Prophylaxis in gynecology.
ELLA MANSFIELD CARYL, M.D., LOS ANGELES, CAL.
Gynecology, the science of diseases of women, is usually divided into medical and surgical gynecology. However, this paper will not attempt to deal with either of the phases of the subject, but will be more particularly concerned with the prophylactic or preventative part of gynecological work.
The time is not so far distant when the major part of the physician's work will be to use his superior knowledge in teaching people how to live to avoid the pitfalls of illness, thus obviating the danger of so many diseases to which womankind is heir. There are a great many reasons for the suffering due to pathological conditions of the female genital organs, and to prevent many of these one should begin with the very young child. The spine and abdominal walls should be manipulated daily, to keep up the circulation and to strengthen the muscles of the back, abdomen and pelvis. As soon as a child is old enough, it should be taught light systematic exercise to take the place of the manipulations. A little later, when the child goes to school, its studies should be varied with manual labor and with exercises done to music in the open air, if possible. The music makes the exercises more enjoyable and the muscles respond to their fullest extent without breaking down so much tissue and filling the muscles with fatigue products, as would otherwise occur without music.
In 1906, Judge Ben Lindsey, the Father of the Juvenile Court, in addressing the Colorado State Conference of Charities and Corrections, said in part: "I have just returned from a great convention in Chicago, where there were noted doctors and teachers, such as Dr. Butler of Columbia University, Jane Addams, and many others who are wrestling with these great problems of delinquent children. The consensus of opinion seems to be that we need more physical and moral training in our schools, as well as manual training." It was also stated at the same convention that "Chicago and other cities were using their school houses for neighborhood social gatherings, and that they have expert teachers to whom they are paying high salaries to teach the children folk dances, and that Chicago had spent thousands of dollars on play grounds, on which physical culture and dancing were being taught." In this way children work off their surplus energy. By exercising the body properly the muscles and ligaments are strengthened and the bony structures of the body are kept in proper anatomical relations. The blood is kept in general circulation, preventing congestion of the pelvis and genitalia, which is more or less responsible for getting children into bad habits, which later on not only impairs the general health, but makes a fertile field for gynecological work.
No young lady should be permitted to wear corsets or bandages which cripple the muscles and interfere with circulation. Thoroughly exercised muscles should not only hold the framework of the body in proper position, but should protect the internal organs in such a manner that ptosis of the viscera would be prevented, and one organ would not interfere with the functionating of another by crowding upon it.
Prolapsus of the pelvic organs could very often be obviated if every woman would take a rest in the middle of the day by lying on her back and lifting her feet far above her head and making rotary motion alternately with each leg while in that position. This would strengthen the pelvic floor and put the pelvic organs back into position, counteracting the force of gravity. This exercise should also be taken before retiring at night, to replace the organs so that the uterine ligaments would be relieved of the tension to which they are naturally subjected while a woman is on her feet.
Children should be taught that the body is sacred, and that every part is for use and not abuse. Young men should be made to feel that they must treat every young lady with the same respect that they would have shown to their own mother or sister and that woman should be a helpmate and not a slave to the sterner sex. He should be made to realize that when he is dissipating he is not only injuring himself, but may be laying the foundation from which the girl whom he leads to the altar may become a helpless invalid, and his posterity be a curse to his name.
At puberty a young lady should be instructed in regard to the functioning of the female organs. It should be impressed upon her mind that the fate of the nation depends upon the young lady in the social world. She should be taught self-control and self-respect, and that the female reproductive organs are intended by the Creator for the purpose of propagating the race; that marriage should not be an institution of convenience, but should be based upon love and respect, and that a home built upon this foundation is the center of civilization. When woman refuses to sell herself to a man in marriage and lives naturally, she will attract her complement in the opposite sex, and the blending of the masculine with the feminine physically, mentally and psychically, each the complement of the other, will tend to keep a perfect equilibrium in the blood and nerve supply, and the gynecologist would find little to do in such a family, and their posterity would be a blessing to the world.
Of course, the above is a somewhat ideal way of dispensing with the gynecologist. The physician will often be called upon to adjust matters as they exist under present conditions. The economic problem will have to be solved before there are ideal conditions for women.
It is reported that no less a personage than Dr. Locke, an eminent divine of Los Angeles, in a recent sermon on "Love and Marriage," said in part: "During the reign of Charles II, the club house was the Londoner's home. A little later woman began to drift from home, numerous women's clubs were organized, and the care of the home and children were left to nurses and servants. Simultaneously there came also a movement of women in professional and business life. While the women were doing the drudgery, the savage men were spending their time smoking and grunting and adorning their persons. It is certain if women want to work and insist upon doing men's work, there are a lot of lazy, worthless scamps who will let them do it. The difference between civilization and savagery is largely a matter of deference and respect with which women are treated. The home has lamentably suffered while women have been coquetting with public life, until it has been facetiously but truthfully questioned whether there are enough mothers left to go around. Woman's work is naturally spiritual, social, idealistic, altruistic and domestic. The fireside is her throne, the cradle her coat of arms."
One can readily see from the above what Dr. Locke thought of the present situation in regard to women, although he may not have thought of the increase in gynecological work, he evidently was interested in woman as a mother.
The greater portion of the female population is naturally endowed to be mothers, and there are comparatively few who have the masculine brain and the female qualities so intimately blended that they can raise a family and yet have the force or fortitude to withstand public opinion, and grope with financial and social problems in the masculine fashion, which we observe in Charlotte Perkins Gillman, Emma Goldman, Madam Curie and others. It is folly to suppose that because these women have made more or less success in their various undertakings that every other woman could do the same and preserve the integrity of the nervous system, upon which so much of the health and happiness of the human race depends.
As women are endowed by nature to be the instruments through which the race is propagated, it should be their business to give some intelligent thought to maternal interests, which includes keeping the pelvic organs in a healthy condition by not permitting themselves to become overworked. Men should solve the problems of economics and finance and relieve women of so grave an injustice as the support of a family. A woman who has to earn her living outside of her own home is liable to anatomical lesions from occupational habits. The function of a joint is motion, and when through habit the spinal column is held in a certain position for an abnormal length of time, there is often an alteration in the mobility of the joint. This condition results in morbid anatomy, ligaments are strained and hardened, and by abnormal pressure on the cord or nerve, naturally interferes with the blood and nerve supply to the organs supplied by that particular segment of the cord. In this way all kinds of menstrual diseases arise. Amenorrhea, dysmenorrhea or profuse menstruation, with their great train of "reflexes," such as headaches, lumbar pains, nervous and gastro-intestinal troubles, etc., and if the lesion is not reduced, it will naturally result in more serious pathological conditions of the pelvic organs.
The physician should look into the history of each individual case and give advice in regard to the change of occupation, or at least teach the patient how best to care for herself under existing conditions. In giving medicine it must be ascertained whether the amenorrhea is the result of poor food and unhygienic surroundings. Macrotys and pulsatilla will not take the place of food and sunshine in an anemic patient where there is no blood to send to the organs, but they will help alleviate the pain in a case where the nerve and blood supply are disturbed on account of a spinal lesion by relaxing the parts, but the spinal lesion must usually be corrected by manual manipulation before one can hope for a permanent cure. It is very evident that a great many physicians are beginning to realize the need of manual therapy, as is evidenced by their willingness to have physical therapeutics incorporated in the curriculum of medical colleges.
There are many things in which the doctor can advise the patient to keep her from the many lamentable conditions in which an uneducated patient finds herself. Her general health should be looked after to find the cause of various aches and pains which arise in the other parts of the organism and are felt in the pelvic region. Vulvitis, due to uncleanliness, is often the result of ignorance on the part of the patient. Inattention to nature's call may cause constipation, producing an overloaded rectum, which may result in a mechanical irritation to the uterus and its appendages. The things that a physician could tell a patient which would preclude diseases of the pelvic organs are too numerous to be mentioned in a short paper.
The obstetrician has a great field in applying his art correctly in carrying a women through pregnancy and delivery without leaving her with some pelvic disturbances.
He should see to it that during gestation her clothes hang from the shoulders, that a lying-in woman does not lie in a sacro-lumbar position too long at a time, as under these conditions a heavy hypertrophic uterus would fall back against the rectum, causing retro-displacement of the uterus, and the stretched uterine ligaments would permit prolapsus of the organ when the woman gets on her feet. The abdominal bandage should not be so tight as to push the uterus back against the sacrum, thereby disposing to prolapsus of the organs, especially if the pelvic floor has been lacerated by neglect of the physician or other unavoidable causes.
The obstetrician should immediately repair perineal lacerations under aseptic conditions to preclude sepsis and uterine displacements, which are more or less responsible for sub-involution with its long train of symptoms, local and general, evidenced by disturbed menstruation, leucorrhea, lumbo-sacral pains, etc., resulting in endometritis and hypertrophy. The above conditions give the gynecologist quite a lengthy job, including curettage, the performance of a round ligament, ventral, etc., suspension operation, etc., all of which would not have occurred with a little care on the part of the doctor.
The physician might, through his knowledge of the human body, teach that congestive endometritis is often due to sexual excesses, and a mother can not afford to be harrassed by a long train of symptoms that follow over-indulgences.
When men and women free themselves from sex slavery and become engrossed in a purer, higher life, then will unborn generations not only be welcome, but the future posterity will be stronger physically, mentally and morally, and books on gynecology would read like ancient history, and the gynecologist would seek more fertile fields in some other occupation.
DR. H. T. WEBSTER: I was very much pleased with the paper, but there is one little idea I would like to advance here, that is, in regard to taking cold in the pelvic organs. You may take all the care the doctor has recommended, but let a woman get into a street car and sit in a cold seat for fifteen minutes, and she may catch a tremendous cold. I would advise the doctor to suggest to her patients that they carry a folded newspaper and before they sit down in a street car, put the folded newspaper under them.
DR. STOESSER: I agree with the paper that the exercise of the limbs by rotary motion is not only good for the pelvic organs, but, in strengthening the heart, and as men are supposed to have hearts as well as women, they could use that exercise, too, especially when they get to be my age. The paper may seem a little harsh to the men who listen, but inasmuch as the men had had two thousand years of rule, according to astronomical conditions the women now have two thousand years, and if we make laws that seem unreasonable the men need not be surprised. The greatest injustice from man to man had been the specific ailments that have been propagated among the species. I have never found anything in medicine that has made me feel so aggrieved as these ailments in young girls and women. They are also the foundation for tuberculosis.
DR. TUCHLER: This paper deserves more than a passing glance. It calls attention to the preventive measures. We ought to educate those that come within our sphere of influence as to the value of observing the moral standards and hygiene, especially. There is nothing so disagreeable to a human being as the propagation of these specific infections. An innocent young lady plights her troth to a man whom she looks up to, and behold, in a, short time, to her surprise, she is a subject for the gynecologist, without knowing the why and wherefore. Some infection has been transmitted. It is the greatest injustice from man to woman, it is a criminal act, and, if we can use our influence in educating the people along these lines of preventive measures, we will do a good thing for mankind and our fellow citizens.
DR. JOHNSON: I very much appreciate this paper, and I realize that to prepare a paper of this kind takes a good deal of work. But there was one little exception I want to take, and that is in regard to massaging the abdomen as a prophylactic measure in gynecology. This seems to be an impracticable treatment, for a woman with a half dozen children in the present day and age does not have time to do this kind of prophylactic work.
DR. ROATH: The doctor recommended dancing to work off the surplus energy of children. I think there are other forms of exercise that would be equal to dancing. I do not like the idea of dancing in public school work.
DR. H. V. BROWN (Los Angeles): I wish to say that I never have believed there was any excuse for a double moral standard for men and women. I am not narrow enough to condemn a man who has committed a sin and ignorantly brought this on future generations, but, at the same time, it does no harm in a convention of this kind to have these questions brought forcibly to our minds in a paper such as Dr. Caryl has read, to jog our minds to the fact that we ought to educate our patients as to the prevention of disease. I think it is a most excellent paper, and we ought to add the weight of our influence along that line.
DR. CARYL (closing): In regard to Dr. Webster's point, I had not thought of having people sit on newspapers. I have advised them to put them under their corsets to keep their liver warm. In regard to the women ruling for two thousand years, I do not know anything about astronomy, and I am not very anxious to rule. I have had woman's rights ever since I was a child and I have had all I wanted. No woman should have to come out and work for the public; she should have a home and children. And every man should have a wife and take care of her properly and there would be no running around.
In regard to massaging the child: If you men had made proper conditions she would have time to massage her children, and they should be massaged until they are old enough to exercise themselves, and they should be taught to exercise their limbs. I was sick all my life until I learned to dance. I was trying to be religious, tried to go to church and do all those things, and my blood did not exercise, but when I began to dance I got well. I believe in it, and do not believe it needs to excite your sex passions at all to dance.
In reference to specific disease—of course, you men think men should have their rights and women should not. That is because women have been suppressed all their lives. They must do as you say, and, of course, men have been educated along these lines, they have had their freedom so long that they think they must indulge themselves—just as they will eat a big beefsteak when they don't need it. But, after my study, I have decided that the sex relation is only for race production. That is my opinion.