Parents would do well to scrutinize the man who "led a fast life" before allowing him marry their daughter. The world would be shocked if it knew how many men with disease enter into conjugal relations. David's father had syphilis. David's feeble-mindedness was probably only one of the awful results.

AILING WOMEN ARE INEFFICIENT

First of All as Home-makers.—No woman can possibly be expected to successfully conduct a home if she is not enjoying a reasonable degree of good health. A home inefficiently supervised is an instrument for evil. It engenders discord and discontent, and it is lacking in the spirit which is essential to the cultivation of good-fellowship and which encourages harmony.

As Wife.—Most men resent the burden and the discomfort and the expense of an ailing wife, no matter how well-intentioned they may be. It is a failing of the male species to be cursed with the inability to understand any type of nervousness in a wife. Being inexplicable to him he attributes the symptoms to an evil imagination or to a bad disposition. He believes he is being imposed upon and proceeds to resent it. Many homes are rendered permanently miserable and unhappy by a failure to comprehend the real source of the trouble and to apply the remedy. Being inefficient as a home-maker the wife is not able to carry out her part as housekeeper. The home atmosphere is wrecked, the husband seeks comfort and congenial fellowship elsewhere. His efficiency is compromised and his earning capacity interfered with.

As Mother.—Anyone familiar with the exacting obligations and responsibilities of motherhood can well appreciate that normal health is an essential requisite to its successful consummation. The success of motherhood depends upon the proper exercise of many diversified qualities, and those in turn primarily depend upon an adequate degree of physical fitness, otherwise failure is certain to ensue. A woman, therefore, cannot exercise her function of motherhood if she is a neurasthenic.

Inasmuch as it has been proved that the regeneration of the race is dependent upon the maintenance of mentally and physically fit mothers, any condition that interferes with this standard is contrary to the eugenic requirement. Children sent out into the word unfit physically or morally are factors detrimental to the best interests of society and to their own progress and prosperity. A mother rendered incapable through sickness is, therefore, a menace to the home and to the eugenic promise.

Few Ailing Women Become Pregnant.—Nature fortunately seems to apprehend the true condition because few of these women become pregnant. This suggests an inquiry into the cause, or causes, underlying this unfortunate situation.

Are women responsible for these ailments?

Most married women whose health is broken down by some disease peculiar to their sex refer the commencement of their suffering to a confinement or premature birth. The large majority of those women whose health is affected, because of some "female weakness," suffer from a displacement, or malposition of the internal organs, and as this condition is most frequently a product of maternity, there would seem to be some reasonable degree of justification for the assumption that the wrecked health is the result of a legitimate physiological act, and consequently a natural phenomenon. This is not, however, altogether true. A displacement is not, under any circumstances, a natural process. It is the result of causes which are avoidable. Most of them are the penalties imposed by nature because of the infraction of her laws. We will not consider those causes which have their beginning in wrong methods of dress or conduct during the years prior to maternity. Many such cases exist, but they are too few in number to justify consideration at this time. They are frequent enough, however, to suggest to mothers that it is always wise to keep a close watch over the tendencies and conduct of their daughters.

The Chief Cause of Female Diseases.—When a woman has given birth to a child her womb begins to contract and in a very brief space of time will resume its normal position, provided nothing interferes with the process. Nature will do exactly what is right if she is permitted to work in her own way. In another part of this book I have explained why it takes time for the recently pregnant womb to contract to its normal size. There is a 600 per cent. increase in volume to be got rid of by absorption. This takes time and nature can not be hurried without "taking chances." This is just where the "cause" exists which we have been looking for. Women do take chances.

Every woman should stay in bed for at least three weeks after confinement and should spend another three weeks convalescing before she assumes any domestic duty. This is a reasonable proposition when one considers the actual situation. There is an enormous amount of readjustment to be undertaken, and there is no way of hastening this process. There is, however, a way to assist nature and to prevent mistakes. That way is to remain in bed a sufficient length of time to allow proper contraction of the womb. While the ligaments and muscles are still lax, to not undertake any muscular effort that will overtax or overstrain them,—a condition that favors displacement by weakening the support of the womb. A woman cannot understand why she should stay in bed when she feels well enough to get up. It is, however, unjust to censure the sex on this account. I am convinced the fault lies with the medical profession who do not take time to explain, in language which a woman may understand, the important reasons why they should stay longer in bed despite the fact that they do feel well.

The Existence of the Average Mother.—In considering this subject it is necessary to give some serious thought to the domestic and financial circumstances of the thousands and thousands of average mothers. Every observing, thinking person knows that the average mother's existence is more or less of a never-ending tragedy. Physically, mentally, and spiritually, they are victims of unalterable economic and social exigencies. They are compelled, because of ignorance, to live an unsanitary and unhygienic existence. The care of home and children, and maybe the unappreciative and inconsiderate attention of a careless and vindictive husband, add to the incidental worries,—fraying her nerves and disposition,—of the ordinary routine of a cheerless, hopeless life. Add to this experience the enormous drain of frequent child bearing upon her vitality, and we have a picture with which every physician is familiar.

Can such a woman possibly observe the essential rules of the hygiene of pregnancy? Has she the time and the means to build up her reserve energy and strength to competently undertake the duties of maternity or motherhood? Is she physically fit to give birth to a child? After it is all over can she devote the time to permit nature to do her share of the physical readjustment? Can she afford, or will she be permitted to remain in bed long enough to allow conditions to be favorable to getting up without "taking a chance"? Inasmuch as her muscular tone is poor, her strength depleted, her vitality wasted, her ambition and hope at a low ebb, nature should be given a longer time, under the most favorable hygienic and domestic conditions, to help in the problem of readjustment, because her whole future, as an efficient machine, as wife, as mother, as home-maker, and as an economic individuality, is dependent upon how this crisis is met. This is the most important problem which an enlightened civilization has before it. It is the supreme eugenic task, and it is the most pressing and the most vital question for statesmen to solve. No man can deny that the permanency of the state is dependent upon the function of motherhood, yet motherhood is conducted by unskilled labor—labor, the quality of which no business would tolerate. We also know that the health of the workman has become an economic problem. Capital finds that labor is of better quality, and consequently more remunerative in every sense, if the environment is conducive to happiness and health. Yet motherhood, the most important labor in the world, upon which the very existence of the state depends, in addition to being performed by unskilled labor, is undertaken by physically unfit and frequently unwilling laborers, in an environment which is a disgrace to civilization and which cannot be duplicated in the whole realm of the brute world. This is the quality of labor, the products of which constitute the state.

If anyone is disposed to believe that this is an over-drawn picture, let him study the facts brought out in the recent patent medicine investigation. It was found that one small, unimportant, quack medical company had under treatment at one time (the day the government closed it up) 200,000 women, suffering exclusively from female diseases. How many similar cases must there be to support the large advertising concerns, whose tentacles reach to the remotest corners of the country and who limit their activity and cater to "diseases of women" only. Let him also give some thought to the fact that no specialty in the whole field of legitimate medical practice has grown with such enormous strides, or is as remunerative to the ordinary physician as the department of "diseases of women."

Female Diseases Are Avoidable.—If, as has been asserted, the great majority of these ailments are traceable to causes which are avoidable, what is the remedy? In one word it is "Enlightenment." We must educate the ordinary mother who is so busy over her wash tubs and babies that she has no time to seek information upon subject which she doesn't even know exist, who does not even know how to feed her baby as well as the scrubbiest cat does her kitten, who does not know what eugenics means and is interested in it even less. We must stop limiting our talks to theorizing in clubs and societies. We must carry the tidings to the firesides of those hundreds of thousands of women who would listen and act, but who do not know what to do or how to correct their faults.

There is another feature of this subject which should be recalled in this connection. It has already been gone into in detail in the article on eugenics. There are many thousands of women who are compelled to fight the battle of life, upon whom an unjust disease has been grafted, which is sapping their strength and vitality, and which they do not appreciate or understand. Husbands infect wives unwittingly, wreck their constitutions, blast their hope of ever having a child, and then heap upon them abuse for an inability for which they are themselves directly responsible. Many homes are desecrated in this way and the real culprit is never suspected. Many women, who begin their married life under the most auspicious conditions so far as physical fitness or temperamental quality is concerned, have their health, and happiness, and success utterly ruined, and after spending a miserable, wretched existence, have their hope of maternity forever blasted on the operating table. The story of "the wife" has never been told. It is God's riddle.

Women Who Don't Want Children.—Sometimes the woman is at fault. Many young wives begin married life with the intention of not having a child for a year or two. They don't want to be tied down too soon. They want some fun themselves. They are willing to become the legal mistress of a man, but they are not willing to assume the responsibilities of married life. It is difficult to understand the ethics of this type of morality. I have always given these young wives credit with simply not knowing what they were doing. Either their education or their common sense is lamentably deficient, or what is still worse, their mother was the wrong kind of a woman. If these unfortunate young wives have no regard for the cultivation of a good conscience, they should at least have some regard for their own health. From a purely selfish standpoint,—the standpoint of efficiency and success,—one would imagine these women would be unwilling to risk their whole future physical welfare on the chance of immunity—and it is a small chance.

Abuse of the Procreative Function.—In order to carry out this programme, various means are brought into requisition. In many cases I have known the wife has compelled the husband to wear devices which rendered conception impossible. This is a highly reprehensible procedure. If continued for any length of time it will seriously affect the husband's nervous system and general health, as this act is simply a form of self-abuse. Any husband who will tolerate such imposition is beginning married life wrong. He will pay a high price for his complacency. Any woman who suggests or acquiesces in such an arrangement is a moral degenerate and is absolutely unworthy of ever becoming a mother.

Some women buy expensive and fantastic syringes and proceed to abuse themselves with strong antiseptic solutions. This will result in killing the sensitiveness of the terminal nerves and end in depriving themselves of the pleasure with which a wise Providence endowed the procreative act. If the element of sexual incompetency enters the home of a young couple, it is the beginning of the end and each chapter of the story will be a worse hell than the one just ended. The wise husband will see that its cause will not be tolerated or begun in his family.

If pregnancy should unwittingly occur they do not hesitate to adopt drastic means to "bring themselves around." They will procure some prescription which may have gone the rounds as a "marvel" but which always fortunately fails when they need it most. Thus they subject their system to the shock of violent medication and lay up for themselves in the future untold miseries. If these means fail, they go to "a woman whom they know" who "brings them around." If these young wives only knew what they were doing they could not be bought at any price to submit to such surgical tragedies. The least probable result will be that when the time arrives and circumstances are opportune to have a baby, and when it is their dearest wish to be a mother, they will discover that they no longer possess the ability to conceive. Many homes have been rendered childless in just this way. You cannot violate the laws of nature without paying the penalty in some way, and it is usually a sad reckoning.

What the Woman With Female Disease Should Do.—To those wives who are suffering with "female weakness," or who are in poor health without apparent or known cause, I would strongly advise a visit to their family physician or to an expert in diseases of women. Tell him exactly how you feel and submit to a thorough examination. Most of the diseases of women are readily curable, and if treated right all the symptoms which have rendered life miserable will disappear. It may be stated with the strongest emphasis, however, that no treatment from an advertising concern, or any patent medicine ever made, will in any sense cure any of these ailments. Every cent invested in any of these nostrums is money wasted. Medicine by the mouth is never necessary to affect a cure of the actual ailment. A physician will doubtless prescribe a tonic for your general rundown condition. But even this would totally fail if the cause of the ill health was not removed, and this necessitates an examination and special local treatment. For any advertising concern to assert that it can tell what ails a patient by simply filling out a symptom blank is utter nonsense. It is worse. It is obtaining money under false pretenses, and should be punishable by imprisonment at hard labor for a long term.

CANCER IN WOMEN

My only object in referring to this disease is to direct the attention of women to its symptoms.

The only cure for cancer at the present time is the knife. If the disease can be reached it can be cured, if taken in hand early.

In women, cancer occurs most frequently in the breast and in the womb.

Cancer of the Breast.—Of all the tumors which affect the breast, cancer is the most frequent. Any tumor in the breast of a woman forty years of age or more is quite likely to be a cancer. A tumor (or lump) which has remained small for years and then begins to grow rapidly has changed its type and become cancerous. Many such tumors change in this way during the "change of life." Any tumor of the breast, at any age, which remains despite effort to dissipate it should be removed by operation. A physician is not justified in assuring a woman that a lump in the breast is harmless. It should be cut into and examined to positively decide its character. Early operation of tumors of the breast has greatly reduced the percentage of deaths from cancer.

Cancer of the Womb.—Occasional slight hemorrhages becoming more frequent, and later more abundant and offensive, constitute one of the first symptoms of cancer of the womb. Between the actual bleedings there is a discharge resembling dish-water. This discharge has a foul odor. Pain is as a rule a late symptom. Sometimes a severe pain extending into the hip or abdomen is an early symptom but it is very infrequent. Every woman over thirty who has a persistent leucorrhea, or any irregularity of the menstrual function, should be examined for cancer.

What Every Woman Should Know About Cancer.—Inasmuch as cancer is curable if taken early, every woman should take steps to be on the safe side.

If cancer is not taken early, it is certain death. A very large number die who could have been saved.

Every lump in the breast should be positively diagnosed by cutting into it and examining it. It would be safer to remove every tumor of the breast at an early date.

Any discharge from the privates of a woman which has a bad or foul odor is suspicious; any irregular bleeding is more than suspicious. Any woman having these symptoms should be examined by a competent physician. Every woman over thirty-five years of age should be examined by a physician every six months. No woman should enter the change of life without a very thorough examination. Cancer is a disease which does not permit "taking a chance" with. It is far better to be certain, since it is curable if caught early, than to find out about it when too late, because, "too late" means death.

"CHANGE OF LIFE." THE MENOPAUSE

The average period of life during which a woman menstruates is from thirty to thirty-two years. When this period is about to expire she enters what is termed the "change of life," or the menopause, or the climacteric.

The average age at which "change of life" occurs in this country is about the forty-sixth year. It may normally occur, however, at any time between the fortieth and fiftieth year. There are cases on record when it has occurred earlier than the fortieth and later than the fiftieth year. When menstruation in a girl begins early, the menopause occurs late. On the other hand, if a girl does not have her regular monthly periods until she is older than usual,—about the eighteenth or twentieth year,—the "change of life" will set in at a very early age. Women who are victims of certain exhausting diseases, as, consumption, Bright's disease of the kidney, diabetes, or whose health is poor because of general physical debility from any cause, or who have had a large number of children in rapid succession, enter the "change of life" earlier than they otherwise would if their health was good. In women who are excessively fat the menopause is apt to occur at an early age. On the other hand disease of the generative organs, or the presence of tumors of the womb may retard the process. Women in the higher walk of life, those living in cities those who do not labor or exercise sufficiently will enter this period at an earlier date than those who live in the country, who work and are physically more healthy.

Symptoms of "Change of Life."—When the menopause begins, the monthly periods are less profuse, the flow is scanty. As the months pass, menstruation becomes less and less until it ceases entirely. In a certain number of cases it stops abruptly and never appears again. Sometimes a period misses altogether, or a number of periods are passed over without any sign of menstruation, after which it may reappear either as a scanty flow, or as a profuse discharge. This may be followed for a number of months by irregular appearances of the menstrual phenomenon and then by its total cessation.

These may be the only symptoms or signs of the "change of life," and this is the normal state if the health is good. It cannot, however, be said that this is the average experience. Unfortunately the women of the present time do not live lives which conduce to robust health at this period of life. We find as a rule that the general health is below par. So they suffer from headache, "flushes," digestive disturbances, and many nervous symptoms which appear to be directly caused by the process through which they are passing. The "flushes" are disagreeable experiences. They consist of a feeling of heat which spreads over the entire body as if the blood was rushing to the surface and to the head. These flushes are followed by sweating and chilly sensations. The nervous symptoms may be quite marked. The woman loses her interest in the daily happenings. She may have mental vagaries, she is irritable and often melancholy and periods of seeming insanity may occur.

Importance of a Correct Diagnosis.—It is a mistake to attribute every symptom a woman may have at this time of life to the menopause. She is just as liable to develop conditions at this time, which she would at any age, and which have no relation to the "change of life." Every symptom should, therefore, be carefully investigated, because serious conditions may complicate the menopause, and if attributed to it and neglected, may end disastrously.

During the "change of life," the generative organs become smaller or, as it has been termed, "dry up." The breasts also are involved in the shrinking process. It is quite a common experience for women to "lay on" fat, to become "flabby," at this age.

It is important that women should become familiar with the ordinary symptoms of the "change of life," in order that they may be constantly on guard against conditions that may indicate danger. Medical investigation has conclusively proved that many women lose their lives because they regarded the presence of certain symptoms as common to the "change of life." There is a tendency to disease at this time which must be intelligently considered, and if women are not posted to note unusual signs or symptoms they may neglect or ignore them, only to find when too late that these signs and symptoms were no part of the "change of life."

The Danger Signals of the Change of Life.—There are certain "danger signals" which should warn every woman that something is amiss, these are:—

(1) Profuse bleeding during the process of the "change."

(2) Bleeding occurring between the regular menstrual periods.

(3) The reappearance of slight bleedings or hemorrhages after menstruation has ceased for a number of months.

These symptoms are always suggestive of the presence of conditions that should not exist. They may indicate cancer, or some less serious condition that is amenable to cure by prompt and efficient treatment. Inasmuch as they may mean the beginning of cancer,—as explained in the preceding chapter on cancer, and which should be read in this connection,—immediate steps should be taken to find out the actual facts. Delay means death if it is cancer, while the most recent statistics show that in many cases a complete cure is possible if the surgeon gets the case early.

Conduct During "Change of Life."—When a woman enters the "change of life" she is approaching a crisis that demands the most conscientious attention on her own part, and the sincerest consideration by all around her. She has reached the time of life when she owes herself something, and if she is wise she will willingly pay the debt. If she is not in good health she must make every effort to regain it promptly, even if radical measures must be employed in doing so. Nothing will contribute to her mental and physical comfort more than robust health during this period.

She must employ every hygienic measure that experience has taught us contributes to our well being. She must live an outdoor life as much as possible, taking sufficient exercise to keep the muscles and bodily functions in good condition. If she cannot exercise enough she should sit out of doors, dressed in seasonable clothing, and she should make up the deficiency in exercise by employing a competent masseuse. A thorough massage twice a week is sufficient. If her physician recommends an occasional Turkish bath it is a desirable aid as it helps the skin to throw off any excess of waste matter that may be circulating in the blood.

The home environment of these women should be congenial, and they should be relieved of the work and worry incident to domestic life. The nervous condition demands this degree of consideration, and the husband should make it his business to see that the wife, who has toiled to aid him during all the long years of married companionship, is accorded every possible help through the most trying and important period of her life. It is not to be understood, however, that she should be left without occupation. It is possible to indulge in congenial work which will occupy her time and attention without overtaxing her strength or fraying her nerves. A certain amount of amusement is desirable, and helps to tide over periods that might lag and encourage introspection and worry. An entire change of scenery and surroundings. A visit to the seashore or to the mountains is to be commended.

During this period the diet should be simple and the bowels should be kept open regularly. Inasmuch as these patients frequently suffer from digestive disturbances, it is wise to refrain from those articles of diet that ordinarily cause indigestion. Such articles are, sweet dishes, pies, pastries, candies, fresh bread, fried food, sugars, and the relishes and seasoning extras which constitute the et ceteras of the table. Meat should never be taken to excess, alcohol and all stimulants are to be avoided. Water may be taken freely to advantage.