The Eugenic Marriage, Volume I. (of IV.)
W >> W. Grant Hague, M.D. >> The Eugenic Marriage, Volume I. (of IV.)So it is with the woman who for weeks or months has made her own life
wretched, and possibly the life of her husband and friends, the same in
imagining all kinds of dreadful things that never take place. It is
undoubtedly an exhibition of weakness, an evidence of failure in the
development of self-control. Childbirth is a natural process,--there is
nothing mysterious about it. If you do your part you have no cause to
fear,--the very fact, however, that you entertain a dread of it, shows that
you are not doing your part. One of the saddest parts of life, one of the
real tragedies of living, is the fact that most of us have to live so long
before we really begin to profit by our experiences. Could we only be
taught to learn the lesson of experience earlier, when life is younger and
hope stronger, we would have so much more to live for and so many more
satisfied moments to profit by. One of the most valuable lessons experience
can teach any human being is not to worry and fret about the future. You
can plant ahead of yourself a path of roses and be cheerful, or you can
plant a bed of thorns and reap a thorny reward. Cultivate the spirit of
contentment, devote all your energy to making the actual present
comfortable. Don't fret about what is going to bother you next week,
because, as the philosopher said, most of the troubles we anticipate and
worry about never occur, but the worry kills.
REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS.--Anesthetics are as a
rule given in all confinements that are not normal. To make this [113]
statement more plain it may be said, that, when it is necessary to use
instruments, or to perform any operation of a painful character, it is the
invariable rule to give anesthetics. As to the wisdom of giving an
anesthetic when labor is progressing in a normal and satisfactory manner,
there is a difference of opinion. Much depends upon the disposition of the
patient and the viewpoint of the physician in charge of the case. It is a
fact that a large number of confinements are easy and are admitted to be
so, by the patients themselves, and in which it would be medically wrong to
give an anesthetic. In a normal confinement, however, when the pains are
particularly severe and the progress slow, there is no medical reason why
an anesthetic could not be given to ease the pain. In these cases it is not
necessary to render the patient completely unconscious. Sufficient
anesthetic to dull each pain is all that is necessary, and as this can be
accomplished with absolute safety by the use of an anesthetic mixture of
alcohol, ether and chloroform, there can be no possible objection to it.
The use of an anesthetic, however, is a matter that must be left entirely
to the judgment of the physician as there are frequently good reasons why
it should not be given under any circumstances.
THE PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER.--It is a
safe rule to exclude every one from the confinement room during the later
stages of labor. Sometimes it is desirable to make an exception to this
rule in the interest of the patient, by permitting the mother or husband to
remain. If this exception is made, however, they must be told to conduct
themselves in a way that will tend to keep the patient in cheerful spirits.
They must not sympathize, or go around with solemn, gloomy faces.
Cheerfulness and an encouraging word will tide over a trying moment when
the reverse might prove disastrous.
Practically the same rule applies to the entire period of convalescence
during which time the patient is confined to bed. This is a very important
episode in a woman's life and the consequences may be serious if it is
misused in any way. Friends and relatives do not appreciate the [114]
absolute necessity of guarding the patient from small talk and gossip, and
an unwitting remark may cause grave mental distress, which may retard the
patient's convalescence and disastrously affect the quality and quantity of
her milk, thereby injuring the child.
HOW LONG SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--To answer this
question by stating a specific number of days would be wrong, because, few
women understand the need for staying in bed after they feel well enough to
get up. If any answer was given, it should be at least fourteen days, and
it would be nearer the truth medically to double that time. Let us consider
what is going on at this period. The natural size of the unimpregnated womb
is three by one and three-quarter inches, and its weight is one to two
ounces. The average size of the pregnant womb just previous to labor is
twenty by fourteen inches, and its weight about sixteen ounces. We have,
therefore, an increase of about 600% to be got rid of before it assumes
again its normal condition. This decrease cannot be accomplished quickly by
any known medical miracle. Nature takes time and she will not be hurried:
she will do it in an orderly, perfect manner if she is allowed to. The womb
will again find its proper location and will resume its work, in a
painless, natural way, in due time, if all goes well. The uterus or womb is
held in its place by two bands or ligaments, one on either side, and is
supported in front and back by the structures next to it. These bands keep
the womb in place in much the same way as a clothes pin sits on a clothes
line, and it will retain its proper place provided everything is just
right. After labor, it is large and top heavy. If you put a weight on the
top of a clothes pin as it sits on a clothes line, what will take place? It
will tilt one way or the other, and if the weight is heavy, it will turn
completely over. So long as the woman lies in bed the womb will gradually
shrink back to its proper size and place; if she sits up or gets out of bed
too soon, the weight of the womb, being top heavy, will cause it to tilt
and sag out of its true position. As soon as it does this the weight of the
bowels and other structures above will push and crowd it further out [115]
of place. This crowding and tilting interferes with the circulation in the
womb and its proper contraction is interfered with, and thus is laid the
foundation for the multitude of womb troubles that exist.
It is a mechanical as well as a medical problem. Being partly mechanical,
it is subject to the rules that govern mechanical problems. The importance
of this dual process will be appreciated by considering the following fact.
Many medical conditions tend to cure or rectify themselves because nature
is always working in our behalf if we give her a chance. Take for example
an ordinary cold. You can have a very severe cold and you can neglect it,
and in spite of your neglect you will get well. It is not wise to neglect
colds, nevertheless, it is true that nature will cure, unaided, a great
many diseased conditions, if she has half a chance. This, to a very large
extent, is the secret of Christian Science, yet the principle is known to
everyone. A mechanical condition, on the other hand, has absolutely no
tendency to get well of its own accord, or without mechanical aid. This is
why Christian Science cannot cure a broken leg. It is this principle that
makes diseases of the womb so persistent, and so stubborn of cure. When a
womb once becomes slightly displaced, the tendency always is for it to grow
worse and never to cure itself. The longer it lasts the worse it gets. Its
cure depends upon mechanically putting it back in place and holding it long
enough there to permit nature to reestablish its circulation, and by toning
and strengthening it so that when the mechanical support is taken away it
will retain its position. There is no other possible way of doing it. Now
since it has been proved that nature takes many days to contract a pregnant
womb, a woman is taking a risk, and inviting trouble by getting out of bed
before that time.
WHY DO PHYSICIANS PERMIT WOMEN TO GET UP BEFORE THE WOMB IS BACK IN ITS
PROPER PLACE?--Without offering the excuse that a woman will not stay in
bed as long as a physician knows she should, there is, however, a large
degree of truth in this excuse. And we are of the opinion that, if a
physician made it a rule to keep all his confinement cases in bed for one
month, [Page 116] he would very soon find himself without these patients.
Experience has taught us, however, that it is safe, under proper
restrictions, and in uncomplicated confinements, to allow patients to sit
up in bed on the 12th and in certain cases on the 10th day, and to get out
of bed on the 12th or 14th day. When the patient is allowed to sit up, out
of bed, it should not be for longer than one or two hours, and during that
time she should sit in a comfortable rocking or Morris chair, which should
be placed by the side of the bed. Each day the time can be lengthened, and
the distance of the chair from the bed increased. This procedure gives her
the opportunity to walk a little further each day, thereby to test her
strength and ability to use her limbs. On the fourth day, if all has gone
well, she may stay up all day and she may walk more freely about the room.
She should be just to herself, however. As soon as she is fatigued she
should not make any effort to try to "work it off." When a feeling of
fatigue appears she should rest completely. If she has any pain or distress
she should acquaint the physician with it at once. She should not try to
hide anything on the mistaken idea that "it isn't much." She does not know,
and she is not supposed to know what the pain may mean; it may be
exceedingly significant. Many women have saved themselves needless
suffering, and their husbands unnecessary expenditure of money, by calling
the physician's attention to conditions, which in time would have been
serious, and would have necessitated long, expensive treatment.
LACERATIONS DURING CONFINEMENT, THEIR MEANING AND THEIR SIGNIFICANCE.--The
only interest a laceration or a tear has to a physician, is whether the
laceration or tear is of sufficient importance to need surgical
interference. The laceration can take place at the mouth of the womb, or on
the outside, between the vagina and rectum.
Those of the mouth of the womb always take place, in every confinement, to
some degree. They are never given any attention at the time of the
confinement, unless under extraordinary circumstances, such as a more or
less complete rupture of the womb, and this is such a rare accident [117]
that most physicians practice a lifetime and never see or hear of one
single case. Those on the outside are always attended to immediately after
labor, or should be, unless they are very extensive and the patient is not
in condition to permit of any immediate operative work. In such a case it
is best to leave it alone until the patient is in condition to have it
operated on at a later date.
It is distinctly preferable to have it attended to immediately after labor
when it is possible, and it is possible in a very large percentage of the
cases. The explanation of this is because it is practically painless then,
owing to the parts having been so stretched and bruised that they have
little or no feeling. If it is left for a day or two and then repaired, it
will be more painful, because the parts will have regained their
sensitiveness. Another good reason in favor of immediate repair is that a
much better and quicker union will take place than if postponed.
When a patient is torn, but not to the degree necessary to stitch, it is to
her advantage to be told to lie on her back and keep her knees together for
twelve hours, thus keeping the torn edges together and at rest, thereby
favoring quick and healthy repair of the tear. Some physicians go as far as
to bind the patient's knees together so she cannot separate them during
sleep.
It is the custom of every conscientious physician to request every woman he
confines to report at his office six or eight weeks after labor. The reason
for this is to find out by examination the character and extent of the
lacerations of the mouth of the womb. No physician can tell at the time of
labor just how much damage has been done, because the mouth of the womb, at
the time of labor, is so stretched and thinned out, that it is impossible
to tell. After the womb has contracted to about its normal size, it is a
very simple matter for any physician to tell exactly the character and
extent of the lacerations. Most of these tears need absolutely no
attention; there are a few however that do. This is a very important matter
for two very good reasons.
1st. Every woman should know, and is entitled to know, just what [118]
condition she is in, because if she has been torn to an extent that needs
attention, and is left in ignorance of it, her physical health may be
slowly and seriously undermined and the cause of it may not be understood
or even guessed at. A woman who becomes nervous and irritable, loses vim
and vitality, has headaches, backaches and anemia, and no symptoms, or few,
that point to disease of the womb, will suffer a long time before she seeks
relief of the right kind, and will be astonished and outraged when she is
told that it all results from a bad tear of her womb that she knew nothing
about.
2nd. A physician should in justice to himself insist on this late
examination, because if a woman is told, at some subsequent time, by
another physician that she is badly torn, and she was not told of it by the
physician who confined her, she is very apt to form an unjust opinion of
his work and to entertain an unfriendly feeling toward him as a man.
Some physicians also, to their discredit, are not slow in permitting an
unjust opinion of a colleague to be spread around, by preserving a silence,
when an explanation would result in an entirely different opinion by the
patient. They permit it to be inferred that the physician was responsible
for the tear, when such is not the case. No physician on earth can prevent
a tear of the mouth of the womb and this should be explained to the
patient. Where the physician is at fault is in the failure to examine his
patients when it is possible to tell that a tear of any consequence exists.
If such an examination is made, he is in a position to state that a tear
exists of sufficient extent to justify careful attention. Immediate
operation is seldom necessary, and if the patient is comparatively young,
it may not be wise to operate, because if pregnancy takes place within a
reasonable time the womb will again tear. She should be told, however, that
should she not become pregnant during the next three years she should be
examined from time to time, and if the condition of her womb, or her health
suggest it, she should have the tear attended to. If after this explanation
she neglects herself she must blame herself, she will at least have no[119]
cause to harbor any resentment against her physician who has done all any
physician is called upon to do under the circumstances. Another important
reason for finding out the character of the laceration is because these
lacerations of the mouth of the womb frequently cause sterility.
* * * * *
[121]
CHAPTER X
NURSING MOTHERS
THE DIET OF NURSING MOTHERS--CARE OF THE NIPPLES--CRACKED
NIPPLES--TENDER NIPPLES--MASTITIS IN NURSING MOTHERS--INFLAMMATION OF
THE BREASTS--WHEN SHOULD A CHILD BE WEANED?--METHOD OF WEANING--NURSING
WHILE MENSTRUATING--CARE OF BREASTS WHILE WEANING CHILD--NERVOUS
NURSING MOTHERS--BIRTH MARKS--QUALIFICATIONS OF A NURSERY MAID.
THE DIET OF NURSING MOTHERS.--A nursing mother should eat exactly the same
diet as she has always been accustomed to before she became pregnant. If
any article of diet disagrees with her she should give up that particular
article. She should not experiment; simply adhere to what she knows agreed
with her in the past. More, rather than less, should be taken, especially
more liquids as they favor milk-making. It is sometimes advisable to drink
an extra glass of milk in the mid-afternoon and before retiring. If milk
disagrees, or is not liked, she may take clear soup or beef tea in place of
it. In a general way milk in quantities not over one quart daily, eggs,
meat, fish, poultry, cereals, green vegetables, and stewed fruit constitute
a varied and ample dietary to select from.
Every nursing mother should have one daily movement of the bowels; she
should get three or four hours' exercise in the open air every day; and she
should nurse her child regularly.
The diet of the nursing mother during the period immediately after
confinement is given elsewhere.
Alcohol, of all kinds, should be absolutely avoided during the entire
period of nursing.
Drugs of every variety, or for any purpose, should never be taken unless by
special permission of her physician.
CARE OF THE NIPPLES.--As soon as the mother has had a good sleep after the
confinement the nipples should be washed with a saturated solution of [122]
boracic acid, and the child allowed to nurse. The milk does not come into
the breast for two or three days, but the child should nurse every four
hours during that time. There is secreted at this time a substance called
colostrum. This is a laxative agent which nature intends the child should
have as it tends to move the bowels and at the same time it appeases the
hunger of the infant. It also accustoms the child to nursing and gradually
prepares the nipples for the work ahead of them.
After each nursing the nipples should be carefully washed with the same
solution and thoroughly dried.
CRACKED NIPPLES.--Cracked nipples often result from lack of care and
cleanliness. If they are not cared for as described above they are very apt
during the first few days to crack. They should never be left moist. They
should be washed and dried after every feeding. If the breasts are full
enough to leak they should be covered with a pad of sterile absorbent
gauze.
Nursing mothers should guard against cracked nipples, as they are
exceedingly painful; frequently necessitating a discontinuance of nursing;
and may produce abscess of the breast.
TREATMENT OF CRACKED NIPPLES.--In addition to washing the nipples, drying
them thoroughly, and placing a pad of dry gauze over them after each
feeding, they should be painted with an 8 per cent. solution of nitrate of
silver twice daily. Before the next feeding, after the silver has been
used, they should be washed with cooled boiled water. If the cracks are
very bad it may be necessary to use a nipple-shield over them while nursing
for a few days.
TENDER NIPPLES.--Many women complain of the pain caused by the baby when it
is first put to the breast. These nipples are not cracked, they are simple
hypersensitive. They should be thoroughly cleansed and dried as above and
painted with the compound tincture of benzoin. They should be washed off
with the boracic acid solution before each feeding. After a few days under
this treatment the tenderness will leave them.
MASTITIS IN NURSING MOTHERS.--When inflammation of the breast takes [123]
place in a nursing mother it is the result of exposure to cold, or it may
result from injury. If infection occurs and an abscess develops, it results
from the entrance, through the nipples, or cracks, or fissures in the
nipple, of bacteria into the breast. There is fever, with chills and
prostration, and very soon it is impossible to nurse the child because of
the pain. Nursing should be immediately discontinued, the breast supported
by a bandage and the milk drawn, with a breast pump, at the regular nursing
intervals. An ice-bag should be constantly applied to the painful area and
the bowels kept freely open with a saline laxative. When the fever and the
pain subside nursing may be resumed.
If the gland suppurates in spite of treatment it must be freely opened and
freely drained.
WEANING
WHEN TO WEAN THE BABY.--Medically there is no exact time at which the baby
should be weaned. Certain conditions indicate when it should be undertaken.
It is desirable to wean the baby between the tenth and twelfth months. A
month or two one way or another will not make much difference if the mother
and child are in good condition. It should be weaned between the periods of
dentition rather than when it is actively teething. The time of year is
important. It would be better to wean it before the hot weather if it is
strong and has been accustomed to taking other food than the breast milk.
On the other hand it would be decidedly better to defer the weaning until
the fall, rather than risk weaning at the tenth or twelfth months if these
fall during the height of the hot weather.
METHODS OF WEANING.--The best way to wean is to do it gradually. It is not
desirable to take the mother's milk away suddenly unless there is a very
good reason for it. The child should be fed small portions of suitable
other food at the beginning of the tenth month. By the end of the tenth
month he should be taking a feeding two or three times a day of food other
than the breast milk. This feeding may be given in a bottle. In some [124]
cases the mother may be able to feed the child with a spoon instead of the
bottle. The substitute feedings allowable at this age are given in another
chapter.
TIMES WHEN RAPID WEANING IS NECESSARY.--There are times when the child must
be weaned suddenly, as, for example, at the death of the mother, serious
sickness of the mother, or in cases where for any cause the mother suddenly
loses her milk. In these cases it is best to wean at once. If an infant
refuses to take the bottle under such circumstances, the best plan to
adopt, and the wisest one in the long run, is to starve the child into
submission. If he gets absolutely nothing but the bottle he will shortly
take it without protest. If a meddling individual attempts to feed the
child some other food and tries to coax it to take the bottle in the
meantime, much harm may result; it is safe only to fight it out for a day
or two and win than to half starve the child and lose in the end.
The child should be weaned if it is not gaining in weight. This may
indicate a deficient quality of the mother's milk, or it may indicate a
lack of proportion between the child and mother. If a robust child is
depending upon the nourishment furnished by a mother who is not in good
physical condition the milk may not be adequate in quality and quantity.
The child will not therefore develop normally and it may be necessary to
wean it.
If the mother becomes pregnant it will be necessary to wean, because
pregnancy invariably affects the quality of the milk. It is a very good
habit to accustom the child to take its daily supply of water from a bottle
from a very early age. This procedure will make it easier to wean at any
time.
Menstruation is not an indication for weaning as has been explained. If,
however, the return of menstruation affects the milk so that it disagrees
with, or fails to satisfactorily nourish the child, it may be necessary to
wean, but not unless.
The best reason for weaning a child at the twelfth month is that a mother's
milk after that time is not adequate in quality for a child of that age. A
child at one year of age has grown beyond the capability of its mother[125]
to nurse it: nature demands a stronger and a more substantial food than any
mother can supply. A mother who nurses her child beyond that period is not
only injuring herself, but she is cheating her child. The exception to this
rule is, as has been explained, the second summer.
The child will evidence its dissatisfaction with the breast supply if it is
not enough; it will not gain in weight, it will be irritable and fretful,
it will tug long and tenaciously at the nipple, it will be unwilling to
cease nursing after it should have finished, and it will drop the nipple
frequently with a dissatisfied cry. These are all signs of insufficient
nourishment, and to the observant mother they will at once indicate that
the child must be weaned and fed upon a mixed diet.
CARE OF BREASTS WHILE WEANING CHILD.--The process of weaning should cause
little or no discomfort. If the weaning is gradual it is necessary to press
out enough milk to relieve the tension from time to time. It usually takes
three or four days.
If it is necessary to wean abruptly, as it is occasionally, there may be
considerable distress. In these cases it is necessary to massage the
breasts completely,--until all the milk is out, or as much as it is
possible to get out,--then rub the breasts with warm camphorated oil, and
bind them firmly. When the breasts are massaged for any reason, the rubbing
should be toward the nipple and it should be done gently. If there are any
hard lumps, or caked milk, in the breasts, they must be massaged until
soft, and the binding renewed. It may be necessary to repeat this process
for a number of days. In binding the breasts use a large wad of absorbent
cotton at the sides, under the arms, to support the breasts, and another
wad between the breasts. This renders the binding more effective; permits
the binder to be put on tighter; and prevents it from cutting into the
skin. When weaning has to be done quickly the patient should absolutely
abstain from all liquids. A large dose of any saline, Pluto, Apenta, or
Hunyadi Water, or Rochelle salts, or Magnesium Citrate, should be given
every morning for four or five days. [Page 126]