DEVOTED TO MEDICINE AND SURGERY SUBSCRIPTION PRICE, ONE DOLLAR PER YEAR Original Communications. CAUSES WHICH IMPERIL THE HEALTH OF THE AMERICAN GIRL AND THE NECESSITY FOR FEMALE HYGIENE.* BY GEO. J. ENGELMANN, A. M., M. D. President Southern Surgical and Gynecological Association; President St. Louis To guide women in greater safety through the dangers which beset her path in life, is one of the highest and most sacred duties of our profession, as we may say that the care of women is the care of the nation; the good health, mental, moral and physical of the woman and mother, is the very foundation of our national growth and prosperity, and the conditions which tend to under *Abstract of President's address before the Southern Surgical and Gynecological Society, Atlanta, Nov. 11, 1890. mine that health cover a field, extent and importance that you will readily realize the necessity of a limitation of my remarks. I shall speak to you of the girl, the coming mother, of adolesence, the most important and interesting period of woman's life, the period of greatest functional activity, during which the foundation for future health is laid. It is the most dangerous period, during which the organism, the budding mind, the developing system, are more susceptible to disturbing influences from without and within. It is in the time when the clay is soft and the vessel is forming, when it yields most readily, and trifling impressions are permanently recorded. It is in this period of school, the period of beginning social life, the period of learning in trades, that the nervous energies of the female are most fully engaged, and her activity is concentrated on the brain function, to the detriment of other functions, above all the developing sexual function, the central and most important, and at that time most readily disturbed. That I speak of the American girl is but natural, and I need hardly say that she is, moreover, subjected to a far greater number of disturbing influences than her sisters in other lands, more recklessly exposed to the very injuries which react most violently upon the female function. True as it generally is, that woman is the exponent of a nation, indicative of its development, of its growth, of its depreciation, the American woman is more closely linked with the state and fate of her nation than the women of other countries. She shares the febrile activity of our existence; she is the factor in our social and political economy; the participant in the rush and crush of the times to the utmost extent of her nerve force and brain power; but especially is this true of the American girl, as compared with the girls of other countries. When I speak of the American girl I speak not of the extremes, not of the rich or poor, but of the girl of the great middle class of our cities-the typical American girl. Compare her to her hearty, scrong-boned English sister; the French girl raised within convent walls, carefully guarded, removed from life until her marriage; or to the average German girl, reared amid the calmness of her surroundings, taught the solid rudiments of learning and educated in household duties. Compare her even to her sister of the village or country, if she still be free from contaminating influences-from the nerve life of city or boarding school. You will recognize her at once. You will recognize the effect of brain work and nerve strain, the rush and mental activity of the day, the want of muscular training, the want of harmony in life, in training and education, mental, moral and physical. Whilst I will not agree with Ploss in his characteristics of the American girl, when he records the statement of an ungallant Yankee, that the American girl has no bones, no muscle, no vitality-only nerves; and what should we expect, he asked, when in the place of bread they eat chalk, in the place of wine they drink ice-water, wear tight corsets and thin shoes. Even now one of our greatest authorities, and one of our keenest observers, Dr. T. Weir Mitchell, says that the American woman is unfit for her duties as a wonan, not quite up to what nature asks of her as a wife and mother. I believe that the essential causative factor to which the illhealth of the American girl must be referred is functional neglect, or ignoring the functions, and over brain work, over exertions of the nerves and emotions, with imperfect development of the muscular system, an inharmonious development and exertion, physical, mental and moral. The peculiar organization of woman is too much ignored, and it is claimed that woman is equal to man in her primitive state, and that her functions are physiologically and naturally not in want of any particular attention. Is this function of such paramount importance, and does it so completely control woman's life? This is a physiological problem upon the solution of which depends the relative capacity of woman for labor, mental and physical, and and an understanding of the causes of diseases, their influences and their remedies. The answer is readily found if we observe with an unprejudiced eye the existing conditions. Throughout all the great kingdoms of nature, the importance of the reproductive function in the female is demonstrated; it is strikingly demonstrated in the vegetable as well as in the animal life; it was recognized by the intuitive keenness of the most primitive people, and distinct expression is given to these fundamental facts in nature, by the great law-givers of the ancient times. Differences in sex are, more or less, well marked throughout the vegetable kingdom, and the supremacy of the reproductive function in the female, with the necessity of additional vitality for its perfect performance is distinctly characterized. This is well exemplified in our common hemp, which developes over fifty per cent. of male plants, when the seed is fairly distributed over fertile soil, as a superabundance must be provided for the necessary waste which follows the distribution of the male pollen by the wind. If the seeds are thickly sown, so that the nutrition is insufficient or scant, the number of female plants will be diminished, as the ample supply for their greater vitality is wanting; and if densely crowded the female plant may be be altogether unable to develop. To the fruit-grower the great demand of vitality for the reproductive function is well known. The apple tree with a luscious growth and foliage bears no fruit, its vitality all being directed towards the one function of vegetable growth. To reduce this the tree is girdled, when with a dimunition of growth and foliage it again fruits. So harmonious development of the function is as necessary for the symetrical growth of the plant, as it it is to the perfect development of the human being. The high importance of the peculiar function of women, which it is a tendency of our enlightened nineteenth century to undervalue and ignore, was fully appreciated by the people of olden times, and the necessity of functional hygiene for the welfare of the community was recognized to such an extent that it was made obligatory by laws of custom or religion, and the highest penalties-expulsion from the community, everlasting damnation, and even death, were imposed for certain transgressions which are thoughtlessly practiced to-day by the refined and enlightened beings of our advanced civilization. The essence of such laws and customs of the savages of to-day, in fact, of all primitive people, from past to present, was rest, functional rest. Instinct and experience have taught primitive people these truths, which in our day are but imperfectly realized even by medical science, and denied by some who call the susceptibility of the woman of to-day and her ailments unnatural, and claim them to be altogether the result of civilization. They claim that woman in her natural state is the physical equal of man, and constantly point to the primitive woman, female of savage people, as an example of this supposed axiom. Do they know how well the same savage is aware of the weakness of woman and her susceptibilities at certain periods of her life? With what care he protects her from harm at these periods, so that health may be retained? The aid of religious superstition and the anger of the gods was invoked to secure this simple but effective female hygiene, to secure the much-needed rest. Rest by isolation during the periods of functional activity, up to nine days each month, up to thirty and ninety after childbirth, and up to five months at puberty. The budding of the maid into womanhood is marked by a long period of rest and isolation, and her return to her tribe is celebrated by ceremonies of various kinds. The importance of surrounding woman with certain precautions during the height of these functional waves of her existence was appreciated by all people living in an approximately natural state, by all races at all times, and among their comparatively few religious customs, this one affording rest to women, was one of those most persistently adhered to. This idea has been so deeply impressed that a mere touch is looked upon as contamination, and that she is accordingly obliged to desist from all the ordinary duties of life and removed from its exertions and excitements by forced isolation. Where isolation is not customary, as we find it among people approaching civilization, a certain characteristic mark or signal is worn, for the wearer a passport of safety; in East India young girls show their condition by a small piece of linen steeped in blood, which |