The seven ages of woman [microform] ; a consideration of the successive phases of woman's life

Preface

There are many excellent and some time-honoured manuals for the instruction of young wives and mothers. My intention in writing this little book is not so much to add to their number as to afford a more general guide for women throughout life.

In my humble and no doubt inadequate effort to fulfil a somewhat lofty ambition, I have found it necessary to consider briefly the life of the young girl with reference to her health, management, and education. To this naturally succeed a few chapters of counsel to the young wife and the young mother that will, I hope, be of service to them during a wonderfully interesting but perplexing period of their life.

A remembrance of my own anxieties and perplexities has led to a few chapters concerning the management of children during " the noisy years "; and the constant requests of my patients to tell them where they can get a book in

Preface

which they will find some guidance during and after the climacteric have induced me to add two short chapters on this subject.

Therefore, to my patients, young, middleaged, and old, I respectfully dedicate this book.

Mary Scharlieb

149, Harley Street, W.

Chapter I The Years Immediately Preceding Puberty Paqe

Importance of the pre-pubertal period — Development and growth of the body — Intellectual and spiritual development — The mother's duty — Go-education of boys and girls ...... 1

THE PERIOD OF PHYSICAL CHANGE

Changes in the skeleton — How the pelvis changes — The spinal Tcolumn acquiring its adult curves — Development of the muscles — Deposition of fat — Development of the breast and of the|pelvic organs — Changes in the hair, complexion, and eyes . 6

Chapter III Advent Of Puberty

Signs of the imminency of menstruation — What the girl should be told — The first period not typical — The ordinary routine to be altered as little as possible 11 vii

Chapter IV Abnormalities Of Menstruation Page

Primary amenorrhcea (absence of menstruation) — Occult menstruation — Secondary amenorrhcea and its causes — Abnormalities of quantity : Metrorrhagia and menorrhagia — Irregular menstruation — Dysmenorrhoea (painful menstruation) and its causes — Membranous dysmenorrhoea ... . .16

Chapter V Domestic Care Of The Yoong Girl

Unstable condition of the adolescent girl — The choice of food — Exercise — Team games — Swedish exercises— The " crocodile " walk — Necessity for ample rest and sleep — Suitable clothing ... 25

Chapter VI Education, And Choice Of A Profession

Advantages of a home education — Greater advantages of a school education — Exceptionally sensitive children— Mentally or physically defective children — Future of education for girls — Choice of a profession — Need for skilled advice — Advantages of training in domestic economy and mother-craft — A balance of activities the ideal — Moral education and sexual physiology — How the truth may be told to children 36

PART 11

THE YOUNG WIFE

General preparation : Sympathetic companionship — Making the best of a husband's circumstances — Joyful acceptance of motherhood — The falling birth-

viii

FA08 rate — Disadvantages of limitation of the family. Special preparation for marriage : Physical fitness — Discretion in choice of a husband ... 60

THE DIFFICULTIES OF EARLY MARRIED LIFE

Household difficulties — Selfishness the arch-enemy — Advent of children — Unwisdom of preventive measures— The Birth-rate Commission — Continence and fertility in man — Physical diflBculties — Examination before marriage — Difficulties arising from disease ......... 70

CHAPTER III

Conception — Development of the pregnant uterus — — Growth of the embryo — First period of pregnancy : Cessation of menstruation — Mammary development — Morning sickness. Second period : Increase in size of abdomen and uterus — Quickening— Sounds of the foetal heart. Third period : Secretion of milk — Alterations in the imibilicus — Pigmentary changes — Subsidence of the abdomen . J)uration of pregnancy , . . . .81

DOMESTIC MANAGEMENT OF PREGNANCY

Pregnancy a normal process with stress and strain — Value of motherhood to the State — Hygienic pre- ~ cautions — Judicious exercise — Clothing — Marital relations during pregnancy .... 94

CHAPTER V PREPARATION FOR LABOUR

_ PAGE

Preparation of the house and of the birth-chamber — The patient's clothing during lying-in — The baby's requirements 101

Part III The Young Mother Signs And Symptoms Of The Three Stages Of Labour

Premonitory pains — True and false labour pains — Length of the first stage — ^The second stage — How the pains differ from those of the first — Chloroform anaesthesia — ^Morphia and scopolamine anaesthesia - Birth of the child— The third stage . . 108

* CHAPTER II

Bliss after pain — ^The requisite attentions — Exercises and massage in bed — Lactation — The mother's food — Puerperal sepsis — Notification and registration of birth — Ophthalmia of the new-born . . . 123

CHAPTER III

Miscarriage — Its causes, signs, and symptoms — ^Treatment— Premature birth — Care and feeding of the premature infant . . . . . .132

DISEASES OF PREGNANCY: TOXIC, NERVOUS, AND MECHANICAL

FAOB

Toxic diseases : Pernicious vomiting of pregnancy — Jaundice — Convulsions (eclampsia). Nervous diseases ; Vomiting — Salivation — Headache — Neuralgia— Disorders of the circulation — Haemorrhoids — Constipation — Diarrhoea. Mechanical disorders : Displaced uterus . . . . . .147

Part IV The Nursing Mother

The secretion of milk — Importance of suckling to both mother and child — Feeding-bottles — Duration of lactation — How to wean a baby — Abnormalities of lactation — Abscess of the breast. . . . 168

ARTIFICIAL NURSING AND WET-NURSING

The foster-mother — Comparison of cow's milk, ass*s milk, and goat's milk — Sterilisation and pasteurisation— Quantity and quality of the infant's meals . 180

CHAPTER III ARTIFICIAL FOOD AND ANTI-SCORBUTICS

Condensed milk, fluid and desiccated — Substitute preparations— Albumin water — Anti-scorbutics : Fresh meat-juice and orange-juice .... 186

THE NURSERY— TEETHING-VACCINATION— CIRGUxMCISION

FAOE

Preparation of the nursery — The night nursery. Eruption of the teeth — ^Troubles of dentition — Convulsions— Night terrors — Tetany — ^Asthma of Millar — Affections of the gums — ^Thrush — Urinary troubles. Vaccination. Phimosis — Paraphimosis — Circumcision . . . . . . .189

Part V The Mother In ''the Noisy Years''

THE CARE OF YOUNG CHILDREN

The period of infancy : Weight at birth — Dawning faculties— Food, clothing, exercise, and sleep. Children from two to five years of age : The child's experiments— Activity of the brain — Moral and religious teaching — Bed-wetting. Children from five to ten years of age : Characteristics and requirements — When education should begin — Correct attitudes — Clothing — Exercise — Sleep 213

Signs and symptoms — Rate of respiration — Pulse-rate — Temperature and how to take it — Examination of the surface of the body — The excreta — Swollen glands. The sick-room — Its furniture — Ventilation — HoWito mend the fire — Avoidance of infections — Chemical disinfection ..... 233 xii

CHAPTER III THE COMMONER AILMENTS OF CHILDHOOD

PAOS

Measles — German measles — Influenza — Ghickenpox — Whooping-cough — Mumps — Diphtheria — Scarlet fever — Worms 246

Part VI The Woman In Middle Age

Involution the keynote of this period — Changes in the skeleton, pelvic organs, and personal appearance — Cessation of menstruation — Difficulties and dangers of the menopause ...... 264

Part VII The Woman In Old Age

How to grow old gracefully — Social value of older women — Their opportunities for useful and disinterested work — Care of the health — Adaptation of mind and body to lessening strength — Evening shadows and promise of dawn . . . 271

Appendix : List of Formulse 279

Index 283 xm

Part I The Young Girl The Years Immediately Preceding Puberty

It is impossible to say which period of a woman's life is the most important. As each age comes under consideration one is tempted to say, This is the most important period. But the years between absolute childhood and the dawn of adolescence claim a very special attention, because on the management of the child during those years depends in a great measure her fitness for the momentous changes that immediately follow them.

As we shall have occason to point out in I a subsequent chapter, the whole human organism is in a constant state of flux and alteration during the years of puberty and adolescence. The few years between the end of childhood and

'^^]:, T of Woman

puberty appear to afford a breathing space intermediate between the rapid growth and development which precede and the still more rapid growth and development which lie immediatelyahead of them. During these years growth continues, and so, to some extent, does development ; but, taken as a whole, these are years of consolidation. Upon the successful management of the pre-pubertal period depends in a great measure the ability of the girl to endure without injury the extraordinary up-rush of developmental energy that will shortly occur. Much has been written and taught concerning the necessity for limiting a girl's activities during the trying years of adolescence ; but it is well to bear in mind that much can be done by way of preparation to render her organism fit to stand the strain. The wise mother will endeavour so to regulate her child's life that it may be adequately prepared for the difficulties that lie before it.

Development and growth of the child's body. —The child's body during the years immediately before puberty grows steadily, although with intervals of rest. Growth is in excess of development, and the child still retains much of its neutral characteristics. There is relatively little difference between the boy and the girl at V this time. There is a certain angularity and ^ sometimes a lankiness of appearance ; it is perhaps not a very prepossessing age, for the girl

The Years Before Puberty

has lost the rounded outline and charm of infancy, and has not yet acquired the still greater charm of adolescence.

The task of the mother or guardian during these years is chiefly one of preparation, of laying a really solid foundation of health that will stand the child in good stead later on. In order that she should be able to fulfil her duty she ought to know something of the structure and functions of the child's body. The mother must remember that her developing children are neither magnified babies nor small adults. If the photograph of a normal baby were enlarged to the same size as the photograph of a child of 10 or 12, and, still more, if it were compared with the photograph of a young adult, it would be seen at once that the powers of Nature secure not only growth in size, but a very noticeable alteration in shape and proportion. These changes in the structure and appearance of the child's body will be considered in detail in the next chapter. For the moment it is sufficient to remember that, great as are the changes during the years immediately preceding puberty, they are yet only the commencement of the transformation scene.

Intellectual and spiritual development.- — Spiritually and intellectually much the same quiet growth and development are occurring. The intellect becomes stronger, more able to fathom the meaning and import of what is learnt, but there is as yet no marvellous display of extra power ; that is reserved for the next stage. The girl still resembles her brother, not only

N^ in body, but also in mind and in general outlook on life. If she has been favoured both by heredity and by environment, she is at this

\ stage perfectly frank and open, there are no concealments, and although affection may be warm and deep, the mirror of the mind is as yet undimmed by the breath of passion. There is probably little appreciation of the beauties of scenery, and little or no love of art. Here and there an exceptional child shows a distinct gift for music, drawing, or other forms of art, but the whole outlook is calm, quiet ; in a

\ word, the child is matter-of-fact, and the mother or guardian has a comparatively easy time in dealing with a nature that still retains much of the simplicity of childhood.

! The great duty of the mother during these preparatory years is to assist her child's organism to gather strength and to collect material ready for the next stage. Spiritually she will find that in most instances the young girl at this period retains the simple, unquestioning faith of the little child ; there is little or no questioning as to the why and wherefore of the facts that she is taught, and still less is there self-consciousness or introspection. One / 4

The Years Before Puberty

of the differences between the years immediately preceding puberty and the period of adolescence which follows is that in the former period the mother can see into her child's mind, while the child herself sees very little ; whereas later on the youthful personality becomes intensely self-conscious, and is at the same time more or less completely hidden, even from the mother's sympathetic eye.

There are those who would have us believe that sexual feelings and sex consciousness develop at a very early age. In abnormal children, no doubt, this may be the case ; but in the healthy child who has been well brought up, sex feelings and consciousness are dormant, if not absent, and boys and girls will associate with each other, confide in each other, and behave generally in a way that would be absolutely impossible after the great awakening.

This neutrality of soul and spirit, this want of self-consciousness, is the great justification for those authorities who approve and practise co-education of boys and girls. There is just sufficient sex difference to make the boy and girl mutually stimulating and therefore mutually helpful from an educational point of view. Exceptions will, of course, be found to this rule, but they are exceptions, and therefore do not necessarily affect the management of children in the pre-adolescent years.

CHAPTER II THE PERIOD OF PHYSICAL CHANGE

Changes in the skeleton. —During the pubertal and adolescent years the changes in the skeleton are so well marked and rapid that they cannot fail to attract the attention of all who are in contact with the young ; and yet it is a curious fact that the phenomenon which appeals most to the ordinary onlooker is the increase in the length of the bones, whereas the most striking change in the skeleton is really the difference of proportion between the head and body of the young adult and the head and body of the little child. The head grows but little after the end of absolute childhood, and does not assume the adult proportion of being about one-twelfth of the total length of the body until growth is finished. If the adult head had grown in proportion to the size that it was in infancy, the effect would be positively grotesque. Holiday after holiday one hears the remark addressed to the adolescent girl, " Why, how you have grown— two or three inches at least ! " And thus the wonderful change is exaggerated. It is true that the rate of growth during adoles-

The Period of Physical Change

cence is very great, but the changes in proportion and in moulding are greater still.

In the girl the most wonderful changes occur in the pelvis. During childhood and early youth the bones of the pelvis and its angle to the horizon are much the same in both sexes, but at the time of puberty great changes occur, the girl's pelvic bones become relatively lighter, thinner, and more graceful. The upper part of the ilium (hip-bone) expands, and instead of its surfaces facing forwards they tend to face each other. This change gives width to the pelvis. At the same time the diameters of the pelvic brim change. In the male throughout life, and in the female up .to puberty, the diameter from front to back is approximately the same as the diameter from side to side,

I but in the female from puberty onwards the latter diameter is markedly the longer. The cavity of the pelvis also enlarges absolutely and relatively, and the pubic arch becomes I wider, having approximately the value of the 4 right angle, whereas in the child and in the male this angle is somewhere about 60° to 70°. These changes are to a certain extent due to the i innate tendency of the bones so to develop, but that they are chiefly due to the great developmental changes in the contained organs, the womb and its appendages, is proved by the fact that where these organs are virtually absent or badly developed the female pelvis fails to undergo the perfect metamorphosis, and remains throughout life more or less masculine in type.

Another skeletal change of interest is that the spinal column acquires its adult curves — much more marked in the female than in the male. The angle formed at the junction of the spine with the sacrum increases, and so too does the inclination of the pelvic brim to the horizon. All these changes in the female spine and pelvis have for their object the facilitation of pregnancy and parturition, the head of the normal human infant fitting the normal adult female pelvis as accurately as the hand fits the glove.

In consequence of the increased width of the pelvis the heads of the femora (thigh bones) are carried farther out, their necks become more oblique, and a greater width is obtained between the upper extremities of these bones. The knees, however, in the erect position remain in contact, and consequently the whole length of the woman's thigh bone slopes from above downwards and inwards. To this must be ascribed the typical feminine gait, which has a grace of its own, but which, if exaggerated, may lead to an undue roll, or even a waddle.

The muscles also undergo typical changes, those around the hip becoming relatively more developed than do those of the male. This, again, increases the comparative heaviness and

The Period of Physical Change

massiveness of the lower part of the female figure.

In addition to these changes in the bones of the skeleton and in the muscles, the girl, as adolescence progresses, tends to develop a certain amount of fat. In normal cases this is only sufficient to add to the beauty of the body, substituting soft curves and graceful outlines for the squareness and angularity of the male.

Changes in the organs. — Among the most obvious outward changes in the organs of the adolescent girl is the development of the breast. From birth up to puberty the breasts of the boy and girl remain flat, small, and undeveloped, but at the advent of puberty the girl's bust undergoes a great change. The gland itself increases not only in size, but also in complexity of structure. In many instances this true development is made to appear more marked than it really is, partly by the development of a certain amount of fat, and partly by the increase of size in the large chest muscles which throw the gland into greater prominence. The nipple, with its areola of delicately coloured tissue, becomes more obvious, and it is evident from the alterations in structure and appearance of the girl's body that the momentous change has been accomplished, and that we have before us a potential mother.

The internal changes in organs which cannot be seen during life are also marvellous. The womb, which had grown but little since infancy, and which had but a languid circulation, becomes larger, plumper, more richly supplied with blood, and its body— the part which is being prepared for the eventual conception of an infant — becomes larger in proportion to the neck, which had hitherto been its equal in length. The ovaries also undergo growth and development ; some of the primitive ovules enlarge, and in doing so begin to protrude a little from the general surface of the organ. One of them becomes fully ripe every twenty-eight days, is seized in the fringed extremity of the oviduct, and bursts, the contained germ cell passing along the tube into the uterus. The mucous membrane of the uterus, in sympathy with these ovarian changes, becomes greatly congested, and relief ensues with the occurrence of the periodic discharge — menstruation.

Changes in personal appearance. — In addition to the development of the bust and hips, a very considerable change occurs in the young girl's appearance. The hair becomes brighter in hue, glossier, and possibly more disposed to curl. The complexion clears and brightens, adding greatly to personal charm, while the eyes acquire a brightness and increased depth of expression which indicate the subtle changes occurring in the soul and spirit.

CHAPTER III ADVENT OF PUBERTY

As the word puberty implies, this time of hfe is associated with an increase in the growth of hair. Especially is this noticeable on the mons veneris and about the vulva, and in the axillae or armpits ; and together with the growth of hair comes the development in the skin of certain glands which secrete a somewhat oily material which is perfectly natural and healthy, but which necessitates a strict attention to cleanliness and a free use of a non-perfumed and non-irritating soap, such, for instance, as Castile soap or olive oil soap. This appearance of hair, L^ taken in conjunction with possibly a colourless discharge and the other changes described in the last chapter, should give the girl's mother ample warning that menstruation is imminent. She ought to tell her daughter what to expect, otherwise the girl may suffer a considerable nervous shock when the great event occurs. Much of a girl's happiness and health depends on her understanding the import of the changes that are occurring in her body. If she unfortunately beUeves that menstruation and its attendant

II phenomena are signs of illness, and if she is encouraged to treat them as if they were abnormalities, the foundation of nervous ill-health is likely to be laid. If, on the other hand, she is taught that these changes are beneficent, that they are necessary to her full development of womanhood, and that indeed they are the promise that after a few years she will be fit to receive the great crown and joy of a woman's life, motherhood, she will then view her condition not only with patience, but also with joy. The motherly instinct is deeply implanted in every young girl, and she will be wilhng, if necessary, to suffer restrictions on present enjoyment and activities in order that the change in her constitution may be satisfactorily accomplished, and that her health may be so well established as to enable her to play her part in life to the greatest advantage. The girl ought to be warned that some day she will find that she has a discharge of blood, or of blood-stained fluid, from the vagina, and that this discharge may be accompanied by feelings of lassitude and heaviness, by discomfort, and perhaps by pain. She must also be told that the amount and the duration of the discharge are uncertain. In these matters each girl and woman is a law unto herself, and equally good health may be maintained whether the monthly discharge (the period, as it is generally called) lasts

Advent of Puberty

three days or seven days, and whether the number of sanitary towels used daily during the first few days be two — the least demanded by decency and comfort — or three. The total number of diapers or sanitary towels that may be needed varies much, but probably any number under eight may be considered to denote scantiness, and any number over twelve profuseness of the discharge. These criteria are, of course, very rough, but they are sufficient to prevent girls who use half a dozen diapers from fearing that they are having a flooding, and, on the other hand, they would indicate to those who are using forty or more diapers that they need not desire medicine to increase the flow.*

A girl must also be warned that a certain amount of flow is especially likely to occur when she first rises from bed. Owing to partial closure of the vagina by the fold of mucous membrane termed the hymen, the discharge collects in the passage during the night and passes away when the erect position is assumed or the first urine is passed. The natural interval between the periods — ^that is to say, the time between the commencement of one period and the commencement of the next —is twenty-eight days ; that is, a lunar month, hence the word menstruation. But it is not to be considered

* Cases illustrative of these two errors were seen by me in one afternoon at the New Hospital for Women, Euston Road, abnormal or a sign of disease if there is some little deviation from this rule. The antedating or postponing of the period by two or three days does not constitute an irregularity.

Some mothers, and still more naturally some children, are very much perturbed if menstruation, after having occurred once, does not immediately become regular. It is, however, quite common for a girl to have a period, and then to see nothing more for six months or a year. This is especially likely to be the case when menstruation has commenced very early— for instance, at 11 or 12 years of age. Far from being a bad sign and indicating ill health, it is really better for so young a girl if the discharge occurs at longer intervals. Further than this, the first few periods are not to be taken as typical of the individual girl's future menstruation ; they may be longer or shorter, scantier or more profuse, at first, but after a time the function settles down and each woman establishes a rule for herself. It is only after the rule has become established that greater or less frequency, and more or less flow, can be considered to be abnormal for the individual.

It is also necessary to impress on mothers and children that pain, or the capacity for bearing pain, varies largely, and that whereas some young girls make light of the natural congestion and discomfort, others, with an un-

H

Advent of Puberty

fortunate capacity for appreciating pain, will consider the same amount of inconvenience to be a veritable illness. Undoubtedly pain varies in intensity, just as does the capacity for bearing it ; but, as a rule, in healthy girls under favourable circumstances neither the pain nor the discharge itself is sufficient to justify withdrawal from the usual duties and pleasures of life. The wise mother should know how to shield her child from undue exertion without making a monthly illness out of a natural function, and so setting up a false standard of health and disease in the mind of the inexperienced adolescent.

It should be easy to arrange that extra long walks, strenuous exercises, games, and dancing should be put aside during the first few days of each period; but in the case of the healthy girl it is most undesirable that too great a difference should be made in her life's routine, and that her own attention and that of her friends should be repeatedly drawn to what, after all, is a normal function. As a rule, it will be found that after a few years, when the function is thoroughly established, the young woman will be able to do very much as usual, and will not need to make any special arrangements for a few days monthly.

«S

CHAPTER IV ABNORMALITIES OF MENSTRUATION

Amenorrhoea, or absence of menstruation. —

The menstrual function may never develop, or, having developed, it may subsequently lapse. The causes of primary amenorrhoea, the variety in which menstruation has never developed, may be due to some deformity of structure in the«» generative organs or to a defect in the nervous mechanism. It is perfectly evident that if any of the organs concerned in the function of menstruation be absent or seriously defective, its phenomena will also be absent. There are cases, happily rare, in which there is a congenital absence of the ovaries, tubes, or uterus. It is very unusual for these organs to be entirely absent ; even in extreme cases some vestige of them is generally to be found. Much more frequently, primitive amenorrhoea is to be found in the case of girls who have altogether failed to undergo the usual developmental changes. In such subjects the breasts remain infantile, the pubes and axillae have little or no hair, and the parts of the vulva resemble those of children of 10 or 12 years of age. The internal organs like-

i6

Abnormalities of Menstruation

wise fail to develop, and the uterus may be found to be small, thin, flat, and with a mucous membrane showing no signs of preparation for function. In such cases little can be done, but an attempt should be made by the administration of suitable drugs, by prolonged treatment with electricity, and by nourishing and stimulating food, to assist the arrested development. Occult menstruation. — These cases resemble primitive amenorrhoea in the fact that no discharge has appeared, but the girls are often strong and well developed. The uterus and ovaries are well formed, and the nervous stimulation is perfect. The trouble is that there is some impediment to the exit of the menstrual fluid. Possibly the hymen is imperforate —thsit is to say, it has no opening — or some obstruction may exist in the vagina or uterus. In such cases the girl probably has all the symptoms of menstruation, and, indeed, a considerable amount of distress at regular monthly intervals, but she lacks the relief of the discharge. The abdomen slowly enlarges until a more or less considerable ; swelling may be felt in the lower part. In all such cases professional advice should be procured, and in almost all relief is safe and easy.

Secondary amenorrhoea. — ^The usual phenohena of puberty may have occurred, the periods have been estabhshed, and have been regular for a time, sometimes for years. Then, either gradually or perhaps suddenly, menstruation ceases, and both the girl and her mother "will be very anxious to know what is the cause, and whether it is remediable. There have been many old superstitions with regard to the absence of menstruation, and in many instances it is attributed to chill or over-fatigue of mind or body. If the chill be so serious as to endanger the general health or to permit of the development of serious disease, such as tuberculosis, then amenorrhoea may follow the chill, but it will be due to the disease, inflammatory, tubercular, etc., and not directly to the chill itself. Amenorrhoea is one of the symptoms of early phthisis, and therefore deserves immediate and careful attention; but it is always to be remembered that it is the phthisis, or other tubercular manifestation, that must be treated, and that if and when health returns the monthly function will return with it.