MARRIAGEABLE AGE. From twenty to twenty-five years of age may be stated as the proper time for contracting marriage on the part of females; and from twenty-five to twenty-eight years of age on that of males. Under favourable circumstances, marriage is conducive to health and longevity. As a general rule the female constitution is not sufficiently matured till the twenty-first year of age to allow marriage without risk of injury to health and comfort. Some exceptions to this exist in persons who have acquired a about nineteen that mental and physical maturity which the majority only obtain some years later. Too early marriage often results in a broken constitution and feeble health in the mother, or in the birth of weakly children. On the other hand, too late marriage often entails much discomfort, and children born of such parents are often sickly, and die prematurely. A considerable disproportion between the ages of the husband and the wife is, for similar reasons, to be avoided. Physiology has, beyond a doubt, established the general truth of these remarks, though it is not presumed that they can or will always be applied. It is most important, however, that they should be instilled as first principles in the minds of the young and their counselors, in order that their application may be facilitated as circumstances permit.
When a reasonable period has elapsed after marriage, and conception not taken place, the question arises, what is the cause.
As we have fully entered into this subject in the Lady’s Manual, we shall here only point out a few of the conditions or causes of sterility, and give general hints as to the treatment when they are at all amenable to personal measures. In nearly all cases, however, a physician should be consulted.
CAUSES. When non-conception is due to faults on the side of the female, the causes may be local or constitutional. Amongst local causes are-a natural defect in the formation of the vagina, uterus, ovaries, etc., which is comparatively rare; polypi or others tumors in the uterus; displacement of that organ; self-abuse; ill-timed or too frequent sexual intercourse; Leucorrhoea, etc.
Constitutional causes include those in which the general physical powers are impaired, or exhausted by acute or chronic disease; also, obesity; too severe exertion; too close mental application, by which an undue amount of nervous power is diverted from the reproductive; a luxurious or inactive mode of life, the hard-working and the poorer classes being much more prolific than the rich, thee indolent, and the free liver; sexual frigidity, etc.
TREATMENT. This must be regulated by the cause. If uterine irregularity, Leucorrhoea, or other functional derangement exist, in must be remedied by such means as have been previously pointed out; and injurious habits must be corrected.
The remedies most serviceable in sterility are-Sepia, Agnus Castus, Baryta Carbonica, Conium, Platina, Ferrum, Phosphorus, etc. Generally, a physician only can decide which remedy, and strength, etc., are necessary. Many drugs recommended as curative of sterility are of doubtful character.
Impregnation depends on the union of certain elements furnished by the male and female organs during sexual congress, both being alike indispensable; and the qualities of the germs furnished at the period of impregnation will cling to the individual through life. It is more than probable that conception resulting from intercourse when the bodily functions or organs are impaired, whether by fatigue, overtaxed digestion, or excesses of any kind, affords a rational explanation of many infirmities or eccentricities in the offspring. The practical lesson, therefore, is, that sexual connection, at least when conception is possible, should only take place under favourable conditions.
The majority of authors agree that the time most favourable to conception is that immediately following the menstrual discharge. Women having then a greater aptitude to conceive, it is also the most favourable time for sexual intercourse. CAZEAUX says, ” everything seems admirably prepared at this period for the reproduction of the species.” The aptitude for fecundation is not, however, always limited to a few days after the menstrual period; the excitement during intercourse being capable of so influencing the ovarian vesicles as to produce changes in them similar to those experienced at the time of menstruation. Not with standing this exception, however, those who are anxious to increase their families should connect their hoped with this period, whilst they who for reasons of health, from poverty or other circumstances do not wish to add to the number of their children, should then exercise particular caution and self- control. An entirely different doctrine has since been enunciated, to the effect that a developing ovum or growing embryo does not belong to a menstrual period just past, but rather to one immediately prevented by fecundation. In short, menstruation is now considered to be a degenerative process, a kind of fatty metamorphosis similar to that which takes place at the end of pregnancy, and by its occurrence to prove that the ovum has already perished. Hence, according to this doctrine, the time most favourable to conception is the few days preceding the monthly period. It is always desirable to ascertain the precise date of conception. CAZEAUX thinks that the women is apt to experience an emotion of painful pleasure, a voluptuous sensation, and a shuddering proceeding from the spine, pain in the region of the navel, sometimes sensation of motion in the abdomen, and uneasy feelings in the region of the hips, followed by languor, fatigue, and sleepiness, and the next day by a sense of fulness, warmth, and heaviness in the abdomen. With the aid of some such signs, that author adds, some females, especially those who have already had children are able to distinguish a prolific intercourse.
XXII. Symptoms of Pregnancy.
1 For a more detailed account see The Lady’s Manual, also Dr. W. Morgan on Pregnancy.
The signs and symptoms of pregnancy vary considerably in different women, both as to their nature and the periods of their occurrence; but as it is often a matter of importance and anxiety to know whether pregnancy does or does not exist, we will enumerate the symptoms which are most common and characteristic. In estimating their conclusiveness, however, reference must be had to their number and importance, the previous condition of the woman, and any accidental causes which may have been in operation to produce abnormal changes.
The only absolutely certain sings of pregnancy are-the movements of the child felt by another, fluctuation, the sounds of the foetal heart, and ballottement, but, with the exception of fluctuation, these cannot be observed till pregnancy is several months advanced, and the last three only by a medical man.
1. Absence of menstruation. When after marriage a women passes the usual time of her menstruation once, twice or even thrice, especially if she has always been previously regular, pregnancy may be suspected, although the suppression may arise from other causes.
2. Morning-sickness. After a few weeks, if sickness, with or vomiting, occur on rising in the morning, or retiring at night, or at any other periodical time, with no apparent cause, the digestion, appetite, and general health continuing good in spite of the nausea, this symptom, added to the first, will strengthen the probability of pregnancy.
3. Enlargement of the breasts. From sympathy with the womb and other parts of the genital apparatus, and in process of preparation for the performance of their own future function, the breasts generally enlarge soon after conception, causing sensations of fulness, throbbing, tingling, and tenderness, and if they are felt, will be found hard and knotty, the whole glands manifestly taking on a more vigorous physiological activity.
4. Darkening of the areola around the nipple. The darkish circle round the nipple (areola), usually becomes much darker in pregnancy, especially in the first. Little prominences or minute glands, like pimples, also arise on the areola, from which subsequently a semi-milky fluid may be squeezed.
5. Milk in the breasts. This usually a good sign of pregnancy, although in some women who have borne children the milk has never ceased to be secreted; and in others who have never been pregnant, a milky kind of fluid may be pressed out of the nipple.
6. Enlargement of the abdomen. This sign, added to those already enumerated, will materially strengthen the presumption of pregnancy. Enlargements may, indeed, occur from other causes, but in these cases the development and shape are not such as characterize pregnancy.
7. Quickening. The rising of the womb out of the pelvis into the abdominal cavity constituted what is termed quickening; this occasionally takes place so suddenly as to alarm the mother, or cause faintness. It was formerly supposed that life did not exist till quickening occurred, but it is now known that thee foetus is alive form the first moment of impregnation. Movements take place probably much earlier than quickening, but are not perceptible to the mother owing to the nature of the bony structure-the pelvis in which the foetus is enclosed during about the first twenty weeks of pregnancy; after this the womb becomes too large to be any longer retained in the pelvic cavity, and, rising up into the abdomen, the sensation of movement is conveyed to the mother through the soft parts. At the same time, movements in the abdomen, felt only by the mother, may bee due to flatulence, imagination, etc.; it is only when the notions of the foetus are distinctly felt by another person that pregnancy can be determined by this sign.
8,9,10,11. Ballottement, fluctuation, kiesteine in the urine, and the sounds of the foetal heart, are signs requiring the skill of a medical man for detection. The last not only conclusively proves pregnancy, but laos that the child is alive.
Other symptoms and conditions which may occur are- salivation, neuralgia of the face, head, or breast, irritability or temper, melancholy, and other nervous complaints; some suffer from one special disorder-Piles, for instance-when pregnant, and at no other time. But none of these ailments, though very common in consequence of artificial habits, the use of drugs, constitutional disease or accidental causes, are essential concomitants of pregnancy, and are to be regarded more as incidental disorders than symptoms of that condition.
These departures from health are subsequently described and directions and prescriptions for their prevention and removal will be found under each disorder.
XXIII. Hygiene during Pregnancy.
DIET. The should be simple, nutritious, and easy of digestion; it should be thoroughly masticated, and but little fluid should be drunk at meal-timed. Plainly-cooked animal food, once a day, well boiled vegetables, ripe fruits, and such articles as rice, tapioca, or arrowroot, if taken in moderation, will rarely disagree with the stomach. Pastry, smoked hams, salted or spiced meets generally, rich sauces, and every article that has been known to occasion indigestion, as well as those substances which have a tendency to produce a costive of the bowels, should be avoided, and brown bread, if it agrees with the patient, should be eaten in preference to white. Late suppers are inadmissible. Stimulating drinks, wines, ardent spirits, ale, porter, strong tea and coffee, are generally hurtful both to the mother and the foetus. In a word, the diet should be whole-some and digestible, and if it has been so previously, no change whatever is necessary. For it is an error to suppose that ladies require more nourishment during pregnancy than at other times, and large quantities of rich food taken in the belief that it will contributed to the sustenance of the child, cannot but be productive of baneful consequences.
DRESS. It would seem scarcely necessary to make any remarks upon thee dress to be worn during pregnancy, were it not that some females, considerably advanced in it, often lace tightly for the sake of attending public entertainments, or of diverting notice from their condition. At no time should stays be worm, for the simple reason that they are never required. But they should especially be avoided during pregnancy, since a continual and forcible compression of the abdomen while nature is at work to secure its gradual enlargement, in order to accommodate the growth of the foetus, must be attended with serious injury to the health of both mother and child. During gestation the uterus increase on an average from two to fourteen inches in diameter. It must be obvious, then, how vain, as well as criminal, must be every effort to contract it. The human body, like all other works of the Creator, is made perfect’ therefore no sensible woman will shut her eyes to the fact that no part of thee system can be unnaturally compressed or altered in shape without affecting the harmony of the whole. IF the circulation of the blood in the abdominal organs be constricted, congestion is the consequence: on the one hand, indigestion, disease of the liver, constipation, piles, painful menstruation, Leucorrhoea, and ovarian disease follow; on the other-above the seat of constriction-palpitation, difficult breathing, spitting of blood, persistent cough, chronic headache, etc.; moreover, the veins of the legs enlarge, the extremities swell, and the child is apt to be deformed; and finally, if the mother escape these self-created perils, it may be questioned whether compressed breasts and nipples, with then tendency to inflammation, soreness, and consequent train of inconveniences, can afford the requisite ailment for the off spring.
Dress should be arranged as to material and quantity, with the view to comfort and to the season. There must be no pressure on any part; even the garters should be loosely worn. The feet and abdomen should be kept warm, since continued coldness of these parts predisposes to colic, headache, and Miscarriage.
EXERCISE. Exercise is a most important means of retaining good health during gestation, of securing a natural delivery, and of favouring the health of the infant. The most useful kind is walking in the open air; for this calls into action more of the muscles of the body than does any other suited to this condition. Such exercise should, if possible, be taken chiefly before dinner, and be of such a character as to interest the mind as well as to strengthen the body. This will operate most favourably as a preventive of a host of morbid feelings which are apt to attend this state. Care must, however, be taken to avoid a degree of exercise which will induce positive fatigue; such as too long walks, going out in slippery weather, dancing, lifting heavy weights, and all kinds of violent motion. The passive exercise of riding in a carriage falls short of the object in view; and, on the other hand, riding on horseback exceeds it, whilst the danger of fright and accident, to which it expose the incipient mother, is better avoided. In wet weather, or when it is impracticable to walk out, she should select a large and well- ventilated room, so that the air she breathes may be pure. I will plain from the tenor of these general remarks, that lassitude and languor should be striven against and overcome. On this account the pernicious habit of sleeping after dinner should not be contracted. Too little sleep is a less evil than too much. And hence, female who pass the interval, or a good part of it between dinner and tea, on the couch or the bed, generally suffer from debility and proneness to disease.
GENERAL HINTS. Theatres, balls, or exciting public meetings should not be attended; early habits should be formed; all excessive mental emotions, as grief, despondency, anger, etc., are to guarded against; a cold or tepid bath, followed by vigorous friction, should be taken daily; and the mind should be kept tranquil, remembering that parturition is not necessarily attended by great suffering or danger, these being, in most instances, the penalty incurred by disregarding the hints suggested in this Section.
SYMPTOMS. The first intimation of it generally occurs on rising from bed. Before getting up the patient may feel as well as usual, but while dressing will be overtaken by nausea, followed by retching, and perhaps by vomiting before leaving the room; or it may not occur until some little time after leaving the apartment, or not till after breakfast, which may be eaten with zest. In this case there will probably be no return of the symptoms till the following day. In some cases, however, sickness is not felt till evening, when it may be simple nausea, or vomiting may occur; in others, sickness may be present all day. The sickness may begin almost immediately after conception, but more frequently it does not commence until after the lapse of several weeks, and then continues more or less constantly and severely for three or four weeks, and in some instances till near the time of quickening, or even until confinement. In some rare instances it does not occur before the last weeks of pregnancy, and is then apt to be severe; in others cases it is altogether absent during the whole period of gestation.
CAUSE. Exaltation of the nerve-force of digestion, to furnish material for enlarged growth, carried to so high a degree as to disturb the equilibrium of the digestive and assimilative forces. It is most common among the wealthy and inactive.
TREATMENT. Nux Vomica. Vomiting, with vertigo, restlessness, and irritability; acid and bitter risings, hiccough, sense of weight at the pit of the stomach, waterbrash, constipation. When this remedy is indicated, it often affords striking and immediate relief, and carried the patient through the remaining term of pregnancy with comparative comfort.
Ipecacuanha. Uneasiness about the stomach; continuous nausea and retching; vomiting of fluids and undigested food, or of bile; relaxed bowels. It is generally sufficient in mild cases; in chronic cases it may be alternated with Sepia.
Kreasotum. A most valuable medicine for persistent morning- sickness, and one which seldom fails.
Tabacum. Continued sick feeling all day without vomiting.
Arsenicum. Vomiting, with great weakness, and attacks of fainting.
Pulsatilla. Symptoms similar to Nux V., but with tendency to relaxation.
ACCESSORY MEANS. The diet should be regulated, and, if necessary, a change made in the times of eating to those hours when the stomach is least likely to be affected. Cold or cool food will sometimes be retained when hot is rejected.
In some cases two or three teaspoonfuls of beef-tea, or soda-water and milk, should be taken frequently; or, when these cannot be borne, small pieces of ice may be sucked. In extreme cases, it may be necessary to give up the attempt of feeding by the mouth, and to depend upon injections by the rectum for a day or two. Several cases have been recorded in which raw beef has retained after every other kind of food has been rejected. Instead of mincing, it is preferable in point of palatableness and digestibility to prepare the beef as follows: a small block of the steak is scraped with a silver spoon till all the is extracted, a new surface is cut, and the operation repeated. The pulp may then be mixed with red currant jelly, or eaten as a sandwich, with salt and pepper. Meat in this form has been found highly beneficial in Diarrhoea, Consumption, or debility form any cause.
XXV. Heartburn and Waterbrash.
SYMPTOMS. A burning sensation up the throat, and sometimes spasm of the stomach, generally attended by frequent eructations of an acid or tasteless watery fluid, when it is termed waterbrash or pyrosis.
TREATMENT. Nux Vomica will generally be found efficient in removing these symptoms, and should be administered three or four times daily for several days, or until better.
Pulsatilla is to be preferred for patients of a mild, timid disposition, with tendency to diarrhoea; dislike of food, especially of fat; eructations, tasting of food; perverted taste; inclination to vomit
Bryonia may afterwards used, and after that Sulphur, if the former remedies only afford partial relief.
Carbo.Veg. Sensation of suffocation; acid eructations, with flatulence, and rumbling in the abdomen.
Sulphuric Acid. Chronic Acidity.
Lycopodium, Arsenicum, Caps., or CalcareaCarb., may be required.
ACCESSORY MEANS. Rich and indigestible food, especially pastry, stews, etc., are to be avoided, the patient also refraining from too full meals. Too. much cold water should not be drunk during a meal; a glass of water half an hour before or an hour after a meal is beneficial.
Spasm, or colic, from flatulent distension of the bowels through cold or improper diet, is apt to occur during pregnancy; it usually affects the large intestines.
TREATMENT. Colocynth, if the colic prevents the patient form resting in one place, and moving about soothes the pains. This remedy is suited to severe as well as mild forms of the disease, especially when accompanied by diarrhoea. Sometimes it may be desirable to precede this or any other remedy by a few doses of Aconitum.
Chamomilla. In nervous and irritable patients, disposed to bilious derangements from fits of passion, etc.
Nux Vomica will be more appropriate if indigestion with constipation exist.
Ignatia, Belladonna, Hyoscyamus Threatened spasms in hysterical patients.
China. Bilious Colic.
ADMINISTRATION. Two drops of the tincture, or four pilules dissolved in a tablespoonful of water, every half-hour or hour, during a paroxysm of colic; afterwards, every fourth hour for several times.
ACCESSORY MEANS During the violent pains of colic, hot applications are useful, but a warm bath is objectionable for colic during pregnancy A pint of tepid water boldly injected up the bowel by means of an enema-syringe, and repeated if necessary, is almost invariably and immediately successful. Persons subject to colic are recommended to wear a piece of flannel around the abdomen in cold or changeable weather, and to keep the feet warm and dry.