THE FOUR EPOCHS OF WOMAN'S LIFE
A Study in Hygiene
BY
ANNA M. GALBRAITH, M.D.
Author of "Hygiene and Physical Culture for Women"; Fellow of the New
York Academy of Medicine ; Ex-President of the Alumnae Association,
Woman's Medical College of Pennsylvania; Attending Physician,
Neorological Department, New York Orthopedic Hospstal and Dispensary.
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WITH AN
INTRODUCTORY NOTE
by
JOHN H. MUSSER, M.D.
Late Professor of Clinical Medicine, University of Pennsylvania.
"As in a building
Stone rests on stone, and wanting the foundation
All would be wanting, so in human life
Each action rests on the foregoing event
That made it possible, but is forgotten
And buried in the earth."
-- LONGFELLOW.
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INTRODUCTORY NOTE
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IT has been well said that the bulwarks of a nation are the mothers.
Any contribution to the physical, and hence the mental, perfection of
woman should be welcomed alike by her own sex, by the thoughtful
citizen, by the political economist, and by the hygienist. Observation
of the truths, expressed in a modest, pleasing, and conclusive manner,
in the essay of Dr. Galbraith contribute to this end. These truths
should be known by every woman, and I gladly commend the essay to
their thoughtful consideration.
JOHN H. MUSSER, M.D.,
Late Professer of Clinical Medicine
in the University of Pennsylvania.
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PREFACE TO THE SECOND EDITION.
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THE author takes this opportunity to thank the medical profession and
the laity for the very cordial reception which has been tendered the
first edition of this small volume.
The necessity for the use of technical expressions in a book written
expressly for the laity must always be a matter of regret. And only
those who have attempted to write a similar work can fully appreciate
the truth of Herbert Spencer's remark, that "Nothing is so difficult
as to write an elementary book on scientific subjects."
The author has added to this edition a section on "The Hygiene of
Puberty," one on "Hemorrhage at the Menopause a Significant Symptom of
Cancer," and one on "The Hygiene of the Menopause."
ANNA M. GALBRAITH.
15 WEST NINETY-FIRST STREET, NEW YORK.
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PREFACE.
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"Ignorance is the curse of God;
Knowledge, the wings wherewith we fly to heaven."
-- "Henry VI."
PERFECT health is essential to perfect happiness. The greater the
knowledge of the laws of nature, and the more closely these laws are
lived up to, so much nearer "ideal" will be the health and happiness
of the individual. Hence the necessity that these same laws should be
as familiar to the adult man and woman as the alphabet. Further, with
our present knowledge of the certain suffering, disease, and death
that are bred by ignorance of all these subjects, it is little less
than criminal to allow girls to reach the age of puberty without the
slightest knowledge of the menstrual function; young women to be
married in total ignorance of the ethics of married life; women to
become mothers without any conception of the duties of motherhood;
other women, as the time approaches, to live in dread apprehension of
"the change of life;" and many women unnecessarily to succumb to
disease at this time.
The masses of women have at last awakened to a sense of the awful
penalties which they have paid for their ignorance of all those laws
of nature which govern their physical being, and to feel keenly the
necessity for instruction at least in the fundamental principles which
underlie the various epochs of their lives; and it is in response to a
widespread demand that this small volume has been written.
This is preeminently the day of preventive medicine; and the physician
who can prevent the origin of disease is a greater benefactor than the
one who can lessen the mortality or suffering after the disease has
occurred.
ANNA M. GALBRAITH.
15 WEST NINETY-FIRST STREET, NEW YORK.
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CONTENTS
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INTRODUCTION
EDUCATION AS THE CONTROLLING FACTOR IN THE PHYSICAL LIFE OF WOMAN
Huxley's Definition of Education; the Correlation of Mind and Body; the
Emotional Nature; Age for Going to School; the Effect of the Study of the
Scientific Branches; Industrial Education
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PART I.-- MAIDENHOOD
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CHAPTER I.
PUBERTY
Sexual Development; Age of Puberty; Physical Changes at Puberty; First
Onset of Menstruation; Psychic Changes at Puberty
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CHAPTER II.
HYGIENE OF PUBERTY
Home Life; Corsets; Shoes; Underwear; Nutrition; Diet; Water;
Constipation; School Life; Spinal Curvature; Exercise; Walking; Running
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CHAPTER III.
ANATOMY OF THE FEMALE GENERATIVE ORGANS
The Vulva; the Hymen; Condition of the Hymen as a Proof of Virginity; the
Bladder; Vagina; Uterus; Respiratory Movements of the Uterus; Fallopian
Tubes; Ovaries
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CHAPTER IV.
PHYSIOLOGY OF THE FEMALE GENERATIVE ORGANS
Ovulation; Etiology of Menstruation; Uterine Nerve-supply; the Function
of the Uterus; Stages of the Menstrual Cycle; Average Duration of the
Menstrual Flow; Character of the Flow; Relation of Ovulation to
Menstruation; the Menstrual Wave; Definition of Menstruation; Premonitory
Symptoms of the Flow; Hygiene of Menstruation
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CHAPTER V.
THE ANOMALIES OF MENSTRUATION
Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea; Leucorrhea;
Pruritus Vulva
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CHAPTER VI.
THE MARRIAGE QUESTION
Herbert Spencer's Definition of Love; What Constitutes a Suitable
Husband; Best Age for Marriage; Shall Cousins Marry? Contraindications to
Marriage; Do Reformed Profligates Make Good Husbands? the Proper Length
of Time for the Engagement; the Right Time of the Year to Marry; the
Selection of the Wedding Day
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PART II.-- MARRIAGE
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CHAPTER VII.
THE ETHICS OF MARRIED LIFE
The Wedding Journey; the Ethics of Married Life; Shall Husband and Wife
Occupy the Same Bed? the Consummation of Marriage; the Marital Relation;
Times when Marital Relations Should be Suspended
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CHAPTER VIII.
SEXUAL INSTINCT IN WOMEN
Sexual Instinct in Women; Excessive Coitus; Causes of Sexual Excitability
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CHAPTER IX.
STERILITY
Sterility; the Prevention of Conception and the Limitation of Offspring;
the Crime of Abortion; Infidelity in Women
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PART III.-- MATERNITY
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CHAPTER X.
PREGNANCY
Nature of Conception; Pregnancy Defined; Duration of Pregnancy; the Signs
of Pregnancy; Quickening; the Determination of Sex at Will; the Influence
of the Male Sexual Element on the Fernale Organism; Heredity; Hygiene of
Pregnancy; Causes of Miscarriage
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CHAPTER XI.
THE CONFINMENT
Preparation for the Confinement; Signs of Approaching Labor; Symptoms of
Actual Labor; The Confinement-bed; the Process of Labor
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CHAPTER XII.
THE LYING-IN
Management of the Lying-in; Lactation; Nursing
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CHAPTER XIII.
THE NEW-BORN INFANT
The Infant's Toilet; the Crib; Feeding of Infants; the Wet-nurse;
Artificial Feeding; Characteristics of Healthy Infants; the Stools;
Constipation; Urination; Teething
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PART IV.-- THE MENOPAUSE
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CHAPTER XIV.
THE MENOPAUSE
Average Duration of the Menstrual Function; Duration of Menopause; the
Menopause; General Phenomena of the Menopause; Prominent Symptoms of
Menopause; Pathologic Conditions of Menopause; Hemorrhage at the
Menopause a Significant Symptom of Cancer; Causes of Suffering at
Menopause
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CHAPTER XV.
HYGIENE OF THE MENOPAUSE
Diet; Constipation; Stimulants; the Kidneys; Skin; Turkish Baths;
Massage; Exercise; Profuse Menstruation; Hemorrhage; Mental Therapeutics
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CHAPTER XVI.
HINTS FOR HOME TREATMENT
Indigestion; Constipation; Enemas; Diarrhea; Vaginal DouchÈ, Baths;
Headache; Fainting; Hemorrhage
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GLOSSARY
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THE
FOUR EPOCHS
OF
WOMAN'S LIFE
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INTRODUCTION.
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EDUCATION AS THE CONTROLLING FACTOR IN THE PHYSICAL LIFE OF WOMAN.
Huxley's Definition of Education; the Correlation of Mind and Body; the
Emotional Nature; Age for Going to School; the Effect of the Study of
tuse Scientific Branches; Industrial Education.
"What is man,
If his chief good, and market of his time,
Be but to sleep and feed? A beast; no more.
Sure, He that made us with such large discourse,
Looking before and after, gave us not
That capability and godlike reason
To fust in us unused."
-- "Hamlet."
THE word education is here used in its broadest sense, and is meant to
include the physical, mental, intellectual, and industrial. Huxley's
definition is as follows: "Education is the instruction of the
intellect in the laws of nature, under which I include not only things
and their forces, but men and their ways; and the fashioning of their
affections and of the will into an earnest and living desire to move
in harmony with these laws. That man, I think, has had a liberal
education who has been so trained in his youth that his body is the
ready servant of his will, and does with ease and pleasure all the
work that, as a mechanism, it is capable of; whose intellect is a
clear, cold, logic engine, to be turned to any kind of work, to spin
the gossamers as well as to forge the anchors of the mind; whose mind
is stored with the great and fundamental truths of nature and the laws
of her operations; one whose passions are trained to come to heel by a
vigorous will, the servant of a tender conscience; one who has learned
to love all beauty, whether of nature or of art, to hate all vileness,
and to respect others as himself."
The Correlation of Mind and Body.-- It is of the utmost importance
that the mutual reaction of mind and body upon each other should be
thoroughly understood. This reaction is so constant, so intricate, and
so complex that it is at times difficult to say which is cause and
which effect. Does the depressed state of the mind cause the
indigestion, or is a torpid liver the real seat of the melancholia?
The brain is the most delicately constructed organ in the entire body.
In the lower animals the brain is simply the great nerve-center which,
with its prolongation the spinal cord, presides over all the functions
of life which differentiate the animal from the vegetable. In the
human being the brain is much more highly developed and complicated;
and is, in addition, the seat of the mind, the intellect, and the
affections. Like all the other tissues of the body, the brain receives
its nourishment from the blood-vessels which pass through it, and its
healthy maintenance is in a direct ratio to the condition of its
blood-supply.
A most interesting psychologic study is found in the case of cerebral
paralysis of young children, where there is mental defect amounting to
stupidity or imbecility, accompanied by extensive paralysis of the
body, so that the child is not able to sit up. With the gradual
improvement of the physical condition, so that the muscles become firm
and the child can sit, stand, and even walk, there is a corresponding
mental development; from being stupid and dull, the expression of the
face brightens and becomes intelligent; the child talks quite as well
as other children of its age, and sometimes becomes really
intellectually precocious. Here we see the development of the brain as
a direct result of the improved physical condition. In certain cases
of insanity, on the contrary, we find that the wasting away of the
body results from the disease of the brain, i. e., the disease of the
brain has wrought the wreck of the body.
From these pathologic studies, or studies of how the diseased state of
the brain and body may be overcome by physical development, on the one
hand, and, on the other hand, how the healthy body may be wrecked by
disease of the brain, we will turn to a consideration of the effect of
the development of the mind and intellect upon the physical health.
On a girl's entering Vassar College an exact and detailed physical
examination is made by the resident physician, a health record is kept
during her stay there, and at the time of her graduation a final
physical examination is made. As a result of these statistics Dr.
Thelberg says: "These statistics, now covering a number of years, show
that not only can girls profitably take a college education, that is
accomplished; but will prove that grave physical imperfections can be
corrected in the period between eighteen and twenty-two years of age,
coincidently with the development of the mind along the lines of
college work; the college work, if not excessive in amount, being a
real and most important factor in the physical development."
But a still more striking proof can be cited of the beneficial result
of mental and intellectual occupation upon the bodily health. At
Vassar a great deal of attention is very properly paid to general
hygiene and the physical development, in addition to the natural
advantages of outdoor life in the country.
Take, for example, a woman's medical college located in the city: the
four years' course places the greatest strain on both mind and body;
practically no time is left for recreation, and very much too little
time is spent in sleep; the amount of exercise taken is the minimum.
Yet in spite of all these disadvantages under which the young women
labor, a great many of them who enter far below par in health, or,
indeed, on the fair road to become chronic invalids, graduate very
greatly improved in health.
The Emotional Nature.-- Formerly much more than now, owing to the
defective methods of her education and mode of life, the emotional
nature of woman was allowed to run riot. The child was coddled; the
girl was allowed to grow up without any of the discipline which young
men receive in their college and business life, and little or no
attention was paid to her physical development. The woman naturally
became a bundle of nerves, highly irritable, unreasonable, and
hysterical. All this reacted in the most detrimental manner upon her
physical health.
The seed for much of this emotional hyperesthesia is sown in
childhood. From birth until the end of the eighth year should be one
grand holiday. During this time the child develops very rapidly,
especially during the first two years of life. And at the end of the
eighth year the brain has attained to within a few ounces of its full
weight. The muscular system has been developed together with the
coordination of motion. The child has learned to use a language fairly
well; she has developed an excellent memory and is most inquisitive
and acquisitive.
Another method for undermining the healthy tone of the nervous system
is the intricate dances taught very young children and then placing
them on public exhibition, where they are wrought up to the highest
pitch. From a purely medical standpoint, children under eight years of
age should not be allowed to take dancing lessons. After this age a
moderate amount of dancing in a well-ventilated room is good exercise.
Children's parties belong in the same category, and, on account of the
injurious effects on the nervous system, should be tabooed. They are
too exciting, and cause an overstimulation of the nervous system and a
precocious childhood and puberty.
Instead of rearing an oversensitive hot - house plant that must be
fragile in the extreme, strive to rear a sturdy plant that can hold
its own amid the storms. The child should spend as much of its life as
possible in the open air, and in the warm months live out-of-doors.
City children should be taken to the seashore or country to spend
several months every summer. Together with outdoor sports, gymnastics
adapted to the age of the child should be begun early and continued
throughout life. Good muscular development is attended with good
digestion and a well-balanced nervous system.
Until after the twelfth year there should be absolutely no difference
between the physical, mental, or industrial education of girls and
boys. And, still further, they should be encouraged to have their
sports together; this will improve the girls physically and broaden
them mentally, and will do a great deal to take the rough edges off
the boys. After this age it will be wise to allow slight barriers to
grow up, without calling the attention of any one to the fact, that
will cause the companionship to be less free and unrestrained.
Age for Going to School.-- Although the child may be allowed to go to
kindergarten long before this time, it should not be allowed to enter
the school-room before eight years of age. And from eight to twelve
years, not more than four hours a day should be spent in study. After
this time it may be put down more closely to intellectual work; but no
more mental work should be required than will enable the girl to enter
college at eighteen. And eighteen years of age is as young as any girl
should be allowed to go to college; after this age the mind is more
matured and acquires knowledge more easily than before, while the
development of the body is less rapid. The physical system has become
more stable. The literature indulged in by girls under eighteen years
of age should be most carefully selected.
The Effect of the Study of the Scientific Branches.-- A knowledge of
the laws of nature is essential to health; hence the necessity for the
study of the natural sciences-- anatomy, physiology, chemistry,
physics, and zoology. Aside from the intrinsic value of this
knowledge, it is almost universally conceded that these studies
develop the judgment; and no one will have the temerity to deny that a
lack of judgment must undermine the health as well as the success and
happiness of the individual.
Industrial Education.-- When it is considered how intimate are the
relations between the physical and the psychic states, and how often
the psychic condition leads to actual disease, and that often of the
most incurable type, it needs no demonstration that a mental
occupation which will take the woman out of herself is a physical
necessity. Therefore when the girl has reached the subjective limit of
her intellectual education,-- that is, when she has reached the limit
of her capacity or taste,-- it is essential to her physical well-being
that she should turn her attention to some industrial occupation. This
may be housekeeping or any other occupation for which she has taste or
talent. A healthy mental occupation is an absolute necessity to
prevent the individual from becoming self-centered. And to become
self-centered is the first step on the certain road to chronic
invalidism.
A most important part of an education is the knowledge of how to
procure the most perfect development of the body possible, and how to
maintain the health. This has not been touched upon here, since the
outlines for the general physical education have already been given in
"Hygiene and Physical Culture for Women,"* and the present volume
concerns itself only with the four critical epochs of woman's life.
* By Anna M. Galbraith, M. D.; published by Dodd, Mead & Co.
With this broad view of an education, as a means to procure the best
physique possible; a mind disciplined to meet to the greatest
advantage all the vicissitudes of life; an intellect developed along
the lines of its greatest possibilities; and an occupation chosen in
accordance with the tastes and talents of the individual; it becomes
an incontrovertible fact that the education is the controlling factor
in the physical life of every woman.
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"Be not simply good; be good for something."
THOREAU.
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PART I.-- MAIDENHOOD.
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CHAPTER I.
PUBERTY.
Sexual Development; Age of Puberty; Physical Changes at Puberty; First
Onset of Menstruation; Psychic Changes at Puberty.
"Self-reverence, self-knowledge, self-control,
These three alone lead life to sovereign power."
-- "OEnone."
Sexual Development.-- Sexual development goes on during all the years
of childhood, but is not complete in the female sex until between the
twenty-second and the twenty-fifth year. If the child has no inherited
taint, and has been properly educated morally, physically, and
intellectually, it must follow that the structural development of the
pelvic organs has been normal; and normal organs always perform their
functions perfectly.
The commencement of the ovarian function does not cause any more
profound change in the system and habits than does dentition. The
various epochs of life are generally spoken of as if they were
paroxysmal-- as though they were separated by some tremendous chasm,
which had to be leapt over or fallen into. Nature makes no such
egregious blunders; preparations for every change in life have been
going on for a very long time before the evidences of such change
become manifest.
In a healthy girl the psychic and physical changes incident to puberty
occur so gradually as to escape the girl's own notice. The first and,
if the girl has not been properly prepared for it, always startling
change is the appearance of the menstrual flow. The mother who has not
told her daughter of this coming change in her life before it is due
has committed a serious error; it is no uncommon occurrence for girls
who know nothing of this function to get into a tub of cold water to
stop the flow; and if they stay in long enough, it generally does
stop, and the girl's health may be ruined for life.
The opinion of Dr. Ely van de Warker is that "if healthy ovulation is
the outcome of healthy childhood, the function will obey the law of
periodicity year by year, and all this time the young woman will be
able to sustain uninterrupted physical and intellectual work as well
as the young man. Not that the laws of health may be violated with
impunity at puberty or any other time of a woman's life; but a law of
health is no more binding upon a young woman than it is upon a young
man; and there really is no such thing as one law for women and
another for men."
Age of Puberty.-- In the temperate regions the age of puberty is
reached between the ages of twelve and fourteen years. The girl is
then said to be nubile; that is, as soon as menstruation appears it is
possible for her to bear children; but she is by no means sufficiently
developed to do so, as she herself will not be completely developed
physically or mentally before the age of twenty-two or twenty-five
years.
Physical Changes at Puberty.-- The physical changes that gradually
take place, beginning at the time of puberty, are: the breasts,
pelvis, and neck enlarge; hair develops over the pubis and in the
arm-pits; the voice alters. As a rule, women continue to grow in
stature until the twenty-fifth year. It is said that brunettes develop
sooner than blondes, and that large women develop more slowly than
women of small stature; city girls develop younger than girls brought
up in the country. Whatever stimulates the emotions causes a premature
development of the sexual organs; as children's parties, late hours,
sensational novels, loose stories, the drama and the ball-room, talk
of beaux, of love and marriage, and children being surrounded with the
atmosphere of riper years. It is generally believed that early
stimulation of the sexual instincts leads to the premature
establishment of puberty, as do also spiced foods and alcoholic
beverages.
First Onset of Menstruation.-- Sometimes the first menstrual discharge
appears suddenly, lasts for a few days, and then stops; it may appear
after an interval of two or three weeks, or not for several months. If
for several months the flow appears at the regular time, and the
quantity is about the same as the first, the menstrual habit may be
said to be established. The mode of onset varies considerably within
the limits of health. So long as the general health remains good, no
anxiety need be felt in regard to the establishment of the menstrual
function.
In other cases there may be a discharge of blood at the first period,
and none afterward for several months; in other words, menstruation
may be established suddenly, intermittently, or gradually. It must be
remembered that certain pathologic conditions cause many disturbances
connected with the onset of puberty.
Psychic Changes at Puberty.-- The angular, gawky feeling gradually
disappears; the girl becomes self-conscious; new impulses arise, and
she gives up many of the hoydenish ways of childhood. The girl's
imagination is more lively, and just at this time mathematics form an
excellent subject for mental occupation. The girl now begins to
question the whys and wherefores, and demands reasons for the course
that is laid out for her, and is full of ideas of her own; so that
while as a child she had accepted almost unquestioningly the commands
of her parents, she can be managed now only through the power of
reason. And this is just as it should be, for the girl has reached the
years of discretion, and now is the time when her reason and judgment
are capable of rapid cultivation.