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THE PSYCHIC STATE IN PREGNANCY.

The Relationship of Maternal and Sexual Emotion—Conception and Loss of Virginity—The Anciently Accepted Signs of This Condition—The Pervading Effects of Pregnancy on the Organism—Pigmentation—The Blood and Circulation—The Thyroid—Changes in the Nervous System—The Vomiting of Pregnancy—The Longings of Pregnant Women—Maternal Impressions—Evidence for and Against Their Validity—The Question Still Open—Imperfection of Our Knowledge—The Significance of Pregnancy.

In analyzing the sexual impulse I have so far deliberately kept out of view the maternal instinct. This is necessary, for the maternal instinct is specific and distinct; it is directed to an aim which, however intimately associated it may be with that of the sexual impulse proper, can by no means be confounded with it. Yet the emotion of love, as it has finally developed in the world, is not purely of sexual origin; it is partly sexual, but it is also partly parental.^[169]

In so far as it is parental it is certainly mainly maternal. There is a drawing by Bronzino in the Louvre of a woman's head gazing tenderly down at some invisible object; is it her child or her lover? Doubtless her child, yet the expression is equally adequate to the emotion evoked by a lover. If we were here specifically dealing with the emotion of love as a complex whole, and not with the psychology of the sexual impulse, it would certainly be necessary to discuss the maternal instinct and its associated emotions. In any case it seems desirable to touch on the psychic state of pregnancy, for we are here concerned not only with emotions very closely connected with the sexual emotions in the narrower sense, but we here at last approach that state which it is the object of the whole sexual process to achieve.

In civilized life a period of weeks, months, even years, may elapse between the establishment of sexual relations and the occurrence of conception. Under primitive conditions the loss of the virginal condition practically involves the pregnant condition, so that under primitive conditions very little allowance is made for the state, so common among civilized peoples, of the woman who is no longer a virgin, yet not about to become a mother.

There is some interest in noting the signs of loss of virginity chiefly relied upon by ancient authors. In doing this it is convenient to follow mainly the full summary of authorities given by Schurig in his Barthenologia early in the eighteenth century. The ancient custom, known in classic times, of measuring the neck the day after marriage was frequently practiced to ascertain if a girl was or was not a virgin. There were various ways of doing this. One was to measure with a thread the circumference of the bride's neck before she went to bed on the bridal night. If in the morning the same thread would not go around her neck it was a sure sign that she had lost her virginity during the night; if not, she was still a virgin or had been deflowered at an earlier period. Catullus alluded to this custom, which still exists, or existed until lately, in the south of France. It is perfectly sound, for it rests on the intimate response by congestion of the thyroid gland to sexual excitement. (Parthenologia, p. 283; Biérent, La Puberté, p. 150; Havelock Ellis, Man and Woman, fourth edition, p. 267.)

Some say, Schurig tells us, that the voice, which in the virgin is shrill, becomes rougher and deeper after the first coitus. He quotes Riolan's statement that it is certain that the voice of those who indulge in venery is changed. On that account the ancients bound down the penis of their singers, and Martial said that those who wish to preserve their voices should avoid coitus. Democritus who one day had greeted a girl as "maiden" on the following day addressed her as "woman," while in the same way it is said that Albertus Magnus, observing from his study a girl going for wine for her master, knew that she had had sexual intercourse by the way because on her return her voice had become deeper. Here, again, the ancient belief has a solid basis, for the voice and the larynx are really affected by sexual conditions. (Parthenologia, p. 286; Marro, La Puberté, p. 303; Havelock Ellis, op. cit., pp. 271, 289.)

Others, again, Schurig proceeds, have judged that the goaty smell given out in the armpits during the venereal act is also no uncertain sign of defloration, such odor being perceptible in those who use much venery, and not seldom in harlots and the newly married, while, as Hippocrates said, it is not perceived in boys and girls. (Parthenologia, p. 286; cf. the previous volume of these Studies, "Sexual Selection in Man," p. 64.)

In virgins, Schurig remarks, the pubic hair is said to be long and not twisted, while in women accustomed to coitus it is crisper. But it is only after long and repeated coitus, some authors add, that the pubic hairs become crisp. Some recent observers, it may be remarked, have noted a connection between sexual excitation and the condition of the pubic hair in women. (Cf. the present volume, ante p. 127.)

A sign to which the old authors often attached much importance was furnished by the urinary stream. In the De Secretis Mulierum, wrongly attributed to Albertus Magnus, it is laid down that "the virgin urinates higher than the woman." Riolan, in his Anthropographia, discussing the ability of virgins to ejaculate urine to a height, states that Scaliger had observed women who were virgins emit urine in a high jet against a wall, but that married women could seldom do this. Bouaciolus also stated that the urine of virgins is emitted in a small stream to a distance with an acute hissing sound. (Parthenologia, p. 281.) A folk-lore belief in the reality of this influence is evidenced by the Picardy conte referred to already (ante, p. 53), "La Princesse qui pisse au dessus les Meules." There is no doubt a tendency for the various stresses of sexual life to produce an influence in this direction, though they act far too slowly and uncertainly to be a reliable index to the presence or the absence of virginity.

Another common ancient test of virginity by urination rests on a psychic basis, and appears in a variety of forms which are really all reducible to the same principle. Thus we are told in De Secretis Mulierum that to ascertain if a girl is seduced she should be given to eat of powdered crocus flowers, and if she has been seduced she immediately urinates. We are here concerned with auto-suggestion, and it may well be believed that with nervous and credulous girls this test often revealed the truth.

A further test of virginity discussed by Schurig is the presence of modesty of countenance. If a woman blushes her virtue is safe. In this way girls who have themselves had experience of the marriage bed are said to detect the virgin. The virgin's eyes are cast down and almost motionless, while she who has known a man has eyes that are bright and quick. But this sign is equivocal, says Schurig, for girls are different, and can simulate the modesty they do not feel. Yet this indication also rests on a fundamentally sound psychological basis. (See "The Evolution of Modesty," in the first volume of these Studies.)

In his Syllepsilogia (Section V, cap. I-II), published in 1731, Schurig discusses further the anciently recognized signs of pregnancy. The real or imaginary signs of pregnancy sought by various primitive peoples of the past and present are brought together by Ploss and Bartels, Das Weib, bd. i, Chapter XXVII.

Both physically and psychically the occurrence of pregnancy is, however, a distinct event. It marks the beginning of a continuous physical process, which cannot fail to manifest psychic reactions. A great center of vital activity—practically a new center, for only the germinal form of it in menstruation had previously existed—has appeared and affects the whole organism. "From the moment that the embryo takes possession of the woman," Robert Barnes puts it, "every drop of blood, every fiber, every organ, is affected."^[170]

A woman artist once observed to Dr. Stratz, that as the final aim of a woman is to become a mother and pregnancy is thus her blossoming time, a beautiful woman ought to be most beautiful when she is pregnant. That is so, Stratz replied, if her moment of greatest physical perfection corresponds with the early months of pregnancy, for with the beginning of pregnancy metabolism is increased, the color of the skin becomes more lively and delicate, the breasts firmer.^[171] Pregnancy may, indeed, often become visible soon after conception by the brighter eye, the livelier glance, resulting from greater vascular activity, though later, with the increase of strain, the face may tend to become somewhat thin and distorted. The hair, Barnes states, assumes a new vigor, even though it may have been falling out before. The temperature rises; the weight increases, even apart from the growth of the fœtus. The efflorescence of pregnancy shows itself, as in the blossoming and fecundated flower, by increased pigmentation.^[172] The nipples with their areolæ, and the mid-line of the belly, become darker; brown flecks (lentigo) tend to appear on the forehead, neck, arms, and body; while striæ—at first blue-red, then a brilliant white—appear on the belly and thighs, though these are scarcely normal, for they are not seen in women with very elastic skins and are rare among peasants and savages.^[173] The whole carriage of the woman tends to become changed with the development of the mighty seed of man planted within her; it simulates the carriage of pride with the arched back and protruded abdomen.^[174] The pregnant woman has been lifted above the level of ordinary humanity to become the casket of an inestimable jewel.

It is in the blood and the circulation that the earliest of the most prominent symptoms of pregnancy are to be found. The ever increasing development of this new focus of vascular activity involves an increased vascular activity in the whole organism. This activity is present almost from the first—a few days after the impregnation of the ovum—in the breasts, and quickly becomes obvious to inspection and palpation. Before a quite passive organ, the breast now rapidly increases in activity of circulation and in size, while certain characteristic changes begin to take place around the nipples.^[175] As a result of the additional work imposed upon it the heart tends to become slightly hypertrophied in order to meet the additional strain; there may be some dilatation also.^[176]

The recent investigations of Stengel and Stanton tend to show that the increase of the heart's work during pregnancy is less considerable than has generally been supposed, and that beyond some enlargement and dilatation of the right ventricle there is not usually any hypertrophy of the heart.

The total quantity of blood is raised. While increased in quantity, the blood appears on the whole to be somewhat depreciated in quality, though on this point there are considerable differences of opinion. Thus, as regards hæmoglobin, some investigators have found that the old idea as to the poverty of hæmoglobin in pregnancy is quite unfounded; a few have even found that the hæmoglobin is increased. Most authorities have found the red cells diminished, though some only slightly, while the white cells, and also the fibrin, are increased. But toward the end of pregnancy there is a tendency, perhaps due to the establishment of compensation, for the blood to revert to the normal condition.^[177]

It would appear probable, however, that the vascular phenomena of pregnancy are not altogether so simple as the above statement would imply. The activity of various glands at this time—well illustrated by the marked salivation which sometimes occurs—indicates that other modifying forces are at work, and it has been suggested that the changes in the maternal circulation during pregnancy may best be explained by the theory that there are two opposing kinds of secretion poured into the blood in unusual degree during pregnancy: one contracting the vessels, the other dilating them, one or the other sometimes gaining the upper hand. Suprarenal extract, when administered, has a vaso-constricting influence, and thyroid extract a vasodilating influence; it may be surmised that within the body these glands perform similar functions.^[178]

The important part played by the thyroid gland is indicated by its marked activity at the very beginning of pregnancy. We may probably associate the general tendency to vasodilatation during early pregnancy with the tendency to goitre; Freund found an increase of the thyroid in 45 per cent. of 50 cases. The thyroid belongs to the same class of ductless glands as the ovary, and, as Bland Sutton and others have insisted, the analogies between the thyroid and the ovary are very numerous and significant. It may be added that in recent years Armand Gautier has noted the importance of the thyroid in elaborating nucleo-proteids containing arsenic and iodine, which are poured into the circulation during menstruation and pregnancy. The whole metabolism of the body is indeed affected, and during the latter part of pregnancy study of the ingesta and egesta has shown that a storage of nitrogen and even of water is taking place.^[179] The woman, as Pinard puts it, forms the child out of her own flesh, not merely out of her food; the individual is being sacrificed to the species.

The changes in the nervous system of the pregnant woman correspond to those in the vascular system. There is the same increase of activity, a heightening of tension. Bruno Wolff, from experiments on bitches, concluded that the central nervous system in women is probably more easily excited in the pregnant than in the non-pregnant state, though he was not prepared to call this cerebral excitability "specific."^[180] Direct observations on pregnant women have shown, without doubt, a heightened nervous irritability. Reflex action generally is increased. Neumann investigated the knee-jerk in 500 women during pregnancy, labor, and the puerperium, and in a large number found that there was a progressive exaggeration with the advance of pregnancy, little or no change being observed in the early months; sometimes when no change was observed during pregnancy the knee-jerk still increased during labor, reaching its maximum at the moment of the expulsion of the fœtus; the return to the normal condition took place gradually during the puerperium. Tridandani found in pregnant women that though the superficial reflexes, with the exception of the abdominal, were diminished, the deep and tendon reflexes were markedly increased, especially that of the knee, these changes being more marked in primiparæ than in multiparæ, and more pronounced as pregnancy advanced, the normal condition returning with ten days after labor. Electrical excitability was sensibly diminished.^[181]

One of the first signs of high nervous tension is vomiting. As is well known, this phenomenon commonly appears early in pregnancy, and it is by many considered entirely physiological. Barnes regards it as a kind of safety valve, a regulating function, letting off excessive tension and maintaining equilibrium.^[182] Vomiting is, however, a convulsion, and is thus the simplest form of a kind of manifestation—to which the heightened nervous tension of pregnancy easily lends itself—that finds its extreme pathological form in eclampsia. In this connection it is of interest to point out that the pregnant woman here manifests in the highest degree a tendency which is marked in women generally, for the female sex, apart altogether from pregnancy, is specially liable to convulsive phenomena.^[183]

There is some slight difference of opinion among authorities as to the precise nature and causation of the sickness of pregnancy. Barnes, Horrocks and others regard it as physiological; but many consider it pathological; this is, for instance, the opinion of Giles. Graily Hewitt attributed it to flexion of the gravid uterus, Kaltenbach to hysteria, and Zaborsky terms it a neurosis. Whitridge Williams considers that it may be (1) reflex, or (2) neurotic (when it is allied to hysteria and amenable to suggestion), or (3) toxæmic. It really appears to lie on the borderland between healthy and diseased manifestations. It is said to be unknown to farmers and veterinary surgeons. It appears to be little known among savages; it is comparatively infrequent among women of the lower social classes, and, as Giles has found, women who habitually menstruate in a painless and normal manner suffer comparatively little from the sickness of pregnancy.

We owe a valuable study of the sickness of pregnancy to Giles, who analyzed the records of 300 cases. He concluded that about one-third of the pregnant women were free from sickness throughout pregnancy, 45 per cent. were free during the first three months. When sickness occurred it began in 70 per cent. of cases in the first month, and was most frequent during the second month. The duration varied from a few days to all through. Between the ages of 20 and 25 sickness was least frequent, and there was less sickness in the third than in any other pregnancy. (This corresponds with the conclusion of Matthews Duncan that 25 is the most favorable age for pregnancy.) To some extent in agreement with Guéniot, Giles believes that the vomiting of pregnancy is "one form of manifestation of the high nervous irritability of pregnancy." This high nervous tension may overflow into other channels, into the vascular and excretory system, causing eclampsia; into the muscular system, causing chorea, or, expending itself in the brain, give rise to hysteria when mild or insanity when severe. But the vagi form a very ready channel for such overflow, and hence the frequency of sickness in pregnancy. There are thus three main factors in the causation of this phenomenon: (1) An increased nervous irritability; (2) a local source of irritation; (3) a ready efferent channel for nervous energy. (Arthur Giles, "Observations on the Etiology of the Sickness of Pregnancy," Transactions Obstetrical Society of London, vol. xxv, 1894.)

Martin, who regards the phenomenon as normal, points out that when nausea and vomiting are absent or suddenly cease there is often reason to suspect something wrong, especially the death of the embryo. He also remarks that women who suffer from large varicose veins are seldom troubled by the nausea of pregnancy. (J. M. H. Martin, "The Vomiting of Pregnancy," British Medical Journal, December 10, 1904.) These observations may be connected with those of Evans (American Gynæcological and Obstetrical Journal, January, 1900), who attributes primary importance to the undoubtedly active factor of the irritation set up by the uterus, more especially the rhythmic uterine contractions; stimulation of the breasts produces active uterine contractions, and Evans found that examination of the breasts sufficed to bring on a severe attack of vomiting, while on another occasion this was produced by a vaginal examination. Evans believes that the purpose of these contractions is to facilitate the circulation of the blood through the large venous sinuses, the surcharging of the relatively stagnant pools with effete blood producing the irritation which leads to rhythmic contractions.

It is on the basis of the increased vascular and glandular activity and the heightened nervous tension that the special psychic phenomena of pregnancy develop. The best known, and perhaps the most characteristic of these manifestations, is that known as "longings." By this term is meant more or less irresistible desires for some special food or drink, which may be digestible or indigestible, sometimes a substance which the woman ordinarily likes, such as fruit, and occasionally one which, under ordinary circumstances, she dislikes, as in one case known to me of a young country woman who, when bearing her child, was always longing for tobacco and never happy except when she could get a pipe to smoke, although under ordinary circumstances, like other young women of her class, she was without any desire to smoke. Occasionally the longings lead to actions which are more unscrupulous than is common in the case of the same person at other times; thus in one case known to me a young woman, pregnant with her first child, insisted to her sister's horror on entering a strawberry field and eating a quantity of fruit. These "longings" in their extreme form may properly be considered as neurasthenic obsessions, but in their simple and less pronounced forms they may well be normal and healthy.

The old medical authors abound in narratives describing the longings of pregnant women for natural and unnatural foods. This affection was commonly called pica, sometimes citra or malatia. Schurig, whose works are a comprehensive treasure house of ancient medical lore, devotes a long chapter (cap. II) of his Chylologia, published in 1725, to pica as manifested mainly, though not exclusively, in pregnant women. Some women, he tells us, have been compelled to eat all sorts of earthy substances, of which sand seems the most common, and one Italian woman when pregnant ate several pounds of sand with much satisfaction, following it up with a draught of her own urine. Lime, mud, chalk, charcoal, cinders, pitch are also the desired substances in other cases detailed. One pregnant woman must eat bread fresh from the oven in very large quantities, and a certain noble matron ate 140 sweet cakes in one day and night. Wheat and various kinds of corn as well as of vegetables were the foods desired by many longing women. One woman was responsible for 20 pounds of pepper, another ate ginger in large quantities, a third kept mace under her pillow; cinnamon, salt, emulsion of almonds, treacle, mushrooms were desired by others. Cherries were longed for by one, and another ate 30 or 40 lemons in one night. Various kinds of fish—mullet, oysters, crabs, live eels, etc.—are mentioned, while other women have found delectation in lizards, frogs, spiders and flies, even scorpions, lice and fleas. A pregnant woman, aged 33, of sanguine temperament, ate a live fowl completely with intense satisfaction. Skin, wool, cotton, thread, linen, blotting paper have been desired, as well as more repulsive substances, such as nasal mucus and feces (eaten with bread). Vinegar, ice, and snow occur in other cases. One woman stilled a desire for human flesh by biting the nates of children or the arms of men. Metals are also swallowed, such as iron, silver, etc. One pregnant woman wished to throw eggs in her husband's face, and another to have her husband throw eggs in her face.

In the next chapter of the same work Schurig describes cases of acute antipathy which may arise under the same circumstances (cap. III, "De Nausea seu Antipathia certorum ciborum"). The list includes bread, meat, fowls, fish, eels (a very common repulsion), crabs, milk, butter (very often), cheese (often), honey, sugar, salt, eggs, caviar, sulphur, apples (especially their odor), strawberries, mulberries, cinnamon, mace, capers, pepper, onions, mustard, beetroot, rice, mint, absinthe, roses (many pages are devoted to this antipathy), lilies, elder flowers, musk (which sometimes caused vomiting), amber, coffee, opiates, olive oil, vinegar, cats, frogs, spiders, wasps, swords.

More recently Gould and Pyle (Anomalies and Curiosities of Medicine, p. 80) have briefly summarized some of the ancient and modern records concerning the longings of pregnant women.

Various theories are put forward concerning the causation of the longings of pregnant women, but none of these seems to furnish by itself a complete and adequate explanation of all cases. Thus it is said that the craving is the expression of a natural instinct, the system of the pregnant woman really requiring the food she longs for. It is quite probable that this is so in many cases, but it is obviously not so in the majority of cases, even when we confine ourselves to the longings for fairly natural foods, while we know so little of the special needs of the organism during pregnancy that the theory in any case is insusceptible of clear demonstration.

Allied to this theory is the explanation that the longings are for things that counteract the tendency to nausea and sickness. Giles, however, in his valuable statistical study of the longings of a series of 300 pregnant women, has shown that the percentage of women with longings is exactly the same (33 per cent.) among women who had suffered at some time during pregnancy from sickness as among the women who had not so suffered. Moreover, Giles found that the period of sickness frequently bore no relation to the time when there were cravings, and the patient often had cravings after the sickness had ceased.

According to another theory these longings are mainly a matter of auto-suggestion. The pregnant woman has received the tradition of such longings, persuades herself that she has such a longing, and then becomes convinced that, according to a popular belief, it will be bad for the child if the longing is not gratified. Giles considers that this process of auto-suggestion takes place "in a certain number, perhaps even in the majority of cases."^[184]

The Duchess d'Abrantès, the wife of Marshal Junot, in her Mémoires gives an amusing account of how in her first pregnancy a longing was apparently imposed upon her by the anxious solicitude of her own and her husband's relations. Though suffering from constant nausea and sickness, she had no longings. One day at dinner after the pregnancy had gone on for some months her mother suddenly put down her fork, exclaiming: "I have never asked you what longing you have!" She replied with truth that she had none, her days and her nights being occupied with suffering. "No envie!" said the mother, "such a thing was never heard of. I must speak to your mother-in-law." The two old ladies consulted anxiously and explained to the young mother how an unsatisfied longing might produce a monstrous child, and the husband also now began to ask her every day what she longed for. Her sister-in-law, moreover, brought her all sorts of stories of children born with appalling mother's marks due to this cause. She became frightened and began to wonder what she most wanted, but could think of nothing. At last, when eating a pastille flavored with pineapple, it occurred to her that pineapple is an excellent fruit, and one, moreover, which she had never seen, for at that time it was extremely rare. Thereupon she began to long for pineapple, and all the more when she was told that at that season they could not be obtained. She now began to feel that she must have pineapple or die, and her husband ran all over Paris, vainly offering twenty louis for a pineapple. At last he succeeded in obtaining one through the kindness of Mme. Bonaparte, and drove home furiously just as his wife, always talking of pineapples, had gone to bed. He entered the room with the pineapple, to the great satisfaction of the Duchess's mother. (In one of her own pregnancies, it appears, she longed in vain for cherries in January, and the child was born with a mark on her body resembling a cherry—in scientific terminology, a nævus.) The Duchess effusively thanked her husband and wished to eat of the fruit immediately, but her husband stopped her and said that Corvisart, the famous physician, had told him that she must on no account touch it at night, as it was extremely indigestible. She promised not to do so, and spent the night in caressing the pineapple. In the morning the husband came and cut up the fruit, presenting it to her in a porcelain bowl. Suddenly, however, there was a revulsion of feeling; she felt that she could not possibly eat pineapple; persuasion was useless; the fruit had to be taken away and the windows opened, for the very smell of it had become odious. The Duchess adds that henceforth, throughout her life, though still liking the flavor, she was only able to eat pineapple by doing a sort of violence to herself. (Mémories de la Duchesse d'Abrantès, vol. iii, Chapter VIII.) It should be added that, in old age, the Duchess d'Abrantès appears to have become insane.

The influence of suggestion must certainly be accepted as, at all events, increasing and emphasizing the tendency to longings. It can scarcely, however, be regarded as a radical and adequate explanation of the phenomenon generally. If it is a matter of auto-suggestion due to a tradition, then we should expect to find longings most frequent and most pronounced in multiparous women, who are best acquainted with the tradition and best able to experience all that is expected of a pregnant woman. But, as a matter of fact, the women who have borne most children are precisely those who are least likely to be affected by the longings which tradition demands they should manifest. Giles has shown that longings occur much more frequently in the first than in any subsequent pregnancy; there is a regular decrease with the increase in number of pregnancies until in women with ten or more children the longings scarcely occur at all.

We must probably regard longings as based on a physiological and psychic tendency which is of universal extension and almost or quite normal. They are known throughout Europe and were known to the medical writers of antiquity. Old Indian as well as old Jewish physicians recognized them. They have been noted among many savage races to-day: among the Indians of North and South America, among the peoples of the Nile and the Soudan, in the Malay archipelago.^[185] In Europe they are most common among the women of the people, living simple and natural lives.^[186]

The true normal relationship of the longings of pregnancy is with the impulsive and often irresistible longings for food delicacies which are apt to overcome children, and in girls often persist or revive through adolescence and even beyond. Such sudden fits of greediness belong to those kind of normal psychic manifestations which are on the verge of the abnormal into which they occasionally pass. They may occur, however, in healthy, well-bred, and well-behaved children who, under the stress of the sudden craving, will, without compunction and apparently without reflection, steal the food they long for or even steal from their parents the money to buy it. The food thus seized by a well-nigh irresistible craving is nearly always a fruit. Fruit is usually doled out to children in small quantities as a luxury, but we are descended from primitive human peoples and still more remote ape-like ancestors, by whom fruit was in its season eaten copiously, and it is not surprising that when that season comes round the child, more sensitive than the adult to primitive influences, should sometimes experience the impulse of its ancestors with overwhelming intensity, all the more so if, as is probable, the craving is to some extent the expression of a physiological need.

Sanford Bell, who has investigated the food impulses of children in America, finds that girls have a greater number of likes and dislikes in foods than boys of the same age, though at the same time they have less dislikes to some foods than boys. The proclivity for sweets and fruits shows itself as soon as a child begins to eat solids. The chief fruits liked are oranges, bananas, apples, peaches, and pears. This strong preference for fruits lasts till the age of 13 or 14, though relatively weaker from 10 to 13. In girls, however, Bell notes the significant fact from our present point of view that at mid-adolescence there is a revived taste for sweets and fruits. He believes that the growth of children in taste in foods recapitulates the experience of the race. (S. Bell, "An Introductory Study of the Psychology of Foods." Pedagogical Seminary, March, 1904.)

The heightened nervous impressionability of pregnancy would appear to arouse into activity those primitive impulses which are liable to occur in childhood and in the unmarried girl continue to the nubile age. It is a significant fact that the longings of pregnant women are mainly for fruit, and notably for so wholesome a fruit as the apple, which may very well have a beneficial effect on the system of the pregnant woman. Giles, in his tabulation of the foods longed for by 300 pregnant women, found that the fruit group was by far the largest, furnishing 79 cases; apples were far away at the head, occurring in 34 cases out of the 99 who had longings, while oranges followed at a distance (with 13 cases), and in the vegetable group tomatoes came first (with 6 cases). Several women declared "I could have lived on apples," "I was eating apples all day," "I used to sit up in bed eating apples."^[187] Pregnant women appear seldom to long for the possession of objects outside the edible class, and it seems doubtful whether they have any special tendency to kleptomania. Pinard has pointed out that neither Lasègue nor Lunier, in their studies of kleptomania, have mentioned a single shop robbery committed by a pregnant woman.^[188] Brouardel has indeed found such cases, but the object stolen was usually a food.

A further significant fact connecting the longings of pregnant women with the longings of children is to be found in the fact that they occur mainly in young women. We have, indeed, no tabulation of the ages of pregnant women who have manifested longings, but Giles has clearly shown that these chiefly occur in primiparæ, and steadily and rapidly decrease in each successive pregnancy. This fact, otherwise somewhat difficult of explanation, is natural if we look upon the longings of pregnancy as a revival of those of childhood. It certainly indicates also that we can by no means regard these longings as exclusively the expression of a physiological craving, for in that case they would be liable to occur in any pregnancy unless, indeed, it is argued that with each successive pregnancy the woman becomes less sensitive to her own physiological state.

There has been a frequent tendency, more especially among primitive peoples, to regard a pregnant woman's longings as something sacred and to be indulged, all the more, no doubt, as they are usually of a simple and harmless character. In the Black Forest, according to Ploss and Bartels, a pregnant woman may go freely into other people's gardens and take fruit, provided she eats it on the spot, and very similar privileges are accorded to her elsewhere. Old English opinion, as reflected, for instance, in Ben Jonson's plays (as Dr. Harriet C. B. Alexander has pointed out), regards the pregnant woman as not responsible for her longings, and Kiernan remarks ("Kleptomania and Collectivism," Alienist and Neurologist, November, 1902) that this is in "a most natural and just view." In France at the Revolution a law of the 28th Germinal, in the year III, to some extent admitted the irresponsibility of the pregnant woman generally,—following the classic precedent, by which a woman could not be brought before a court of justice so long as she was pregnant,—but the Napoleonic code, never tender to women, abrogated this. Pinard does not consider that the longings of pregnant women are irresistible, and, consequently, regards the pregnant woman as responsible. This is probably the view most widely held. In any case these longings seldom come up for medico-legal consideration.

The phenomena of the longings of pregnancy are linked to the much more obscure and dubious phenomena of the influence of maternal impressions on the child within the womb. It is true, indeed, that there is no real connection whatever between these two groups of manifestations, but they have been so widely and for so long closely associated in the popular mind that it is convenient to pass directly from one to the other. The same name is sometimes given to the two manifestations; thus in France a pregnant longing is an envie, while a mother's mark on the child is also called an envie, because it is supposed to be due to the mother's unsatisfied longing.

The conception of a "maternal impression" (the German Versehen) rests on the belief that a powerful mental influence working on the mother's mind may produce an impression, either general or definite, on the child she is carrying. It makes a great deal of difference whether the effect of the impression on the child is general, or definite and circumscribed. It is not difficult to believe that a general effect—even, as Sir Arthur Mitchell first gave good reason for believing, idiocy—may be produced on the child by strong and prolonged emotional influence working on the mother, because such general influence may be transmitted through a deteriorated blood-stream. But it is impossible at present to understand how a definite and limited influence working on the mother could produce a definite and limited effect on the child, for there are no channels of nervous communications for the passage of such influences. Our difficulty in conceiving of the process must, however, be put aside if the fact itself can be demonstrated by convincing evidence.

In order to illustrate the nature of maternal impressions, I will summarize a few cases which I have collected from the best medical periodical literature during the past fifteen years. I have exercised no selection and in no way guarantee the authenticity of the alleged facts or the alleged explanation. They are merely examples to illustrate a class of cases published from time to time by medical observers in medical journals of high repute.

Early in pregnancy a woman found her pet rabbit killed by a cat which had gnawed off the two forepaws, leaving ragged stumps; she was for a long time constantly thinking of this. Her child was born with deformed feet, one foot with only two toes, the other three, the os calcis in both feet being either absent or little developed. (G. B. Beale, Tottenham, Lancet, May 4, 1889).

Three months and a half before birth of the child the father, a glazier, fell through the roof of a hothouse, severely cutting his right arm, so that he was lying in the infirmary for a long time, and it was doubtful whether the hand could be saved. The child was healthy, but on the flexor surface of the radial side of the right forearm just above the wrist—the same spot as the father's injury—there was a nævus the size of a sixpence. (W. Russell, Paisley, Lancet, May 11, 1889.)

At the beginning of pregnancy a woman was greatly scared by being kicked over by a frightened cow she was milking; she hung on to the animal's teats, but thought she would be trampled to death, and was ill and nervous for weeks afterwards. The child was a monster, with a fleshy substance—seeming to be prolonged from the spinal cord and to represent the brain—projecting from the floor of the skull. Both doctor and nurse were struck by the resemblance to a cow's teats before they knew the woman's story, and this was told by the woman immediately after delivery and before she knew to what she had given birth. (A. Ross Paterson, Reversby, Lincolnshire, Lancet, September 29, 1889.)

During the second month of pregnancy the mother was terrified by a bullock as she was returning from market. The child reached full term and was a well-developed male, stillborn. Its head "exactly resembled a miniature cow's head;" the occipital bone was absent, the parietals only slightly developed, the eyes were placed at the top of the frontal bone, which was quite flat, with each of its superior angles twisted into a rudimentary horn. (J. T. Hislop, Tavistock, Devon, Lancet, November 1, 1890.)

When four months pregnant the mother, a multipara of 30, was startled by a black and white collie dog suddenly pushing against her and rushing out when she opened the door. This preyed on her mind, and she felt sure her child would be marked. The whole of the child's right thigh was encircled by a shining black mole, studded with white hairs; there was another mole on the spine of the left scapula. (C. F. Williamson, Horley, Surrey, Lancet, October 11, 1890.)

A lady in comfortable circumstances, aged 24, not markedly emotional, with one child, in all respects healthy, early in her pregnancy saw a man begging whose arms and legs were "all doubled up." This gave her a shock, but she hoped no ill effects would follow. The child was an encephalous monster, with the extremities rigidly flexed and the fingers clenched, the feet almost sole to sole. In the next pregnancy she frequently passed a man who was a partial cripple, but she was not unduly depressed; the child was a counterpart of the last, except that the head was normal. The next child was strong and well formed. (C. W. Chapman, London, Lancet, October 18, 1890.)

When the pregnant mother was working in a hayfield her husband threw at her a young hare he had found in the hay; it struck her on the cheek and neck. Her daughter has on the left cheek an oblong patch of soft dark hair, in color and character clearly resembling the fur of a very young hare. (A. Mackay, Port Appin, N. B., Lancet, December 19, 1891. The writer records also four other cases which have happened in his experience.)

When the mother was pregnant her husband had to attend to a sow who could not give birth to her pigs; he bled her freely, cutting a notch out of both ears. His wife insisted on seeing the sow. The helix of each ear of her child at birth was gone, for nearly or quite half an inch, as if cut purposely. (R. P. Roons, Medical World, 1894.)

A lady when pregnant was much interested in a story in which one of the characters had a supernumerary digit, and this often recurred to her mind. Her baby had a supernumerary digit on one hand. (J. Jenkyns, Aberdeen, British Medical Journal, March 2, 1895. The writer also records another case.)

When pregnant the mother saw in the forest a new-born fawn which was a double monstrosity. Her child was a similar double monstrosity (cephalothora copagus). (Hartmann, Münchener Medicinisches Wochenschrift, No. 9, 1895.)

A well developed woman of 30, who had ten children in twelve years, in the third month of her tenth pregnancy saw a child run over by a street car, which crushed the upper and back part of its head. Her own child was anencephalic and acranial, with entire absence of vault of skull. (F. A. Stahl, American Journal of Obstetrics, April, 1896.)

A healthy woman with no skin blemish had during her third pregnancy a violent appetite for sunfish. During or after the fourth month her husband, as a surprise, brought her some sunfish alive, placing them in a pail of water in the porch. She stumbled against the pail and the shock caused the fish to flap over the pail and come in violent contact with her leg. The cold wriggling fish produced a nervous shock, but she attached no importance to this. The child (a girl) had at birth a mark of bronze pigment resembling a fish with the head uppermost (photograph given) on the corresponding part of the same leg. Daughter's health good; throughout life she has had a strong craving for sunfish, which she has sometimes eaten till she has vomited from repletion. (C. F. Gardiner, Colorado Springs, American Journal Obstetrics, February, 1898.)

The next case occurred in a bitch. A thoroughbred fox terrier bitch strayed and was discovered a day or two later with her right foreleg broken. The limb was set under chloroform with the help of Röntgen rays, and the dog made a good recovery. Several weeks later she gave birth to a puppy with a right foreleg that was ill-developed and minus the paw. (J. Booth, Cork, British Medical Journal, September 16, 1899.)

Four months before the birth of her child a woman with four healthy children and no history of deformity in the family fell and cut her left wrist severely against a broken bowl; she had a great fright and shock. Her child, otherwise perfect, was born without left hand and wrist, the stump of arm terminating at lower end of radius and ulna. (G. Ainslie Johnston, Ambleside, British Medical Journal, April 18, 1903.)

The belief in the reality of the transference of strong mental or physical impressions on the mother into physical changes in the child she is bearing is very ancient and widespread. Most writers on the subject begin with the book of Genesis and the astute device of Jacob in influencing the color of his lambs by mental impressions on his ewes. But the belief exists among even more primitive people than the early Hebrews, and in all parts of the world.^[189] Among the Greeks there is a trace of the belief in Hippocrates, the first of the world's great physicians, while Soranus, the most famous of ancient gynæcologists, states the matter in the most precise manner, with instances in proof. The belief continued to persist unquestioned throughout the Middle Ages. The first author who denied the influence of maternal impressions altogether appears to have been the famous anatomist, Realdus Columbus, who was a professor at Padua, Pisa, and Rome at the beginning of the sixteenth century. In the same century, however, another and not less famous Neapolitan, Della Porta, for the first time formulated a definite theory of maternal impressions. A little later, early in the seventeenth century, a philosophic physician at Padua, Fortunatus Licetus, took up an intermediate position which still finds, perhaps reasonably, a great many adherents. He recognized that a very frequent cause of malformation in the child is to be found in morbid antenatal conditions, but at the same time was not prepared to deny absolutely and in every case the influence of maternal impression on such conditions. Malebranche, the Platonic philosopher, allowed the greatest extension to the power of the maternal imagination. In the eighteenth century, however, the new spirit of free inquiry, of radical criticism, and unfettered logic, led to a sceptical attitude toward this ancient belief then flourishing vigorously.^[190] In 1727, a few years after Malebranche's death, James Blondel, a physician of extreme acuteness, who had been born in Paris, was educated at Leyden, and practiced in London, published the first methodical and thorough attack on the doctrine of maternal impressions, The Strength of Imagination of Pregnant Women Examined, and exercised his great ability in ridiculing it. Haller, Roederer, and Sömmering followed in the steps of Blondel, and were either sceptical or hostile to the ancient belief. Blumenbach, however, admitted the influence of maternal impressions. Erasmus Darwin, as well as Goethe in his Wahlverwandtschaften, even accepted the influence of paternal impressions on the child. By the beginning of the nineteenth century the majority of physicians were inclined to relegate maternal impressions to the region of superstition. Yet the exceptions were of notable importance. Burdach, when all deductions were made, still found it necessary to retain the belief in maternal impressions, and Von Baer, the founder of embryology, also accepted it, supported by a case, occurring in his own sister, which he was able to investigate before the child's birth. L. W. T. Bischoff, also, while submitting the doctrine to acute criticism, found it impossible to reject maternal impressions absolutely, and he remarked that the number of adherents to the doctrine was showing a tendency to increase rather than diminish. Johannes Müller, the founder of modern physiology in Germany, declared himself against it, and his influence long prevailed; Valentin, Rudolf Wagner, and Emil du Bois-Reymond were on the same side. On the other hand various eminent gynæcologists—Litzmann, Roth, Hennig, etc.—have argued in favor of the reality of maternal impressions.^[191]

The long conflict of opinion which has taken place over this opinion has still left the matter unsettled. The acutest critics of the ancient belief constantly conclude the discussion with an expression of doubt and uncertainty. Even if the majority of authorities are inclined to reject maternal impressions, the scientific eminence of those who accept them makes a decisive opinion difficult. The arguments against such influence are perfectly sound: (1) it is a primitive belief of unscientific origin; (2) it is impossible to conceive how such influence can operate since there is no nervous connection between mother and child; (3) comparatively few cases have been submitted to severe critical investigation; (4) it is absurd to ascribe developmental defects to influences which arise long after the fœtus had assumed its definite shape^[192]; (5) in any case the phenomenon must be rare, for William Hunter could not find a coincidence between maternal impressions and fœtal marks through a period of several years, and Bischoff found no case in 11,000 deliveries. These statements embody the whole of the argument against maternal impressions, yet it is clear that they do not settle the matter. Edgar, in a manual of obstetrics which is widely regarded as a standard work, states that this is "yet a mooted question."^[193] Ballantyne, again, in a discussion of this influence at the Edinburgh Obstetrical Society, summarizing the result of a year's inquiry, concluded that it is still "sub judice."^[194] In a subsequent discussion of the question he has somewhat modified his opinion, and is inclined to deny that definite impressions on the pregnant woman's mind can cause similar defects in the fœtus; they are "accidental coincidences," but he adds that a few of the cases are difficult to explain away. At the same time he fully believes that prolonged and strongly marked mental states of the mother may affect the development of the fœtus in her uterus, causing vascular and nutritive disturbances, irregularities of development, and idiocy.^[195]

Whether and in how far mental impressions on the mother can produce definite mental and emotional disposition in the child is a special aspect of the question to which scarcely any inquiry has been devoted. So distinguished a biologist as Mr. A. W. Wallace has, however, called attention to this point, bringing forward evidence on the question and emphasizing the need of further investigation. "Such transmission of mental influence," he remarks, "will hardly be held to be impossible or even very improbable," (A. W. Wallace, "Prenatal Influences on Character," Nature, August 24, 1893.)

It has already been pointed out that a large number of cases of fœtal deformities, supposed to be due to maternal impressions, cannot possibly be so caused because the impression took place at a period when the development of the fœtus must already have been decided. In this connection, however, it must be noted that Dabney has observed a relationship between the time of supposed mental impressions and the nature of the actual defect which is of considerable significance as an argument in favor of the influence of mental impressions. He tabulated 90 carefully reported cases from recent medical literature, and found that 21 of them were concerned with defects of structure of the lips and palate. In all but 2 of these 21 the defect was referred to an impression occurring within the first three months of pregnancy. This is an important point as showing that the assigned cause really falls within a period when a defect of development actually could produce the observed result, although the person reporting the cases was in many instances manifestly ignorant of the details of embryology and teratology. There was no such preponderance of early impressions among the defects of skin and hair which might well, so far as development is concerned, have been caused at a later period; here, in 7 out of 15 cases, it was distinctly stated that the impression was made later than the fourth month.^[196]

It would seem, on the whole, that while the influence of maternal impressions in producing definite effects on the child within the womb has by no means been positively demonstrated, we are not entitled to reject it with any positive assurance. Even if we accept it, however, it must remain, for the present, an inexplicable fact; the modus operandi we can scarcely even guess at. General influences from the mother on the child we can easily conceive of as conveyed by the mother's blood; we can even suppose that the modified blood might act specifically on one particular kind of tissue. We can, again, as suggested by Féré, very well believe that the maternal emotions act upon the womb and produce various kinds and degrees of pressure on the child within, so that the apparently active movements of the fœtus may be really consecutive on unconscious maternal excitations.^[197] We may also believe that, as suggested by John Thomson, there are slight incoördinations in utero, a kind of developmental neurosis, produced by some slight lack of harmony of whatever origin, and leading to the production of malformations.^[198] We know, finally, that, as Féré and others have repeatedly demonstrated during recent years by experiments on chickens, etc., very subtle agents, even odors, may profoundly affect embryonic development and produce deformity. But how the mother's psychic disposition can, apart from heredity, affect specifically the physical conformation or even the psychic disposition of the child within her womb must remain for the present an insoluble mystery, even if we feel disposed to conclude that in some cases such action seems to be indicated.

In comprehending such a connection, however at present undemonstrated, it may well be borne in mind that the relationship of the mother to the child within her womb is of a uniquely intimate character. It is of interest in this connection to quote some remarks by an able psychologist, Dr. Henry Rutgers Marshall; the remarks are not less interesting for being brought forward without any connection with the question of maternal impressions: "It is true that, so far as we know, the nervous system of the embryo never has a direct connection with the nervous system of the mother: nevertheless, as there is a reciprocity of reaction between the physical body of the mother and its embryonic parasite, the relation of the embryonic nervous system to the nervous system of the mother is not very far removed from the relation of the pre-eminent part of the nervous system of a man to some minor nervous system within his body which is to a marked extent dissociated from the whole neural mass.

"Correspondingly, then, and within the consciousness of the mother, there develops a new little minor consciousness which, although but lightly integrated with the mass of her consciousness, nevertheless has its part in her consciousness taken as a whole, much as the psychic correspondents of the action of the nerve which govern the secretions of the glands of the body have their part in her consciousness taken as a whole.

"It is very much as if the optic ganglia developed fully in themselves, without any closer connection with the rest of the brain than existed at their first appearance. They would form a little complex nervous system almost but not quite apart from the brain system; and it would be difficult to deny them a consciousness of their own; which would indeed form part of the whole consciousness of the individual, but which would be in a manner self-dependent." It must, if this is so, be said that before birth, on the psychic side, the embryo's activities "form part of a complex consciousness which is that of the mother and embryo together." "Without subscribing to the strange stories of telepathy, of the solemn apparition of a person somewhere at the moment of his death a thousand miles away, of the unquiet ghost haunting the scenes of its bygone hopes and endeavors, one may ask" (with the author of the address in medicine at the Leicester gathering of the British Medical Association, British Medical Journal, July 29, 1905) "whether two brains cannot be so tuned in sympathy as to transmit and receive a subtile transfusion of mind without mediation of sense. Considering what is implied by the human brain with its countless millions of cells, its complexities of minute structure, its innumerable chemical compositions, and the condensed forces in its microscopic and ultramicroscopic elements—the whole a sort of microcosm of cosmic forces to which no conceivable compound of electric batteries is comparable; considering, again, that from an electric station waves of energy radiate through the viewless air to be caught up by a fit receiver a thousand miles distant, it is not inconceivable that the human brain may send off still more subtile waves to be accepted and interpreted by the fitly tuned receiving brain. Is it, after all, mere fancy that a mental atmosphere or effluence emanates from one person to affect another, either soothing sympathetically or irritating antipathically?" These remarks (like Dr. Marshall's) were made without reference to maternal impressions, but it may be pointed out that under no conceivable circumstance could we find a brain in so virginal and receptive a state as is the child's in the womb.

On the whole we see that pregnancy induces a psychic state which is at once, in healthy persons, one of full development and vigor, and at the same time one which, especially in individuals who are slightly abnormal, is apt to involve a state of strained or overstrained nervous tension and to evoke various manifestations which are in many respects still imperfectly understood. Even the specifically sexual emotions tend to be heightened, more especially during the earlier period of pregnancy. In 24 cases of pregnancy in which the point was investigated by Harry Campbell, sexual feeling was decidedly increased in 8, in one case (of a woman aged 31 who had had four children) being indeed only present during pregnancy, when it was considerable; in only 7 cases was there diminution or disappearance of sexual feeling.^[199] Pregnancy may produce mental depression;^[200] but on the other hand it frequently leads to a change of the most favorable character in the mental and general well-being. Some women indeed are only well during pregnancy. It is remarkable that some women who habitually suffer from various nervous troubles—neuralgias, gastralgia, headache, insomnia—are only free from them at this moment. This "paradox of gestation," as Vinay has termed it, is specially marked in the hysterical and those suffering from slight nervous disorders, but it is by no means universal, so that although it is possible, Vinay states, to confirm the opinion of the ancients as to the beneficial action of marriage on hysteria, that is only true of slight cases and scarcely enables us to counsel marriage in hysteria.^[201] Even a woman's intelligence is sometimes heightened by pregnancy, and Tarnier, as quoted by Vinay, knew many women whose intelligence, habitually somewhat obtuse, has only risen to the normal level during pregnancy.^[202] The pregnant woman has reached the climax of womanhood; she has attained to that state toward which the periodically recurring menstrual wave has been drifting her at regular intervals throughout her sexual life^[203]; she has achieved that function for which her body has been constructed, and her mental and emotional disposition adapted, through countless ages.

And yet, as we have seen, our ignorance of the changes effected by the occurrence of this supremely important event—even on the physical side—still remains profound. Pregnancy, even for us, the critical and unprejudiced children of a civilized age, still remains, as for the children of more primitive ages, a mystery. Conception itself is a mystery for the primitive man, and may be produced by all sorts of subtle ways apart from sexual connection, even by smelling a flower.^[204] The pregnant woman was surrounded by ceremonies, by reverence and fear, often shut up in a place apart.^[205] Her presence, her exhalations, were of extreme potency; even in some parts of Europe to-day, as in the Walloon districts of Belgium, a pregnant woman must not kiss a child for her breath is dangerous, or urinate on plants for she will kill them.^[206] The mystery has somewhat changed its form; it still remains. The future of the race is bound up with our efforts to fathom the mystery of pregnancy. "The early days of human life," it has been truly said, "are entirely one with the mother. On her manner of life—eating, drinking, sleeping, and thinking—what greatness may not hang?"^[207] Schopenhauer observed, with misapplied horror, that there is nothing a woman is less modest about than the state of pregnancy, while Weininger exclaims: "Never yet has a pregnant woman given expression in any form—poem, memoirs, or gynæcological monograph—to her sensations or feelings."^[208] Yet when we contemplate the mystery of pregnancy and all that it involves, how trivial all such considerations become! We are here lifted into a region where our highest intelligence can only lead us to adoration, for we are gazing at a process in which the operations of Nature become one with the divine task of Creation.

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