of that organ, through pressure from above. Absorption of long-retained contents, especially waste material from an improper diet, may interfere with the secretion of milk, and may materially reduce its quality. Therefore, in order to prevent in jury to both mother and babe, the intestines must be made to discharge their waste regularly and sufficiently. Whether or not there has been any noticeable strain upon the kidneys during the period of pregnancy, these important organs must not be overtaxed during the post-confinement period. To prevent this, considerable water and fruit juices, or fresh fruits, should be taken regularly ; also the green vegetables, unless the milk diet is taken. But the maintenance of normal skin activity is of almost equal importance in sparing the kidneys.

For general health, as well as for the health of any particular organs, there should be sufficient bathing. The mother should accustom herself to cool baths. A warm (not hot) bath, followed by a cool (not necessarily cold) one, should be taken daily. Also the nude body should come in with freely circulating air daily, and as often as possible sun-baths should be taken. Clothing should be light and loose, so as to permit access of air to the skin. All constrictions should be strictly avoided, except for the temporary abdominal bandage, if that has been considered necessary for a short time immediately after delivery. The subject of exercise has already been sufficiently covered. I am fully aware that the care of one or more babies is a vast responsibility; but it is not so much of a responsibility that the mother should feel the weight of the world upon her shoulders. In other words, do not take life and your responsibilities too seriously. If you know what is required for the health of yourself and your child or children, it will be comparatively easy to maintain a calm, unruffled temper. It is the purpose of this book to give you this knowledge.

When should sexual relations be resumed ?

In a broad, general way, and from the strict standpoint of physiological welfare, sexual relations should be refrained from during the entire nursing period, whether six or eight months, or longer. There are a number of reasons for this. First, the quality of the milk itself is likely to undergo certain chemical changes as the result of sexual stimulation, just as it may become a deadly poi-son to the child under the influence of furious anger. Secondly, a nursing mother should never be subjected to the risk of pregnancy. The simultaneous drain of lactation and gestation is a men-ace to health, and tends to weaken the natural resistance towards tuberculosis and other wasting disorders. This explains why cows are so subject to tuberculosis. They are constantly

milked, even while heavy with calf. The lime salts and essential minerals are drained out of their systems by the double demand of the milker and the growing animal. The consequence is that when the tubercular germs find their way into the lung cells, there is no available lime in the cow’s blood to form an enclosing wall about them and render them harmless. And, thirdly, inasmuch as menstruation is usually not established during the period of lactation, there is no definite way of determining just when a new pregnancy has taken place. Therefore, for the best interest of mother and babe, and for the interests of the babe that is to come, this intercourse should never occur until from nine to eleven months after the birth of the child in arms. Involution, or the return of the womb to approximately its normal size, takes place in about six weeks. Intercourse can be resumed any time after this. But, to repeat, the longer it is deferred, the better are the chances for continued good health on the part of both mother and nursing babe.

Chapter XX

Does Maternity Mean the Loss of Your Figure?

A MONG the most antique of old wives’ fables is the one which says that after a baby or two a woman ceases to be a girl. She becomes a “matron"—usually identified by a flabby condition of the breasts, a pendulous abdomen, and a rather luxurious accumulation of embonpoirrt. Truth to tell, this description fits a distressingly large number of women who have borne children. They lose the slim, girlish lines, the buoyancy, the Brace, the bright vivacity and air of ingenuousness characteristic of youth; in their place come stolidity, mental and physical lethargy, and a fatuous resignation to what is commonly supposed to be the inevitable. Yet the fact remains that unless a woman is actually swamped with household cares (and with the practice of intelligent birth control there isn’t the slightest necessity for this), there is little or no excuse for her becoming fat, flabby, and careless as to her appearance. One of the best proofs of the contention is furnished by women athletes who keep themselves in shape after the birth of their children. The following story of a woman athlete illustrates possibilities that are open to every woman:

How i bore two children-yet kept my girlish figure

I am twenty-six years of age, and I have borne two beautiful children. The older boy is now eight, the baby twenty-nine months old. My first baby weighed nine and one-half pounds; the second weighed eight and one-half. And I felt so strong and well that the day following their birth I could have gotten up, if the dottor had permitted me to do so. Having these babies and giving them the tenderness of a mother’s care has been a wonderful experience for me. But the most wonderful of all is that I had my babies, and have given them everything that the most devoted mother could give of herself—her care and unremitting attention—yet I have since their birth been awarded a prize as the most beautifully formed woman in the world. I kept my figure despite motherhood. Any woman can do just as I did, if she will only make up her mind to try. But most women are too lazy to exert themselves. They let themselves become slovenly, untidy, and fat. And then they blame it on their blessed babies, when they should be honest enough to blame themselves. First, I want to tell you that your breasts are bound to be larger while you are nursing your baby. But they go back to normal size again, if only you exercise the muscles in the way I shall teli you. I nursed both my children, and with my younger I had so much milk that I gave the oversupply to the child of a neighbor downstairs, whose baby was dying because the mother had no milk for it, and the doctor couldn’t get a formula that would nourish the child. The doctors say I saved this child’s life by giving it the rich milk that my own baby did not need. I do all my own work nowadays—it’s too hard to get the right kind of a maid. But I want to tell you that making beds, sweeping floors, and doing all kinds of housework is perfectly splendid exercise, bringing into play practically all the muscles in the body. H you sweep correctly, and throw a lot of damp scraps of newspaper or some sweeping powder on the floor, you don’t need to raise any dust at all. And really, there are very few exercises a woman can take that tone up the abdomen muscles the way sweeping does.

It is that pendulous condition of the abdomen that is one of the surest “earmarks" of motherhood. I think women bring on this condition themselves by depending on the abdominal bandage—and on corsets. While it may be a good thing to wear a snug abdominal bandage for a week or so after your baby is born, I believe that mothers bring about a sagging of the wall of the abdomen by wearing the bandage too long, as well as by wearing corsets. I have never worn corsets, and I have never worn a bandage longer than a few days after my babies came. Nature gave us our muscles for use. And if we don’t use them, they become soft and baggy." Now, here is what I do: First thing in the morning when I get up, I drink two glasses of hot water, into which I have squeezed the juice of half a lemon. This clears out the mucus which accumulates in the stomach during the night, and tends to stimulate the liver and the bowels to increased activity. I find it one of the very best methods I know of for overcoming constipation and liver torpor. It also gives the stomach glands a chance to do better work and to secrete more pepsin and stomach acid, so that you can better digest your food. After this I take a bath. I get right into the tub, take a stiff bath brush or bath mit, and rub the skin as hard as I can, especially under the breasts and over the abdomen. Then I stand upright in the tub, and with a bath sponge or a big towel, soaked with the cold water from the faucet, I splash myself quickly all over. I then take a heavy crash bath towel and rub myself until my skin is pink, with the exercise of rubbing and the friction of the towel. I lost fifteen pounds in this way inside of a month, after my second baby came. And I assure you that no matter how tired and sleepy you may be, a bath like this will put new life into you. After you get accustomed to the routine, it doesn’t take more than five or ten minutes for your bath—and you feel much better all day for it. Also the bath and the brisk rub will help in a wonderful way to make your flesh firm, and tone up the muscles of the breast and abdomen, keeping them from getting flabby. One of the greatest of all health-giving measures I have ever tried is the internal

bath. I have made a practice for many years of taking an internal bath on an average of once a week. For, no matter how freely the bowels may have seemed to move, I find that there are hardened particles of fecal matter that cling to the bowels and really can only be gotten rid of by the thorough washing out that they get when you take an internal bath. I have told more than a score of women about this, women who used to be troubled with pimples, bad breath, sallow complexion, and a blotchy skin —and in every single case, after they had used the cleansing enema for a month or so, their pimples disappeared, their complexions cleared up, and their cheeks became pink and rosy instead of sallow and blotchy. Just as soon as possible after your baby comes, you should take up some form of exercise especially some kind that will keep you in the open air. The trouble with most women is that they sit around, eat, and get other people to do their work. They don’t take a bit of interest in getting themselves back into shape. In fact, the most active exercise many women take is to play cards, go to a matinée, or have their nails manicured. One of the best of all the exercises I know to strengthen the muscles of the breast and abdomen, as well as to tone up the womb itself, is to “bend the crab." You may not be able to bend backward until you can touch the floor with your hands. But you can stand a few feet from the wall, and, putting your hands over your head, bend back until they touch the wall. Then let your hands “crawl" down the wall—a little lower each day. This is the most wonderful exercise you can take for stretching the spine and limbering up the backbone, as well as toning up the body muscles, “lifting" up the stomach, and helping to keep your figure slim. I need hardly say that women should always be careful not to overeat. It is so easy for mothers to get into this habit. But overeating combined with underexercising puts on more fat in a day than you can take off in a week. My own meals are very simple, consisting of milk, eggs, and plenty of green vegetables and fruit. I never, if I can avoid it, eat “demineralized" food of any kind ; no white bread, crackers, polished rice, pearled barley, or any of the lifeless breakfast foods so generally eaten nowadays. Nor do I let my children have any of these “robbed foods."

Also, I very seldom eat pastry, candy, or any sugary foods. No woman who has any tendency to put on fat can eat this sort of food and not pay for it with the loss of her figure. In short, I live hygienically. I follow the laws of health set forth in these chapters. If every woman would do the same, there would be more happy families in the land. There would be more contented husbands. And there would be none of that loss of charm and beauty that women have wrongly blamed on their motherhood.

Chapter XXI

Keeping the Breasts Firm After Childbirth

W OMEN who have never given the proper care to their bodies are almost certain to neglect them more than ever after the birth of child. As explained elsewhere in this volume, there should be a well-defined effort to develop the highest possible degree of bodily vigor before and during pregnancy. Whether this has been accomplished or neglected or found impossible for any reason, it is important to make every effort to maintain and improve the health after childbirth; and with this should be associated an effort to prevent that “loss of figure" so frequently experienced after childbirth. The woman who does not endeavor to retain her more youthful outlines, but allows her abdomen and breasts to become pendulous, her thighs and hips to amass layer upon layer of wrinkled fat, and the rest of her body to show, too early, the signs of advanced maturity, need not be surprised if her husband does not continue to regard her as .his sweetheart as well as his wife or house-keeper. And she can retain those youthful outlines if she makes the effort. In fact, if she has allowed her body to enlarge materially before the period of maternity, she can still regain the slimness of girlhood. However, she must not expect to accomplish this by the use of girdles, corsets, etc. The only way to achieve such an end is through exercise and a control of the appetites. If the exercises given in Chapter XVII are taken regularly, as suggested, much will be done by these alone to prevent a sagging abdomen and accumulation of fat in other regions of the body. The breasts are very much inclined to droop after confinement. Sagging breasts are a defect that will mar any figure, no matter how attractive it may otherwise

be. In the restoration of the bust to normal the following exercises will be found useful:

1. While lying on the back bring the arms with elbows rigid from as far out to the sides as you can reach to a position immediately over the head. Lower and repeat. Or the arms may be crossed in front of the chest, and the exercise repeated.

2. Take the same exercise with the arms as far back of the head as you can reach. Bring them to over the head, or extend them downward to the sides, and return to over-the-head position.

As you gain in strength, a book, or a light weight of some kind, can be held in the hands while taking these two exercises.

3. Stand facing the wall with the feet from two to three feet away. Place the arms high over the head, and, resting the hands upon the wall, slowly fall forward until the body is resting as much weight as possible on the hands. Now force yourself backward by pushing against the wall with the hands. Repeat until tired. At first it will probably be best to have the hands only at shoulder height, gradually placing them higher up the wall until they are overhead.

4. Stand with the feet together, arms horizontally forward, palms inward; inhale normally as the arms are swung vigorously sidewise and backward in an endeavor to strike the backs of the hands together in the rear. Repeat several times.

5. Stand with the feet together, arms to the sides, shoulder-high. Swing the arms

high across the chest under the chip. Return them far backward to the sides, and repeat.

6. Standing, fiex the arms shoulder-high, elbows as far back as possible. Rotate the body far to the right and then to the left, aiming to keep the rotation above the waist as much as possible.

7. Place one clenched hand in the other folded hand in front of the chest; with one arm force the other elbow as far to the rear as possible. Reverse and force the opposite elbow to the rear, and repeat.

8. Standing with the feet slightly apart, reach diagonally upward and forward with one hand, and downward and backward with the other, slightly twisting the body and getting full stretch upon the chest and abdomen. Repeat by alternating.

9. Hold a towel against the back of the head, hands six or eight inches apart; pull forward with the arms while resisting with the neck muscles. This can be repeated several times.

10. Stand in an open door, the palms against the casing. Try to force the body through while resisting with the hands. Give way slowly so that at the end of the move the body is through the door, the elbows and shoulders far back.

These exercises stimulate the milk secretion and help to keep the tissues of the breasts firm. When taken with sufficient vigor and with proper regularity, the breasts should return to their former size and shape. If they sagged before conception, their shape and tone should be improved by these exercises.

They are most effective when taken before pregnancy, and as much as possible during pregnancy. Prevention of drooping is easier than correction after the drooping has become more or less pronounced. Swimming and golf are two excellent forms of exercise for women, and tennis should be safe for most. Basketball is an excellent exercise for developing or maintaining the figure and for toning up the bust, if the general strength will permit. The exercises given in Chapter XVII are excellent for the abdomen and the body in general, and should be used regularly. Only a few of the above exercises should be taken at first, and these performed only a few times. Repetitions may be increased as strength increases. In other parts of this book I have discussed the value of milk in preventing or overcoming certain abnormal conditions. Here I want to emphasize its value in securing and maintaining a firm condition of the breasts. Without the best food exercise will be ineffective. If milk is taken in sufficient quantities during pregnancy and after confinement, the breasts will secure the necessary quantity of richly nourishing blood to keep their tissues normal, provided the surrounding muscles secure proper exercise. The milk diet is highly advisable for this purpose, but at any rate there should be a considerable amount of milk taken daily—not in addition to regular full meals, but as part of the regular nourishment. The condition of the breasts depends to no small extent upon the condition of the uterus and ovaries; if they are not supplying a proper amount and quality of their secretions, the breasts are almost sure to relax. The milk diet tends to normalize the action of the pelvic organs, together with that of all other organs, structures, and fluids of the body. It will therefore help in this manner, also, to keep the breasts toned up. Exercise and milk, then, especially the full milk diet, are two extremely valuable and important means of preserving a normal figure, particularly so far as the breasts are concerned. And to me it seems that there is no legitimate reason why motherhood should alter the physique in the human family any more than it does in the lower animals. If women have a proper pride in their persons, they will observe in every detail that personal hygiene which will keep them as youthful

in body as they should be in mind. Motherhood will then be in no way nor in any degree a handicap or a misfortune, but a benediction, and mother and child will be mutual blessings.

THE END