Chapter XIV: Part VII: The Change of Life (6)

The number of the entirely authenticated cases now known of the birth of fully developed children within from two to five months of each other, can leave no doubt as to the possibility of such an occurrence. The only question which remains is in regard to the periods of conception. Are the two children in such cases twins, conceived at the same time, but the growth of the last-born so retarded that it did not arrive at maturity until a number of months after its fellow? or, Has a second conception taken place at an interval of several months after the first? If this latter view be true, then, in the instance of Marie Anne Bigaud, above related, the second child must have been conceived after the first had quickened. Then, also, two children of different ages, the offspring of different fathers, may exist in the womb at the same time. The weight of scientific observation and authority has now established the fact that, in very rare instances, a second conception may take place during pregnancy. It must not be understood as necessarily following from this statement, that when two children are born at the same time,--one fully developed, and the other small and apparently prematurely born,--the two were conceived at different times. The smaller may have been blighted and its growth hindered by the same causes which bring about such effects in cases of single births of incompletely developed children. A similar supposition may account for the birth of a second child within a month or two after the first, for the first may have been prematurely born, and the second carried to full term. But no such supposition can explain the cases referred to, and others which might be mentioned, in which the interval has been five or six months, each child presenting every indication of perfect maturity. The only explanation possible in such instances, which, as has been said, are well authenticated, although few in number, is, that a second pregnancy has occurred during the first.

The above facts would seem sufficiently wonderful. There are others, however, of the same nature still more so. In some instances, the product of the second conception, instead of developing independently of the first, has become attached to it, and the phenomenon has been presented of the growth of a child within a child--a foetus within a foetus. Such a singular occurrence has been lately recorded in a German journal. A correspondent of the _Dantzic Gazette_ states that on Sunday, February 1, 1869, at Schliewen, near Dirschau, 'a young and blooming shepherd's wife was delivered of a girl, otherwise sound, but having on the lower part of her back, between the hips, a swelling as big as two good-sized fists, through the walls of which a well-developed foetus may be felt. Its limbs indicate a growth of from five to six months, and its movements are very lively. The father called in the health commissioner, Dr. Preuss, from Dirschau, and begged him to remove the swelling together with the foetus. The doctor, however, after a careful examination, declared that there was a possibility in this extraordinary case of the child within the swelling coming to fruition. Its existence and active motions were palpable to all present. No physician could be justified in destroying this marvelous being. It ought rather to be protected and cherished. The new-born girl, notwithstanding her strange burden, is of unusual strength and beauty, and takes the breast very cheerfully.'

We find something further in regard to this singular birth in the _Weser Zeitung_ of February 20, 1869. It quotes from the _Dantzic Gazette_ some remarks by the health commissioner, Dr. Preuss of Dirschau, in which the doctor declares the facts contained in the report given above to be correct. He was summoned on the 1st of February to the child, and saw the vigorous movements, and felt the members of a foetus within the swelling, as described. It was evidently a double creation. The case thus far, though rare, is not unique. 'But what is novel, and hitherto perfectly unnoticed in medical literature, is the fact that not only the girl, which has been carried its full term, is alive to-day, but the foetus within the swelling has also, in the eleven days after birth, further developed, and palpably increased in size. The swelling is now four and a half inches long, three and a half inches wide, and high and pear-shaped; the head lies underneath on the left, the body towards the right.'

Further particulars and the latest intelligence we have concerning the progress of this case are to the effect that the child was brought by special request before the Natural History Society of Dantzic, and thence the mother went to Berlin for medical advice.

MORAL ASPECTS OF THIS QUESTION.

Upon proper judgment and discrimination in the application of the facts we have just been dwelling upon, may depend a wife's honor, and the happiness of the dearest social relations. We will suppose an example. A husband, immediately after the impregnation of his wife, is obliged to quit her, and remains absent a year. In the meanwhile she gives birth to two children, at an interval of a number of weeks. The question will then come up, Whether, under such circumstances, it is possible for her to do so consistently with conjugal purity.

It will be recollected that, in speaking of twins, we remarked that it was not very uncommon for an interval of days or weeks to elapse between the births, and it has just been stated that impregnation during pregnancy is extremely rare. The presumption, therefore, in the case supposed, is as very many to one that the two births were the result of a twin pregnancy. In the absence of any other evidence against the wife's chastity, it should not even be called in question. This decision receives the support of the maxim in law that a reasonable doubt is the property of the accused, and of the Christian principle that it is better that ninety-nine guilty should escape than that one innocent should be condemned. Hence the teachings of science and of human and divine law all coincide to protect the sacred rights and the precious interests at stake against an unjust suspicion, which even the doctrine of chances would render untenable.

CAN A CHILD CRY IN THE WOMB?

There are some cases, recorded on undoubted authority, in which the child has been heard to cry while in the womb. These are very exceptional. Under ordinary circumstances, it is impossible for the child either to breathe or cry, because of the absence of air. It is only when the bag of membranes has been torn, and the mouth of the child is applied at or near the neck of the uterus, that this can take place. The infant is not unfrequently heard to cry just before birth, after labor has commenced, but before the extrusion of the head from the womb, in consequence of the penetration of air into the uterine cavity.

IS IT A SON OR DAUGHTER?

It is a common saying among nurses, that there is a difference in the size and form of the pregnant woman, according to the sex she carries. This may well be doubted. Neither is it true that one sex is more active in its 'movements' than the other. It is quite possible, however, for a wife to know the sex of the foetus, if she can tell about what time in her month conception took place. If it occurred directly after a monthly sickness, the child is a girl; if directly before, it is a boy. When a woman is 'out' in her reckoning, and goes beyond the period of her expected confinement, it will ordinarily turn out to be a boy. The skilful doctor can, in the later months of pregnancy, settle the question of sex in some cases. The beats of the foetal heart are more frequent in females than in males. The average frequency of pulsations of twenty-eight female foetuses has been found to be one hundred and forty-four in the minute, the lowest figure being one hundred and thirty-eight; of twenty-two male foetuses, one hundred and twenty, the lowest figure being one hundred and twelve. Therefore, when the pulsations of the heart of the child in the womb are counted,--as can easily be done by a practised medical ear during the last months of pregnancy,--and are found to be over one hundred and thirty in a minute, it is a daughter; if under one hundred and thirty, a son. In this manner, the sex of an unborn child can be predicted with tolerable accuracy, excepting only when illness of the foetus has deranged the action of its heart.

ARE THERE TWINS PRESENT?

Certain signs lead to the suspicion of twins, such as being unusually large, and the fact that the increase in size has been more than ordinarily rapid. Sometimes also the abdomen is divided into two distinct portions by a perpendicular fissure. In other cases the movements of a child can be felt on each side at the same time. And in twin pregnancies the morning sickness is apt to be more distressing, and all the other discomforts incident to this condition increased. But these signs and symptoms, when present in any given case, are not conclusive, for they may be noticed when there is only one child. The doctor has one characteristic and infallible sign by which he can ascertain whether the woman be pregnant with twins. It is furnished to him again by the art of listening,--or auscultation, as it is technically called,--the same that, as we have already seen, may enable him to determine the sex of the child. When the beatings of two foetal hearts are heard on opposite portions of the abdomen, the nature of the pregnancy is apparent.

LENGTH OF PREGNANCY.

What is the ordinary duration of pregnancy? Almost every woman considers herself competent to make the answer--nine months. She may be surprised to learn, however, that such an answer is wanting in scientific precision. It is too indefinite, and is erroneous. There is a great difference between the calendar and the lunar month. Each lunar month having twenty-eight days, the period of nine lunar months is two hundred and fifty-two days. Nine calendar months, including February, represent, on the contrary, two hundred and seventy-three days. Now the average duration of pregnancy is two hundred and eighty days, that is forty weeks, or ten lunar months.

While most extended observations have shown that as a general rule, forty weeks, or two hundred and eighty days, is the true period of pregnancy, are we justified in the conclusion that this is its invariable duration? This important question, upon the answer to which so often depend the honor of families, the rights of individuals, and sometimes the interests of nationalities, has been in all times the subject of careful research by physicians, philosophers, and legislators. On the one side, have been those who contend that the laws of nature are invariable, and that the term of pregnancy is fixed and immutable. On the other side, have been those who assert that the epoch of accouchement can be greatly advanced or retarded by various causes, some of which are known, and others not yet appreciated. Abundant and satisfactory testimony has proved that the prolongation of pregnancy beyond the ordinary period of two hundred and eighty days, or forty weeks, is possible. Nor is this contrary to what is observed in regard to other functions of the human body. There is no process depending upon the laws of life which is absolutely invariable either as to the period of its appearance or duration. It is known, as we have already pointed out, that puberty may be advanced or retarded; the time at which the change of life occurs in women, as we shall have occasion hereafter to show, is also subject to variation; and it is a matter of common observation with mothers, that the period of teething is sometimes strangely hurried or delayed. A certain degree of variability, therefore, being frequently observed, and entirely compatible with health, in the various other natural processes, why should that of pregnancy form an exception, and be invariably fixed in its duration? And observation upon the lower animals affords most convincing evidence that nature is not controlled by any uniform law in reference to the length of pregnancy. In the cow, the usual period of whose pregnancy is the same as in the human female, instances of calving six weeks beyond the ordinary term are not at all uncommon.

As an illustration of the great interest sometimes attaching to the inquiry under discussion, we may cite the celebrated Gardner Peerage Case, tried by the House of Lords in 1825. Allen Legge Gardner petitioned to have his name inscribed as a peer on the Parliament Roll. He was the son of Lord Gardner by his second wife. There was another claimant for the peerage, however,--Henry Fenton Iadis,--on the ground, as alleged, that he was the son of Lord Gardner by his first and subsequently divorced wife. Medical and moral evidence was adduced to establish that the latter was illegitimate. Lady Gardner, the mother of the alleged illegitimate child, parted from her husband on the 30th of January, 1802, he going to the West Indies, and not again seeing his wife until the 11th of July following. The child whose legitimacy was called in question was born on the 8th of December of that year. The plain medical query therefore arose, Whether this child born either three hundred and eleven days after intercourse (from January 30th to December 8th), or one hundred and fifty days (from July 11th to December 8th), could be the son of Lord Gardner. As there was no pretence that there was a premature birth, the child having been well developed when born, the conception must have dated from January 30th. The medical question was therefore narrowed down to this: Was the alleged protracted pregnancy (three hundred and eleven days) consistent with experience? Sixteen of the principal obstetric practitioners of Great Britain were examined on this point. Eleven concurred in the opinion that natural pregnancy might be protracted to a period which would cover the birth of the alleged illegitimate child. Because, however, of the moral evidence alone, which proved the adulterous intercourse of Lady Gardner with a Mr. Iadis, the House decided that the title should descend to the son of the second Lady Gardner.

There is on record one fact, well observed, which establishes beyond cavil the possibility of the protraction of pregnancy beyond two hundred and eighty days, or forty weeks. The case is reported by the learned Dr. Desormeaux of Paris, and occurred under his own notice in the Hôpital de Maternité of that city. A woman, the mother of three children, became insane. Her physician thought that a new pregnancy might re-establish her intellectual faculties. Her husband consented to enter on the register of the hospital each visit he was allowed to make her, which took place only every three months. So soon as evidence of pregnancy showed itself, the visits were discontinued. The woman was confined two hundred and ninety days after conception.

The late distinguished Professor Charles D. Meigs of Philadelphia published a case, which he deems entirely trustworthy, of the prolongation of pregnancy to four hundred and twenty days, or sixty weeks. Dr. Atlee reports two cases, which nearly equaled three hundred and fifty-six days each. Professor Simpson of Edinburgh records, as having occurred in his own practice, cases in which the period reached three hundred and thirty-six, three hundred and thirty-two, three hundred and twenty-four, and three hundred and nineteen days. In the Dublin _Quarterly Journal of Medical Science_ a case of protracted pregnancy is related by Dr. Joynt. The evidence is positive that the minimum duration must have been three hundred and seventeen days, or about six weeks more than the average. Dr. Elsässer found, in one hundred and sixty cases of pregnancy, eleven protracted to periods varying from three hundred to three hundred and eighteen days.

In treating of the subject of miscarriage, we mentioned instances, recorded by physicians of skill and probity, proving beyond a shade of doubt that a woman may give birth to a living child long before the expiration of the forty weeks. The Presbytery of Edinburgh, Scotland, some time since decided in favor of the legitimacy of an infant born alive, within twenty-five weeks after marriage, to the Rev. Fergus Jardine.

One of the most enlightened countries in Europe has, in view of the facts in reference to the extreme limits of pregnancy, enacted, in the Code Napoléon, that a child born within three hundred days after the departure or death of the husband, or one hundred and eighty days after marriage, shall be considered legitimate. The law further states that a child born after more than three hundred days shall not be necessarily declared a bastard, but its legitimacy may be contested. The Scotch legislation on this subject is very similar to the French.

CAUSES OF PROTRACTED PREGNANCY.

It has been asserted by some that an infant is born at ten or eleven months because at nine months it has not acquired the growth which is necessary in order to induce the womb to dislodge it. The popular notion is, that a child carried beyond the usual term must necessarily be a large one. Rabelais has reflected this common opinion in his celebrated romance entitled 'Gargantua,' in which he represents the royal giant of that name as having been carried by his mother, Gargamelle, eleven months. When born, the child was so vigorous that he sucked the milk from ten nurses. He lived for several centuries, and at last begot a son, Pantagruel, as wonderful as himself. Such reasoning cannot, however, be seriously maintained, as many children carried longer than nine months have not been more fully developed than some born a few weeks prematurely; and the size of the child has nothing to do with the bringing on of labor, as we shall show hereafter. Protracted pregnancies are caused by a defect in the energy of the womb, induced by moral as well as physical influences. As a rule, a woman who leads a regular life, and observes the physiological laws of her being, which laws it has been our aim to point out, will be confined at the term that nature usually marks out, that is, at the expiration of two hundred and eighty days, or forty weeks, from conception.

This brings us to the consideration of the question,

HOW TO CALCULATE THE TIME OF EXPECTED LABOR.

Many rules for this purpose have been laid down. We shall merely give one, the most satisfactory and the most easily applied. It was suggested by the celebrated Professor Naëgelè of Heidelberg, and is now generally recommended and employed by physicians. The point of departure in making the calculation is _the day of the disappearance of the last monthly sickness_; three months are subtracted, and seven days added. The result corresponds to the day on which labor will commence, and will be found to be two hundred and eighty days from the time of conception, if that event has occurred, as ordinarily, immediately after the last menstrual period. Suppose, for instance, the cessation of the last monthly sickness happened on the 14th day of January; subtract three months, and we have October 14; then add seven days, and we obtain the 21st day of the ensuing October (two hundred and eighty days from January 14) as the time of the expected confinement. This method of making the 'count' may be relied upon with confidence, and only fails, by a few days, in those exceptional cases in which conception takes place just before the monthly period, or during the menstrual flow.

CARE OF HEALTH DURING PREGNANCY.

This subject, the proper management of the health from conception to childbirth, is worthy of careful consideration. The condition of pregnancy, though not one of disease, calls for peculiar solicitude, lest it should lead to some affection in the mother or in the child. For it ought to be remembered that the welfare of a new being is now in the balance. The woman has no longer an independent existence. She has entered upon the circle of her maternal duties. She became a mother when she conceived. The child, though unborn, lives within her; its life is a part of her own, and so frail, that any indiscretion on her part may destroy it. The danger to the child is not imaginary, as the large number of miscarriages and still-births proves.

All mothers desire to have healthy, well-formed, intelligent children. How few conduct themselves in such a manner as to secure a happy development of their offspring! Puny, deformed, and feeble-minded infants are daily ushered into the world because of a want of knowledge, or a sinful neglect of those special measures imperatively demanded in the ordering of the daily life, by the changed state of the system consequent upon pregnancy. We shall therefore point out those laws which cannot be infringed with impunity, and indicate the diet, exercise, dress, and, in general, the conduct most favorable to the mother and child during this critical period, in which the wife occupies, as it were, an intermediate state between health and sickness.

FOOD.

The nourishment taken during pregnancy should be abundant, but not, in the early months, larger in quantity than usual. Excess in eating or drinking ought to be most carefully avoided. The food is to be taken at shorter intervals than is common, and it should be plain, simple, and nutritious. Fatty articles, the coarser vegetables, highly salted and sweet food, if found to disagree, as is often the case, should be abstained from. The flesh of young animals--as lamb, veal, chicken, and fresh fish--is wholesome, and generally agrees with the stomach. Ripe fruits are beneficial. The diet should be varied as much as possible from day to day. The craving which some women have in the night or early morning may be relieved by a biscuit, a little milk, or a cup of coffee. When taken a few hours before rising, this will generally be retained, and prove very grateful, even though the morning sickness be troublesome. Any food or medicine that will confine or derange the bowels is to be forbidden. The taste is, as a rule, a safe guide, and it may be reasonably indulged. But inordinate, capricious desires for improper, noxious articles, should of course, be opposed. Such longings, however, are not often experienced by those properly brought up. It is a curious fact, that the modification in the digestive system during pregnancy is sometimes so great that substances ordinarily the most indigestible are eaten, without any inconvenience, and even with benefit, while the most healthful articles become hurtful, and act like poison.

As pregnancy advances, particularly after the sixth month, a larger amount of food, and that of a more substantial character, will be required. The number of meals in the day should then be increased, rather than the quantity taken at each meal.

CLOTHING.

The dress during pregnancy should be loose and comfortable, nowhere pressing tightly or unequally. The word _enceinte_, by which a pregnant woman is designated, meant, originally, without a cincture,--that is, unbound. The Roman matrons, so soon as they conceived, were obliged to remove their girdles. Lycurgus caused the enactment of the Spartan law, that pregnant women should wear large dresses, so as not to prejudice the free development of the precious charges of which nature had rendered them the momentary depositaries. Stays or corsets may be used, in a proper manner, during the first five or six months of pregnancy, but after that they should either be laid aside, or worn very loosely. Any attempt at concealing pregnancy, by tight lacing and the application of a stronger busk, cannot be too severely condemned. By this false delicacy the mother is subjected to great suffering, and the child placed in jeopardy. The shape of the stays should be moulded to that of the changing figure, and great care should be taken that they do not depress the nipple or irritate the enlarging breasts.

The amount of clothing should be suited to the season, but rather increased than diminished, owing to the great susceptibility of the system to the vicissitudes of the weather. It is especially important that flannel drawers should be worn during advanced pregnancy, as the loose dress favors the admission of cold air to the unprotected parts of the body. A neglect of this precaution sometimes leads to the establishment of the painful disease known as rheumatism of the womb.

Pressure upon the lower limbs, in the neighborhood of the knee or the ankle joint, should be avoided, more particularly towards the last months. It is apt to produce enlargement and knotting of the vein, swelling and ulcers of the legs, by which many women are crippled during their pregnancies, and sometimes through life. Therefore the garters should not be tightly drawn, and gaiters should not be too closely fitted, while yet they should firmly support the ankle.

EXERCISE.

Moderate exercise in the open air is proper and conducive to health during the whole period of pregnancy. It should never be so active nor so prolonged as to induce fatigue. Walking is the best form of exercise. Riding in a badly-constructed carriage, or over a rough road, or upon horseback, as well as running, dancing, and the lifting or carrying of heavy weights, should be scrupulously avoided, as liable to cause rupture, severe flooding, and miscarriage. During the early months, in particular, extraordinarily long walks and dancing ought not to be indulged in. Journeys are not to be taken while in the pregnant state. Railway travelling is decidedly objectionable. The vibratory motion of the cars is apt to produce headache, sickness at the stomach, faintness, and premature labor. All these precautions are especially to be observed in the first pregnancy.

We must not be understood as condemning exercise and fresh air. They are of the greatest importance to mother and child. But the amount of exercise should be regulated by the dictates of common sense and the woman's own sensations. If she can only walk a short distance each day with comfort, let that suffice. She should not force herself to go to a certain place nor to promenade during a certain time in the twenty-four hours. So soon as fatigue is felt, the walk should cease. Let the walks be frequent and short, rather than few and long. They should also be made as pleasant as possible, by companionship and surroundings that will occupy the feelings and imagination in an agreeable manner with new and cheerful impressions. A tendency to indolence is to be combated. A gently active life is best calculated to preserve the health of the mother and her unborn child. But with even the most robust a moderation of the ordinary pursuits and avocations is called for. The nervous and delicate cannot make with safety their customary daily exertions in the performance of their household or social duties and pleasures.

Towards the end of pregnancy the wife should economize her forces. She should not remain long standing or kneeling, nor sing in either of these postures.

BATHING.

Those who have not been accustomed to bathing should not begin the practice during pregnancy, and in any case great care should be exercised during the latter months. It is better to preserve cleanliness by sponging with tepid water than by entire baths. Foot-baths are always dangerous. Sea-bathing sometimes causes miscarriage, but sea air and the sponging of the body with salt water are beneficial. The shower-bath is of course too great a shock to the system, and a very warm bath is too relaxing. In some women of a nervous temperament, a lukewarm bath taken occasionally at night during pregnancy has a calming influence. This is especially the case in the first and last month. But women of a lymphatic temperament and of a relaxed habit of body are always injured by the bath.

VENTILATION.

We have spoken of the benefits of outdoor air during pregnancy. Attention should also be directed to keeping the atmosphere in the sitting and sleeping rooms of the house fresh. This can only be accomplished by constantly changing it. The doors and windows of every room, while unoccupied, should be kept thrown open in the summer-time, and opened sufficiently often in the winter to wash out the apartments several times a day with fresh air. The extremes of heat and cold are to be, with equal care, avoided. The house should be kept light. Young plants will not grow well in the dark. Neither will the young child nor its mother flourish without sunlight. The ancients were so well aware of this, that they constructed on the top of each house a solarium, or solar air-bath, where they basked daily, in thin attire, in the direct rays of the sun.

SLEEP.

During pregnancy a large amount of sleep is required. It has a sedative influence upon the disturbed nervous system of the mother. It favors, by the calmness of all the functions which attends it, the growth of the foetus. Neither the pursuit of pleasure in the evening, nor the observance of any trite maxims in regard to early rising in the morning, should be allowed to curtail the hours devoted to slumber. Pregnant women have an instinctive desire to lie abed late, which, like the other promptings of nature during this period, should not be disregarded. At least eight hours out of the twenty-four can be profitably spent in bed. No night-watching ought ever to be undertaken during pregnancy.

Feather beds should be avoided. The heat which they maintain about the body is inconvenient and dangerous, predisposing to flooding and exhausting perspirations. The hair or sponge mattress is to be preferred. The bed-clothing should not be too heavy. Blankets are to be employed rather than coverlids, as they are lighter and more permeable to perspiration. The mattress and cover should be well aired during the day. The sleeping-room should be capacious and well ventilated, and no curtains permitted about the bed.

Occasional rest is also necessary in the daytime. A nap of an hour or two upon a sofa or lounge will then prove very refreshing. In the earlier months of pregnancy it will tend to prevent miscarriage, and in the latter months to relieve the distress consequent upon the increased size of the womb. It is not unusual, as the close of pregnancy approaches, for a feeling of suffocation to ensue when the woman attempts to lie down. This may be overcome by supporting the back and shoulders with cushions and pillows. Or a bed-chair may be employed. This, if well constructed and covered, will often be found very grateful at night, in the last few weeks of pregnancy.

THE MIND.

A tranquil mind is of the first importance to the pregnant woman. Gloomy forebodings should not be encouraged. Pregnancy and labor are not, we repeat, diseased conditions. They are healthful processes, and should be looked upon as such by every woman. Bad labors are very infrequent. It is as foolish to dread them, as it is for the railway traveller to give way to misgivings in regard to his safety. Instead of desponding, science bids the woman to look forward with cheerfulness and hope to the joys of maternity.

The bad effects of fear upon the mother's mind are illustrated by Plutarch, who, in his Life of Publicola, mentions that, 'at a time when a superstitious fear overran the city of Rome, all the women then pregnant brought forth imperfect children, and were prematurely delivered.' But we have already spoken, in treating of mothers' marks, of the influence of mental emotions over the unborn child, and the necessity of avoiding their exciting causes.

Because of their deleterious tendency, severe study as well as arduous and protracted manual labor ought to be avoided. The nervous systems of many women are also injuriously affected during pregnancy by perfumes, which at other times are agreeable and innocuous. It is therefore prudent not only to exclude all offensive scents, but also to abstain from the strong odors of various strong perfumes, eau-de-cologne, and of flowers. Large bouquets often cause feelings of faintness, and sometimes temporary loss of consciousness. The extreme liability of the nervous system of the pregnant woman to be affected injuriously to herself and child by scenes of suffering or distress, and by disgusting or frightful objects, cannot be too strongly impressed upon every one. She should be protected from all that will disturb her, and should be constantly treated with soothing and encouraging kindness. Her manifestations of irritability, her caprices, her melancholy anticipations, are not to be scoffed at, but combated with a mixture of reasoning and patient forbearance. On her part, she should endeavour to co-operate with those around her, in sedulously shunning all injurious influences, and in banishing as quickly as possible all improper longings. She should remember that, although she herself may escape mischief from them, her child may suffer. She is the custodian of interests dearer to her than her own.

RELATION OF HUSBAND AND WIFE DURING PREGNANCY.

During those days when the wife, if she were not pregnant, would have been 'unwell,' marital intercourse should be abstained from. It is then injurious to the mother, and dangerous to the life of the child, as it is liable to excite miscarriage. But if this habitual epoch of the monthly sickness be avoided, there is no reason why passion should not be gratified in moderation and with caution during the whole period of pregnancy. There is one exception to be made to this general course of conduct. In those cases in which a miscarriage has occurred in the first pregnancy, every precaution should be employed--for reasons which have been dwelt upon in a previous article--to prevent its happening again after the second conception. Under such exceptional circumstances, therefore, the husband and wife should sleep apart during the first five months of pregnancy. After that period their ordinary relations may be resumed. When a miscarriage has taken place, intercourse should not be permitted within a month of the accident. The observance of this direction is of the utmost importance. Its neglect is the frequent cause of severe and intractable diseases of the womb.

EFFECT OF PREGNANCY ON HEALTH.

We have had occasion to remark that pregnancy is not a condition of disease. It is not only an evidence of health, but during its continuance it confers increased physical vigor. As a rule, a woman enjoys _better health_ during her pregnancy than at any other time; she is less liable to contagious and other maladies; she is less apt to die than at any other period of her life; and her general constitution seems also then to receive a favorable impress, for wives and mothers live longer than celibates. It is wisely decreed that when woman is engaged in this, to her, anxious stage of reproduction, she shall not be exposed to the pains and dangers of disease, and that those great covenants of nature--marriage and child-bearing--shall be rewarded by added strength and length of days.

There are certain disorders incident, in exceptional cases, to pregnancy, of which we shall shortly speak. In general, however, we repeat that this condition is one of extraordinary health. More than this, in numerous instances it exerts an ameliorating influence upon pre-existing diseases, suspending their march, or bringing about a decidedly curative effect. Thus, various obstinate chronic affections of the skin, of the womb and ovaries, and of the brain and nervous system, frequently get well during pregnancy; and it is well known to every physician, that by the judicious management of this state, and of the lying-in period, troublesome displacements of the womb may be arrested.

It should nevertheless ever be recollected that the condition of pregnancy is one of excitement and enhanced susceptibility to impressions of all kinds. For this reason a change in the habits of life is necessary; and the importance of the directions laid down for the care of the health during this period, cannot be too strongly insisted upon.

The diseases to which the wife is exposed during pregnancy will be treated of in the chapter on 'Health in Marriage.'

CONFINEMENT.

_PREPARATIONS FOR CHILDBIRTH._

Certain foolish preparations are sometimes made by wives, with the best intentions. Perhaps one of the most common and absurd of these is the local use of sweet oil, in order to facilitate the dilatation of the parts, for which purpose it is perfectly inert. There are, however, some wise and even necessary precautions which every wife should know and employ, to guard against unpleasant and dangerous complications in childbirth.

In particular, _the condition of the breasts_ towards the close of pregnancy demands attention. Scarcely any pain in the lying-in chamber is greater or more difficult to bear than that which the young mother suffers from excoriated nipples. This troublesome and often very intractable affection is nearly always the consequence of the want of care previous to confinement. During the latter part of pregnancy the nipples sometimes become sunken or flat, being retracted as the breasts increase in size, because of the want of elasticity on the part of the milk tubes. In order to remedy this fault, we have known a breast-pump or puppy to be applied. Such treatment is dangerous, as it may excite premature contraction of the womb, and miscarriage. Nipple-shields, with broad bases and openings, should always be obtained. They are safe, and effectually secure the prominence of the nipples, when worn constantly, day and night, during the last month or so of pregnancy. Wives who have never had children ought to take special care to ascertain before labor whether this depressed condition of the nipples exists, and to correct it in the manner indicated.

In the first pregnancy it is also important to _harden the nipples_. This may be done by occasionally gently rubbing them between the thumb and finger, and by bathing them twice a day during the last six weeks with tincture of myrrh, or with a mixture of equal parts of brandy and water, to which a little alum has been added. This procedure will render the surfaces less sensitive to the friction of the child's mouth, and thus avert the distress so often occasioned in the first confinement by tenderness of the nipples.

If the nipples be rough or nodulated in appearance, like a strawberry or a raspberry, they are more apt to become excoriated or fissured than if they present a smooth surface. Under such circumstances, make a solution of the sulphate of zinc, of the strength of one grain to the ounce of rose water, in a wide-mouthed bottle, then tilt the bottle upon the nipple, and allow it to remain there for a few minutes several times a day. Simple tenderness of the nipples and slight fissures may be averted by the application either of a lotion of borax (two scruples of borax in three ounces of water, and an ounce of glycerine), of the honey of borax, or of the tincture of catechu, and by protecting the parts from the pressure of the stays and the friction of the flannel vest.

It is of the greatest moment to the comfort of the mother, that all affections of the nipples should be prevented or remedied before labor; for the treatment of sore nipples when the child is at the breast is often unsatisfactory, while the suffering they occasion is very great, even sometimes giving rise to mammary abscess.

There are certain _articles of clothing_ and _dressings for the bed_ which should be cared for in advance, in order that they may be ready when required.

The mother should be provided with short-gowns, to be worn over the chemise instead of the ordinary night-gowns. It is of consequence to procure a proper _bandage_. It should be made of heavy muslin, neither too coarse nor too fine; an ordinarily good quality of unbleached muslin is the best. The material is to be cut bias, about one and a quarter yard in length, and from twelve to eighteen inches in breadth, varying, of course, with the size of the person. It should be just large enough to encircle the body after confinement, with a margin of a couple of inches, and to extend down below the fulness of the hips. The measurement should be taken, and the bandage made to fit, when four and a half months advanced. It should be narrow above, wider below, and gored in such a manner that it will be a little narrower at the lower extremity than a few inches above, so as to prevent it, when adjusted, from sliding upwards. A bandage constructed in this manner will be very comfortable; and is not apt to become displaced, after application, as is invariably the case when a towel or a straight piece of muslin is used. The way in which it is to be applied will be detailed hereafter.

The _child's clothing_ should consist first of a piece of flannel or some woollen material for a binder. This should be from four to six inches in width, and from twelve to sixteen inches in length; that is to say, wide enough to extend from the armpits to the lower part of the abdomen, and long enough to go once and a half times around the child, having the double fold to come over the abdomen. There should be no embroidery about this. A shirt, which it is desirable should be woollen, is to be provided to place over the binder. It should be made to come up tolerably high in the neck, and to extend down the arm. Neither it nor any other portion of the child's clothing should be starched. The petticoat, which may be open its whole length behind, is to be put over the shirt; two may be used--a short and a long one. Next comes the child's ordinary frock or slip, and above this an apron to protect the dress from the frequent discharges from the stomach. Then a shawl, of flannel or any other warm material, is to be provided, to throw over the shoulders if the weather be cold. Socks, and pieces of old soft linen, free from stiffening, for napkins or diapers, complete the child's outfit.

For the _permanent and temporary dressing of the bed_ there should be provided a piece of impervious cloth (oiled silk is the neatest) about a yard square; a piece of ordinary table oil-cloth or rubber-cloth; a number of old sheets and comfortables, and a piece of thick carpet. The manner in which these are to be used will be explained shortly.

A pair of small rounded scissors; a package of large pins, one and a half inches in length, for the bandage of the mother, and smaller ones for that of the child; some good linen bobbin for the doctor to tie the navel-string; good toilet soap and fine surgical sponge for washing the child; a piece of soft linen or muslin for dressing the navel; a box of unirritating powder; and a pile of towels,--should all be had and laid aside many weeks before they are wanted. These, together with the material for dressing the bed, the child's clothing, and the mother's bandage, ought to be placed together in a basket got for the purpose, in order that they may all be easily and certainly found at a time when perhaps the hurry and excitement of the moment would render it difficult otherwise to collect them all immediately.

SIGNS OF APPROACHING LABOR.

One of the earliest of the preliminary signs of the coming on of confinement occurs about two weeks before that event. It is a dropping or subsidence of the womb. The summit of that organ then descends, in most cases, from above to below the umbilicus, and the abdomen becomes smaller. The stomach and lungs are relieved from pressure, the woman breathes more freely, the sense of oppression which troubled her previously is lost, and she says she feels 'very comfortable.' This sensation of lightness and buoyancy increases, and a few days before the setting in of labor she feels so much better that she thinks she will take an extra amount of exercise. The mother of a number of children is acquainted with this sign, but the wife with her first child may exert herself unduly in the house or outdoors, and induce labor when in the street or away from home. Hence the importance of a knowledge of this premonitory symptom.

A second precursory sign of labor is found in the increased fulness of the external parts, and an augmented mucous secretion, which may amount even to a discharge resembling whites, and requiring the wearing of a napkin. This symptom is a good one, indicating a disposition to relaxation, and promising an easy time.

The third preliminary sign which we shall mention, is the change in the mental state of the pregnant woman. She has a feeling of anxiety and of fidgetiness, sometimes accompanied with depression of spirits. This condition of emotional distress, modified in particular cases by reason, self-control, and religion, may continue for several days, perhaps, when

THE SYMPTOMS OF ACTUAL LABOR

make their appearance. The first of these is generally the 'show.' It is the discharge of the plug of mucus which has occupied the neck of the womb up to this time, and is ordinarily accompanied by a little blood. Perhaps before this, or perhaps not for some hours after, the 'pains' will develope themselves. These recur periodically, at intervals of an hour or half an hour at the outset, and are 'grinding' in character. _True_ labor pains are distinguished from _false_ by the fact that they are felt in the back, passing on to the thighs, while false pains are referred to the abdomen; by their intermittent character, the spurious pains being more or less continuous; and by the steady increase in their frequency and severity. In case of doubt as to their exact nature, the doctor should be summoned, who will be able to determine positively whether labor has begun.

The other symptoms which point to the actual commencement of labor are a frequent desire to empty the bowels and bladder, nausea and vomiting, which, in the early part of confinement, is a good sign; shiverings, unattended with any sensation of cold; and, finally, the rupture and discharge of the contents of the 'bag of waters.'

Before passing on to the consideration of the management of the confinement into which the wife has now entered, a few words may be appropriately said upon the

CAUSE OF LABOR.

Neither the size nor the vigor of the child has any influence in bringing about delivery at full term. The ancient theory--which received the support of the distinguished naturalist Buffon--that the infant was the active agent in causing its own expulsion, is an exploded one. It was asserted by some that hunger excited the foetus to struggle to free itself from the womb; others were disposed to attribute its efforts to accomplish its entrance into the world, to the need of respiration which it experienced. But all these ingenious theories, which presupposed the embryo to be actuated by the same feelings which would influence a grown person if shut up in such a confined abode, are unsatisfactory, and not tenable. It is well known that the child may die in the womb, without retarding or interfering in any way with the coming on of the process of labor. This fact alone shows that the foetus is, or at any rate may be, absolutely passive either in regard to the induction or advancement of delivery. The determining cause of labor is seated in the womb itself. The contractions of this organ occasion the 'pains' and expel the child, assisted by the muscles of the abdomen and the diaphragm. That the assistance of the latter forces is not necessary, is conclusively proved by the occurrence of childbirth after the decease of the mother. For instance, a case is on record in which labor commenced and twins were born after the mother had been dead for three days.

CARE DURING LABOR.

We will suppose labor to have commenced. The _preparation of the bed_ for the occupancy of the mother is now to be attended to. As she is to lie on the _left side_ of the bed, this is the side, and the only one, which is to be dressed for the occasion. In order to do so, remove the outer bed-clothes one at a time, folding them neatly on the right side of the bed so that they can easily be drawn over when desired. The _permanent dressing_ is to be placed beneath the lower sheet and upon the mattress. A soft impervious cloth--which, in speaking of the preparation for confinement, we directed to be procured--is placed next to the surface of the bed. The upper edge should be nearly as high as the margin of the bolster, and it should extend down to a distance at least a foot below the level of the hips, so as to certainly protect the bed from the discharges. Upon the top of this a blanket or sheet is laid, and the whole fastened by pins. The lower sheet of the bed, which had been turned over to the right side, to permit the application of the dressing, is now to be replaced. Over the position of this permanent dressing, on the top of the bed-sheet, a neatly-folded sheet, with the folded edge down, is adjusted and pinned in its place. It is upon this sheet that the patient is to be drawn up after her confinement, which will take place upon the _temporary dressing_ of the bed now to be arranged. It consists of an oil-cloth, which should extend up beyond the lower edge of the permanent dressing, overlapping the folded sheet which has been placed above it, and should fall over the side and bottom of the bed. A comfortable or any soft absorbent material is placed over this impervious cloth and covered with a folded sheet, completing the temporary dressing. The bed-clothes may now be adjusted, concealing the dressings from view until they are wanted. The valances at the foot of the bed should be raised, and a piece of carpet placed on the floor. The bed should have no foot-board, or a very low one.

_The dress of the mother._--Either a folded sheet should be adjusted around the waist as the only skirt, so as not to interfere with the walking, or a second chemise should be put on, with the arms outside the sleeves, to extend from the waist to the feet. Then the chemise next the body should be drawn up and folded high up around the breast. It should be plaited neatly along the back, and brought forward and fastened by pins. This should be thoroughly done, so that the linen may not be found wet nor soiled when it is drawn down after confinement. A wrapper or dressing-gown may be worn during the first stage of labor, before it is necessary to go to bed. When, however, that time comes, the wife will take her place on her left side on the temporary dressing, with a sheet thrown over her, her head on a pillow so situated that her body will be bent well forward, and her feet against the bed-post. A sheet should be twisted into a cord and fastened to the foot of the bed, for her to seize with her hands during the accession of the 'bearing-down pains.' Care should be taken to have a number of napkins, a pot of fresh lard, and the basket containing the scissors, ligature, bandage, etc.--which have been previously enumerated in the remarks on preparations for childbirth--at hand, for the use of the doctor.

We have now noted all that it is useful for the wife to know in regard to the preparation for and management of confinement, when a physician is in attendance, as, for obvious reasons, he should always be. In some instances, however, the absence of the doctor is unavoidable, or the labor is completed before his arrival. As a guide to the performance of the necessary duties of the lying-in room under such circumstances, we give some

HINTS TO ATTENDANTS.