By J. A. Fulton, M. D., Astoria, Oregon.

[Read before the Oregon State Medical Society, June 9,

1897.]

"In sorrow shall she bring forth." The old scriptural punishment visited upon all womankind for the one sin of Mother Eve has been added to in modern times, and today, woman must in a large proportion of such cases, in addition to the pain and torture of labor, stand pain and suffering through all the child bearing period. Also the old scriptural saying, "that the sins of the father are visited upon the children," is added to and now very often the father's sin is first visited upon the mother of his children.

That child bearing should be a physiological process and not a pathological one, that marriage and child bearing is only nature working along natural lines, and that woman may be with proper training, the equal of man in physical endurance, are facts which seem to have been entirely overlooked by a portion of our profession today.

Every year our medical colleges are turning out numberless young men armed with a diploma and the idea that they must at once do something brilliant and thus astonish the world; that women alone must furnish the field upon which they are to win fame and glory; that fame can only be obtained through shedding of blood, and that woman must furnish the blood.

Every town has one or more special woman doctors. Young men, who are only a short time away from their homes and colleges claim themselves to be specialists in diseases of women. The classes of professors of diseases of women in medical colleges are more largely attended than those of other branches, and the articles in our medical journals, and the reports of medical societies might lead one

co believe that the diseases of women are almost entirely surgical.

The ordinary professor of diseases of women is an enthusiast when it comes to delivering a lecture before his class. He must make his subject interesting and over common, ordinary diseases he passes hurriedly. But upon the wonderful brilliant results and technique of modern gynecology he dwells with fervor and enthusiasm. Is it any wonder then that when the student leaves college, he does so with the idea that if he is to win success he must become a specialist in diseases of women? Is it any wonder that he thinks almost all the diseases of womankind are surgical ones? That even the process of parturition is surgical, and that the medical treatment of woman is a thing of the past, or something to be left to the older members of the profession.

Every writer and speaker on the subject today dwells with glowing words upon the wonderful results of the modern treatment of the diseases of women, and speaks of the immense numbers that have been raised from beds of pain and helplessness to become useful members of society. Few, however, speak of that not inconsiderable number of women who go from one doctor to another, one hospital to another, from one charlatan to another and never for more than a few weeks at a time admit that they are well.

Since the time of Hippocrates how many different methods of treating diseases have been followed by the entire profession with what was thought to be brilliant results, but which in time have been given up entirely for some new one and have become forgotten and unheard of.

All who have practiced their profession for twenty years recollect the time when every cervical laceration had to be repaired and every pain in the back indicated a pessary or local application of some kind to the os uteri. In those days did not the specialists claim brilliant results? Were women. not cured then as well as now?

Women have borne children in wedlock and out, have had lacerated cervices and perinea since Adam ate the apple in the garden of Eden, and still the proportion of women to that of men has been about the same all the time, no matter what was the medical treatment during the various epochs of their history. Among the savages and half civilized it has been about the same with the one difference, i. e., the further away from civilization we go the less difference there is in the physical endurance of the two sexes.

That carcinoma, cystoma, fibroma and allied affections require surgical treatment goes without saying, and that there is and always will be plenty of genuine work for the surgeon to do no one can doubt. But it is the various aches and pains called reflex, those various deviations of the uterus from the plane which the normal uterus is supposed to remain in, and the hundred and one other aches and pains which the ambitious gynecologist thinks he can cure with an operation simply because he can think of nothing else to do, that give rise to the doubts and questions of the benefits of so much specialism and doctoring.

Theories are no doubt largely to blame for this. We have had so many beautiful theories about the origin of diseases and their proper treatment, which have, however, failed to stand the test of time, that the physician is not altogether to blame. He has a patient who complains of pains and aches which resist the ordinary treatment. He feels that he must do something or lose his patient, and so with true scientific spirit he evolves a theory, founded upon his inherited or acquired ideas of reflexes (a name, by the way, which has for many years covered up untold ignorance) and decides the pain is a reflex one. And if it is, according to his theory, reflected from an organ which can be removed, he at once brilliantly removes the organ, and though the patient may afterwards have the same old pain with a new one added to it, he notes the case down as a successful operation. It is this kind of work which so called specialists are doing that, in my cpinion not only is going to injure the whole profession if not checked, but which also inflicts needless and often criminal (because needless) operations upon trusting suffering

women.

Ambition is praiseworthy in any calling or profession, and it should ever be the ambition of every man in our profession to find better and more certain ways of relieving the sick and the suffering. But we should be careful that our ambition does not lead us along the path of errors and of needless mistakes.

Looking at the question from its various standpoints, I can arrive at no other conclusions than, that along with the brilliant useful work being done by the profession today, there is much which should be left undone; that women are doctored too much, and that the entire profession is responsible for it.

While I would not remove one star from the bright crown

of modern gynecology, nevertheless it is often wisdom to look backward and compare the past with the present. It is wise to consider well the history of what has at each period seemed to be an advancement in the treatment of diseases. No one claims more faithful allegiance to the true principle of our noble profession than myself, and none can more fully appreciate the true advances and brilliant work of modern gynecology. And yet, when I see the intense rivalry in the profession,a rivalry not always, I am afraid, to see who can cure the most diseases, but rather to see who can perform the most brilliant, the most difficult and the greatest number of surgical operations, I am compelled to pause and ask, is all this work necessary? Is there not some less radical measure which will accomplish the results aimed at? Is it good to remove that which in health is necessary and which we can never replace?

There are more specialists in the diseases of women today than ever before, although the rate of mortality has not increased or decreased among women any more than it has among men. The average duration of life in both has for many years been slowly increasing. Now why is it that the specialists are on the increase? Is it actually true that women are more subject to diseases than men, or than they were in the days gone by? Is it really true that child bearing is so serious a thing and that its effect upon the health of woman is so terrible? Is the ordinary general practitioner less able, less intelligent and less competent to treat the diseases of women than in the times gone by? These are questions which have arisen in other minds as well as that of my own. It is easy to criticize but criticism alone does not help if we can offer nothing better. If what we are doing today is wrong, what can we do to right the wrong?

I have for years firmly believed in the theory of rest and of exercise in the treatment of many of the diseases of women. I have also believed and now firmly believe that women should, be, and naturally are, the equals of men in physical endurance. That rest is beneficial all will admit. That exercise is beneficial none can deny. Then, why not give women a rest from experimental surgery, a rest from the speculum, the tampon, the hot water douche, the daily or weekly application to the os uteri, and the pernicious habit of believing that all their ailments originate in their womb?

Then, give them exercise, real, genuine exercise. Can any one give any sensible reason why women can not stand phys

ical exercise as well as men? Is it not true that in countries where women are compelled to undergo the same privations and the same physical labor as men, they are the equals of men in endurance? Notwithstanding they have also to go through the throes of child-birth, and afterward the nursing of their offspring?

Is it true that education and civilization deteriorates the human race physically? Certainly not. Man himself is as strong if not stronger today than ever before. Our college bred athletes could go into the arena with the gladiators of old and outclass those old fellows in every way. Is it true that education of our women is at the expense of their physical development? I cannot think so. I believe, and the more extensive my observation and experience becomes the more firmly do I believe, that the principal cause of woman's complaints today is the lack of physical exercise and out of door work. That if women could take the same exercise and the same amount of it as the men do, they would have just as much endurance as men and would improve mentally as well as physically. Let women throw off the yoke of bondage which society and Mrs. Grundy has put upon them. Let them risk the sneers and jeers of their fellow women and go cut of doors, ride the bicycle (not hampered with long skirts to please society, but dress so as to be on an equality with their brothers), and they will ride as far and as fast as their brothers do. Let them learn to ride, and drive and row and sail, play lawn tennis, roll nine pins, punch the bag, run hurdle races and in fact do any kind of exercise that men do for their physical development. Let them do this and there will be less of hysteria, less of backache, less of headache, constipation, neurasthenia and all of those aches and pains which are causing the immense increase of specialists in our ranks.

I wish to say before I close that I believe in specialists to a certain extent and under certain conditions. I believe it is absurd, however, for a newly fledged graduate to start out as a specialist in any branch of our profession as it would be for him to start into the general practice of medicine after taking but a single course of lectures. No amount of theory without practice can possibly make one equal of another, possessing both theory and practice. Therefore, I am inclined to the belief that while we are striving to make laws that will keep out of our profession ignorant and dishonest men, we might do well to regulate affairs inside our ranks.