ON CAUSES OF ILL HEALTH AMONG WOMEN. By Miss Dr. A. E. TYNG, Member of the Rhode Island Medical Society, the Providence Medical Association, the American Medical Association, the Gynecological Society of Boston, and of the Alumna Association of the Woman's Medical College of Pennsylvania. Many of the causes of ill health among women having their origin in the fashions and customs of the day, are supposed to have but temporary effects, as may sometimes be the case, but even these may be inherited. The things which are truly only of the present, will change whether they are attacked or not; to get at and to prevent evils, we must work now for the next gene- ration, looking upon each child as a future grandparent, and teaching it that it owes a duty to its posterity, and through them to the world, which they have the power to bless or to curse. ' Each man and woman should consider the pre-natal influences of off- spring, and endeavor to make these as perfect as possible, according to the best intelligence and information they have. The health of women during the child-bearing period, both the mental and moral, as well as the physical condition, their work and recreations, their surroundings and their thoughts are reproduced in their children, and while some attention is given to the so-called and much mis-called mother’s marks, through frights and whims, which often only show the weak-mindedness and lack of self-discipline of that mother, little attention has been paid to their prevention, or to the good that might be wrought out by the well-trained mind and disciplined charac- ter of both parents. Immediately after the birth of the child there begins a mismanagement which affects its health and longevity. Through ignorance and supersti- tion, every hygienic law of food, clothing, bathing and sleeping is broken. Then when nature demands active exercise for growth and muscular de- velopment, repression is the only idea—the convenience of the adult con- sidered of more importance than the well-being of the child. The primary public schools, presided over chiefly by young girls who have not them- selves learned self-government, enforce repression and confinement to one position for a length of time difficult even for adults. Until puberty, the sexes are about equal mentally and physically, but at this time the idea of 2 repression shows itself more forcibly upon girls. The study of anatomy teaches of the growth and development of bones in the growing child. The pelvic bones, which have had several centres of ossification, begin to unite at about the thirteenth year, three hones joining into one. The sacrum also ossifies more perfectly, completing this process at about the twenty-fifth year. During these years, when the whole future health of the woman depends upon the perfectness and completeness of this pelvic de- velopment, and when girls should be allowed, therefore, the greatest free- dom of muscular movement, repression is most enforced. She must not romp, must have quiet manners, must be shut up indoors, until her vital powers are reduced. "When she does go out she must he dressed to form such a figure as is demanded by the ignorance of fashion. Long dresses, with the weight at the bottom furthest from the point of support, the weight and heat of which falls upon the growing pelvis with excessive and unequal pressure, change the natural gait. She must wear close-fitting if not too tight corsets, misnamed supports, which impede respiration, circu lation, digestion, and the peristaltic action of the intestines, thus producing one ofv the chief causes of constipation, with all its recognized train of evils, so much more common among women than men; these weaken the power of the muscles which aid in child-birth; pads over the breasts im- pede their natural growth, and deprive them later of one of the privileges of maternity. No thought is given to preparing the body to facilitate future child-bearing. The spine is heated and distorted, and though women have and wear more clothes now than did those of the last century, they are ill protected just where most clothing is needed. Cold feet and a hot head is the general condition: the feet and limbs are not warmly dressed, while the head is heated by false hair and by wearing the bonnet indoors. Much has been said on dress, and efforts made at reform so far as underclothing is concerned, yet evm our wealthiest women, who have least excuse, are insufficiently lad. Efforts in this direction have had some effect in regard to the size of the waist, but there is still too much compression. The excitements of social life are greater in this country than in Europe, and girls are allowed them at an earlier age; the late hours and insufficient sleep during the hours authorized by nature, all tend to induce early and excessive menstruation, to disturb the nervous system, and to derange the function of every organ, making us notorious among nations as a people of nervous temperaments and more subject to nervous diseases. It is not merely going to places of amusement and excitement, as concerts, theatres, halls, etc., but the too early participation in them themselves, and in ex- hibitions of all kinds. Our public schools set a bad example in this respect. Fictitious literature gives girls romantic and unreal ideas as to marriage and domestic life; later, when they come to find the reality different, they grow to hate these cares and become restless for excitement, “ Si votre fille lit des romains a dix ans elle aura des vapeurs a vingt.” Among the poorer 3 classes hard work is begun at this time of life, combined with ill-ventilated homes, especially sleeping apartments, and such food as does not help in the healthy development of bone. Among the wealthier classes, indulgences in too rich and overstimulating food develope those national diseases, dyspepsia and catarrh. Dyspepsia was entailed upon us by our grandparents, with their salt pork and fried meats eaten by them even through the summer season; now we are passing it on to the next genera- tion by our pies, doughnuts, and highly-seasoned food; even our school- girls must have sweet meats, cakes, and pickles. Out door pursuits and games calculated to create muscular power, are discouraged because they do not accord with the general idea that an appearance of delicacy in form and complexion is more suitable for women. Here, also, we present a contrast to European women. The imperfectly performed light gymnastics drearily gone through with in our schools, are supposed to be sufficient to develop all the muscular power needed. One might as well teach children to play and laugh by rule, so far as any real development of muscle or menfal re- laxation is obtained. A more healthy performance of natural functions would promote efforts for the prevention of disease, and secure more regu- larly established menstruation with more ease in its performance. "As the importance and relative value of a living being maybe estimated by the time it takes to attain perfection, I may reasonably infer that the longer the reproductive apparatus lays dormant in women, the stronger will be their constitution; the more harmoniously will its functions be performed, and the more favorable will be the influence of this apparatus on the whole sys- tem.”* Owing to the various excitements and stimulations above men- tioned, first, menstruation occurs early in this country, and earliest among the higher classes than in the poorer. Unfortunately ignorant of these conditions, many mothers adopt a forcing system of medicines, baths, etc., often thereby destroying good health; while others allow girls to grow up in ignorance of this coming change, and when taken by surprise, the shock, the fright leads them into imprudences which result in hysteria. Many diseases are thus traced to the bad management of girls at puberty. “ The effects of a badly passed puberty are seen in over excitable circulation, ex- cessive nervous susceptibility, dysmenorrluea, sterility.”! * * * becom- ing at last victims of consumption or other disorders of which the founda- tion had been laid in an unproperly conducted physical and moral educa- tion.:}:” Physiology is taught only in the high schools, which a large portion of the future mothers never reach, and there it is taught only partially, with much positively needful for the youth to know, carefully culled out. They are thus left to learn, and continue to hand down to posterity, through the ignorance and superstition of servants, or from the vulgar among their asso- ♦“Preservation of the Health of Women,” E, J. Tilt, M D., England. 1“Diseases of Women,” C. D. Meigs, M. D.; Philadelphia. 4 ciates, and from the obscene literature which is being thrown broad cast among our schools, what they should learn only of parents, or of teachers capable of making them respect the highest functions of human nature. If the half-time system, which has worked so well in England and Germany, could be introduced into our public schools, at least in the primary and in- termediate grades, and the remainder of the time applied to systematic training in industrial work for and by both sexes, the working classes of our population would be better prepared for self support ; have a more healthy physical development, and become better citizens. The graduates from our high schools are crowded with studies which they have no use for in private life, and which they soon forget, because crammed only to get their averages and percentages of rank, to obtain a diploma, that being the highest and often the only goal and without which they will not easily get situations as teachers, and they are fitted for no other career. They cannot all be teachers, the supply is greater than the demand, mean- while other fields are waiting for laborers. I place ignorance among the chief causes of evils, although I am fre- quently met with the argument that women have had time and opportunity to learn differently. Time is not so much needed as encouragement, or rather the cessation of discouragement. Women often see evils before them, know that they are evils which could be and should be remedied, but do not know how to remedy them. Complaints are met with the argument that duty lies in making the best of and being satisfied with what is. It may be suggested here that one remedy lies in the dissemination of proper knowl- edge by authorative bodies, such as the Boards of Health in the various states. I say ‘proper,’ because there is so much of worse than useless trash learned through almanacs, newspapers, and the advertisements of empirics so often circulated even in the streets. Women have generally been taught that they are to marry, to be mothers and housekeepers. They have not been taught how to make marriage beautiful, and neither sex is taught the value of cultivating within themselves a power of adaptation to the other’s character, and when the fruit of an inharmonious marriage is nervous and ill-tempered, the blame is laid upon Providence instead of where it rightly belongs, on the want of knowledge of the laws which that Providence made and meant should regulate marriage and procreation. But it is not only with the inharmonious mar- riages; in the best marriages there exists an ignorance of child-bearing and its results; a forgetfulness that motherhood is the crowning glory of woman- hood, and as a consequence of this forgetfulness an infinity of methods for the prevention of conception, not necessary to refer to more directly; for those wdio are ignorant of these are blessed and rewarded in their igno- rance,—for those who do use them there is always the punishment which nature awards to her broken laws. I have frequently given my opinion for years past that this prevention of conception leads to a large part of the diseases peculiar to women. Poor little Pip, in “Great Expectations,” 5 spoke as the representative of a numerous class when he said, “I was al- ways treated as if I had insisted on being born in opposition to the dictates of reason, religion and morality, and against the dissuading arguments of my best friends.” 1 quote from an address by Prof. Maudsley, of University College, Lon- don, the following, because I want these views more widely known and meditated upon: “Take notice how little people ever think of the power which they have over their own destiny, and over the destiny of those who spring from them! How amazingly reckless they»show themselves in this respect! They have continually before their eyes the fact that by care and attention the mo3t important modifications may be produced in the constitu- tion and character of the animals over which they have dominion; that by selective breeding an animal may almost be transformed in the course of generations; they perceive the striking contrast between the low savage, with whom they shrink almost from confessing kinship, and the best speci- mens of civilized culture, and know well that such as he is now such were their ancestors once; they may easily, if they will, discover examples which show that by ill living people may degenerate until they revert to a Re- graded state of barbarism, disclosing their former greatness only in the magnitude of their moral ruins, and yet seeing these things they never seriously take account of them and apply to themselves the lessons which lie on the surface. They behave in relation to the occult laws which govern human evolution very much as primeval savages behaved in relation to the laws of physical nature, of which they were entirely ignorant,—are content with superstitions where they should strive to get understanding and to exert intelligent will. They act altogether as if the responsibility for human progress upon earth belonged entirely to higher powers, and not at all to themselves, llow much keener sense of responsibility and stronger sentiment of duty they would have if they only conceived vividly the eternity of action, good or ill; if they realized that under the reign of law on earth sin and error are inexorably avenged, as virtue is vindicated, in its consequences; if they could be brought to feel heartily that they are actually determining by their conduct in their generation what shall be pre- determined in the constitution of the generation after them! For assuredly the circumstances of one generation make much of the fate of the next.” Thus it is that people pay no regard in marriage to the evils which they bring upon their children, or in their lives to the sins by which the curse of a bad inheritance is visited upon them, and neglect to apply knowledge to the improvement of the race. When through more enlightened educa- tion, parental responsibility shall be placed on higher grounds, not only disease but crimes will diminish, and in time we may “produce, if not a higher species of beings than we are, a race of beings, at any rate as superior to us as we are superior to our primeval aucestors.”* Too much * Mauds] ey. 6 cannot be said on the subject of heredity until it is believed, understood and acted upon, for we have only just entered upon research in this direc- tion. As there cannot be good wine without fermentation, so every new movement has its opposers to raise discussion, and thus ‘‘agitation of thought is the beginning of wisdom.” The objection has been raised that the belief in heredity is used too frequently as an excuse for various wrong doings and criminalities. This, so far as true, is not because the laws of heredity are too well believed and understood, but rather the contrary ; and that there is a neglect of»their proper application, and these cases seem to illustrate that the inheritance was not recognized early enough in the in- dividual and care taken to eradicate it, or to stimulate the power and duty of self-control, and such qualities of mind and body as tend to oppose the natural bias. By such care one of the most fruitful sources of disease and crime may be diminished, for manjr things harmful to health and character, sound body and sound mind, are under human control. “When devia- tions or violations of the normal standard of physiology, perfect in structure and healthy in function, are continued through two or three generations, thejr effects become more marked and intensified. As all these changes are brought about by human agency, the remedy is lodged in the same hands.”* “ So to observe nature as to learn her laws and to obey them, is to observe the commandments of the Lord to do them.”f As to housework, with all its monotony of routine, its confinement, often to ill-ventilated rooms, its constant wearying muscular movements, its long hours of work, its lack of change of thought and scene, and not one of these conditions changed even during the periods of child-bearing; what wonder that women break down and wear out ? What other fate could be predicted for them? These influences cannot be salutary either to bodily or mental health. Here, also, ignorance plays a large part. Many, persons who consider themselves good cooks would be astonished to be accused of being the cause of indigestion, of diseases of the skin, of the blood, of the nerves, etc., etc., in their families. There is now a movement at work in several of our large cities for the training of cooks. There are cooking clubs of ladies in training, not for servants, but for their own improvement. These schools are not for the teaching of making doughnuts, pastry, and such already too common mixtures and compounds, but to teach healthful cooking and chemistry, and such principles of physiology that in the gene- ration to come we shall know what materials should be eaten by each indi- vidual for the necessities of his or her harmonious and equable growth and development. Such training schools should be encouraged by the whole community; also for teaching the preparation of proper nourishment for the sick, to take the place of the wretched slops now too frequently used. Also training for other kinds of house-work, that by more orderly method *Dr. N. Allen. “ The prevention of Disease, Insanity, Crime and Pauperism,” t Maudsley, 7 time and steps and backaches may be saved. Much that is valuable has been said and written by practical women on the organization of household labor. When these ideas meet with more understanding and encourage- ment, so that they can be acted upon, we shall see fewer worn-out women, consequently healthier ones, and healthier offspring. However good the training, it cannot be properly carried out until there is more improvement in the building and arrangement of houses, and for this we need women architects, who will best know the neces- sities of women in this respect. There are in this citjr thousands of bed-rooms which cannot be ventilated thoroughly, which are not properly lighted, where work of any kind cannot be done to the best advantage, and which are choked by the fumes of tobacco and sink- drains, and the odors and smoke of cooking. Many an over worked woman into whose life few bright hours ever come, has thought seriously, deeply, broadly on these subjects, but feels helpless to change anything. She has no time to study, scarcely time to converse with others, and in the attempt to draw her out to take part in some fresher, newer ideas and ac- tions, one feels that so long as the daily life is a perpetual struggle for ex- istence, efforts to rouse the mind to other considerations seem unavailing. While speaking of cooking, I cannot forbear quoting a few sentences from an interesting and ably written paper by Mary G. Ware, for the Woman’s Education Association, on “Prevention of Crime among Women.” “Foul air nauseating the stomach, bad cooking irritating it, insufficient food ex- hausting it, want of sufficient clothes and fuel chilling the circulation, each or perhaps all together, stimulate the appetite for some kind of intoxicating drink.” “Another efficient influence would be schools where women could be taught to cook in such a way that the family table should be a comfort and satisfaction. The dissatisfaction of the stomach which follows the eating of badly cooked food produces a desire for intoxicating drinks, so that the good cook promotes not only health, but morality.” “The opening of diet kitchens in several cities is a movement in the right direction,” where regu- lated so as to not to encourage idleness and pauperism, “for the prevention of intemperance by the suppression of its causes.” With the brain clogged by foul blood because the lungs are clogged by foul air, how can we expect high or even intelligent moral action? How much do the higher classes do to prevent, how much to encourage these evils? It has been said that it is easy to be a good Christian for one who has a sound spine and a sound stomach, so it is easier for one with bodily wants well supplied to re- sist the temptations of liquor and to refrain from crime. In addition to cooking schools, there is needed instruction on the import- ance of well ventilated and clean houses, and especially among the poorer classes, of the necessity for the removal of all effete matters, and of the need of a good blood and bone making diet, in place of the half-starving diet of bread and tea, which unfortunately has made its way among our 8 working classes of all sorts, but especially of sewing women, as the popular diet. It is not wholly, if at all, a question of means to obtain better food, for tea is not cheap, but to the ignorance of cooking and of what is suitable and wholesome for them. A cause of ill health among the women who work in mills, besides those included in what has already been said, are injuries to the digestion and the nerves, by the habit of tobacco “dipping,” not confined to the South, but practiced largely in this state; these women also suffer from over heated air, whether dry or laden with moisture; in cotton mills by dust from the carding process, (less since the modern improvements than it was a few years ago.) Among shop-girls there is confinement in over-crowded, badly ventilated shops, deficient sunlight and out door excercise, air exhausted by gas and heated over repeatedly; by so much standing, infrequent and irregular meals. After standing several hours, exhausted and needing good food, they are allowed often too short an interval at mid-day, that there is not time to go to their cheap boarding place or homer and being too poorly paid to afford a meal at a restaurant, they only too soon learn what affords the most stimulus for the least money. Said an older shop-girl to one re- cently from the country, “Don’t waste your money on pie, get a glass of gin, it’s cheaper.” Those who do not reach this degradation, partake in- ordinately of tea or patent tonic medicines. “If the temperament be ner- vous and the work mental, there is much more danger from the use of stimulants than when the avocations are manual.”* “As a rule people are underfed. This is especially true of women. The tone of the system is thus lowered and local congestions of different parts of the body are pro- duced.”! Diseases of the digestive organs, consumption and uterine irregularities prevail with this class of women. The wealthier classes do not escape disease because of not being obliged to work. “In a discourse upon the consequences of employments, the case of the unemployed has really no place; yet this negative con- dition of doing nothing has its consequences, and very serious ones too, in connection with the health of its possessors. The lack of definite occupation, or of occupation satisfying the mind and conscience, and which is fraught with blessing, is especially the misfortune of women, more particularly so in the case of unmarried women in so-called ‘easy circumstances.’ Among them may be seen the bad consequences of a purposeless, useless, selfish existence. What a lamentable array of dis- orders is their lot! a group of nervous ailments largely associated with the ill defined and ill understood condition called hysteria. “ It is a praise- worthy feature of the present day that great endeavors are made to find em- ployment for women to enlarge the bounds of pursuits calculated to arouse their interest, and to foster physical exertion.”! “In young women with- * Rachel B. Gleason, M. D. 1 Wm.A, Hammond, M. D. t Address of Dr. J. T. Arliilge, before the British Medical Association, 1878, 9 out useful occupation, the moral nature becomes perverted in addition to derangement of bodily health. The mothers’s sympathies too often only foster the morbid proclivities by insisting on the delicacy of constitution and the necessity of various artificial methods for restoration. Such a girl is not the victim of high pressure or mental strain in her own person, but she may inherit a susceptible brain from an over-worked parent. The remedy is work, not rest; occupation, not idleness; a luxurious life is hex- curse. Insanity as well as hysteria is developed by such a mode of exist- ence. Life must have an aim, although to achieve it there ought not to be prolonged worry.”* “Skilled industry of the hands makes the bi-ain more orderly in action. The child taught to use the hands skillfully is more apt to become an industrious citizen, and the habit of industry is the basis of orderly life.”f Of causes directly affecting mental health, in addition to those already mentioned, among the working classes there is icorry fi-om small wages, and intensity of anxiety night and day, causing sleeplessness. This also extends to all classes of women; the married from never having any sum or purse of their own, and consequently the utter misery that cannot be conveyed to the comprehension of the other sex; the ingenuity to make ends meet, the contrivances to avoid asking, especially when the need of economy is pressing upon them, even where the husband is generous and kind; all these, where the strain has been long continued, the same set of ideas maintained in exhausting recurrence, the same part of the brain is kept continuously at work, and a weakness results which may end in in- sanity. It is said that insanity is on the increase, especially among the ignorant classes, and that only ten per cent, of these are cured. If this be correct, it is necessary that its causes should be searched for, and something done for its prevention. It is not an exclusively nervous disease, but may and does originate in deterioration of the body through intemperance, dissipa- tion in all its forms, over work, mental and physical, insufficient food, lack of ventilation, and neglect of moral culture. All these factors apply to both sexes, but bear more severely upon women, who have, in addition to their greater nervous susceptibility, the care and anxiety of children, menstrual ii-regularities, miscarriages and the consequent diseases of the pelvic organs. Absence of rational employment of the mental powers leads to indulgences in vices, drinking, etc., especially favorable to insani- ty, in addition to the inheritance from parents who indulged in like habits, for “ by free indulgence in stimulants and in tobacco, the parents debilitate their own constitutions and transmit feeble ones to their children.”:}: A superintendent of one of our New England Hospitals for the Insane has said that “the dissemination of more correct views of the true way of living, and a more rigid observance of the laws of health and nature, * “Insanity and its Prevention,” D. II. Take. fMiry J. Ware. :£Tuke. 10 would greatly diminish insanity.” The Commissioners in Lunacy in Scot- land, in a recent report said, that “ Insanity is, to a large extent, a'prevent- able malady; that it is always attended with some bodily defect or disorder, of which it may be regarded as one of the expressions or symptoms; pre- ventable diseases will be diminished in amount when education is so con- ducted as to render the people both intelligent and dutiful guardians of their own physical, intellectual and moral health.” “A study of the rela- tion between modern life and insanity shows that it is of a many sided and complex character; that a large amount is preventable; that beer and gin, mal nutrition, a dreary monotony of life, muscular exhaustion, domestic distress, misery, poverty and anxiety, account largely not only for the number of poor who become insane in adult life, but who from hereditary predisposition are born weak-minded, or actually idiotic.”* “Insanity in women rarely takes place without the concurrence of both physical and moral causes.”! Physicians have known for a long time that much insani- ty results from ignorance of the laws of life and health, or a disregard of them, and that it might be prevented by an avoidance of such habits as exhaust nervous power, but the community in general do not know this, and should be instructed. It is also well known to physicians that there are abnormal mental changes in women suffering from various diseases peculiar to their sex, and chief among the causes of these should be placed forced abortions. To the increase of this evil, attention was called by Dr. D. II. Storer, in 1855, then Professor of Obstetrics at Harvard, in his public address intro- ductory to the annual lectures. In 1857, the American Medical Association appointed a committee to report upon criminal abortion with a view to its general suppression, with Dr. II. R. Storer as its chairman; and in the vol- ume of its transactions for 1858 will be found a series of resolutions by which the Association present the subject to the attention of the several leg- islative bodies of the Union, desiring that the laws on this subject may be revised. In 1860, Dr. H. R. Storer, published a volume entitled, “Criminal abortion in America,” in which he set forth the evils resulting, its increase in this country more than abroad, and the weakness of the laws in those States in which there were any laws. At that time Rhode Island had no statute, and here, as in some other States, in the absence of special statute, the crime could only be reached at common law, and this only if the death of the woman occurred; no thought being taken for the death of the child, or of the ill health of the woman for the remainder of her life. Thus, in States where a definite statute does exist, it is practically useless, and is often evaded because legislators and the public fail to recognize the true character of the crime, as, for instance, here in Rhode Island the statute passed in 1872 takes cognizance of the murder of the child, or if the mother