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So that improper education causes the troubles we are discuss-
ing, and proper education avoids them. Therefore, from the big
subject of the nervous overdevelopment of women, I select
the single thread of education.

I am among those who believe that woman is entitled to her
maximum development, mentally, morally, physically; that is to
say, to her maximum nervous development. But what is this
maximum, and what are the results of nervous overdevelopment?

A woman may be educated out of proportion to her
possible destiny, out of sympathy with her environment, and
still be within the scope of her mental and physical capacity.
Happiness being the basis of health, this is only a medical ques-
tion when it results in unhappiness. An American girl, likewise,
may be so Europeanized in her education that she is thrown out
of sympathy and interest with American men of the same social
possibility. But this again is sociology, and only becomes
medical when it brings unhappiness to the individual.



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NEW YORK ACADEBiY OF MEDICINE. 115

Aside from these social phases, a woman may be said to be
overcivilized when her nervous system disqualifies her for utility
as sweetheart, wife, mother. This is the view-point of man — the
Church — the State. Individualism is the particular enemy of
the State, which legislates against it at every turn.

But the right to develop her individuality may seem more
sacred to the woman herself than her communal function of
breathing the breath of life into the masculine clay — with its
attending maternity. When is a woman overcivilized from a
woman's point of view?

The overtrained, broken-down athlete is muscularly over-
civilized. The brilliant intellect of a Guy de Maupassant,
pushed by every form of proper and improper stimulation beyond
the limits of finite capacity, is an extreme form of another over-
civilization. Women will concede that their sisters are over-
civilized when they present an analogy with either of the above
extremes. A training, an environment, a habit of life, that
results in even a partial disqualification for the average obliga-
tion, the average return to the race for the blessing of existence,
is an overcivilization. What results follow overeducation in
women?

The governor on a motor retards an accelerating speed and
keeps the machine from racing itself to pieces. As in mechanics,
so in biology nature has a very definite average for each species
and has implanted a strong instinct to hold these limits. Were
giants and giants, pigmies and pigmies — physical or intellectual
— to weld, were an omnipotent Burbank of the human garden
permitted to breed and rebreed selections from the largest and
best of humanity, average limits would be broken, and we
should have a race of demi-gods. Human instinct — a biological
governor — defeats this. The very zests of humanity — ^witness
that of the giant for the little woman, and vice versa — are
equalizing forces.

It is the same in the realm of the mind. Where in all history
is the posterity of genius? There is no law of psychical entail.
Let one but "o'erinf orm the tenament of clay," and nature prepares
to stop the process with the ofifending generation — and wisely so.
Hence the oversubtle among the women are rarely mothers,
and when so are almost always delivered with instruments.
Thus nature shows her intolerance of attempts to trespass
average limits.

Now, woman is peculiarly susceptible to educational influences.
Her inviting plasticity cries aloud for the master hand in the
moulding. It is this wonderful alchemy of feminity — ^transform-
ing a coarse and knotted paternal element as from baser to finer
grade — that preserves for the race the higher psychical qualities.
Our fathers reason and deduce; our mothers aspire and arrive
intuitively. The very best women are capable of receiving,
therefore, enhances every feminine value, and really extends their



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116 TRANSACTIONS OF THE

life-limit. But, again, the question comes, what is the best?
And what of the overtrained?

Civilization has no brighter triumph than the American women
of highly evolved nervous organization; the poised, yet alertly
flexible creature, with accurate intuition, natural insight, and a
trained keenness of edge as fine as the soprano she distils from
the paternal growl. But the virtue of her great susceptibility
has its vice in her peculiar readiness to run into a nervous over-
development. But one further turn of the key, but one slight
overstretch of the bow — and we may have the mystic, with
introverted mind, an occult seeker of visions, given to illumina-
tions and elixir of moonbeams — with the well-known attending
troubles. Woman is naturally the orient to man's Occident;
but this overorientalization certainly disqualifies her for the
average obligation and the average return.

The unfair division of vital force, the overdevelopment of the
physical element, leaves the physical — especially the glandular
elements — undeveloped or demagnetized; and we may have an
almost sexless mentality instead of a woman. Nature stops this
process of overbreeding by withholding posterity.

The basis of life must always remain the primative and elemen-
tal gland call for cell union. A demagnetized gland, regardless
of bulk, lacks the primative power. We see men enduring,
aspiring — ^inflicting death and even losing life — for the elemental
and primal; but never solely for the brilliant intellectual.

And this is our test. Civilize the civilizable, mould the eager
mind, give such a nervous development that woman may "forge
the anchors as well as wave the gossamers of the mind." But
let her not demagnetize her elemental gland capacity by an
unfair division of vital forces.

Just as the discovery of the radio-activity of the supposedly
ultimate elements has led to a still further division of matter and
has revolutionized modem physics — ^just as the concept of the
vital integrity of the cell is surely pointing to the cancer cause —
so this problem of the conservation and equal distribution of vital
force is looming into the medical problem.

But even if woman were to choose the individuality instead of
the posterity, and were to welcome the sterility there would
still be a grave penalty. Infantile uterus has long been recognized
as the result of overexpenditure of vital force in intellectual or
emotional outlay. Bulk has little to do with the comprehensive
malady of infantile uterus and demagnetized gland; and it has
wider moment than question of race and posterity.

" Less than five years will sometimes change an infantile uterus
in an unmarried girl with amenorrhea, into a condition of turgid
pelvic congestion with profuse menstruation. The pathology is
obscure, but there is an analogy between this condition and the
gastric engorgment and hemorrhages attending certain stages of
cirrhosis of the liver." These patients frequently reach the
operating table as a consequence, and there as a final penalty



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NEW YORK ACADEMY OF MEDICINE. 117

give up their essential essence of femininity, with a result to
longevity that I have elsewhere elaborated.

But suppose our oversubtle women are only partially so, and
become mothers. We handle them judiciously; we deliver them
adroitly with instruments. On the other hand, suppose nature is
trying to shut up the oversubtlety within the ofifending genera-
tion by inflicting uterine and mammary atrophy. Our routine
gynecology sometimes thwarts her, and helps pass along over-
subtlety along to another generation. We have resourceful
methods with the local organs.

But now comes my hobby. All this being within our capacity,
we yet transcend ourselves when we train women to become
mothers naturally — when we keep the local organs from need
of local attack.

Foreseeing, f orethinking, and f oreplanning do this.

Dr. Egbert H. Grandin considered the topic under two heads:
The sociological aspect was of vital importance to the integrity
of the race, and it was the duty of the physician, in so far as in
him lay, to teach his patients the importance of beginning the
training for marriage from childhood up. In short, prophylaxis
was the self-evident remedy against the rearing of the type of
woman so graphically portrayed by Dr. Newell. Poor hygienic
surroundings during childhood, education of the brain at the
expense of the body, lives of leisure without physical exercise,
of necessity these factors resulted in undeveloped nerve centers
and in infantile genital systems. The end-result was that such
women were not suitable for entering into matrimony. Should
they do so we as physicians were up against the questions pro-
pounded by Dr. Newell in the event of conception ensuing, and
the resulting child meant simply a second edition of the neurotic
mother.

The second phase of the paper — the practical phase — dealt with
the management of labor. He had very decided views, the result
of his experience, and he could not aJtogether endorse certain
of Dr. Newell's statement. Thus, reference had been made to
scopolamin-morphine anesthesia. He would object to this
because the use of morphine during labor interfered with the
eliminatory organs and it was above all essential that these
should act physiologically, especially since just after labor extra
strain was of necessity thrown upon them. Again, the chemistry
of scopolamin was rather obscure, and the reports from European
clinics proved that it was not free from danger both from the
side of the woman and of the fetus. Further still, he was satisfied
that certain well-established measures answered better in case
of these neurotic, undeveloped women. Fortunately, this type
of woman was rarely met with among the poorer classes where
the renumeration of the physician — at best very inadequate —
did not permit of the careful supervision which women in the well-
to-do class could command. The physician should be the master
in the lying-in room. Anxious relatives should be excluded.



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118 TRANSACTIONS OF THE

Moral suasion could thus be brought to bear and nervous tone be
maintained at a higher average. When the uterine contractions
became efficient during the first stage, a large dose, twenty
grains by mouth or forty by rectum, of quinine intensified the ac-
tion of the involuntary muscles. One one-himdredth of hyoscine,
under the skin, often controlled nervous excitement. Chloral,
in fifteen-grain doses, repeated half hourly, for three to four doses,
equalized the force of the contractions, the intervals between
becoming longer and the duration of the contractions as well.
The first stage completed, in the absence of contraindication from
the side of the liver, chloroform administered during the muscular
expulsive contractions, took the edge off the suffering. On
appearance of maternal or fetal exhaustion, version or forceps
according to indication entered into consideration. Thus he
had guided scores of neurotic women through labor, and this
too without ever feeling that in the absence of relative or abso-
lute indication the Casarean section was allowable. Indeed,
in reference to this latter point, he could not speak too strongly.
The field for this latter operation he was opposed to widening
unnecessarily, lest as a result the mortality rate, now at such low
ebb, should be materially raised.

Dr. George L. Brodhead had found it very difficult to
estimate just how much a nervously overdeveloped woman
would do in labor, and he spoke of a case which had come
recently under his observation. In her first labor some years
ago she had delivered herself after a long labor spontaneously,
with extensive laceration of the cervix and perineum which were
not sutured, but the patient recovered slowly and was told by
the attending physician that the soft parts were in as good a
condition as before her labor. At the time of her second labor
she was safely delivered, by a moderately difficult median forceps
operation, of a nine pound child. In her last labor the woman
became exhausted, with the head just dipping in the pelvic
brim. Forceps were tried ineffectually and version was resorted
to; the extraction was very difficult, but finally a deeply asphyxi-
ated ten pound child was born, with a fractured humerus and
Erb's paralysis. In this particular case, induction of labor
at the eighth month would probably be a wise procedure. Dr.
Brodhead did not believe that one could tell without a previous
history how much assistance would be required for some patients,
for it was impossible to tell how much pain the woman could
suffer, or how far labor would proceed before intervention be-
came necessary.

Dr. Newell had spoken of prophylaxis, and Dr. Brodhead
believed he was perfectly correct in advocating rest and relaxa-
tion. The tendency among women, especially in the cities,
was to spend too much time at bridge whist, suppers, social
functions, with too little fresh air and relaxation.

One should advise these nervous patients to spend a large
amount of time in the open air and to take moderate exercise.



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NEW YORK ACADEMY OF MEDICINE. 119

He was not sure that too much exercise was beneficial, for some
of the most diflBcult labors he had attended were in young women,
who had been very athletic.

He did not remember that Dr. Newell had mentioned the
subject of diet. Many women were allowed to go to full term
without instruction as to diet, being allowed to eat any amount
of sweets and starches, and in some instances the children were
very large. Personally he had observed that by limiting the
diet mainly to proteids after the sixth month, the child would
be of moderate development. Some years ago Dr. Brodhead
said he had read a paper in which he stated that in his practice
he used forceps in fully 50 per cent, of the primiparae. Dr.
Cragin had taken part in the discussion and had stated that
many women simply thought that all they had to do was to go to
full term, and ** press the button" and the obstetrician would do
the rest. There seemed to be an inability or an unwillingness,
or both, on the part of many patients to stand the requisite
amount of pain for spontaneous delivery. He believed that in
cases of delayed labor the use of the Champetier de Ribes bags
was of the greatest value.

With regard to the use of drugs, he had tried scopolamine
and morphine in a dozen cases; he could not see that any better
results followed than were obtained by the use of morphine
alone or with chloral and bromides.

Cesarean section he had never done in the type of cases men-
tioned in Dr. Newell's paper, but in selected cases he could see
no reason why the operation should not be performed.

Dr. Franklin S. Newell of Boston said, in answer to Dr.
Cragin's question as to what must be done to lessen the educa-
tional strain to which the girls at the present time are subjected,
that in his opinion the educational period must be extended so
that they will be subjected to less strain at the time of puberty
and in the years immediately following.

In the education of boys, as the requirements have been in-
creased, the age of graduation from college has grown steadily
greater until at the present time the average age of graduation
is twenty-three instead of twenty-one as a few years ago.

With girls, on the other hand, although the requirements
have been markedly increased within the last few years, the
age at which a girl must enter society remains practically the
same, that is, from eighteen to nineteen. In order to lessen the
strain on the individual girls either the requirements of education
must be lessened or the length of time given to education
increased.

In regard to the question as to whether a college education
did more harm than society life for the average girl, he believed
that it was certainly no greater strain if careful supervision was
maintained, but the average girl is more ambitious than her
brother and much more likely to overwork and injure herself



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120 REVIEWS.

in college than he, and, therefore, must be guarded against
overwork and too late hours.

In regard to the statement of Dr. Cragin's that he was unable
to determine in advance what primiparae needed intervention
before the beginning of labor and felt that the test of labor must
be applied in practically all cases before the patient could be
properly classified, he said that the one definite exception to
his opinion to Dr. Cragin's statement was, the older primipara
who gives a bad nervous history, whose early life showed that
she was unfit to bear burdens imposed on her during her ordinary
life, whether as the result of the strain of society or from being
primarily unfit.

These cases he believed are not proper subjects to be sub-
jected to any unnecessary strain and advised interference before
labor began.

It is a difficult question to decide in border-line cases how far
we are justified in giving a woman a chance. Experience has
shown that many patients will react badly to labor but will
stand the strain of operation well. The choice between abdomi-
nal and pelvic delivery must be carefully considered, according
to the conditions present in each individual case. Cesarean
section done by a competent surgeon, prior to labor is attended
practically with no risk to life and the after-results as regards
health are good. If a pelvic delivery is performed, in many
women there will be damage to the pelvic organs, such as lacera-
tion of the cervix or rupture of the perineum, and from the pelvic
injury nervous symptoms may develop which may render such
a patient an invalid. In his opinion Cesarean section offered
less chance of serious complications afterward.

In regard to the question of limiting the patient's diet so as
to reduce to a minimum the size of the child at birth, he believed
it was not so much the question of what the woman ate as it
was of how much she ate. If such women could be made to eat
simply enough food to keep themselves in good physical condi-
tion instead of seeing how much they could eat during preg-
nancy the supply of nourishment going to the fetus would be
lessened and the baby itself smaller.



REVIEWS.



Medical Jurisprudence, Forensic Medicine and Toxicology.
By R. A. WiTTHAUS, Professor of Chemistry, Medical Juris-
prudence and Toxicology in Cornell University, and Tracy
C. Becker, A. B., L. L. B., Professor of Criminal Law and
Medical Jurisprudence in the University of Buffalo. Second
Edition. Volume III. New York, William Wood and
Company, 1909.
The third volume of this series maintains the high standard of

the previous two. The book opens with a section of 123 pages



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REVIEWS. 121

Upon ** Vision and Audition and Injuries to the Eye and Ear,"
by J. H. Woodward. As we would expect, the author devotes
the larger part of the text to traumatic lesions. The chapter on
** Sympathetic Irritations and Inflammation" is most exhaustive.
The second section is devoted to the medico-legal relations of
insurance by Alfred L. Becker. The chapter on ** Insanity in
its Relations to Medical Jurisprudence," by E. D. Fisher, covers
200 pages and leaves nothing to be desired. This section is
succeeded by two sections on "Medical Unsoundness in its Legal
Relations," by Tracy C. Becker and Chas. A. Boston, and the
"Medico-legal Aspects of Marriage and Divorce," by Alfred
L. Becker. The section on the ** Medico-legal Relations of the
X-rays and Skiagraphs," by Albert G. Geyser is worthy of
especial commendation. The two final sections on **The
Medico-legal Examination of the Blood and of the Hair," are
written by James Ewing. The reputation of this author as an
authority on the blood is well known, and this section fulfills
every expectation. The numerous pitfalls which must be avoided
in the examination of the blood for medico-legal purposes are
fully described, and the recent work on the biological determination
of the blood species is excellently summarized.

E. M.

A Text-Book on Practical Obstetrics. By Egbert H.

Grandin, a. B., M. D. With the collaboration of George W.

J arm AN, M. D., and Simon Marx, M. D. Fourth Edition,

Revised and Enlarged, Octavo, 538 pages; 47 plates and 116

text illustrations. F. A. Davis Co., Philadelphia, 1909.

This volume is a good practical book covering the entire subject

in a satisfactory manner. Part IV, which deals with obstetric

surgery is unusually complete for a short treatise. Necessarily

both the aim and the size of the book preclude any attempt

to deal with doubtful questions, or to discuss the pathology of

diseases in detail.

• The plates, prepared chiefly from photographs, are, on the
whole, clear and instructive; the wood cuts in the text are
largely obsolete or too schematic. R. T. F.

Travaux d'obstetrique, par le docteur Samuel Gaghe,
Professeur agr^g6 k la Faculty de medicine de Buenos- Aires;
Directeur de la Maternity de THdpital Rawson. Large
octavo, 418 pages, Paris, 1909. Price, 15 francs. G. Steinheil,
Paris.

The early death of the author placed the collection and
publication of these monographs in the hands of his friends. All
the subjects dealt with are of interest to the obstetrician, some
of them have never been presented before in such a complete
and masterly manner. Fecundity in women of sixty-six coun-
tries practically includes the entire globe. Rachitis in North
and South America and its influence on obstetrics is the first



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122 REVIEWS.

serious attempt to collect statistics of the native-bom population
of these continents. Pregnancy and labor in primiparae of
thirteen to sixteen years (ninety-two cases), and labor in aged
primiparae, thirty-eight to forty-six years, shows a normal course
in both groups. Methods of inducing and accelerating labor;
Bossi's dilator; Cesarean section; Tumors complicating preg-
nancy; Rupture of the uterus; Retention of the tom-off head;
Eucaine and stovaine in obstetrics, are some of the subjects
discussed. Coitus during pregnancy is a subject greatly neglected
by text-books. It is dealt with in great detail in the concluding
chapter.

The author's work shows a large experience, careful clinical
observation, wide knowledge of the literature, and an attractive
method of presentation. R. T. F.

Transactions of the American Gynecological Society.

Volume xxxiv, for the year 1909. Published by the Society.

William J. Doman, Printer, Philadelphia, 1909.

This handsome volume of 876 pages is one of the largest ever
issued by the Society. It contains, besides the papers and discus-
sions brought before the Society at its thirty-fourth annual
meeting, held in New York on April 20th to 22d, 1909, the
candidates' theses; in memoriam tributes to Edebohls, Reamy,
and Murray, and a full record of the banquet given by the
New York and Brooklyn members of the Society in honor of
Ephraim McDowell and the centenary of the first Ovariotomy
done by him in America in 1809.

Medical Gynecology. By Samuel Wyllis Bandler, M. D.
Fellow of the American Association of Obstetricians and Gy-
necologists; Adjunct Professor of Diseases of Women, New
York Post-Graduate Medical School and Hospital; Associate
Attending Gynecologist to the Beth Israel Hospital, New
York City. Second Revised Edition. Octavo of 702 pages
with 150 original illustrations. Philadelphia and London,
W. B. Saunders Company, 1909. Cloth, $5.00 net; Half
Morocco, $6 . 50.

The first edition of this book was reviewed in this journal
for February, 1909. That a second edition has been found neces-
sary within a year is sufficient indication that the work has
found favor.

This volume differs from the first edition in but a few
unimportant particulars. The chapters on electricity and
hydrotherapy have been enlarged, while a chapter of six pages
upon the subject of Head Zones has been added. These addi-
tions have been carried out by the author in a satisfactory man-
ner, and we see no reason, therefore, to change our previous
favorable opinion of the author's work.

E. M.



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REVIEWS. 123

Diseases of Women. A Manual for Students and Practitioners.
By Charles Gardner Child, Jr., M. D. (Yale^. Clinical
Professor of Gynecology, New York Polyclinic Meaical School
and Hospital; Attending Gynecologist to the City Hospital;
Junior Attending Surgeon to the Woman's Hospital. Series
Edited by Victor Cox Pedersen, A. M., M. D., Genito-urinary



Online Libraryof Rhodes. Spurious works AndronicusThe American journal of obstetrics and diseases of women and children → online text (page 13 of 109)