THE EDUCATION OF GIRLS FROM A MED- ICAL STANDPOINT. BY EDWARD W. JENKS, M. D., LL.D. Vice-President American Gynecological Society, Fellow Obstetrical Society of London, Cor- responding Member Boston Gynecological Society, Ex-Pres. Detroit Gynecolog- ical Society, Eto., Etc., Etc. REPRINT FROM TRANSACTIONS OP Michigan State Medical Society, 1889. '0-y/ (y: r/'ian'u/ jhwAd; 84 Lafayette Avenue. [Reprint prom Proceedings of Michigan State Medical Society, 1889.] ANNUAL ADDRESS ON OBSTETRICS AND GYNECOLOGY. THE EDUCATION OF GIRLS FROM A MEDICAL STAND-POINT. EDWARD W. JENKS, Detroit. I deem it but just to this society and myself before entering upon the consideration of my subject, that a brief explana- tion should be made. I had been led to believe that my address would be given in the evening, following in regular order the President’s address and the addresses on Practical Medicine and Surgery. For this reason I have carefully avoided in this paper the discussion of my subject in the same manner I would if I had expected my audience to be entirely a medical one. In truth, the ordinary technical expressions that, as a rule, are unavoidable in a medical paper, are as much as is possible, ex- cluded from this one. The subject which I have chosen as the text for my remarks, namely, The Education of Girls From a Medical Stand-point, will not be elaborately considered, as the time allotted to me on this occasion will scarcely permit of anything like an exhaustive paper. What I say will be rather suggestive of certain matters than otherwise, and yet the topic is worthy of a lengthy disser- tation. At the last annual meeting of the Detroit Gynecological Society, upon retiring from its presidency, I briefly discussed the Education of Girls as Affecting Our Country’s Future, and in consequence of letters I afterwards received from vari- ous localities regarding this subject, I have become more firmly convinced than ever before that it is one of major importance to every lover of his country and his kind. I have, therefore, no apology to offer for bringing up this topic for a limited examin- ation before the representative association of the medical profession of our State, and of embodying in my address at this time views which I have heretofore expressed in a local society. 2 STATE MEDICAL SOCIETY. It is often said that American women are not as healthy as European women. It can scarcely be denied that the average standard of health among the women of our country is below what it has been in the past. In other words, there has been a deterioration of their physical health. This condition is not con- fined to the wealthy or ultra-fashionable, but is found among all classes. Nervous, hysterical school girls with flabby muscles are to be found in the mechanic’s cottage, as well as in the millionaire’s mansion. If our American women have depreciated it is not in beauty, but in physical strength and power of endurance. It is also frequently remarked that American families are smaller than are the families of other countries. It is related that on a certain festive occasion where some of these topics had been discussed, after the ladies had been toasted in elo- quent speeches, a certain physician proposed the following sentiment: “ Long life to our grandmothers who are rapidly becoming extinct and are probably the last this country will ever see.” There is involved in this semi-humorous sentiment a hint at a condition of things in our country worthy of serious thought. The smallness of American families and the fact that some are fast becoming extinct, while the rapid increase of population is chiefly due to foreign immigration and the prolificacy of the multitude who come from other countries to this for homes, is a matter of no small degree of interest. This matter of the lessening fecundity of Americans has also become an affair for serious consideration to the sociologists of this day. While English enterprise, tenacity, and strength, German perseverance, frugality and health, Irish warm hearted- ness, hopefulness and prolificacy, and a lesser admixture of the qualities of the Latin races, may in themselves form a desirable compound in our national make-up, still there are other quali- ties and customs of each of these nationalities which are equally undesirable. At the present rate of increase in the numbers of foreign immigrants and of the first generation of their off- spring, the elements which we wish most of all to preserve— the essentially American—threaten to be swamped. EDWARD W. JENKS. 3 With the proper restrictions which have been laid upon it in the last few years no one can be reasonably opposed to foreign immigration, for by that means this vast country has been populated and developed with a rapidity otherwise impossible. But sociologists and all others who are possessed with the true American spirit must deplore the fact that the replenishing of the population is contributed far more by the foreign born than by Americans. Wherein lie the causes of this condition and how they can be remedied, are questions of importance, as they relate to the future of our country. There is one cause underlying this state of affairs which I will not discuss, namely, foeticide. There is, however, another cause which can, I believe, be remedied if fashion can be made subservient to hygiene and common sense, for it is undeniable that fashion is an element which exerts a considerable amount of power in social life. It is not always the mode of dress that is the immediate cause of small American families, although that it is a remote one, is capable of proof. Two causes, namely, a disposition to marry late in life or not to marry at all, are partially the result of a certain mental attitude taken by this generation and are questions for the social reformer and sometimes for the physician. Another cause is one which claims the physician’s attention; that is, the increasing physical incompetency of our young women. Al- though often in apparent health at the time of marriage, yet when they come to undergo the hardships of maternity, they find that their physicial vigor, their staying powers, so to speak, are fre- quently insufficient to carry them through either with safety or without subsequent loss or depreciation of health. It is the exception and not the rule to see more than two or three chil- dren in a family, and often only one, especially in the better classes. In cases where the number rises to five or six it is rare to see the mother like some of the English or German mothers, who look as fresh and blooming and almost as young as their eldest daughters. From time immemorial the wise have ever paid a tribute of gratitude and affection to the mothers of the people, for it is 4 STATE MEDICAL SOCIETY. the mothers who give character to a nation. If they have a heritage of health, wisdom and good morals to bequeath to their children, then are these blessed among the nations of the earth. The fundamental principles of human action which are to guide one in after life, the child learns at the mother’s knee. The impressibility of the child-mind was never more clearly pointed out than by the learned and zealous Jesuit who once showed his belief in the tenacity of early impressions, when he said to one of another faith, “ Give me the training of a child till he is seven years old and I will give him to you afterwards.” In view of these things are we not best serving the future generation by inquiring of what material are the future mothers made? Oliver Wendell Holmes has quaintly suggested that we might be different if we could have superintended the edu- cation of our grandmothers. At present we seem to be denied that privilege, but we can do the next best thing, namely, edu- cate the grandmothers of posterity. By education I do not designate only mental training by study, which is its most commonly accepted meaning, but I use it in its broadest signification : the drawing out of all the powers of the human being, moral, intellectual and physical. The parents, teachers and preachers have usually shown themselves capable of caring for the first two, but who interests himself for the last ? Who troubles himself about the bod}'- except to dose it when it is ill or dress it becomingly when it is well ? From the time Eve left the garden to begin her worldly career until the millennium shall appear there have been and will be numerous ailments, whose coming neither the devices of man nor the provisions of nature can avert. Unfortunately these do not constitute the sole field, as they ought to do, in which the physician must exercise his art. The physical degeneracy of girls of the latter part of the nineteenth century has proved a fruitful source of unnecessary material for the physician of the present and the future. This deterioration is charged by some to climate; by others to the modes of living; but many with preconceived ideas on the subject, ideas which prevailed in earlier times concerning the proper amount of mental training of girls, hold that any EDWARD W. JENKS. 5 attempt at special development of the intellectual powers is gained only at the expense of the physicial. It is true that this latter outcome is a possibility but not a probability. Mental work of itself is not in my opinion the cause. I am a firm believer in the healthfulness of properly directed intellectual labor. The revered Dr. Tappan asserted that “ brain work is good for the health.” Wherein, we may then ask, is the education of girls in a degree responsible for physical degene- racy ? The task of replying to this interrogatory is nowise difficult. The intellectual portion of the being has been educated while the physical portion has been neglected. It is not study j>er se that distorts and destroys, but a disregard of the laws of health and development, a neglect to supply sufficient oxygen to the blood by fresh air, and to produce that regular metamor- phosis of tissue—the constant exchange of the old for the new —which only goes on properly under the stimulus of periodical, vigorous use of the muscles and by the assistance of good food and sufficient sleep. There are certain laws under which the growing girl best attains the normal development of maturity and maintains a healthy organization; by the violation of these laws, a condition of physical or even mental vulnerability is engendered, which renders the body a prey to every external disturbing influence and causes it to succumb sooner or later to the ever besieging ills which a healthy physique ought and could hold at bay. Dr. Nathan Allen read a paper at the meeting of the American Institute of 1879 on the “ Education of Girls Con- nected with Growth and Development,” in which he deprecated “ the high pressure of educational influence ” as being the cause of physical degeneration of American girls. While I do not stand with him on the ground he has taken in this matter, nevertheless I agree with him when he says : “ In no part of female education is there so much need of reform as in that of physical culture.” The remark has been made, “ Educate a woman and you educate a race.” The saying is full of mean- ing and capable of different interpretations. Its meaning or application must depend upon the term educate—how and in 6 STATE MEDICAL SOCIETY. what way it is done. This “ educating ” should have reference to the future as well as the present, to the body as well as to the mind, for the highest development of brain and nerve tissue alone will never go far toward educating a race; in fact, it will cause it to run out. If a girl seems less vigorous than should be expected during the first part of her developmental period, then her work at school should be lessened or she should be taken from school entirely for a few months or a year. This does not mean that all mental work shall cease during that time, but simply that the hard and fast lines which must necessarily be laid down for well organized school work, are temporarily done away with. Labor suitable to the individual and not to the masses, is to be imposed upon her. Because a girl has not the strength to carry out the routine of school she should not consider herself an invalid and be allowed to mope about in the house and’pass her time in read- ing sensational novels. It is an observed fact that the emo- tional element occupies a greater place in woman’s nature than in man’s, and as one should expect, reaches its maximum in those of nervous temperament. This is a piece of information so ancient that one feels like prefacing it with an apology until he looks about him for methods based upon its indications, then indeed, he might think he had said the newest thing under the sun. The more emotional the girl, the more inflammatory is the literature she will be inclined to consume; the more excite- ment she will crave. To discuss the direct mental and moral effects of over-feeding the emotions is not in my province, but to protest against its indirect injury to the nervous system, every physician has had to do and must do again. The beautiful things of life are one factor in that great whole which has for its object the uplifting of humanity. But he misses his mark widely who seeks to substitute this part for the whole. A grouping together of stately pillars, finely wrought cornices and rare mural ornamentations, would result in a miserable architectural failure, as far as the use or comfort it could afford. But let these adornments be a part of a struc- ture composed of solid foundations, firm walls and a substantial EDWARD W. JENKS. 7 roof, and they are no longer a failure, but serve their highest purpose in affording comfort and giving pleasure. So it is with accomplishments which are the outer adornments of the mind and body. They are a beneficial ornament in a girl’s education, if they are not perverted in their use. But if they are substituted for sound mental training, moral teaching and physical culture, they fail to meet their purpose. Accomplish- ments adorn most when a woman has an educated intellect and a healthy, well-developed body. Many girls have both accomplishments and learning, but no knowledge of themselves or the laws for the preservation of health. In consequence of the ignorance of parents and their daughters the nerve force of the latter is often deflected into wrong channels at a time when it is needed to sustain and further the process of normal growth and development. The attempt to participate in social pleasures and fulfill school duties at the same time is a hazardous undertaking, which militates alike against good scholarship and good health. The attainment of certain accomplishments is considered by many to be a proper occupation for a portion of the time which a girl employs in obtaining an education. Within certain limits this is true; but when long hours are devoted to fine needle- work, amateur painting, piano practice, etc., without intervals of change of work or out-door exercise, these limits are far over-reached and the results are frequently deplorable. How many parents are actually giving their girls a patho- logical education, training them to be patients? A system of physical culture carried out with some regu- larity should occupy a defined position in every girl’s education. In school a certain fraction of the working hours should be allotted to the daily practice of calisthenics; and I don’t doubt that the monotonous movements of gymnastic exercises would be performed briskly and cheerfully if done in time to music. Until children are ten or eleven years old they should scarcely realize that they are boys or that they are girls, but simply that they are young human beings with duties and pleasures very much in common. The separate qualities which characterize mature manhood and womanhood begin to bud 8 STATE MEDICAL SOCIETY. in the earliest years of the boy and girl, as is best demon- strated in the kind of plays they choose; but these differences are not strongly marked before the age of ten, except as the result of training. This constant repression of natural physical activity in the growing girl, while the same thing is encouraged in the boy, is a sad mistake. Vigorous outdoor plays are as beneficial for the girl as the boy. If this entails an untidiness of appear- ance and an occasional too intimate acquaintance with mother earth that distresses the careful mother’s eye, she can console herself with the knowledge that some measure of health and strength for her girls will be her recompense. Out of school, in vacations and when school days are over, a little time should be given to out-of-door exercise, such as walking or riding, etc. Open-air sports should be encouraged, and when fashion shall pronounce a more decided judgment in their favor, there is no doubt that they will become popular. In the long lists of both summer and winter sports, rowing, horse- back riding, lawn tennis, archery, skating, coasting, etc., there will be some one or more that will please the individual tastes of all. There is an indoor exercise which deserves to be popu- lar, because it not only developes the muscles, but because it gives to the body in its movements extreme suppleness and grace—this is fencing. If our girls would copy after the English as regards their love of out-door activity as zealously as some of our young men imitate the brothers of the latter in the matter of clothes and various fads, it might almost be worth while for them to become Anglo-maniacs. The curse pronounced upon Adam which entailed labor upon all after-coming humanity has not been without its hidden blessing. To be obliged literally to earn his bread by the sweat of his brow, or metaphorically by the sweat of his brain? is not a misfortune to man, except when work descends to drudg- ery. Activity is the price of well being. The best mental and physical development is based upon a life in which every 24 hours is divided into alternating periods of vigorous, muscle- tiring action; perfect rest; mental work, absorbing but not EDWARD W. JENKS. 9 over-taxing; and light occupation for both mind or body. But this activity must be that which refuses to bear company with haste, worry and excitement. For that matter, we might as a people do well even to cultivate the phlegmatic. There are certain qualities of mind and body possessed by our girls to a noticeable degree of which we, as Americans, may well be proud. They are noted the world over for their grace and beauty; for their brightness, cleverness and keenness; above all for their independence. I say above all, for this is an outgrowth in the development of our national character. The spirit of freedom which permeates every class in this republic has touched the daughters as well as the sons, and the individual as well as the mass. Liberty of opinion is in this country, a privilege that every girl considers her birthright; she comes into the possession of it at her majority the same as any other inheritance. She feels that she has the right to do whatever she can do honestly and well. Her rights as a human being are not curtailed because of her sex alone. Capacity, and not sex, are the boundaries set about her. But, endowed by nature with gifts which any might envy, the American girl is so fre- quently handicapped by an inferior physique, that she cannot always finish the race in which she should be the victor. She is ■expected to win and yet she is persistently too heavily weighted. In no other nation do women participate so largely in the active affairs of life as in the United States. Whether this eager participation is the best thing for women and for the world, has been and is still a matter of great diversity of opinion. Somewhere in the future that great solver of problems, time, will settle it probably in the affirmative, but possibly not with such an affirmative as the radicals of this day could desire. The spirit of modern progress is enthusing all the world and especi- ally this liberty-loving people. We have an ambition to be best and foremost in everything and in the general diffusion of this feeling it is not strange it has infected women as well as men. At all events, whether we will or not, women have entered the race and it is but the justice which one human being owes another that we prepare them for it as best we can. Whatever 10 STATE MEDICAL SOCIETY. they gain for themselves will not be merely an ephemeral pos- session, for some part will be handed down to their daughters and more to their sons. I will not enter into any discussion concerning the subject of a girl’s mental training. In times past there was great diver- sity of opinion in this matter, both among educators and the general public, but, of late years greater unanimity on the subject seems to prevail. Formerly it was held that sex was the chief limitation of high intellectual acquirement. But theories must ever yield to facts, and the facts brought forth by this genera- tion have proved otherwise. The elements which influence the extent of education are mental capacity, inclination and health. These are the attri- butes of individuals, and not of one sex. We no longer educate one person after one method because he is a boy, and another person after another system because she is a girl; but we train each with some reference to his or her ability and natural tendencies. If these differ, then some lines in their education must diverge; if they are the same, then the mental training of each may be the same both in kind and extent. As lovers of our country and of our fellow beings we must be interested in the education of our girls. As physicians we have a greater interest in their physical training. The general practitioner stands in closer relations with a larger portion of the community than the gynecologist, whose services are not needed in every household as are those of the family doctor. To him the gynecologist appeals, now and then, to give a word of warning to parents and to interest him- self a little in the physical condition of the growing girls while they are still well. Although gynecology as a specialty is comparatively young in the history of medicine, it has already bestowed untold blessings upon the human family. But be- cause of the great capabilities of this specialty we cannot desire that every woman may be ill that we may have the satisfaction of restoring her to health and happiness. The profession has, in times past, been called upon to treat diseases rather than to prevent them; but prophylactic meas- ures are daily receiving wider attention, and here is presented EDWARD W. JENKS. 11 a problem in prevention which ought to engage the serious attention of every member of this society. My learned friend, Dr. Emmet, of New York, said: “As a profession we shall be judged derelict if we do not instruct the masses in regard to these matters and in the proper mode of educating the women of the coming generation.” In conclusion I beg to state that, while deploring the fact, that, for some reason, there has been a certain amount of physical degeneration of American women, I am in no sense a pessimist on this point. As one who has for many years practiced a specialty that necessitated at least some familiarity with the subject under discussion, the queries have often reverted to my mind: Why are there so many feeble, imper- fectly developed girls and prematurely aged women to be found in every community? Excluding heredity, what is the primal and preventable cause of such feebleness and early decay? How much is due to faulty education? These are questions with which not gynecologists alone, but with which every family physician has to be familiar. I am in favor of the highest type of education for women in keeping with their means and station, but not at the expense of health or by wrong methods, which lead to disease and early decay. Dr. Elizabeth Blackwell has well said of her own sex: “We need muscles that are strong and prompt to do our will; we need strong arms that can cradle a healthy child and toss it crowing in the air, and a back that will not break under the burden of household cares; a frame that is not weakened by the round of daily duties. We need muscles so well developed that they shall make the human body really a divine image; a perfect form, rendering all dress graceful, and not requiring to be patched and filled up and weighed down with clumsy con- trivances for hiding the deformities; bodies that can move in dignity, in grace, in airy lightness or conscious strength; bodies that are erect and firm, energetic and active; bodies that are truly sovereign in their presence, expression of a sovereign nature.” This is attainable and is an important part of the highest type of a girl’s education.