freedom, repose,
the cessation of the obligatory routine of
employment become
necessary. This is the opinion of Pinard, the chief
authority on
this matter. Many, however, fearing that economic
and industrial
conditions render so long a period of rest too
difficult of
practical attainment, are, with Clappier and G.
Newman, content
to demand two months as a minimum; Salvat only asks
for one
month's rest before confinement, the woman, whether
married or
not, receiving a pecuniary indemnity during this
period, with
medical care and drugs free. Ballantyne (_Manual of
Antenatal
Pathology: The Foetus_, p. 475), as well as Niven,
also asks only
for one month's compulsory rest during pregnancy,
with indemnity.
Arthur Helme, however, taking a more comprehensive
view of all
the factors involved, concludes in a valuable paper
on "The
Unborn Child: Its Care and Its Rights" (_British
Medical
Journal_, Aug. 24, 1907), "The important thing would be to
prohibit pregnant women from going to work at all,
and it is as
important from the standpoint of the child that this
prohibition
should include the early as the late months of
pregnancy."
In England little progress has yet been made as
regards this
question of rest during pregnancy, even as regards
the education
of public opinion. Sir William Sinclair, Professor
of Obstetrics
at the Victoria University of Manchester, has
published (1907) _A
Plea for Establishing Municipal Maternity Homes_.
Ballantyne, a
great British authority on the embryology of the
child, has
published a "Plea for a Pre-Maternity Hospital"
(_British Medical
Journal_, April 6, 1901), has since given an
important lecture on
the subject (_British Medical Journal_, Jan. 11,
1908), and has
further discussed the matter in his _Manual of Ante-
Natal
Pathology: The Foetus_ (Ch. XXVII); he is, however,
more
interested in the establishment of hospitals for the
diseases of
pregnancy than in the wider and more fundamental
question of rest
for all pregnant women. In England there are,
indeed, a few
institutions which receive unmarried women, with a
record of good
conduct, who are pregnant for the first time, for,
as
Bouchacourt remarks, ancient British prejudices are
opposed to
any mercy being shown to women who are recidivists
in committing
the crime of conception.
At present, indeed, it is only in France that the
urgent need of
rest during the latter months of pregnancy has been
clearly
realized, and any serious and official attempts made
to provide
for it. In an interesting Paris thesis (_De la
Puériculture avant
le Naissance_, 1907) Clappier has brought together
much
information bearing on the efforts now being made to
deal
practically with this question. There are many
_Asiles_ in Paris
for pregnant women. One of the best is the Asile
Michelet,
founded in 1893 by the Assistance Publique de Paris.
This is a
sanatorium for pregnant women who have reached a
period of seven
and a half months. It is nominally restricted to the
admission of
French women who have been domiciled for a year in
Paris, but, in
practice, it appears that women from all parts of
France are
received. They are employed in light and occasional
work for the
institution, being paid for this work, and are also
occupied in
making clothes for the expected baby. Married and
unmarried women
are admitted alike, all women being equal from the
point of view
of motherhood, and indeed the majority of the women
who come to
the Asile Michelet are unmarried, some being girls
who have even
trudged on foot from Brittany and other remote parts
of France,
to seek concealment from their friends in the
hospitable
seclusion of these refuges in the great city. It is
not the least
advantage of these institutions that they shield
unmarried
mothers and their offspring from the manifold evils
to which they
are exposed, and thus tend to decrease crime and
suffering. In
addition to the maternity refuges, there are
institutions in
France for assisting with help and advice those
pregnant women
who prefer to remain at home, but are thus enabled
to avoid the
necessity for undue domestic labor.
There ought to be no manner of doubt that when, as
is the case
to-day in our own and some other supposedly
civilized countries,
motherhood outside marriage is accounted as almost a
crime, there
is the very greatest need for adequate provision for
unmarried
women who are about to become mothers, enabling them
to receive
shelter and care in secrecy, and to preserve their
self-respect
and social position. This is necessary not only in
the interests
of humanity and public economy, but also, as is too
often
forgotten, in the interests of morality, for it is
certain that
by the neglect to furnish adequate provision of this
nature women
are driven to infanticide and prostitution. In
earlier, more
humane days, the general provision for the secret
reception and
care of illegitimate infants was undoubtedly most
beneficial. The
suppression of the mediæval method, which in France
took place
gradually between 1833 and 1862, led to a great
increase in
infanticide and abortion, and was a direct
encouragement to crime
and immorality. In 1887 the Conseil Général of the
Seine sought
to replace the prevailing neglect of this matter by
the adoption
of more enlightened ideas and founded a _bureau
secret
d'admission_ for pregnant women. Since then both the
abandonment
of infants and infanticide have greatly diminished,
though they
are increasing in those parts of France which
possess no
facilities of this kind. It is widely held that the
State should
unify the arrangements for assuring secret
maternity, and should,
in its own interests, undertake the expense. In 1904
French law
ensured the protection of unmarried mothers by
guaranteeing their
secret, but it failed to organize the general
establishment of
secret maternities, and has left to doctors the
pioneering part
in this great and humane public work (A. Maillard-
Brune,
_Refuges, Maternités, Bureaux d'Admission Secrets,
comme Moyens
Préservatives des Infanticide_, Thèse de Paris,
1908). It is not
among the least benefits of the falling birth rate
that it has
helped to stimulate this beneficent movement.
The development of an industrial system which
subordinates the human body
and the human soul to the thirst for gold, has, for a
time, dismissed from
social consideration the interests of the race and even of the individual,
but it must be remembered that this has not been always and everywhere so.
Although in some parts of the world the women of savage peoples work up to
the time of confinement, it must be remarked that the
conditions of work
in savage life do not resemble the strenuous and
continuous labor of
modern factories. In many parts of the world, however, women are not
allowed to work hard during pregnancy and every
consideration is shown to
them. This is so, for instance, among the Pueblo
Indians, and among the
Indians of Mexico. Similar care is taken in the
Carolines and the Gilbert
Islands and in many other regions all over the world. In some places,
women are secluded during pregnancy, and in others are compelled to
observe many more or less excellent rules. It is true
that the assigned
cause for these rules is frequently the fear of evil
spirits, but they
nevertheless often preserve a hygienic value. In many
parts of the world
the discovery of pregnancy is the sign for a festival of more or less
ritual character, and much good advice is given to the expectant mother.
The modern Musselmans are careful to guard the health of their women when
pregnant, and so are the Chinese.[6] Even in Europe, in the thirteenth
century, as Clappier notes, industrial corporations
sometimes had regard
to this matter, and would not allow women to work during pregnancy. In
Iceland, where much of the primitive life of
Scandinavian Europe is still
preserved, great precautions are taken with pregnant
women. They must lead
a quiet life, avoid tight garments, be moderate in
eating and drinking,
take no alcohol, be safeguarded from all shocks, while their husbands and
all others who surround them must treat them with
consideration, save them
from worry and always bear with them patiently.[7]
It is necessary to emphasize this point because we have to realize that
the modern movement for surrounding the pregnant woman with tenderness and
care, so far from being the mere outcome of civilized
softness and
degeneracy, is, in all probability, the return on a
higher plane to the
sane practice of those races which laid the foundations of human
greatness.
While rest is the cardinal virtue imposed on a woman
during the later
months of pregnancy, there are other points in her
regimen that are far
from unimportant in their bearing on the fate of the
child. One of these
is the question of the mother's use of alcohol.
Undoubtedly alcohol has
been a cause of much fanaticism. But the declamatory
extravagance of
anti-alcoholists must not blind us to the fact that the evils of alcohol
are real. On the reproductive process especially, on the mammary glands,
and on the child, alcohol has an arresting and
degenerative influence
without any compensatory advantages. It has been proved by experiments on
animals and observations on the human subject that
alcohol taken by the
pregnant woman passes freely from the maternal
circulation to the foetal
circulation. Féré has further shown that, by injecting alcohol and
aldehydes into hen's eggs during incubation, it is
possible to cause
arrest of development and malformation in the chick.[8]
The woman who is
bearing her child in her womb or suckling it at her
breast would do well
to remember that the alcohol which may be harmless to
herself is little
better than poison to the immature being who derives
nourishment from her
blood. She should confine herself to the very lightest of alcoholic
beverages in very moderate amounts and would do better still to abandon
these entirely and drink milk instead. She is now the
sole source of the
child's life and she cannot be too scrupulous in
creating around it an
atmosphere of purity and health. No after-influence can ever compensate
for mistakes made at this time.[9]
What is true of alcohol is equally true of other potent drugs and poisons,
which should all be avoided so far as possible during
pregnancy because of
the harmful influence they may directly exert on the
embryo. Hygiene is
better than drugs, and care should be exercised in diet, which should by
no means be excessive. It is a mistake to suppose that the pregnant woman
needs considerably more food than usual, and there is
much reason to
believe not only that a rich meat diet tends to cause
sterility but that
it is also unfavorable to the development of the child in the womb.[10]
How far, if at all, it is often asked, should sexual
intercourse be
continued after fecundation has been clearly
ascertained? This has not
always been found an easy question to answer, for in the human couple many
considerations combine to complicate the answer. Even
the Catholic
theologians have not been entirely in agreement on this point. Clement of
Alexandria said that when the seed had been sown the
field must be left
till harvest. But it may be concluded that, as a rule, the Church was
inclined to regard intercourse during pregnancy as at
most a venial sin,
provided there was no danger of abortion. Augustine,
Gregory the Great,
Aquinas, Dens, for instance, seem to be of this mind;
for a few, indeed,
it is no sin at all.[11] Among animals the rule is
simple and uniform; as
soon as the female is impregnated at the period of
oestrus she absolutely
rejects all advance of the male until, after birth and lactation are over,
another period of oestrus occurs. Among savages the
tendency is less
uniform, and sexual abstinence, when it occurs during
pregnancy, tends to
become less a natural instinct than a ritual observance, or a custom now
chiefly supported by superstitions. Among many primitive peoples
abstinence during the whole of pregnancy is enjoined
because it is
believed that the semen would kill the foetus.[12]
The Talmud is unfavorable to coitus during
pregnancy, and the
Koran prohibits it during the whole of the period,
as well as
during suckling. Among the Hindus, on the other
hand, intercourse
is continued up to the last fortnight of pregnancy,
and it is
even believed that the injected semen helps to
nourish the embryo
(W.D. Sutherland, "Ueber das Alltagsleben und die Volksmedizin
unter den Bauern Britischostindiens," _Münchener
Medizinische
Wochenschrift_, Nos. 12 and 13, 1906). The great
Indian physician
Susruta, however, was opposed to coitus during
pregnancy, and the
Chinese are emphatically on the same side.
As men have emerged from barbarism in the direction of civilization, the
animal instinct of refusal after impregnation has been completely lost in
women, while at the same time both sexes tend to become indifferent to
those ritual restraints which at an earlier period were almost as binding
as instinct. Sexual intercourse thus came to be
practiced after
impregnation, much the same as before, as part of
ordinary "marital
rights," though sometimes there has remained a faint suspicion, reflected
in the hesitating attitude of the Catholic Church
already alluded to, that
such intercourse may be a sinful indulgence. Morality
is, however, called
in to fortify this indulgence. If the husband is shut
out from marital
intercourse at this time, it is argued, he will seek
extra-marital
intercourse, as indeed in some parts of the world it is recognized that he
legitimately may; therefore the interests of the wife, anxious to retain
her husband's fidelity, and the interests of Christian morality, anxious
to uphold the institution of monogamy, combine to permit the continuation
of coitus during pregnancy. The custom has been
furthered by the fact
that, in civilized women at all events, coitus during
pregnancy is usually
not less agreeable than at other times and by some women is felt indeed to
be even more agreeable.[13] There is also the further
consideration, for
those couples who have sought to prevent conception,
that now intercourse
may be enjoyed with impunity. From a higher point of
view such intercourse
may also be justified, for if, as all the finer
moralists of the sexual
impulse now believe, love has its value not only in so far as it induces
procreation but also in so far as it aids individual
development and the
mutual good and harmony of the united couple, it becomes morally right
during pregnancy.
From an early period, however, great authorities have
declared themselves
in opposition to the custom of practicing coitus during pregnancy. At the
end of the first century, Soranus, the first of great
gynæcologists,
stated, in his treatise on the diseases of women, that sexual intercourse
is injurious throughout pregnancy, because of the
movement imparted to the
uterus, and especially injurious during the latter
months. For more than
sixteen hundred years the question, having fallen into the hands of the
theologians, seems to have been neglected on the medical side until in
1721 a distinguished French obstetrician, Mauriceau,
stated that no
pregnant woman should have intercourse during the last two months and that
no woman subject to miscarriage should have intercourse at all during
pregnancy. For more than a century, however, Mauriceau remained a pioneer
with few or no followers. It would be inconvenient, the opinion went, even
if it were necessary, to forbid intercourse during
pregnancy.[14]
During recent years, nevertheless, there has been an
increasingly strong
tendency among obstetricians to speak decisively
concerning intercourse
during pregnancy, either by condemning it altogether or by enjoining great
prudence. It is highly probable that, in accordance with the classical
experiments of Dareste on chicken embryos, shocks and
disturbances to the
human embryo may also produce injurious effects on
growth. The disturbance
due to coitus in the early stages of pregnancy may thus tend to produce
malformation. When such conditions are found in the
children of perfectly
healthy, vigorous, and generally temperate parents who have indulged
recklessly in coitus during the early stages of
pregnancy it is possible
that such coitus has acted on the embryo in the same way as shocks and
intoxications are known to act on the embryo of lower
organisms. However
this may be, it is quite certain that in predisposed
women, coitus during
pregnancy causes premature birth; it sometimes happens that labor pains
begin a few minutes after the act.[15] The natural
instinct of animals
refuses to allow intercourse during pregnancy; the
ritual observance of
primitive peoples very frequently points in the same
direction; the voice
of medical science, so far as it speaks at all, is
beginning to utter the
same warning, and before long will probably be in a
position to do so on
the basis of more solid and coherent evidence.
Pinard, the greatest of authorities on puericulture,
asserts that
there must be complete cessation of sexual
intercourse during the
whole of pregnancy, and in his consulting room at
the Clinique
Baudelocque he has placed a large placard with an
"Important
Notice" to this effect. Féré was strongly of opinion that sexual
relations during pregnancy, especially when
recklessly carried
out, play an important part in the causation of
nervous troubles
in children who are of sound heredity and otherwise
free from all
morbid infection during gestation and development;
he recorded in
detail a case which he considered conclusive
("L'Influence de
l'Incontinence Sexuelle pendant la Gestation sur la
Descendance,"
_Archives de Neurologie_, April, 1905). Bouchacourt
discusses the
subject fully (_La Grossesse_, pp. 177-214), and
thinks that
sexual intercourse during pregnancy should be
avoided as much as
possible. Fürbringer (Senator and Kaminer, _Health
and Disease in
Relation to Marriage_, vol. i, p. 226) recommends
abstinence from
the sixth or seventh month, and throughout the whole
of pregnancy
where there is any tendency to miscarriage, while in
all cases
much care and gentleness should be exercised.
The whole subject has been investigated in a Paris
Thesis by H.
Brénot (_De L'Influence de la Copulation pendant la
Grossesse_,
1903); he concludes that sexual relations are
dangerous
throughout pregnancy, frequently provoking premature
confinement
or abortion, and that they are more dangerous in
primiparæ than
in multiparæ.
Nearly everything that has been said of the hygiene of pregnancy, and the
need for rest, applies also to the period immediately
following the birth
of the child. Rest and hygiene on the mother's part
continue to be
necessary alike in her own interests and in the child's.
This need has
indeed been more generally and more practically
recognized than the need
for rest during pregnancy. The laws of several countries make compulsory a
period of rest from employment after confinement, and in some countries
they seek to provide for the remuneration of the mother during this
enforced rest. In no country, indeed, is the principle carried out so
thoroughly and for so long a period as is desirable. But it is the right
principle, and embodies the germ which, in the future, will be developed.
There can be little doubt that whatever are the matters, and they are
certainly many, which may be safely left to the
discretion of the
individual, the care of the mother and her child is not among them. That
is a matter which, more than any other, concerns the
community as a whole,
and the community cannot afford to be slack in asserting its authority
over it. The State needs healthy men and women, and by any negligen