J. Morris Slemons

“ Most cells can do no more than produce units like themselves. The bodies of women contain, however, a type of cell which possesses a far more wonderful power. Provided the requisite conditions for such development are met, these cells are capable of developing into human beings. Each of these remarkable units is called an Ovum, or egg-cell, and represents one variety of the germinal cells. But the other variety, represented by the Spermatozoon and developed only in the male sex, is also required for the production of a human being.
Every ovum originates in the ovaries. ”

“ CHAPTER III THE EMBRYO The Development of Form—The Determination of Sex—Twins—The Rate of Growth—The Newborn Infant—Heredity—Maternal Impressions.
The new human being begins existence, as I have shown, as soon as the ovum is fertilized, though at that moment it consists merely of a solitary cell formed by the union of the two parental cells. From a beginning relatively simple the human body develops into the most complex of living structures ”

“ Ventilation takes care of itself in summer, when the windows are open, but in cold weather, when in our anxiety to keep the temperature comfortable we may overlook the need of fresh air, it demands close attention. The necessity of ventilation at all times is due, of course, to the composition of the atmosphere and to the changes produced in it as we breathe.
The air about us is a mixture of gases, of which oxygen and nitrogen are the most important. ”

“ INTRODUCTION In all branches of medicine the master word is prophylaxis, or prevention, and its benefits are nowhere more strikingly illustrated than in the practice of obstetrics. In former times every woman who gave birth to a child or passed through a miscarriage was exposed to grave danger of infection or child-bed fever; but at present—thanks to the recognition of the bacterial origin of the disease and of its identity with wound infection—this danger can be practically eliminated by the rigid observance of surgical cleanliness and aseptic technique. ”

“ THE PLACENTAL STAGE.—Although the third stage is chiefly concerned with the separation and the delivery of the after-birth, on which account it is known as the placental period, the description of other no less remarkable events belongs here. Even after the infant is born the umbilical cord extends from its navel to the placenta, just as it has done throughout pregnancy. Among larger mammals separation of the new-born from the mother is brought about in one of two ways; sometimes the activity of the young breaks the navel-string, though more frequently the mother bites it in two. ”

“ In the face of so many negative instances it is amazing that any person, even though ignorant of medical teaching, should be inclined to attribute abnormal development to something the mother has seen or heard, thought or dreamt, or otherwise experienced while she was pregnant. Yet unfortunately many do believe this. It is worth while, therefore, to supply further evidence, and thus escape any suspicion of unfairness in argument, to prove that maternal impressions are unable to affect the formation of the embryo. ”

“ In the fertilized ovum the dawn of development is shown at first by unusual activity within and later by alterations upon the surface. Before very long the circumference of the cell becomes indented as if a knife had been drawn around it, and shortly two cells appear in place of one. These two cells in turn divide, yielding four cells which grow and divide into eight. In this manner division follows division until a multitude of cells have sprung into existence, all of which cling together in the shape of a ball. Development always proceeds in the same orderly way ”

“ To these weeks physicians usually apply the technical term puerperium, the child's period, a designation which brings to mind the secretion of milk which, though not a retrogressive change, is, nevertheless, one of the most distinctive results of childbirth.
Radical as the bodily changes in progress at this time are, the lying-in period is not a period of illness. But there is, perhaps, no other time in a woman's life when she may cross the boundary between sickness and health so easily; for here nature tolerates no trifling. ”

“ At Common Law, abortion is punishable as homicide when the woman dies or when the operation results fatally to the infant after it has been born alive. If performed for the purpose of killing the child, the crime is murder; in the absence of such intent, it is manslaughter. The woman who commits an abortion upon herself is likewise guilty of the crime.
The great majority of those who desire the interruption of pregnancy feel they have not assumed an illegal position so long as they avoid instrumental procedures. ”

“ At all events the point has now been reached where the average man or woman knows something of anatomy, physiology, and the laws of hygiene. Such knowledge should be helpful, and generally is, but if it causes anyone to think incessantly about the workings of the body, to that person it is detrimental. We all know such individuals. They are made miserable because they scrutinize functions, like the beating of the heart, that go on automatically and should be left unobserved, or they minutely analyze their feelings and misinterpret normal sensations as the evidence of disease. ”

“ Generally the diet should be a mixed one, consisting of milk, gruels, soups, vegetables, bread, and meat. In order that monotony may not dull the appetite, no one article of food should be employed continuously. With this exception food should be selected with regard only for its wholesomeness and digestibility. All food is milk-making food; no sharp distinctions between the various kinds can be recognized. Milk, because it contains all the elements necessary for perfect nutrition, is particularly wholesome. ”

“ DESIRABLE QUALITIES IN THE NURSE.—It is rarely advisable to select as nurse a member of the family or an intimate friend. Some of the motives governing such a course—sentiment, mutual devotion, and the desire to be humored—are inconsistent with the best kind of nursing. If the nurse knows the patient intimately, undue anxiety may interfere with her judgment; thoroughness in routine duties may be hindered by mistaken consideration for the patient; and in an emergency sympathy rather than reason may guide her. A successful nurse must satisfy at least two requirements ”

“ Naturally serious consequences may be expected if they are worn with the design of compressing the abdomen so as to render pregnancy less noticeable or perhaps to conceal it altogether. Thus worn, the corset becomes not only an instrument of torture but a source of danger both to the mother and to the child. ”

“ In order to learn how frequently prospective mothers may have disagreeable experiences which they fear will affect the formation of the child, I have lately asked the patients whom I have attended, "Was there any incident during your pregnancy to which you could have attributed the infant's condition, had it been marked?" ”

“ To predict absolutely the length of labor for any particular patient is impossible. The averages calculated from large groups of cases have no more than a broad scientific interest; when applied to any individual they are apt to be very misleading. Thus, from statistics we should expect the first labor to be longer than subsequent ones, but we are often surprised by an unusually rapid delivery. ”

“ Menstruation is more apt to return prematurely after the birth of the first child than of later ones. This may be due in part to a kind of accommodation of the maternal organism to the reproductive process as one pregnancy follows another; but I am convinced that it is also due in part to the greater physical and mental composure of experienced mothers. Until a woman has learned the unwelcome consequences she is apt to take over household duties before she is equal to the task, or she may engage in too strenuous amusements; and most mothers err in a too energetic care of the baby. ”

“ A description of development, in order to be perfectly clear, must begin with a word about the fundamental structure of the adult body. Everyone knows that the various parts of the body perform different functions; but not everyone, perhaps, realizes that, in spite of their different functions, all the organs of the body are composed of similar structural units, known as cells. Of course, cells are definitely arranged according to the use for which the tissue that they chance to compose may be designed ”

“ THE CAUSE OF LABOR.—It is evident that, in a general way, the muscular contractions of the womb cause the birth of the child; but before we thoroughly understand the act, science must discover what stimulates the muscle to contract. Although careful research has thus far failed to disclose the source and character of the stimulus, it has taught many properties of the contractions themselves. Their force has been measured and found to increase as the end of labor is approached; the pressure they exert varies between nine and twenty- seven pounds. ”

“ THE RATE OF GROWTH.—When we recall the definite and often marked differences in the physical character of women, such as weight and height, it is surprising to learn that the prenatal development of their children proceeds with uniform speed. One very practical result is that the physician is thus enabled, at the birth of a premature infant, to estimate accurately the period of its development. ”

“ HABITUAL MISCARRIAGE.—Experience teaches that women who have had one miscarriage must be more careful than other prospective mothers if they would escape a repetition of the accident. Persons who know themselves to be subject to miscarriage should regard no precaution as too burdensome. Not only should they avoid motoring, driving, railroad journeys, sea voyages, and every kind of strenuous exertion, they must accept every opportunity to be quiet and rest. Often such hygienic care yields sufficient protection; but occasionally medicine is also necessary. ”

“ It is always advisable not to crowd the exercise of a day into a single period but rather to take it in several installments, for example, an hour in the morning, and another in the afternoon. Under all circumstances, it must never be forgotten that the feeling of fatigue is a peremptory signal to stop, no matter how short the walk has been. ”

“ Since most women are absorbed in the affairs of the home, it may be well to begin by saying that the existence of pregnancy by no means requires the abandonment of domestic duties. On the contrary, when it is convenient, the prospective mother should have a share in the housework. She should not undertake everything that is to be done about the house, for no matter how small the household there are certain duties too laborious for her to attempt ”

“ It is equally true, as we shall see in the next chapter, that the nucleus of the ovum and the nucleus alone transmits maternal qualities. The material which conveys inheritable characters can be seen and has been identified in both germinal cells; from each of them the fertilized ovum derives equal amounts. As the parental nuclei unite, the material which they contain intermingles and establishes a new being; to attain full development, it requires nothing further from the father, and nothing save nourishment from the mother. ”

“ After consultation with her physician each patient will decide what is particularly advisable for her. Nevertheless, I would emphasize the importance of securing a competent nurse and retaining her for at least four weeks. Even with those who must guard their expense account the truest economy will lie in such a course. Whenever lack of resources seems likely to prevent this arrangement, the patient who is looking to her best interests should enter a hospital where excellent care can be provided at a cost within her means. ”

“ At the end of the fifth month, the weight of the fetus is from nine to ten ounces; whereas an average infant when born at the expiration of the full term of pregnancy, that is, with the completion of the tenth month, weighs about seven pounds. The fetus, therefore, acquires roundly ninety per cent, of its weight during the second half of pregnancy, which clearly indicates that Nature reserves this period of gestation for the fetus to increase in size, a phenomenon less mysterious but no less important than the evolution of the embryo. ”

“ At the time of birth, in consequence of the expulsion of the child, the after-birth, the amniotic fluid, and a varying amount of blood, there is necessarily a loss of from ten to fifteen pounds. Later, as the maternal tissues, whose growth has been stimulated during pregnancy, return to their original condition, a further loss in weight takes place. It is not unusual, however, for women to remain permanently better nourished than before they became pregnant. Under ordinary conditions the food of the prospective mother provides not only for her own wants but also for those of the embryo. ”

“ Fat in all probability is not digested in the stomach; even starch and protein are not broken down sufficiently by the time gastric digestion is complete to permit them to be absorbed into the body. "The value of digestion in the stomach," as Howell says, "is not so much in its own action as in its combined action with that which takes place in the intestine." It is even possible for satisfactory digestion to take place without the assistance of the stomach. This fact has been substantiated by several cases in which men have lived for years after the stomach was removed to eradicate a disease. ”

“ From my own experience as a teacher and consultant, I state without hesitation that in no other branch of medicine or surgery are graver emergencies encountered than in certain obstetrical complications whose treatment involves the greatest responsibility and requires the highest order of ability to insure a successful outcome for the mother and her child. ”

“ Most of us realize that disturbances may occur in the course of digestion, and we are also aware that the excretory organs occasionally fail to do their work in a satisfactory way. But what laymen, perhaps, do not appreciate is that the intermediary steps— between the time when the food is absorbed and the time when the waste material is finally eliminated—may not be taken precisely as health requires. Of course, any person may be the subject of one or another of these nutritional disorders, but unquestionably such disorders are somewhat more frequent during pregnancy than at other times. ”

“ Water and mineral matter, on the other hand, are never a source of energy; they assist in building new tissue or in repairing tissue that already exists. The proteins are unique, in that they may serve either purpose. Primarily the proteins are tissue-builders, but in the absence of sufficient fat or carbohydrate the body burns protein to secure heat and energy.
Each food-stuff, therefore, serves a distinct purpose, and some of them render services which the others cannot perform. A man will die if either water or mineral matter or protein is completely withdrawn from his diet. ”

“ CHAPTER X THE BIRTH OF THE CHILD The Cause of Labor—The Course of Labor—The Stage of Dilatation—The Stage of Expulsion—The Placental Stage—The Effect of Labor upon the Child—Meddling—Justifiable Intervention—Management of Birth without the Doctor—Methods of Reviving the Child.
The birth of a child is an act of nature, an act generally performed as satisfactorily as any other bodily function. ”

“ These are closely set upon the inner surface of the oviduct; their outer ends are free and continually sway to and fro like a wheat field on a windy day; and by their motion they create a current in the direction in which the ovum should move, namely, toward the uterus. While passing through the oviduct, the ovum has no attachment whatever to the mother, yet development is going on all the time. It is thus made perfectly clear that development is not directed by the parent. ”

“ THE CHOICE OF FOOD.—There is no diet specifically adapted to the state of pregnancy; the prospective mother may usually exercise the same freedom as anyone else in the selection of food. She should, however, choose what will agree with her and avoid that which she cannot digest and assimilate. Personal experience in the main must guide everyone as to what to eat, and most women may follow the dictates of appetite after they become pregnant as safely as they did before. ”

“ With the possible exception of such individuals as are spending their lives in solitary confinement, there is scarcely a human being who has not in the course of nine consecutive months some untoward physical or mental experience which engraves itself upon the memory. Prospective mothers are not apt to be exempt from a rule so general in its application, but if by good chance one happens so to be she will hardly fail to hear of the misfortune of others, which, according to the doctrine of maternal impressions, may be equally effective in interfering with the proper development of the child. ”

“ As chemically combined in the food-stuff known as protein, nitrogen is indispensable to animal life; but our bodies make no use of the gaseous form of nitrogen. Oxygen, on the other hand, supports life; and though it forms less than one-fifth of the atmospheric air, it is present in ample amount for our needs. After we draw air into our lungs, the oxygen it contains is absorbed by the blood and used by the tissues. In return our tissues give up a waste product, carbonic acid gas, which is thrown off by the lungs. ”

“ Our bodies utilize their fuel more perfectly than any machine that man has invented; but they fail, nevertheless, to do so completely. And just as the efficiency of an engine cannot be maintained unless the smoke escapes and the ashes are raked away, so no human being can enjoy health unless his waste products are promptly removed. The task of removal, as most of us know, is assumed by our excretory organs, which include the bowels, the kidneys, the skin, and the lungs.
During pregnancy the mother must get rid not only of her own waste products, but also of those of the child. ”

“ Since another factor in the problem, namely, the size of the child, cannot be accurately predicted, occasionally the physician may hesitate to express as definite an opinion as the patient may wish. Nevertheless, though it may be impossible to learn every detail, the available information well repays the time and trouble expended. In nine out of ten cases nothing whatever is found out of the way; the result is an assurance which always justifies the examination. ”