Part 17

Montgomery, in the year 1850, was of the opinion that conception could occur apart from the previous influence of menstruation. For, as he said, if they are necessarily dependent the one on the other, “no woman could conceive at any time, except at, or just after, the menstrual period.” And in support of this he refers to instances of women who, having never menstruated, yet became pregnant, and also of girls who had borne children before they menstruated.

In such an event the left ovary would always be the first to operate. Nysten records the case of a girl of thirteen, who, having not yet menstruated, died at the Hotel Dieu, Paris; after death a tumour was found in the situation of her left ovary, having every appearance of a blighted fœtus. In my investigations I observed the case of a village girl of nineteen who became pregnant, and at seven months was taken seriously ill. Up to the actual moment of parturition, both the midwife and the girl’s mother refused to believe that the labour pains could betoken a possible pregnancy, as the patient had never menstruated; she gave birth to a premature female infant.

A young married woman, whom I met recently, gave birth to a baby girl, although she had not menstruated for two years before becoming pregnant, and could give no dates to her doctor for calculating the date of the babe’s arrival.

Mr. Whitehead, of Manchester, has given particulars of nine cases in which pregnancy occurred previous to menstruation. He did not give the sex of the offspring, but, according to all the evidence I have been able to collect, such pregnancies almost invariably result in female issue.

My explanation is that menstruation was either temporarily suppressed, or that it did occur, but was so scanty as hardly to be recognised for a normal period. We must, therefore, accept it as extremely unlikely that ovulation which, as before explained, is the discharge of a ripe ovum, can occur apart from the influence of menstruation.

Biologists, who at one time believed that ovulation must happen simultaneously with menstruation, found it difficult to account for the large numbers of conceptions occurring before the beginning of the catamenial flow, or after its complete cessation. The suggestion that the spermatozoa might lie in wait for the ovum is not reasonable, taking into consideration that the actual monthly discharge, when at its height, would almost certainly carry off the spermatozoon, which is still in the nature of a foreign body until it has fertilised the ovum.

Another popular idea is that ovulation and fertilisation are spontaneous. This implies a necessary state of consciousness and active responsiveness on the part of the female, which cannot be backed by any kind of circumstantial evidence. Too many examples exist of women who not only had no sensation during conception, but became pregnant under the influence of drugs, asphyxia, drunkenness or even deep sleep. Also the fact of rape, which has so often resulted in offspring, again disposes of the natural and perhaps more pleasant conclusion of mutual spontaneity in impregnation. It must strike one that nature seems to have made a slip in this respect, thereby involving in undue horrors and anxiety the victim of criminal assault.

According to Montgomery, a woman may be delivered during sleep, without being conscious even of first labour. This must be of rare occurrence, especially among women who have not previously borne children and whose organs are thus less disposed to dilate; it might be possible in warmer countries than those of Europe. A lady told me her first three children, born in India, gave her no trouble at all, but during her last three confinements in England she nearly lost her life each time; and it is well known that most Anglo-Indians prefer an Indian confinement to a home one. There is no doubt that the summer confinement is, as a rule, quicker and easier for the same patient than one occurring in winter.

But this is a digression. To return to my argument, there exists no biological fact to dispute the theory that the ovum, whether before or after the menstrual period, may lie for a few days awaiting fertilisation. It is entirely unreasonable to suppose that the catamenial flow might carry away, not only all belated spermatozoa, but even the ovum itself. So for that very reason, the ovum is discharged separately from the flow, although in direct relation to it. Thus, one month it is thrown out after the uterus has been emptied of its menstrual flow, and the next month it is thrown out before the period is due, and some seven or eight days previous to the actual discharge. This is the normal rule. The exception occurs when an abnormal ovary allows the ovum to escape during the period; even then it happens only after the bulk of the discharge has been eliminated from the ovary. Thus nature protects the ovum, which otherwise might well be carried away by the purifying process of the period at its height.

With reference to menstruation occurring during pregnancy, Montgomery says: “The safety of the ovum would appear incompatible with the profuse and frequently repeated discharge which some women experience, without abortion ensuing.” At the same time there appears to be no reason, anatomical or physiological, why a certain amount of menstrual discharge should not escape in the ordinary way, but, should it do so, it is bound to interfere with the well-being of the ovum.

A woman I knew had a fine boy whom she nursed, although menstruation started at the second month, and continued regularly. But her horror was great when she noticed that her figure was growing in size, and when the “quickening” at four months assured her that she was again pregnant, she weaned her boy at once; but the menses continued until she gave birth to a puny six-month boy, still-born as the result of this triple strain on the maternal constitution.

It is the apparently independent action of ovulation and menstruation which has so often puzzled biologists of all ages, affording, as it does, ample explanation of the doubts they have expressed as to the possibility of any allied action between them. Menstruation without ovulation may possibly take place, but can ovulation happen without menstruation? The presence in the ovary of the ripening Graafian follicle doubtless encourages the catamenial flow to start, in the one case before its actual rupture, and in the other seven days after it has burst and thrown out the ovum into the tube, but the menses may occur equally where ovulation is immature, faulty or entirely absent.

However this may be, it must be insisted on that conception during the actual flow cannot take place, for the reason that the embryo, in all probability, would be carried off with the bulk of the natural discharge. But after the second or third day this is usually scanty and slow, insufficient to disturb a possible fertilisation. Such happenings, however, are not desirable. However scant the discharge or even if it be quite dried up, the uterus should in no wise be disturbed before the eighth day.

Even so, where a “freak” ovary is suspected, should intercourse happen in the fruitless month, it is desirable to take a hot douche for three successive days after the seventh day of period. This clears away danger of conception from a “freak” ovary. Such a practice, further, is not only entirely harmless, but cleanly and productive of much local comfort and well-being. Where there is danger of undesirable fertilisation, it is the one and only decent means of avoiding such an occurrence; otherwise the alternative is to resort to “birth control” methods of a less healthy or desirable nature. Even in the fruitful month, healthy conception is not desirable before the eighth or ninth day of period, i.e. two or three days after the cessation of the actual flow.

Throughout this book I have endeavoured to make clear how it is possible to avoid such pitfalls. By adhering to the times and dates set forth in the preceding chapters, every healthy and regular woman can ensure the normal conception and pregnancy of a child, boy or girl as she desires. Not only is she assured of immunity from the advent of undesired offspring, but also the power is placed in her hands of limiting the number of her children, without having recourse to methods prejudicial alike to the sources of health and happiness.

XVIII

THE LENGTH OF GESTATION

“Truth remains true, the fault lies in the prover.”—BROWNING.

It has frequently been asked in the course of discussions on the alternate action of the ovaries, whether both take an active part in each pregnancy. We have seen that after the removal of one ovary, the other, in due course, takes to itself the work of both, doing double duty and thus allowing menstruation to proceed on more or less normal lines. Similarly it may be concluded that, supposing the right ovary has produced a fertile ovum, the left one will remain inactive during the whole period of pregnancy, ceasing both to ovulate and to menstruate. Thus, the entire alimentary discharge is left for the use of the right ovary, which by sole reason of its activity attracts and distributes the double supply. Moreover, the placenta is supplied direct from this ovary with sanguine nutrition wherewith to feed the fœtus, and it is interesting to note that Jaquemier specified anæmia in numbers of women as commencing after the middle period of pregnancy; this is accounted for by the huge supply of blood nutriment absorbed by the placenta feeding the fœtus.

Another theory, however, is that ovulation and menstruation of both ovaries do continue during gestation, but that the one ovary does not directly feed the ovum of its rival, but passes its alimentary fluid to the opposite side—by so doing directly helping to sustain the fœtus. But all evidence I have collected seems to point to the former theory. No doubt, in the case of mixed twins, both ovaries concur directly and alternatively in the nourishment of their own fertilised ova.

In post-mortems on women advanced in pregnancy, the corpus luteum has been found in the ovary whence came the embryo, according to its sex. While on the opposite side no fresh scars of false corpura lutea from recent menstruation were found, although within a few weeks these would certainly have shown a distinct yellow mark on the ovarian surface; from this we gather that the last false corpus luteum formed in that ovary appeared before the commencement of the pregnancy.

Another point that should be made quite clear is that relating to the duration of gestation, which differs according to the sex of the child. Dr. Chavasse was of the opinion that, as girls so often seemed to arrive at the beginning of the month as counted from the last period, they were evidently conceived after the period, whereas boys, he argued, arriving often at the end of the month and generally later than was expected, were evidently conceived at the end of the month and a few modern physicians still uphold this theory. But, needless to say, it is entirely erroneous. Chavasse says also he is inclined to believe that girls are carried longer than boys. This, again, is exactly the reverse of the facts, if we study them in a clear light, considering them as they actually are and not as they appear to be.

A boy takes longer to mature in the uterus than a female for two reasons:

1. He does not, as previously explained, find the preparation of decidua in the uterus; hence a slower development in the early stages.

2. He weighs at birth about 1 lb. more than the average girl; so he requires extra time in which to develop.

French medical authorities cherish the idea of longer girl-gestation for the reason that a female fœtus will, they say, often be carried fully thirty-nine weeks and she may even, though this is rare, be carried forty weeks, but when this happens in the case of a girl, the pregnancy becomes “protracted,” and the result is either an enormous child, weighing from 11 to 12 lbs., or an arrested and abnormal pregnancy. A boy usually goes his full thirty-nine weeks; often he is carried forty, or even sometimes forty-one weeks; thus, though begun after the period, he will yet run right on to the end of the ninth month, or into the tenth month of gestation.

Personally I have rarely met with the case of a girl-child of under 7 lbs. weight, carried beyond thirty-eight weeks; thirty-nine is the extreme normal limit, and results in a child weighing from 7-8 lbs. at least; forty weeks is abnormal. I know many families of girls where each was carried barely thirty-six or thirty-seven weeks; they were all healthy and normal, weighing from 5-7 lbs. It may be that the greater restlessness of the female fœtus hurries, to some extent, the process of girl-gestation; and the fact that anæmia is very frequent during girl-pregnancies may be the cause of less endurance in the mother, and helps to explain why girl-babies are carried a shorter time. It is never safe to count on a nine-month gestation with a girl. Real “full-time” girl-babies are exceptions to the rule, and often a mistake arises through the belief that a child was conceived two or three weeks previous to its real date of conception. Frequently mothers show me new-born babies weighing 4½ to 5 lbs., with the remark, “Yes, I carried her full-time; it was close on nine months since my last period when she was born,” and in nine cases out of ten these infants have been carried barely thirty-six weeks. Yet they grow and flourish as well as the “full-time” babies.

Anyone who has been in a position to await and watch, as I have, great numbers of births, cannot fail to have noticed that the girl baby comes unexpectedly early, often before preparations have been completed.