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THE PROSPECTIVE MOTHER
A Handbook for Women During Pregnancy
J. MORRIS SLEMONS
Associate Professor of Obstetrics, The Johns Hopkins University.
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This book, written for women who have no special knowledge of medicine, aims to answer the questions which occur to them in the course of pregnancy. Directions for safeguarding their health have been given in detail, and emphasis has been placed upon such measures as may serve to prevent serious complications. Treatment of such conditions has not been discussed, as it can be judiciously carried out only by a physician who has the opportunity to observe and study the individual patient. Furthermore, if there is to be notable improvement in the management of cases of childbirth, the appearance of untoward symptoms should not be awaited before consulting a physician; on the contrary, prospective mothers must be taught that they should be under competent medical supervision throughout pregnancy.
At present intelligent women demand some knowledge of the anatomical and physiological changes incident to the development of the embryo and the birth of the child. These subjects do not readily lend themselves to popular description, but I have told the story as simply as possible, following in a general way the text-book of my teacher and friend, Professor J. Whitridge Williams; indeed, my main purpose has been to reproduce his book "in words of one syllable." The use of a number of technical words has been unavoidable, and, though their meaning has been given in the context, it has not been feasible to repeat the definition every time an unfamiliar term was used. On that account a glossary has been provided.
It is with pleasure that I avail myself of this opportunity to acknowledge the cheerfully given assistance of many friends. In particular I wish to thank Doctor Henry M. Hurd, until recently Superintendent of the Johns Hopkins Hospital, for his interest and advice. I am also under deep obligation to my friend John C. French, of the English Department of the Johns Hopkins University, for helpful criticism of the manuscript, and to my colleagues, Doctors Rupert Norton and Thomas R. Boggs, for valuable assistance. To many others--doctors, nurses, and patients--I am indebted for numerous suggestions which have been made either consciously or unconsciously.
J. MORRIS SLEMONS.
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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. Physicians have also learned that the most effective method of coping with other serious complications of pregnancy and labor is by preventing their occurrence, or at least by subjecting them to treatment in their earliest stages; for, if they be allowed to go on to full development, the results are little better than in times past. Furthermore, a careful examination some weeks before the expected date of confinement enables us to recognize the existence of abnormal presentations and of disproportion between the size of the mother's pelvis and that of the child's head. Timely recognition of such conditions makes appropriate treatment possible and practically insures a successful outcome; while tardy recognition is frequently followed by disastrous results.
These few examples give some idea of the benefits of prophylaxis in the practice of obstetrics. Prospective mothers should understand not only that there is an advantage in taking such precautions, but that they may be risking their lives, or at least their future well-being, unless they insist upon competent medical attention. It is true, of course, that pregnancy and childbirth are generally normal processes, but they are not always so. Fortunately, most of the abnormalities give timely warning of their occurrence, and in most instances may be relieved by comparatively simple measures; or, if not, they afford indications for treatment which should lead to a happy termination. The recognition of the existence of such conditions, however, is not always easy, and their ideal treatment requires careful training and sometimes the utmost nicety of judgment. Consequently, if prospective mothers wish to be assured of the best care, they should be cautious in the choice of their medical attendant. As the ordinary layman has no means of determining the real qualifications of a physician, the choice should not be made upon the advice of casual acquaintances; but, instead, the family physician should be consulted, who, should he feel unwilling to assume the responsibility of the case, will be able to recommend a thoroughly competent substitute.
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. For these reasons a physician should be chosen only after mature deliberation, and his services should be esteemed much more highly than is usually the case.
In order that the principles of prevention may receive their fullest application during pregnancy, labor, and the lying-in period, it is also advisable that intelligent women should possess some knowledge of the Reproductive Process in human beings. This information is imparted by Doctor Slemons' book, which I can thoroughly recommend to prospective mothers. The subject matter has been carefully chosen, and the author has wisely refrained from giving advice with regard to treatment which can be satisfactorily directed only after careful study by a physician. At the same time he has given a clear account of the physiology of pregnancy and labor, and has laid down sound rules for the guidance of the patient.
One of the most important facts emphasized by Doctor Slemons is the value of medical supervision for several weeks after the child is born; this precaution contributes greatly toward a rapid and complete convalescence. During the lying-in period the physician should supervise the care of the mother and the child, should insist upon the necessity for maternal nursing, and should keep the mother under observation until perfectly normal conditions are regained. If the latter duty is conscientiously fulfilled many years of invalidism may be saved and thousands of operations rendered unnecessary.
Although there have been notable advances in the science and in the art of obstetrics since the middle of the eighteenth century, a great many fundamental facts must yet be learned. For example, we are almost totally ignorant of the stimulus which causes the mother to fall into labor approximately 280 days after the last normal menstruation.
There are two points which I desire to impress especially upon the readers of this book. Firstly, that the advance of the science of obstetrics, and consequently improvements in its practice, must depend greatly upon the cooperation of intelligent women. They must come to realize that they will secure the best treatment only as they demand the highest standard of excellence from their attendants; and they can aid in securing this for their poorer sisters and their children by interesting themselves in obstetrical charities.
Secondly, they must realize that real progress in the science of obstetrics can be expected to proceed only from well equipped clinics connected with strong universities, and in charge of thoroughly trained and broad-minded men. As yet such institutions scarcely exist in this country. Women who are anxious to promote the welfare of their sex can find no better way of doing so than by bringing this need to the attention of wealthy men interested in philanthropy and education. Furthermore, they should bear in mind that most of our important discoveries would not have been made had animal experimentation not been available, as it is solely by this means that modern surgical and obstetrical technique has been brought to its present degree of perfection; and further progress can scarcely be expected without its aid. They should remember also that whenever they take such a well-known drug as ergot for the control of bleeding, or make use of many other apparently simple measures, they are unconsciously rendering tribute to this type of investigation.
J. WHITRIDGE WILLIAMS.
Johns Hopkins University, September, 1912.
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I. THE SIGNS OF PREGNANCY AND THE DATE OF CONFINEMENT II. THE DEVELOPMENT OF THE OVUM III. THE EMBRYO IV. THE FOOD REQUIREMENTS DURING PREGNANCY V. THE CARE OF THE BODY VI. GENERAL HYGIENIC MEASURES VII. THE AILMENTS OF PREGNANCY VIII. MISCARRIAGE IX. THE PREPARATIONS FOR CONFINEMENT X. THE BIRTH OF THE CHILD XI. THE LYING-IN PERIOD XII. THE NURSING MOTHER
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