The People's Common Sense Medical Adviser in Plain English Part 17

Then commences a wonderful series of transforming operations, rudimentary changes preliminary to the formation of tissues, structures and functions, which finally qualify the organism for independent existence. The ovum, when expelled from the ovary, enters the fimbriated, or fringe-like extremity of the Fallopian tube, to commence at once its descent to the uterus. The process of pa.s.sing through this minute tube varies in different animals. In birds and reptiles, the bulk of the expelled ova is so great as to completely fill up the tube, and it is a.s.sisted in its downward course, partly by its own weight and partly by the peristaltic action of the muscular coat of the ca.n.a.l. In the human subject, however, the ova are so minute that nature has supplied a special agent for their direct transmission; otherwise they might be retained, and not reach their destination. Accordingly, the fimbriated, trumpet-shaped extremity of the Fallopian tubes, which is nearest to the ovaries, and, consequently from the ovary first receives the ovum when expelled; is provided with a series of small hairs, termed _cilia_, forming the lining or bas.e.m.e.nt membrane of the tubes, and, the movements of these cilia being towards the uterus, transmit, by their vibrating motion, the ovum from the ovary, through the Fallopian tubes, to the uterus.

The mature ovum, however, is not by itself capable of being converted into the embryo. It requires fecundation by the spermatic fluid of the male, and this may take place immediately on the expulsion of the ovum from the ovary, or during its pa.s.sage through the Fallopian tube, or, according to Bischoff, Coste, and others, in the cavity of the uterus, or even upon the surface of the ovary. Should impregnation, however, fail, the ovum gradually loses its vitality, and is eventually expelled by the uterine secretions. It occasionally happens that the descent of the impregnated ovum is arrested, and the formation of the embryo commences in the ovary. This is termed _ovarian pregnancy_. Or again, the ovum may be arrested in its pa.s.sage through the Fallopian tube, causing what is termed _tubal pregnancy_; or, after it has been expelled from the ovary, it may fail to be received by the fimbriated extremity, and escape into the cavity of the abdomen, forming what has been termed _ventral pregnancy_. If the microscopic germ lodges in some slight interstice of fiber, during its pa.s.sage through the walls of the uterus, it may be detained long enough to fix itself there, and when this occurs, it is termed _interst.i.tial pregnancy_. All these instances of extra-uterine pregnancy may necessitate the employment of surgical skill, in order that they may terminate with safety to the mother. Their occurrence, however, is very rare.

The intense nervous excitement produced by the act of coition is immediately followed by a corresponding degree of depression, and a too frequent repet.i.tion of it is necessarily injurious to health. The secretions of the seminal fluid being, like other secretions, chiefly under the influence of the nervous system, an expenditure of them requires a corresponding renewal. This renewal greatly taxes the corporeal powers, inducing la.s.situde, nervousness, and debility. It is a well known fact that the highest degree of mental and bodily vigor is inconsistent with more than a moderate indulgence in s.e.xual intercourse.

To ensure strength, symmetry, and high intellectual culture in the human race, requires considerable care. Consideration should be exercised in the choice of a companion for life. Const.i.tutional as well as hereditary ailments demand our closest attention. Age has also its judicious barriers. As before stated, when reproduction commences, growth, as a rule, ceases, therefore, it is inexpedient that matrimony should be consummated before the parties have arrived at mature stature.

PREVENTION OF CONCEPTION.

Much has been written upon the question whether married people have a right to decline the responsibilities of wedlock. The practice of inducing abortion is not only immoral but criminal, because it is destructive to both the health of the mother and the life of the embryo being. If both the parties to a marriage be feeble, or if they be not temperamentally adapted to each other, so that their children would be deformed, insane, or idiotic, then to beget offspring would be a flagrant wrong. If the mother is already delicate, possessing feeble const.i.tutional powers, she is inadequate to the duties of maternity, _and it is not right to lay such burdens upon her_. Self-preservation is the first law of nature, which all ought to respect. The woman may be able to discharge the duties of a loving wife and companion, when she cannot fulfill those of child-bearing. If the husband love his wife as he ought, he will resign all the pleasure necessary to secure her exemption from the condition of maternity. It seems to us, that it is a great wickedness, unpardonable even, to be so reckless of consequences, and so devoid of all feeling, as to expose a frail, feeble, affectionate woman to those perils which almost insure her death. To enforce pregnancy under such circ.u.mstances is a crime. Every true man, therefore, should rather practice self-control and forbearance, than entail on his wife such certain misery, if not danger to life.

Undoubtedly, the trial is great, but if a sacrifice be required, let the husband forbear the gratification of pa.s.sions which will a.s.suredly be the means of developing in his delicate wife symptoms that may speedily hurry her into a premature grave. Before she has recovered from the effects of bearing, nursing, and rearing one child, ere she has regained proper tone and vigor of body and mind, she is unexpectedly overtaken, _surprised_ by the manifestation of symptoms which again indicate pregnancy. Children thus begotten are not apt to be hardy and long-lived. From the love that parents feel for their posterity, from their wishes for their success, from their hopes that they may be useful from every consideration for their future well-being, let them exercise precaution and forbearance, until the wife becomes sufficiently healthy and enduring to bequeath her own vital stamina to the child she bears.

From what has been said on this subject, it behooves the prudent husband to weigh well the injurious, nay criminal results which may follow his l.u.s.t. Let him not endanger the health, and it may be the life, of his loving and confiding wife through a lack of self-denial. Let him altogether refrain, rather than be the means of untold misery and, perhaps, the destruction of the person demanding his most cherished love and protection. On so important a subject, we feel we should commit an unpardonable wrong were we not to speak thus plainly and openly. An opportunity has been afforded us, which it would be reprehensible to neglect. We shall indeed feel we have been amply rewarded, if these suggestive remarks of ours tend in any way to remove or alleviate the sufferings of an uncomplaining and loving wife. Our sympathies, always susceptible to the conditions of sorrow and suffering, have been enlisted to give faithfully, explicitly, and plainly, warnings of danger and exhortations to prudence and nothing remains for us but to maintain the principles of morality, and leave to the disposal of a wise and overruling Providence the mystery of all seemingly untoward events. In every condition of life, evils arise, and most of those which are encountered are avoidable. Humanity should be held accountable for those evils which it might, but does not shun.

By a statute of the national government, prevention of pregnancy is considered a punishable offense; whereas every physician is instructed by our standard writers and lecturers on this subject, that not only prevention is necessary in many instances, but even abortion must sometimes be produced in order to save the mother's life. As we view the matter, the law of the national government a.s.serts the ruling principle, and the exceptions to it must be well established by evidence, in order to fully justify such procedure. The family physician may, with the concurrence of other medical counselors, be justified, in rare cases, in advising means for the prevention of conception, but he should exercise this professional duty _only_ when the responsibility is shared by other members of the profession, and the circ.u.mstances fully and clearly warrant such a practice.

After fecundation, the length of time before conception takes place is variously estimated. Should impregnation occur at the ovary or within the Fallopian tubes, usually about a week elapses before the fertilized germ enters the uterus, so that ordinarily the interval between the act of insemination and that of conception varies from eight to fourteen days.

DOUBLE CONCEPTION.

If two germs be evolved simultaneously, each may be impregnated by spermatozoa, and a twin pregnancy be the result. This is by no means a rare occurrence. It is very unusual, however, to have one birth followed by another after an interval of three or four months, and each babe present the evidences of full maturity. Perhaps such occurrences may be accounted for on the supposition that the same interval of time elapses between the impregnation of the two germs as there is difference observed in their birth; that after the act of insemination, sperm was carried to each ovary; that one had matured a germ ready for fecundation, then impregnation and conception immediately followed, and the decidua of the uterus hermetically sealed both Fallopian tubes, and thus securely retained the sperm within the other Fallopian ca.n.a.l. The stimulus of the sperm so pent up causes that ovary to mature a germ, although it may do so slowly, and after two or three months it is perfected, fertilized, and a second conception occurs within the uterus.

If each embryo observe a regular period of growth and each be born at maturity, there must be an interval of two or three months between their births. But it is far more common for the parturition of the first, displaying signs of full maturity, to coincide with the birth of a second which is immature and which cannot sustain respiratory life. The birth of the latter is brought about prematurely, by the action of the uterus in expelling the matured child.

UTERINE PREGNANCY.

There are many who manifest a laudable desire to understand the physiology of conception, the changes which take place, and the order of their natural occurrence. When impregnation takes place at the ovaries or within the Fallopian tubes, there is exuded upon the inner surface of the womb a peculiar nutritious substance. It flows out of the minute porous openings surrounding the termination of the Fallopian tube within the uterine cavity, and, thus, is in readiness to receive the germ, and retain it there until it becomes attached. Undoubtedly, the germ imbibes materials from this matter for its nurture and growth. This membranous substance is termed the _decidua_, and disappears after conception is insured. Two membranes form around the embryo; the inner one is called the _amnion_, the outer one the _chorion_. Both serve for the protection of the embryo, and the inner one contains the _liquor amnii,_ in which it floats during intra-uterine life. Immediately after conception, the small glands in the neck of the uterus usually throw out a sticky secretion, filling the ca.n.a.l, or uniting its sides, so that nothing can enter or leave the uterine cavity.

The fertilized ovum rapidly develops. After its conception it imbibes nourishment, and there is a disposition in fluids to pa.s.s into it, through its delicately-organized membranes. If this process is not involuntary, it is, at all events, at the convenience and use of the developing germ. After three months the embryo is termed the _foetus_.

Its fluids are then so much more highly organized, that some of them are tinged with sanguine hues, and thenceforward acquire the characteristics of red blood. Out of red blood, blood-vessels are formed, and from the incipient development of the heart follow faint lines of arteries, and the engineers of nutrition survey a circulatory system, perfecting the vascular connections by supplementing the arteries with a complete net-work of veins and capillaries.

THE PLACENTA OR AFTERBIRTH.

Whenever conception occurs, a soft, spongy substance is formed between the uterus and the growing ovum, called the _placenta_. It is composed of membrane, cellular tissue, blood-vessels, and connecting filaments.

The princ.i.p.al use of this organ seems to be to decarbonate the blood of the foetus, and to supply it with oxygen. It performs the same function for the foetus that the lungs do for the organism after birth. It allows the blood of the foetus to come into very close contact with that of the mother, from which it receives a supply of oxygen, and to which it gives up carbonic acid. This interchange of gases takes place in the placenta, or between it and the uterus, through the intervening membranes. This decarbonating function requires the agency of the maternal lungs, for the purpose of oxygenating the mother's blood.

The placenta is attached to the uterus by simple adhesion. True, in some instances, morbid adhesion takes place, or a growing together in consequence of inflammation, but the natural junction is one merely of contact, the membranes of the placenta spreading out upon the cavity of the uterus, so that, finally, the former may be entirely removed without a particle of disturbance or injury to the latter. Formerly, it was supposed that the placental vessels penetrated into the substance of the uterus. We know now there is no such continuation of the vessels of the one into the other. The decarbonation of the blood requires the placental and uterine membranes to be in contact with each other.

If the union were vascular, the mother's blood would circulate in the foetal body, and the impulses of the maternal heart might prove too strong for the delicate organism of the embryo. Besides, the separation of the placenta from the uterus might prove fatal to both parent and offspring. The placenta is only a temporary organ, and when its functions are no longer required, it is easily and safely removed.

THE UMBILICAL CORD.

The foetal blood is transmitted to and fro between the body of the child and the placenta, by a cord which contains two arteries and one vein.

This is called the _umbilical cord_, because it enters the body at the middle of the abdominal region, or _umbilicus_. It is composed, also, of its own proper membranous sheath, or skin, and cellular tissues, besides the blood-vessels. Two months after pregnancy, this cord can be seen, when it commences to grow rapidly.

QUICKENING.

Not until the mother feels motion is she said to be quick with child.

That is, the child must be old and strong enough to communicate a physical impulse, which the mother can distinctly perceive, before it is regarded as having received life. This is a fallacy, for the germ has to be endowed with life before organization can begin. The act of impregnation communicates the vital principle, and from that moment it starts upon its career of development. A long period elapses after this occurs before it can make the mother feel its motions. Before quickening, the attempt to destroy the foetus is not considered so grave a crime by our laws, but after this quickening takes place, it is deemed a felony.

THE RIGHT TO TERMINATE PREGNANCY.

The expediency and the moral right to prematurely terminate pregnancy must be admitted when weighty and sufficient reasons for it exist. Such a course should never be undertaken, however, without the advice and approval of the family physician, and, whenever it is possible, the counsel of another medical pract.i.tioner should be obtained. There may be so great a malformation of the pelvic bones as to preclude delivery at full term, or, as in some instances, the pregnant condition may endanger the life of the mother, because she is not able to retain nourishment upon the stomach. In such cases only, is interference warranted, and even then the advice of some well-informed physician should be first obtained, to make sure that the life of the mother is endangered before so extreme a measure is resorted to.

Those who are qualified for maternal duties should not undertake to defeat the intentions of nature, simply because they love ease and dislike responsibility. Such persons may be considered genteel ladies, but, practically, they are indifferent to the claims of society and posterity. How such selfishness contrasts with the glorious, heroic, Spartan spirit of the young woman who consulted us in reference to the acceptance of a tempting offer of marriage! She was below medium size and delicately organized. She hesitated in her answer, because she was uncertain as to her duty to herself, and to her proposed husband, and on account of the prospective contingencies of matrimony. After she was told that it was doubtful whether she could discharge the obligations of maternity with safety to herself, and yet that she might prove to her intended husband a true and valuable wife, she quickly answered, her black eyes radiant with the high purpose of her soul: "If I a.s.sent to this offer, I shall accept the condition and its consequences also, even if pregnancy be my lot and I know it will cost me my life!" She acceded to the proposal, and years found them one in happiness; then a daughter was born, but the bearing and nursing were too much for her delicate const.i.tution, and she continued to sink until she found rest in the grave. Of all her beautiful and n.o.ble sayings, none reflect more moral grandeur of spirit than the one in which she expressed her purpose to prove true to posterity.

THE SIGNS OF PREGNANCY.

The symptoms which indicate pregnancy are cessation of the menses, enlargement of the mammae, nausea, especially in the morning, distention of the abdomen, and movement of the foetus. A married woman has reason to suspect that she may have conceived, when, at the proper time, she fails to menstruate, especially when she knows that she is liable to become pregnant. A second menstrual failure strengthens this suspicion, although there are many other causes which might prevent the appearance of the menses, such as disease of the uterus, general debility, or taking cold, and all of these should be taken into account. In the absence of all apparent influences calculated to obstruct the menses, the presumption ordinarily is that pregnancy is the cause of their non-appearance. The evidence is still more conclusive when the mammae and abdomen enlarge after experiencing morning sickness. Notwithstanding all these symptoms, the audible sound of the heart, or the movements of the foetus, are the only _infallible_ signs of a pregnant condition.

THE DURATION OF PREGNANCY.

The ordinary duration of pregnancy is about forty weeks, or 280 days. It is difficult to foretell exactly when a pregnancy will be completed, for it cannot be known precisely when it began. Some gestations are more protracted than others, but the average duration is the time we have given. A very reasonable way to compute the term, is to reckon three months back from the day when the menses ceased and then add five days to that time, which will be the date of the expected time of confinement. It is customary, also, for women to count from the middle of the month after the last appearance of the menses, and then allow ten _lunar_ months for the term. This computation generally proves correct, except in those instances in which conception takes place immediately before the fast appearance of the catamenia. A few women can forecast the time of labor from the occurrence of quickening, by allowing eighteen weeks for the time which has elapsed since conception, and twenty-two more for the time yet to elapse before the confinement. With those in whom quickening occurs regularly in a certain week of pregnancy, this calculation may prove nearly correct.

The English law fixes no precise limit for the legitimacy of the child.

In France a child is regarded as lawfully begotten if born within three hundred days after the death or departure of the husband. There are a sufficient number of cases on record to show that gestation may be prolonged two, and even three, weeks beyond the ordinary, or average term. The variation of time may be thus accounted for: after insemination, a considerable interval elapses before fecundation takes place, and the pa.s.sage of the fertilized germ from the ovary to the uterus is also liable to be r.e.t.a.r.ded. There are many circ.u.mstances and conditions which might serve to diminish its ordinary rate of progress, and postpone the date of conception. This would materially lengthen the _apparent_ time of gestation.

It is likewise difficult to determine the shortest period at which gestation may terminate, and the child be able to survive. A child may be born and continue to live for some months, after twenty-four or twenty-five weeks of gestation; it was so decided, at least, in an ecclesiastical trial.

We have not the s.p.a.ce to describe minutely, or at length, the formation and growth of the foetal structures, and trace them separately from their origin to their completion at the birth of the child. The student of medicine must gain information by consulting large works and exhaustive treatises on this interesting subject.

What trifling contingencies defeat vitality! Conception may be prevented by acrid secretions, the result of disease of the reproductive organs.

Leucorrheal matter may destroy the vitalizing power of the sperm-cells.

There are many ways, even after impregnation, of compromising the existence of the frail embryo. Accidents, injuries, falls, blows, acute diseases, insufficient nutrition and development, in fact, a great variety of occurrences may destroy the life of the embryo, or foetus.

After birth, numerous diseases menace the child. By what constant care must it ever be surrounded, and how often is it s.n.a.t.c.hed from the very jaws of death!

What, then, is man but simply a germ, evolving higher powers, and destined for a purer and n.o.bler existence! His latent life secretly emerges from mysterious obscurity, is incarnated, and borne upon the flowing stream of time to a spiritual destination--to realms of immortality! As he nears those ever-blooming sh.o.r.es, the eye of faith, illuminated by the inspired word, dimly discerns the perennial glories.

Quickened by Faith, Hope, and Love, his spirit is transplanted into the garden of paradise, the Eden of happiness, redeemed, perfected, and made glorious in the divine image of Him who hath said, "I am the Way, the _Truth_, and the LIFE."