CLELIA DUEL MOSHER, “THE RELATION OF HEALTH TO THE WOMAN MOVEMENT” (15 MAY 1915)
 Professor William T. Sedgwick of the Boston Institute of Technology, in an interview published in the New York Times, January 16, 1914, says that the new doctrine (the Feminist Movement) if it succeeds will throw the world back 1000 years. He quotes a feminist advocate who says: “Bring Boys and Girls up by the same method, let them as men and women have the same interests and occupations and in a few generations there will be no difference in the sexes but of anatomy.” In refutation Dr. Sedgwick asserts that “Sex is a deep seated structural difference affecting every organ, every tissue, every cell in the body,” and goes on to say: “Women have narrower, rounder shoulders than men, broader hips, more fatty tissue under their skin, smaller stature, lesser weight, smaller feet and hands. There is no reason to doubt that sex makes a difference throughout the entire structure, the brain included.” After quoting from a distinguished physiologist (unnamed) he concludes: “my experience as a teacher has proved the existence of these handicaps. I have been obliged to use different methods when teaching women.” This is discouraging, if true. But what of the facts?
 Life itself, not the feminist movement, is altering the status of women. Olive Schreiner in her book called “Woman and Labor” published only four years ago, points out that the changes in economic conditions have taken away the women’s occupations as a manufacturer in the home. Even the demands made by her profession of motherhood have been lessened by the economic limitations in the size of the family. With these diminishing requirements there is danger that she will sink into a condition of parasitism which will result, not only in her own physical and mental deterioration, but in an injury to the race. Her book ends with “today we are found everywhere raising our strange new cry—”Labor and the training which fits us for labor.”
 The European war is demonstrating that women may not only fight in the trenches but may receive the same rewards for bravery as her husband or brother. In England regiments of women are being trained for home defense. In France, Germany, England and Italy women are replacing men in all occupations, both the higher and the lower, even those requiring great endurance to exposure and physical strain: we hear of women conductors and motormen, railroad laborers, cab drivers, baggage porters: we have long heard of their plowing, sowing, and reaping. In other words while the man is at the front the work of the world is being carried by women.
 At the present moment every profession and occupation is not only open to woman but are being successfully undertaken by her. Only yesterday women went to college at great personal sacrifice. And dire were the predictions of the evil results to her health, and to the race. Characterized “as hermaphrodite in mind,” and “divested of her sex,” the college woman failed to develop the anticipated evils. She was found to be rather healthier than her sisters who did not go to college, to marry as other women of her class, and to bear a rather large number of healthy children. Today women go to college as a matter of course and without comment.
 The women of California as in twelve other states and one territory in the United States, millions in number, cast their votes, perform their civic duties, even serving as election officials, without destroying health or homes. Where are the traditional handicaps of sex? What becomes of the statement made by the distinguished physiologist (unnamed) whom Professor Sedgwick quotes as follows: “During the periodical recurrence there is apt to be more or less discomfort and nervous irritability; the woman is not quite herself, and those responsible for her happiness ought to watch and tend to her with special solicitude, forbearance, and tenderness and protect her from anxiety and agitation. Any strong emotion, especially of a disagreeable character, is apt to work harm that may be followed by serious consequences, perhaps of a lasting structural character. A sudden chill often has the same effect. Violent exercise at this time should also be avoid. The climateric as a critical period, various local disorders are apt to supervene and mental derangement resulting in abnormal behavior.”
 If this statement is true the outlook for the future of the race is gloomy indeed. Olive Schreiner’s cry for labor has already been answered; millions of women as we have seen are carrying on every kind of labor and daily the number is augmented. Millions on millions of women, instead of being sheltered and cared for during that so called incapacitating periodic function of menstruation are suffering every hardship and exposure; could there be emotions more poignant, conditions of labor and even conditions of life more frightful than those the women of the warring nations are now called upon to endure? Even in our own peaceful country the increasing strain of modern life inevitably deprives women of this sheltering care. But is the statement true?
 The historical development of the modern woman and the traditions which have unconsciously shaped women’s mental attitude toward themselves and toward life have been traced by Mrs. Coolidge to her book “Why Women are So.” Is it not possible that at least some of women’s physical disqualifications as well, have been owing to surrounding conditions rather than inherent in her sex? I agree with Professor Meyer of Stanford University in his statement that “we cannot make a man into a woman nor a woman into a man”—I will go still further and say that we do not even wish to try to do so. But we may make a judicial examination of these traditional handicaps in the light of scientific knowledge. Indeed we must do this since a large portion of the race promises to be exterminated by the slaughter of the best manhood in the warring nations engaged in this most barbarous war in history, and since women are of necessity obliged to undergo the strain of unparalleled labor which they are traditionally unfit to bear; in this intolerable situation the need for truth with regard to women’s physical limitation becomes imperative.
 In 1892 every physiology still taught that women breathed costally and men abdominally. The costal respiration of women was believed to be a provision against the time of gestation. In 1894 the writer while at Stanford University and Dr. Fitz at Harvard, independently and almost simultaneously demonstrated that there is no sexual difference in the type of respiration. My own experimental work on respiration has demonstrated that pregnancy interferes less with the respiration than has generally been believed. The respiratory movements in the different regions tend to become equalized, but the diaphragmatic respiration persists as late as the eighth and even the beginning of the ninth month of pregnancy. The movements of the diaphragm materially aid the expulsion of the bile from the common duct as has been experimentally proved by Heidenhain and his pupil according to Naunyn. We may here have one of the factors in the production of gall stones which are of more frequent occurrence in woman than man. Another undesirable result of unnecessary costal breathing in women. Moreover strong abdominal muscles are essential to a good figure. They aid in the second stage of labor, are the chief support of the kidneys and abdominal organs as we shall presently see are very potent factors in preventing menstrual pain and excessive flow. Both the experiments of Dr. Fitz and my own clearly demonstrate that clothing is the most potent factor in the production of the costal type of respiration in many women.
 Now if we analyze the serious objections to women in industry and the plans for her care and protection, we inevitably come to the one function, menstruation, whether this is to be put into words or not.
 What I am about to say in regard to the function of menstruation is based on the study of perhaps 800 or more women during a probably 6000 or more menstrual periods. The observations and work in the physiology and hygiene laboratories has extended over a period of 23 years. May I ask you to discard all your preconceived ideas, your sex traditions, and your individual experiences, and consider judicially the statements I am about to present?
 The painful menstruation so commonly observed is, in the larger number of cases, congestive in type, and is produced by: (1) the upright position (Moscati), (2) alteration of the normal type of respiration by disuse of the diaphragm and of the abdominal muscles, (3)the lack of general muscular development (4) inactivity during the menstrual period, (5) psychic influences. In order to follow the relation between these causes and the physiologic treatment about to be suggested, it is necessary to have clearly in mind not only the following anatomic but also certain physiologic facts concerning circulation.
 The circulatory apparatus in human beings is not materially different from that in the higher mammals which go on all fours and thus carry the body in the horizontal instead of upright position. The vena cava is without valves; and therefore, in the upright posture, a great column of blood must be sent back to the heart against the force of gravity. You have all had the experience of walking when your hands have been down to your sides, of noticing they will first grow warm, then swell, and finally hurt. This is the effect of gravitation on the circulation of your arms. The chief factor in the return of the blood to the heart is the negative pressure in the thorax. “At each inspiration blood is sucked from the extrathoracic into the intrathoracic vein.” The thoracic portion of the vena cava inferior which under less pressure than the abdominal portion has this difference increased by the descent of the diaphragm and the contraction of the abdominal muscles.
 Whatever part of the body is functioning at any particular time has a larger supply of blood. You have all also had the experience when doing close mental work of having your head hot and your hands and feet cold; a larger supply of blood is in your brain and less in your hands and feet. You have also tried to do hard mental work after a hearty dinner and found your brain less active; the larger supply of blood was in your digestive organs and less in your brain. Thus the uterus, during the menstrual period, has its blood-supply augmented and at the same time the general blood-pressure is lowered and the local blood pressure raised. By the menstrual hemorrhage the excessive local blood-pressure is relieved. Contrary to the old Hebrew belief, the menstrual flow is not getting rid of impurities; this blood, lost in the menstrual flow, is the same kind of blood as that used for mental activity or physical activity and represents, therefore, potential energy. In the intermenstrual period more energy of the person must be used to replace the loss.
 This periodic physiologic congestion of the uterus in woman, which occurs about the time of menstruation is frequently so excessive that it produces pain. The upright position, lax abdominal muscles, costal instead of diaphragmatic breathing, and constriction of the body by clothing which interferes with the use of the abdominal muscles and diaphragm—all combine to develop and promote this excessive pelvic congestion. As a result, there is a pain at the menstrual period, prolonged hemorrhage, and undue loss of blood.
 In a large number of cases I have corrected these conditions by the following physiologic method: “All tight clothing having been removed, the woman is placed on her back, on a level surface, in the horizontal position. The knees are flexed and the arms are placed at the sides to secure perfect relaxation. One hand is allowed to rest on the abdominal wall without exerting any pressure, to serve as an indicator of the amount of movement. The woman is then directed to see how high she can raise the hand by lifting the abdominal wall; then to see how far the hand will be lowered by the voluntary contraction of the abdominal muscles, the importance of this contraction being especially emphasized. This exercise is repeated ten times, night and morning, in a well-ventilated room, preferably while she is still in bed in her night-clothing. She is cautioned to avoid jerky movements and to strive for a smooth, rhythmical raising and lowering of the abdominal wall.” These exercises should be taken twice daily every day in the month including the time of menstruation. The bladder should be emptied before the exercises are begun. In many cases and particularly in those who most need the exercise, the voluntary contraction of the muscles will at first be very slight. The exercises must be continued over a considerable period of time to accomplish any very striking results, long enough to develop these muscles and to establish their more or less constant use without conscious effort. Not until these muscles are developed to a point where a good contraction is possible, can any marked result be expected. This seems to be especially true in women who have no pain, where to shorten the period a longer time is required to make any appreciable difference.
The best developed women who have come under my observation have a period of not more than two days, free from pain, and in many cases are at their maximum efficiency every day in the month, so far as menstruation is concerned.
 These exercises have in a number of cases controlled the hemorrhage of the menopause; stopped excessive flow at puberty with a resulting gain in growth and weight of girls who were becoming anemic, languid and who, through increasing in height were not gaining in weight. In my experience the accepted theory that menstruation is an inevitable “illness” produces a morbid attitude while the traditional treatment of rest in bed, keeping the woman very warm, directing the attention solely to the sex zone of the body, at the same time leaving the mind without wholesome occupation, favors the development and exaggeration of whatever symptoms there may be.
 The lassitude, headache and nervous irritability which it has been customary to associate with the menstrual function may readily be explained by (1) the lowered general blood-pressure and the excessive congestion of the uterus which causes the lack of a proper blood supply in other organs, and (2) an inactivity which brings about both a lessened oxygen intake and a decreased carbon dioxide elimination, thus favoring the development of these undesirable symptoms. To these factors must be added the normal stimulation of the sex centers at this time, which may express itself in nervous irritability and depression.
 The periodic raising of the local blood-pressure and the lowering of the general blood-pressure has been grossly exaggerated in the woman by her physical inactivity and by her constricting dress and unhealthful habits.
 Constructive dress and inactivity apparently interferes more with the abdominal muscles than with the diaphragm. The degree to which they induce menstrual pain may be suggested by a comparison of my observations made in 1893-6 with others made in 1910-14. In the earlier group a larger proportion of the women had pain and discomfort of severe type and of relatively long duration. In the latter group the larger number of cases have no disability and such pain as the remainder have is rarely severe and is of short duration. In 1893-6 the average width of skirts worn by 98 young women was 13.6 feet—the widest 15 and the narrowest 9 feet. The weight of the outside skirt alone was often nearly as much as the weight of the entire clothing worn by a modern girl. At that period, too, every woman must have a wasp-like waist while several under petticoats were also carried from the waist. It is certainly not difficult to understand why so many women had menstrual pain at that period.
 We should rejoice in the freedom of the modern girl with her large normal waist. The only other factor which is tolerably constant in the two groups compared above is that of exercise. In some measure the greater activity of modern girls made possible by lighter and looser clothing, has undoubtedly assisted to lessen the menstrual hemorrhage, its duration, and the associated pain.
 Under normal conditions there should be no more women suffering with disorders of the generative organs than with disturbances of the digestion, respiration, or heart. But it is still very difficult for us to lend an open mind to any theory which opposes the accepted one of inevitable menstrual disability among women.
 The first step in the physical regeneration of women is to alter their habits of mind in regard to bodily functions. They now accept periodic disability as inevitable. The terms “sick time,” “unwell,” etc. for the function of menstruation and the mental acceptance of disability is so firmly fixed in traditional thinking that it is difficult to get a woman even to try to be well, however simple the method of relief offered to her.
 The economic loss to the woman who has to earn her living and is yet periodically more or less incapacitated is very great; and even to the married woman the loss in time and working capacity is considerable. But these losses ae relatively unimportant as compared with the inability of the periodically depleted woman to be a vigorous mother to the race.
 The first of these remedies is the removal of the factors which are producing the disability—constrictive clothing and the inactivity of the muscles of the abdomen and the diaphragm. But more important even than this is an alteration of the morbid attitude of women themselves toward this function, and almost equally essential is a fundamental change in the habit of mind on our part as physicians; for do we not tend to translate too much the whole of a woman’s life in terms of menstruation? If every young girl were taught that menstruation is not normally a “bad time” and that pain or incapacity at that period is as discreditable and unnecessary as bad breath due to decaying teeth, we might almost look for a revolution in the physical life of women.
 I have found three women whose menstrual flow did not exceed a stain the size of a dollar. The first one, still an exceptionally vigorous woman at 60 or over, has born eight perfect children and is a grandmother; the second, also an exceptionally vigorous woman, had three children and is a grandmother; the third bore two children. If this periodic loss of blood is not necessary to make a woman capable of child bearing, we may well ask what purpose it does serve.
 I believe the menstrual hemorrhage is Nature’s effort to relieve the undue congestion of the uterus which has been induced (1) by the upright and (2) by interference with the normal physiologic return of the blood to the heart which should be accomplished by the action of the diaphragm an the abdominal muscles. The undue congestion is more frequently the cause of pain at the beginning of the menstrual period, this pain disappearing as soon as the flow is well established, which relieves the undue congestion.
 I believe that menstruation represents, not a supplemental wave of nutrition (Jacobi), but rather a waste of potential energy in the form of blood which might be used in productive work when not required for the development of the embryo. No physiologic purpose is served by the excessive congestion so frequently found in women of the uterus and adnexa. No harm can possibly come from bringing about by the physiologic method here suggested a better circulation of the blood through the generative organs. The healthy functioning of any organ is dependent on perfect circulation which brings oxygen and nutritive material to its cells and carries away its waste products, not on being overfilled by a sluggish blood-flow. In this overcongestion, often unduly prolonged, have we not a condition favoring the development of pathological conditions?
 At present all the evidence points to the menstrual hemorrhage as a secondary matter more or less fixed by the upright position. It is unnecessary and undesirable that it should be of more than brief duration or of more than slight amount. Pain and discomfort, where no organic lesion exists, are readily controllable by the physiologic regulation of the circulation from the abdomen and pelvis back to the heart through the restoration of the tone and action of the diaphragm and also the abdominal muscles which give proper support to the abdominal organs. The coincident functional disturbances in other organs are result, directly or indirectly, of the undue congestion in the pelvis which has drafted off too much blood from the general circulation leaving other parts, as the digestive area or skin, too depleted to function properly. The congestive headache, whether they occur at the menstrual or intermenstrual period, are often relieved by the equalizing of the circulation by these exercises.
 Let us return for a moment to the climacteric, menopause, or change of life, referred to by the distinguished unnamed physiologist quoted be Professor Sedgwick, as “a critical period—when mental disorders are apt to supervene resulting in abnormal behavior.” From girlhood to womanhood the attention is directed of necessity, but often unduly, to so obvious a function as the menstrual flow. From the moment a girl hears of it, she is taught, as we have seen, to regard it as a periodic illness. The terms “sick time,” “being unwell,” have long been grafted into our ordinary speech. The result upon the mind of constantly anticipated misery can scarcely be measured. Imagine what would be the effect on the function of the digestion if from childhood everyone were taught to refer to it a sick time! After each meal every sensation would be exaggerated and nervous dread would presently result in a real condition of nervous indigestion, a functional disturbance. Or again, imagine the effect upon the periodic evacuation of the bowels, if every boy and girl were taught that constipation was practically inevitable for every person. Would there not be an inhibition of the normal action and a resultant imperfect functioning? It is said that it is possible to make a man ill by simply having a number of people tell him how ill he looks. Certainly, there is no disputing the fact that the mind has a powerful, if unconscious, control of organic processes. How for generations, if we have taught girls anything at all in regard to menstruation, we have been instilling the idea that it is periodic illness involving suffering and incapacity. Surely this is a very potent factor in the emphasis and exaggeration of every sensation at this time. Dr. Crile’s recent work (in connection with quite another subject) gives a possible physical basis for this statement. He has shown that emotions, such as fear and worry, bring about the disintegrating changes not only in the nerve cells of the brain but also in certain other organs of the body. This may be also the explanation of other common observations in regard to menstruation, such as (1)dysmenorrhea on alternate months; (2) the disabilities which are ascribed to some indiscretion or exposure at a previous period, although no trouble resulted at the time. Further, from girlhood to middle age, women are brought up in anticipation of misery, for even the cessation of menstruation, the menopause, is regarded with apprehension. Ask any woman how she feels about the coming change of life, and she will invariably tell you she looks forward to it with dread, expecting to be incapacitated or perhaps insane. Thus her own nervous anticipation tend to increase whatever incapacity she may have to suffer. While it is true that a certain number of women are incapacitated at this time, yet I do not hesitate to affirm that much of the incapacity of this period is unnecessary and avoidable. There is no occasion for a woman to dread this period unduly. Instead of morbid unhappiness, the climacteric should produce in the mind of a normal healthy woman no more than a mild regret that the period of youth and potential motherhood is over, and should be naturally welcomed as a release from the inconvenience attendant upon menstruation. Much of the trouble is due, first, to a nervous letting go of the woman’s self-control; an acceptance of the “inevitable incapacity.” Second, to her muscular inactivity. Third, to social and family changes as much to physical causes. If the woman has been the mother of a family, her family has grown up, her period of financial stress and effort in helping to build up the family fortune is over. If she has had intellectual interest earlier in life, she has dropped them. She is confronted with a loss of her usual occupations and an absence of all necessity to exert herself; and at the same time her attention is directed unduly to her physical discomforts, be they small or great, or be they only a mere physical consciousness of altering conditions. Her condition is almost exactly analogous to that of an active man who stops business in middle life. Such a man often develops neurasthenic symptoms. Why should we be surprised when a woman does the same, with even greater reason? Without absorbing occupation, without mental diversion, and encouraged by the sympathetic pity of her friends, she lets herself go to pieces nervously and spends a period of years in wearing out her family and finding life not worth living.
 Dr. Archibald Church has called attention to the nervous and mental disturbances of the male climacteric.
 Setting aside the women who have organic disease, what classes do we find escape the disturbances of the menopause and climacteric? The answer may be given without fear of contradiction: those who are busy and useful. The women who have absorbing occupations, who are vitally necessary in the world, are the ones who get through this period unharmed. A prominent woman physician in the east declared a few years ago that not a single woman physician of her acquaintance had gone to pieces at the change of life. Among a considerable number of women who are teacher or authors or (in some cases) have carried the burden of being the mother of a family while occupying a salaried position throughout menopause, not one has had to quit work for this cause while four have certified that their research work which has brought them distinction was done without any inconvenience whatever during the years of this functional change.
 Thus it would seem that many of the disabilities of menstruation and the change of life are due to removable and preventable causes, vis, bad hygiene.
 Constipation: You have seen why constipation may cause menstrual discomfort. It is for anatomic reasons. The lax abdominal muscles often permit the sagging of the abdominal organs and occasion consequent imperfect functioning. Constipation is often associated with bad skin conditions and paves the way for many physical derangements. It is often prevented by a glass of cold water drunk every day before breakfast, a regular unhurried hour for attention to this function and by regular and wholesome food. How many women will have plead guilty of neglect because they are habitually hurried in the morning. Constipation may also be corrected by abdominal breathing since the descent of the diaphragm and contraction of the abdominal muscles massage the intestines and thus bring about normal action; the development of the abdominal muscles helps to keep abdominal organs in proper functioning.
 Water: The average women needs more water inside and out. How many of my readers habitually drink from 8 to 12 glasses of water a day? Yet insufficient water not only may be a cause of constipation but concentration of the urine may cause irritable bladder which will require too frequent emptying, one of the reasons frequently given for the neglect of water drinking. You have also seen the anatomic relation of the bladder to the uterus and the dangers of a neglect of this function.
 Bathing: Before I found the cause, for four years I had been observing the distribution of acne on some of the bodies of women who have imperfect skins. If pimples are present they are usually on a triangle on the chest, across the shoulders, the buttocks, the back of the arms or legs. They may be in one or all of these localities. Have you ever considered that these are the places which receive less soaking in your tub baths? The triangular area on the chest is seldom covered with water, the body usually rests against the tub on some or all of these places. The correctness of my theoretical explanation has been proved in more than one case where additional attention to the proper bathing of the affected parts corrected a condition not yielding to medical treatment with ointments, etc.
 Feet: We hear constantly of broken arches and we go to get support without inquiring why this degenerative change is so rapidly increasing. Yet the answer is not far to seek. We distort our feet quite as much as the Chinese did with foot binding of their women, ours is another but not a less distortion. Can we expect the foot, so similar in structure to the hand, not to feel the evil effects of being splinted to a stuff unyielding support in an abnormal position so that its muscles can never be properly exercised? Should we wonder that ligaments and unused muscles fail to keep the foot in normal condition?
 Fatigue: Dr. Hodge has shown that there is an actual using up of the cell substance in the brains of bees and swallows during the day’s activities. The exhausted cells, rested and fed, were seen to return to apparently normal condition. I take it that these studies suggest what proper periods of rest and proper food alternated with suitable activity may do for woman. The tendency to burn the candle at both ends, to cut short periods of rest and sleep, to hurry with or omit meals, to unduly increase the periods of activity, means simply taking away the time needed for the restoration of the cell substance used up by the legitimate activities of the day. The disregard of regular habits of eating and sleeping means, ultimately for the woman who habitually ignores these requirements, nervous breakdown.
 Today woman is offered unlimited freedom unhampered by any tyranny of fashion, which rests with her alone to remove.
 Can you expect a good walk or fine carriage of the body supported by such feet as fashion has developed for the average women? With fashion molding the feet into some new form each year, with kangaroo posture one year, the debutante’s slouch the next, with woman’s body resembling the wasp at one time and emulating a cylinder soon after; with the strapping the breasts down to hide one of nature’s greatest beauties until they hang at the waist line like the dugs of an animal, what can we expect? The drooping heads, the flat chests, the winged scapulae, the prominent abdomen go with inefficiency and weakness. The weak shoulder girdle already referred to by Professor Sedgwick in large measure a habit of defect. Nothing in the ordinary life of a woman brings about much use of the arms even shoulder height; we do up our hair; and but recently fashion compelled us to adjust our hats in place before we put on our dress waist. There is no structural difference which would prevent the same activities and the use in this part of the body in two sexes.
 If woman is to use the opportunities thrust upon her, she must be physically equal to them. We must go back to the old Greek ideal of Physical perfection. A great responsibility rests upon us as physicians and teachers of physical training for we must lead women to ideas of health, to hold out to each an attainable physical ideal, to teach the mechanism of our wonderful bodies so that she obeys the laws of her body, laws learned so perfectly that they are obeyed automatically. To manage this highly complex machine and work it at its maximum efficiency with the minimum of wear, is the problem.
 The day of the type of woman who is all spirit, a burning flame, consuming her misused body, is passing. What we need are women no less fine and womanly, but with beautiful perfect bodies, a suitable receptacle for their equally beautiful souls, who look sanely out on life with steady nerves and clear vision.
 These are the women to whom, in spite of the encroaching demands of the woman movement, we may safely leave the future of the race.