During pregnancy the breasts increase markedly in size, forming at this time the preliminary milk or colostrum, a thin silvery fluid which can be pressed out of the nipples. The real milk, however, does not appear until the third or fourth day after childbirth. The cause of this phenomenon has been studied for many years, but only recently has a satisfactory explanation been forth-coming.

MANY a woman is extraordinarily ignorant about her body and its organs. She will explain that she has a pain in the chest and point to the navel, or she will say that she “feels funny inside” or “has it in the stomach”, when the abdomen or the bowels or the womb causes trouble.

There are plenty of grown-up women who do not know that they have a womb and ovaries and they know nothing about the correct functioning of their organs, conception, childbirth and so forth. Dr. Novak has rendered a considerable service to women by writing a popular book with the extraordinary title The Woman asks the Doctor.

I would give a few extracts which will show the simplicity and clarity of description employed by the writer which will, undoubtedly, induce many to buy it.

“The tubes (fallopian tubes) are two hollow channels which extend outward from each side of the top of the womb toward the ovaries, with which they are in intimate contact. Their principal function is to transport the eggs from the ovaries to the womb.

The walls of the tubes are made up chiefly of muscle, so that by their gentle contractions they can squeeze the egg along its proper course. The inside of the tube is lined by a layer of cells, many of which possess tiny hair-like projections or cilia, which by their lasting movement, in a direction from ovary to uterus, also help to push the ovum along toward the latter.

“The calibre of the tube is very small, especially at its inner end, where the canal is only large enough to admit a very fine bristle. It can thus be seen that the slightest obstruction, as by even a mild degree of the inflammations which are so common in women, may block the channel so that eggs cannot reach the womb. This is one of the most common causes of childlessness in women, and it is this point which the gynaecologist tries to clear up by means of blowing carbon-dioxide gas through the tube in the now well-known Rubin test.

If the gas passes through, it is safe to assume that the eggs and the spermatozoa can also do so, and that they have a chance to make contact, with fertilization as a result. If the tube is only partially blocked, it may happen that the spermatozoa can pass up, but that the fertilized egg cannot get through and into the uterus, so that it sometimes plants itself in the tube, which is much too small to permit of its normal development. This, therefore, is a common cause of the so- called extra-uterine pregnancy, generally signifying a pregnancy in the tube, and almost always calling for surgical treatment.

“At its middle part the tube is wider than elsewhere, and it is believed that it is here that the spermatozoa generally encounter the female egg, and that fertilization takes place. The outer end of the tube ends in a funnel-like mouth surrounded by a number of fringes or fimbriae (the fimbriated end). One of these extends directly to the ovary, so that it forms a sort of bridge across which the egg can travel when it is discharged from the ovary.

On the surface of this little bridge-like fringe there are the same little cilia which are found in the tube, and these are believed to be important in directing the egg toward the open mouth of the tube. As the surface is always bathed in a thin layer of fluid, the lashing movement of the cilia, always toward the tubal mouth and uterus, creates a little current toward the opening of the tube. In this way the discharged egg, hovering in space, as it were, is rather irresistibly drawn into the tube and thus put on the right road toward the uterus.

“The two ovaries are the gonads, or sex glands, of the woman, corresponding to the testes, or male gonads. They are almond- shaped structures which are situated, one in each side of the pelvis, between the walls of the latter and the uterus. They are about 1 1/2 inches in length, about I inch in width and perhaps 3/4 of an inch in thickness. Their chief function is the production of the female eggs or ova (singular, ovum).

At birth there are something like 100,000 of these potential eggs, all of tiny microscopic size, in each ovary. As they exist in the ovary in this unripened form, however, they are not capable of fertilization by the male cell, not indeed until they go through a series of preparatory or ripening changes. Each of them is enclosed in a very tiny sac called the follicle (graafian follicle) or egg-sac.

It is not until the advent of puberty and the beginning of the reproductive phase of life that complete ripening processes are seen, although imperfect maturation may be observed much earlier in childhood”.

“Women, like hens, produce eggs, but there is a considerable difference between the eggs of the two and between their mechanisms of reproduction in general. All the eggs which are to be used throughout the womans reproductive life are present in her ovaries at birth, and even before this. Not only that, but nature gives her an enormous reserve supply, for each ovary starts out in life with a supply of something like 100,000 of these ova, far more than can ever be used for purposes of possible conception.

As a matter of fact, since only one egg is ordinarily given off during each menstrual cycle, and since the average duration of the womans menstruating life is about thirty-two or thirty-three years, not much more than 400 eggs are actually extruded from the ovary and are thus exposed to the possibility of fertilization by the male germ cell, and only 1 of 500 ova achieves admission to this aristocratic 400. With the male, nature is even more prodigal in her factor of reserve, for each ejaculation of the male semen, i.e. the amount of semen given off by the male in intercourse, contains about 226,000,000 spermatozoa. And yet only one of these is necessary for fertilization.

“What becomes of all the female eggs which do not achieve full maturity and which are not extruded from the ovary? It will be recalled that just after menstruation a considerable number of follicles begin to grow, but that one of these outstrips the others, being destined to reach full maturity and to give off the ovum of that month.

“The others reach varying stages of development and are then blighted, the egg dying and the follicle being converted into a tiny cystic cavity which soon shrivels up and disappears. This takes place month after month, so that many ova are thus destroyed. The many which still remain at the time of the menopause likewise undergo degeneration, so that the ovary of the old woman is small, shrivelled and devoid of ova.

“The human egg, to the layman whose ideas of eggs is apt to revolve about the eggs of the hen, will seem like a very tiny structure, for it is no larger than a grain of very fine sand, so that ordinarily it must be studied under the microscope. And yet it is larger than, or certainly as large as, the egg of any other mammalian creature, not excluding the whale. Show quite graphically the relative size of three mammals the whale, the mouse, and man and also the relative sizes of their eggs. The tiny mouse has an egg almost half the size of that of the mammoth whale.

“To make more graphic the minuteness and yet the enormous potentiality of the germ cells of the two sexes, let me quote the following passage from a paper by my colleague, Dr. Carl G. Hartman, a distinguished investigator in this field:. “Let us assume that the entire human race comprises in the aggregate two billion individuals. Suppose one could assemble in one place all of the eggs from which will arise the next generation of mankind 2,000,000,000 eggs. How much space would they occupy? Would they amount to a houseful, or a roomful, or a hatful? The last guess is right a derby hat would suffice.

“Now each human egg, before it can develop, must be “fertilized” by a male cell or spermatozoon. Male cells are tremendously smaller than the eggs: the 2,000,000,000 of them necessary to fertilize the eggs from which will come the next generation of mankind would easily go into an elliptical vessel the size of a capital letter “O” in the text of this page”.

“Absence of menstruation often occurs as a manifestation of some disease, though often not of serious nature. Even such factors as improper diet, not so rare in these days of strenuous dieting among women, may produce the disorder, for the ovaries are singularly sensitive to certain nutritional disorders. For example, it has been shown by experiments that in such animals as the rat the reproductive cycle can be abolished by simply withdrawing from the diet certain vitamin principles.

I have seen similar effects produced in young women who have been dieting too strenuously. Many similar constitutional conditions associated with lowered vitality, such as anaemia, diabetes or tuberculosis, may bring about cessation of the periods.

“After all, however, the cases of amenorrhoea which present the most frequent and often the most baffling problems to the doctor are those in which the disorder is due to what the laity like to speak of as glandular disturbance, meaning by this a disturbance of the endocrine glands. The most common type of all is that in which the patient stops menstruating and at the same time gains much weight. I have seen such a patient gain as much as seven stone within a year”.

“The women who should be especially on their guard are those beyond the age of thirty, although the cancer is not rare in women below this age. The point which should perhaps be most emphasized is a negative one, viz. pain is not a sign of cancer, except in a very late incurable state, so that just because the woman has no pain whatsoever and perhaps feels at her best, she should not take it for granted that she cannot possibly have a cancer. This cannot be too strongly stressed, for about the only thing which seems to bring many women for medical advice is pain. I have often thought what a godsend it would be if cancer started with terrible pain, for then all cases would come to the doctor in an early stage.

“The sign which more than any other should put a woman on her guard is unnatural bleeding of one sort or another. Especially important is irregular staining or actual bleeding occurring in between the periods, often after intercourse, with defecation, or after physical exertion. The menses themselves may be normal or they may be rather free. Of great importance also is bleeding after the menopause, perhaps many years after the cessation of the menstrual function.

Such warnings should never be neglected, although in perhaps the majority of cases some other cause than cancer will be revealed. But there is no way for the woman, or for the doctor, to know this unless the proper sort of examination is made. If the doctor consulted merely pats you on the back reassuringly or ridicules your fears without a proper examination, he is not a good doctor, and you had better consult someone else who is more conscientious.

“In some cases the first suspicious sign is a watery or slightly stained discharge, and this likewise should be investigated, while in a few there are no symptoms whatever until the disease has secured a serious foothold, so that the woman, no matter how intelligent and alert she may be, really hasnt a chance to suspect serious trouble until too late. But such cases, fortunately, are exceptions.

A fact which cannot be too strongly driven home is that excessive bleeding or flooding at the menopause is not normal, as so many women seem to think. This belief has cost thousands of women their lives. It is true that many other things than cancer can cause such bleeding, but here again no woman is going to gamble with her life if the matter can be definitely cleared up, as it always can.

“It is not strange, in view of the great frequency and the gravity of cancer, that many women develop a fear of cancer which reaches morbid proportions. Thus many a woman dreads going to a doctor because she is sure she will be told that she has cancer, and in the majority of such cases there is no ground for her fears. Such women suffer the tortures of the damned, often for years, rather than brave the medical consultation, which would probably send them on their way with a great load lifted from their minds.

If by any chance cancer actually exists, valuable time is lost by this dread of facing the truth, and of bravely doing all that can be done to fight the disease. It is as if a soldier shuts his eyes so as not to see the enemy instead of girdling up his loins and putting up the very best fight he can, with often victory as a result.

“There has been such a widespread campaign of popular education on cancer that almost inevitably many women have come to think about it much more than they should, and cancerophobia has become quite common. A healthy fear of the disease in the sense of being on the alert for warning signals is highly desirable, for there is no human being living who theoretically may not sometimes fall a victim to it. But it would be a miserable world if we all developed such a panicky fear of it as to spoil the happiness which life can bring.”.

“The breast gland is an appendage of the reproductive system. With the awakening of the latter at puberty, the breasts become developed, and during the whole reproductive period of life they are under the influence of the ovarian secretions. It is even believed by some investigations that certain non-cancerous tumour-like conditions of the breast are due to disturbances in the secretory function of the ovaries. It is not strange, moreover, that some women at the time of menstruation experience soreness or even pain in the breasts.

“During pregnancy the breasts increase markedly in size, forming at this time the preliminary milk or colostrum, a thin silvery fluid which can be pressed out of the nipples. The real milk, however, does not appear until the third or fourth day after childbirth. The cause of this phenomenon has been studied for many years, but only recently has a satisfactory explanation been forth-coming.

It appears now to have been established that the motivating force is a hormone (prolactin) produced in the anterior lobe of the pituitary gland, but that it can produce lactation only when the breast has been previously under the influence of the ovarian hormones, as it is during pregnancy. Once lactation has been initiated, the process is kept up by the suckling act of the infant, though the continued activity of the pituitary is also essential”.

Emil Novak