THE “ABDOMINAL METHOD” 
OF 
SINGING AND BREATHING 
AS A CAUSE OF 
“FEMALE WEAKNESSES.” 
CLIFTON E. WING, M.D., Boston. “ ABDOMINAL METHOD” OF SINGING AND BREATHING 
THE 
AS A CAUSE OF “FEMALE WEAKNESSES.”* 
Clifton E. Wing, M.D., Boston. 
The following cases, all happening under observation within a 
comparatively short time, have seemed to me sufficiently interesting to 
warrant their publication. The calling of attention to a possible 
danger that, as a rule, is not suspected or dreamed of by singers or 
their instructors, may lead to the use of the ounce of prevention 
which in the case of uterine troubles is often worth much more than 
the pound of cure. At the present time so many of our young 
women are practising, and so many instructors are teaching, singing 
(and, in courses in elocution, breathing) by what is termed the “ab- 
dominal method ” that the matter is not without importance. 
Case I. The first patient was a young unmarried lady, a resi- 
dent of this city, who had previously enjoyed excellent health. 
Eleven months before she consulted me she began to suffer with 
pain in her back and sides, “bearing down,” and, with these local 
symptoms, great depression of spirits. At about the same time her 
menses, which previously had come regularly each four and a half 
weeks, became more frequent and profuse. She found that occa- 
sionally after walking her symptoms were aggravated. For three 
months she had been troubled with frequent desire to pass water. 
She suffered with constipation, and movements of the bowels were 
at times painful. 
The lady had come to consult me because, as she said, she felt 
sure, from having heard from other sufferers with uterine troubles 
their symptoms, that she had the same trouble herself. Upon my 
asking what she thought could have induced such a difficulty, she at 
once replied that she felt certain that she had injured herself by 
singing by the “ abdominal method,” which she had taken much inte- 
rest in and had practised a good deal; that from the first it had 
made her feel badly, when she had previously been well; that, find- 
* A paper read before the Boston Society for Medical Improvement, at its meeting, 
November 22, 1880, and communicated to the Boston Medical and Surgical Journal. 2 
ing she always was worse after singing, she gave it up for a while, 
when her symptoms at once improved and menstruation became less 
frequent; that getting better, and thinking that, perhaps, after all, 
her singing exercises had had little to do with her past symptoms, 
she again resumed them, when her troubles returned, and she finally 
became worse than ever. She ended by asking me if I did not 
think she was right. Knowing nothing about singing, and not really 
understanding what she meant by the “ abdominal method,” I did not 
express a decided opinion. In fact, I gave little attention to her 
idea. Proceeding to make my examination, I found a well-marked 
displacement of the womb, that organ being thrown completely 
backward. 
There is nothing particularly instructive in the further history of 
the case. A prolapsed ovary gave considerable trouble in the fit- 
ting of a comfortable supporter, but there were no adhesions; the parts 
were finally replaced, and the uncomfortable feelings in the back of 
the neck and the top of the head, and, as the patient expressed it, 
u the total inability to think properly,” which were at times marked, 
as often (although not always) is the case with uterine ailments, 
were greatly relieved. For a time the patient could scarcely believe 
that the improvement in her mental feelings was all due to improve- 
ment in the local condition; but when, not long ago, she dispensed with 
her supporter for a while, with the result that the womb again fell 
backwards, with a return of all the head symptoms, which again dis- 
appeared with the readjustment of the pessary, she became con- 
vinced. 
Case 11. The lady was thirty years old, and had been married 
seven years. Never pregnant. Menstruation, which was established 
at the age of thirteen, before marriage had always been painful. 
Since her marriage she had been free from pain at those pe- 
riods. She consulted me the first time for leucorrhoea and local ir- 
ritation, which I judged from her story to be due to a simple inflam- 
mation of the vagina. She at this time had no marked uterine 
symptoms, and I did not deem an examination necessary, but pre- 
scribed some simple injections, telling her if she did not get better 
in a short time I would then investigate the case more thoroughly. 
In a few days she reported herself as so much relieved that she thought 
further treatment unnecessary. I did not see her again, profession- 
ally, for about five months, when I was called to the house, and found 
her in bed, suffering with acute pain in the small of her back and 
across her hips, and unable to stand, walk, or even move in her bed 
without increasing her sufferings. Making a uterine examination, I 
found the womb turned backward toward the hollow of the sacrum, 
pressed low down in the pelvis, acutely congested, and very tender. 
There was no inflammation in the neighborhood. 3 
Here, again, I was asked if “ abdominal singing ” could have pro- 
duced the displacement, and, on inquiring into the matter, learned 
the following story : The lady had been taking instruction in sing- 
ing for some months. Hearing of another teacher who was said to 
be remarkably good, and to have a “ new method,” she had gone to 
her, taking her first lesson on the previous Friday (I was called to 
see her on a Monday morning). She had gone to the teacher, ac- 
cording to directions, wearing no corsets, that she might be free to 
go through the necessary movements and manipulations. After the 
lesson she went home, feeling “ dreadfully” in the pelvic region, but 
never for a moment supposing that she could in this way do herself 
serious harm, she repeated the exercises on the next day, after 
which she felt still worse, and taking a horse-car home was scarcely 
able to get from the car to the house, on account of the pain in her back 
and sides, “bearing down,” and “feelings as though she was coming 
to pieces.” Symptoms such as these she had never before experi- 
enced. She immediately took to her bed, where she remained up to 
the time that I saw her. 
The parts were replaced and a supporter was fitted. The patient 
wore it for a few months, after which it was dispensed with. I re- 
cently met her, and she told me she remained perfectly well. It 
was lucky for her that her symptoms were so acute at the outset, 
for had the case not received the early attention which it did she 
would not have been able to do without the supporter so.soon. It 
is unnecessary to add that she has not resumed the singing exercises. 
Case 111. Miss 8., aged twenty, single. Menstruation began at 
fifteen, and always is pretty regular. Time of flow, four days. 
Amount normal. Has always had some pain the first day when 
unwell, but lately the pain has been getting worse, and has lasted 
longer. For some months she has noticed that she has not been able 
to walk, as she formerly could, without getting tired out. Lately she 
has had pain across the abdomen and low down in each side, and has 
been unable to sit any length of time without a severe pain in the 
back, which latter pain makes it difficult for her to rise after having 
been seated, and is always worse when she is unwell or after she 
has walked any distance. Suffers with constipation. Micturition 
not especially troublesome. Is “ depressed in spirits.” 
Six months before seen she began a course of instruction in sing- 
ing by the “ abdominal method.” At this time, as she states, she 
was in excellent health. At about the time she began the method 
she was warned by the lady whose case is the first one I report, with 
whom she was acquainted, to be careful and not injure herself, as 
she had done, and this friend even went so far as to see her teacher 
and ask her to take especial care to prevent such a result. The 
latter, although she did not believe such harm could result from these 4 
singing exercises, undoubtedly was as careful as she could be. Un- 
der the coarse of instruction the voice was thought to be decidedly 
improved, and it became much more powerful. (A like result was 
noticed in the case of the first patient.) Her progress, so far as 
the singing was concerned, was eminently satisfactory, and she was 
told that she had “got the method right;” but soon after she entered 
upon the course her local symptoms began to appear, and they grew 
gradually worse, until she was so poorly that she deemed it best to 
take medical advice. On uterine examination I again found a com- 
plete displacement of the womb backward. 
I asked the patient, who was quite positive as to what had brought 
on her trouble, if she could not think of some cause other than her 
singing. She replied that she could think of nothing else. She had 
noticed that she always felt worse after singing, and lately it had 
really hurt her each time. 
I fitted a proper supporter, which the patient is still wearing. 
She is now feeling quite nicely. Recently, as an experiment, she 
sang a little, when her old symptoms again began to show themselves. 
Case IY. The fourth case is of value here as evidence in the 
same direction. The patient was seen by me in consultation with a 
physician of this city, who had recently been called in, and who 
requested me to assume the case. The lady was twenty-three, mar- 
ried, and the mother of two children, the youngest eighteen months 
old. She was having backache, “ bearing down on walking,” “ pain 
in the womb,” etc. etc., which were easily accounted for by the 
large, congested, tender, “ sagging uterus ” found on examination. 
Under appropriate treatment she was getting along nicely, and had 
become quite free from pains and aches, when one day, at my office, 
she said she wanted to ask me a question, which was this: “ Doctor, 
can Ido myself harm by singing ? Is it possible for any one to 
cause uterine trouble in that way ?” Rather surprised, I asked her 
if she had heard so. She replied that she had never heard the sub- 
ject mentioned, but was disposed to think so because, having recently 
sung, a thing she had not attempted before for a considerable time, 
she had noticed that "bad bearing down ” followed. Asking what 
method she used in singing, the reply was, “ The abdominal method.” 
I would call attention to the fact that eacli of these patients, of 
her own accord and without my having suggested the idea, advanced 
the opinion that the singing had caused the troubles. Indeed, until 
the cases repeated themselves, knowing nothing of the method in 
question, I was not disposed to adopt their opinion. 
Becoming interested in the matter, I applied to Dr. S. W. Langraaid, 
of this city, thinking lie would be able to give me the information I 
desired, and he lias kindly permitted me to publish the following 
contents of his letter in reply : 
“ I have no doubt that injuries such as you describe have been 
produced by attempts at 'abdominal’ (diaphragmatic) respiration. 5 
“I have known the digestive functions disturbed, pain and soreness 
in various parts of the abdomen produced, and, in one case, the oc- 
currence of prolapsus uteri brought about during the act of attempt- 
ing to use the abdominal method of breathing in singing. 
“The injuries result not from properly conducted abdominal res- 
piration, but from a wrong method of using it and a misconception 
of its legitimate use and limit. Such misconception is common 
enough among singing teachers and their pupils. 
“ Abdominal respiration gives the singer the greatest control of 
the column of air to be used in vocalization. If, however, the proper 
action of the muscles (relaxation) during inspiration does not precede 
the expiratory effort (contraction), the contraction is not only pro- 
ductive of imperfect sounding processes, but may be the cause of 
injury to organs which are so situated as to be influenced by the 
pressure exerted by the contraction. 
“ The tendency of the abdominal walls to return to a normal 
position, out of which they have been carried during inspiration, is 
sufficient to regulate the flow of air during ordinary singing. A 
forced contraction results in an increased blast of air, which is 
needed to give greater intensity to tone. 
“ The common fault consists in the attempt to contract from an 
already retracted abdominal wall, the inspiration having been lim- 
ited to a superficial thoracic (‘ clavicular ’) respiration. If, now, 
there is added the restrictive action of a close and unyielding corset, 
any of the movable organs in the abdomen or pelvis must yield to 
the vis a ter go of the abdominal contraction. A priori with regard 
to the effect upon the uterus, retroflexion or retroversion would be 
the common forms of displacement, unless a tendency to prolapsus 
existed.” 
Lately I have talked with a number of ladies, and have been sur- 
prised to find how many of those acquainted with the subject, on my 
mentioning the matter to them, have at once said that they had no 
doubt whatever that the method was often injurious. Several had 
attempted it themselves, and finding that they did not feel so Avell 
after it had given it up. Others knew of its bad effect upon friends. 
From one lady I got the following story: Five women werettaking 
instruction from one teacher at the same time. One, previously 
well, gave out entirely, and was afterward treated for uterine dis- 
placement. A second, after four weeks of practice, began to have 
leucorrhoea and pain upon walking, symptoms she had never before 
had. In two others dysmenorrhoea made its appearance, when for- 
merly menstruation had been painless. The fifth one—the only one 
of the five who went through the process without developing more 
or less of what are in general terms called “ uterine symptoms ” 
became a good singer, and is now teaching the method to others. 6 
The opinion seems to be general that this method “ brings out the 
voice5' in a marked degree. Several have asked why some (and a 
number of the most celebrated professional lyric artists of the day 
have been named to me as singing in this way) can practise the 
method, while others cannot without injury to themselves. The law 
of “ the survival of the fittest ” may be a partial explanation. Possi- 
bly they have acquired the “ right method 55 and have avoided the 
“ wrong methods,” although what constitutes the “ right method ” 
seems to be a matter of dispute among teachers, each think- 
ing his (or her) method the one, and I must leave the decision of 
this point to those who are competent to settle it.* Probably some 
who have been injured in this way, go on singing in total ignorance 
of the cause of their suffering. Perhaps in certain instances the 
reputation and the income derived from the possession of a wonderful 
voice by the professional singer may be sufficient to induce the latter to 
bear with physical aches and pains. This last idea has been suggested 
by the fact that I have been recently informed that a teacher of this 
city, when told by a pupil that since beginning the method she was 
unable to walk as formerly, replied, “ A singer must expect to be 
unable to walk if she is to sing well,” and I have heard of a some- 
what similar remark made by a noted prima donna. 
It may be well to call attention here to the tissues which normally sus- 
tain the uterus, and to the forces which, on the other hand, tend to press 
it down out of its proper position. In general terms, the tissues which 
hold the womb in position are elastic, and although their strength is 
undoubtedly somewhat affected by the general health, as that of all 
ligaments and tissues must be, they are not like the common muscles, 
contractile and capable of being greatly strengthened by exercise. Igno- 
rance of this fact is very common among the laity, and often leads 
to futile attempts at remedying uterine displacements by general 
gymnastic exercises, which often, perhaps as a rule, increase the down- 
ward pressure, and thus not infrequently make a bad matter worse. 
Indeed, general muscular strength and development is by no means 
a sure protection from “ uterine weakness,5’ as every physician 
knows. 
Barnes, in his well-known and excellent text-book on the Diseases of 
Women, writes, “ The downward force is always acting. It is ex- 
erted at every expiratory effort, and is exaggerated by coughing, . . . 
by every exertion, in short which fixes the chest. . . . Then the 
force of gravity is added, and is always at work when the body is 
in the upright posture.” He points out how naturally it follows that 
when the sustaining tissues are, from any cause, weakened, displace- 
ments ensues, and then, discussing the opposite side of the matter, 
* It is a noticeable fact that the pupils invariably consider their own instructor the best 
of all, and always feel certain that the method they are acquiring is the only correct one. 
This however is but natural, for did they think otherwise they would take other instruction. 7 
says that even in virgins “force alone exerted upon healthy structures is 
enough to cause prolapse. The force obviously comes from above. 
It is produced by the pressure of the intestines, bladder, and broad 
ligaments propagated from the diaphragm and abdominal walls." 
He cites cases of displacement brought on by coughing. The mar- 
ried and those who have borne children are of course more liable to 
such displacements than virgins. Again Dr. Barnes writes (page 
553), “In the great majority of cases prolapsus is accomplished by 
small forces acting continuously or with brief intermissions over a 
long period of time.” The conditions which, according to this able 
writer and noted practitioner, produce the majority of cases of pro- 
lapsus, would seem to be exceedingly well fulfilled by the abuse of 
the “abdominal method.” What he says of prolapsus applies 
equally well to all displacements downward.* 
That serious uterine troubles should be caused in this way will 
not therefore surprise physicians once informed of this method and 
the manner in which it is practised at the present time. lam as- 
sured by good authority that one Boston teacher boasts that by 
11 proper practice" such power may be acquired that if the person be 
placed back against the wall, and a full sized piano be moved up 
against the retracted abdomen, the latter, by the “ abdominal method,” 
can be so forcibly expanded that the piano will be pushed rapidly 
away. A medical education is hardly necessary to enable a person 
to understand that by such procedures injurious pressure must come 
upon the internal organs, especially in the female. In the cases I 
have reported, however, no such extreme measures were practised. 
The teachers seem to have been quite careful with their pupils, so far 
as they knew how to be so. 
As a specialist, practising exclusively the treatment of uterine 
affections, doubtless more of these bad results have come to my 
notice than would have been the case in the same short time, had I 
been in general practice, but from the number I have heard of since 
my attention was directed to the subject, I am disposed to think 
that upon investigation such .cases will be found common enough to 
render the subject worthy the attention of the family physician. I 
strongly suspect that we have in the abdominal method, as now 
practised, a fruitful source of those common troubles, uterine dis- 
placements. 
[Note.—Since the foregoing was written another instance, which 
is worth reporting, has come under my observation. In the course of 
my inquiries I was told by a patient that one of her lady friends— 
* The gradual and insidious way in which serious uterine displacements may sometimes 
be produced by this practice is well shown inCase 111. The teacher, having been forewarned, 
took especial pains to frequently ask her pupil when she was practising in her presence, if 
while singing she felt dragging sensations or local pains of any kind, but up to a few weeks 
before she came to me, although her health was gradually giving out, the patient had not 
felt her singing hurt her. 8 
with whom it so happened I was acquainted—knew all about the 
subject, having taken instruction in elocution (which, by the way, ap- 
pears to have been “ quite the rage ” of late), in the course of 
which she was taught “ the proper method of abdominal respiration,” 
and she agreed to tell her that I wanted information about it. A 
few days later I met the lady on the street. She told me that my 
patient had spoken to her, and she kindly volunteered to call at my 
office at some future time and talk with me upon the subject, ex- 
pressing herself as quite sure that my patients had not acquired the 
“ right method,” and that all their troubles were due to this fact. I 
saw nothing more of the lady until a few days ago, when, going to 
my office in the morning, I found her awaiting me. Supposing, of 
course, that she had come to give me the desired information, I was 
very much surprised to hear that she wished to consult me profes- 
sionally. She was a lady of exceptional muscular strength, of 
which she was rather proud ; was fond of gymnastic exercises, and 
had taken much interest in “abdominal breathing.” This latter she 
had lately practised quite assiduously in connection with her elocu- 
tion. She had the mistaken notion—previously referred to—that it 
would tend to strengthen the “ muscles which support the womb,” 
and thus be rather a safeguard against future uterine trouble. The 
week previous she had practised the method a certain length of 
time on four successive days, feeling on each occasion a “pulling in 
the back.” The fifth day she became used up, and could not go 
through the exercise. Since that she had become sleepless and very 
nervous, and remembering her conversation with me on the subject 
concluded to consult me at once. I found a marked prolapse of the 
womb, the cervix being very near the vulva. 
As the result of her experience the lady has changed her opinion, 
and intends to give up elocution and the “ abdominal method.”] 
David Clapp & Son, Printers.