Popular Science Monthly/Volume 71/September 1907/The Health of American Girls

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IN a paper, 'Alumna's Children' published in this magazine in May, 1904, the wish was expressed that some one might determine how far 'the way in which our girls go to school' governs their health in later life. This article is an attempt to consider that question. To any one familiar with all that has been written on the health of American women the subject must seem exhausted in one sense at least. As one reads the different monographs giving the cause of woman's physical weakness, each writer dwelling upon some one condition which is of itself entirely sufficient in his opinion to overthrow her health, one can but think of the man who committed five murders and was condemned to be put to death five times. Yet perhaps there is a word more to be said. A large proportion of the papers have discussed college students or adult women and almost every serious consideration of the health of the schoolgirl has been by a physician and necessarily from his point of view. A girl is more fully and more normally known to her mother and her teacher than to her doctor; they observe all the influences of her life as he can seldom do. For some reasons a wise mother would seem to be the one best fitted to speak on this matter; she should know more intimately than any one else the nature of her daughter. But the mother is limited to the conditions that have operated in her own family. The daughter's teacher learns the personality of the individual girl with a thoroughness second only to that of the mother and she knows just as intimately scores of other girls who have grown up under vastly different conditions, so that she is able to draw general conclusions as the mother of one or two can not do. I have not come upon any full discussion of the health of our girls from the teacher's point of view; it is this that I shall try to present.

The delicacy of our American women, noted abroad and admitted at home, is coming to be a tremendously vital question. The condition apparently is peculiar to no class and it appears in the second generation of other nationalities immigrating here. Lack of fecundity is only one of its indications. Does it not seem to you that most of the women whom you know confess that they are 'not very strong'? Nervous exhaustion and what the newspaper advertisements call 'womanly weaknesses' are the most common ailments, but there seems to be in women far more often than in men a lack of general vitality, an inability to resist disease.

This state of affairs is generally admitted, but there is no evidence that it was nature's original plan. On the contrary, there is reason to believe that the woman was meant to be quite as strong as the man; nature has ordained the hardest tasks for her, and has given her a wonderful equipment for them. Among primitive races the woman is fully the equal of the man in strength, his superior in endurance. Superior in endurance in certain respects she remains even under modern conditions, as dentists and surgeons bear testimony. But where has gone the vigor that she requires to meet the demands that life makes of her? Is it the schools and the teachers that are responsible for its loss?

I was moved anew to thought on the subject by seeing last June the Ivy-day procession of a woman's college and the next week the graduating exercises of a large high school. The college girls looked notably robust, sunburned as to cheeks and arms and hair, but attractive for their evident health. They seeemed far above the average American women in their physical vigor and did not lead one to believe that a college education makes invalids. The girls in the high-school class—the man beside me, himself the father of one of them, expressed their appearance adequately though bluntly when he said, "Those girls are a puny-looking lot." The characterization was true of that class; is it true of the average high-school girl? Consider the question for yourself as you see in June the graduates of your local high school. And those before you are the fittest who have survived; they are very few in number compared with those who have dropped by the way.

Ten years ago I read an unforgettable paper written by a high-school senior. She was a brilliant student who, maintaining the highest rank in her class, had done the preparation for Radcliffe, but had given up any hope of a college course because she was completely broken in health. Her essay was a scathing arraignment of our public-school course; I have been trying ever since to determine how far it was just.

Discussion of the health of the students in women's colleges is always a popular subject; has due attention been given to the physical condition of the young girls in the public schools? The public schools are of course immeasurably more important than the colleges. From the beginning of our national life great sacrifices have been made for the maintenance of our schools, sacrifices are still being made. They are expensive in money; in most of our towns no other appropriation is so large as that for education. They are also costly in the men and women that they use up, the teachers that they suck dry of health and strength and throw aside. The teachers seem to think that the work is worth their sacrifice; the tax-payers give ungrudgingly for their children. But if the physical vigor of the children or of a part of the children is one of the expenses of the public-school system, then popular education is costing too much.

The school system is a manufacturing plant and as such its efficiency is properly judged by its output—that is, its graduates. These are subject to physical examination as properly as to mental examination. The boys in the last years of the high school seem encouragingly robust. They usually take a little lower rank in their classes than do the girls, but, as they would themselves express it, they do their work 'well enough' and when their lessons are done they have supplies of unexpended energy. In athletics they show considerable endurance and many boys partly support themselves by working in shops and offices outside of school hours. In their own homes they prove active, hungry and without excess of nerves.

The condition of the average girl is manifestly different. She appears to the casual observer anæmic, flat-chested, round-shouldered and out of symmetry, and a member of her family knows that she is fickle of appetite, regularly subject to headaches, nervous and irritable. Some of the girls are frivolous, devoted to 'society' and to trashy novels; the average is conscientious about her work and almost morbidly painstaking. She worries over every lesson until it is prepared as well as she can do it, probably after that because it is not done as well as some one else could do it. Her study—and her worry—exhaust her and any other work is a burden. At best she needs complete rest after graduation; at worst she joins, perhaps for life, the ranks of the women who are not strong. A large number of pupils leave the high-school before completing their course. More boys than girls drop out, it is true, but the boys go to earn a living or because they have not met the requirements of the school. The girl very often goes by her physician's advice.

If we consult a doctor for an ailing high-school girl he makes a diagnosis and a prescription almost at sight—"over-study; take her out of school." Often he does not find it necessary to inquire about any other habits of hers except her habit of study. But is her going to school the chief factor in the girl's breaking down? If so, things were better managed in the days of our grandmothers when no girl had much public schooling after she was fourteen years old.

If a girl breaks down under a course of study on which a boy thrives does it indicate that she has less mental power? We dislike to admit it and the experience of our teachers does not in general indicate it. Why should we attribute the widely different result to the one thing that is exactly alike for both sexes? Brother and sister come into the world with the same mental and physical heritage. The girl inherits tendencies of body and mind from her father quite as much as from her mother. The boy and the girl have the same food and the same course of study. At the high-school age the development of heart and lung and brain is at about the same stage in both sexes; the girl is a little nearer to her adult weight and height. What circumstances of their lives have been different for them? When do they begin to show differences in themselves? From a very early age there have been certain differences—in clothes, in occupation and in recreation, but these have manifestly been superficial and insufficient to account for the contrast. Very little difference appears between the sexes until they are nearly through the grammar school. Then a great change comes to the girl. "My daughter has become a woman" is the phrase which our grandmothers used to describe the epoch; and far as the callow, fourteen-year-old maiden seems from womanhood, the term is the exact expression of a vital truth.

It is at this very beginning of woman-life that especial attention is needed. We know that the boy who is overworked before he gets his growth is always an undersized man; just as surely a girl who is over-worked physically or mentally during her period of puberty is always an undeveloped woman. And mental overwork is fully as injurious as physical overwork.

To speak plainly, the maturing girl must have blood and vitality to perfect the organs essential to her complete being and to establish regularly the periodic function characteristic of her sex. She must do these things at the time appointed. If she must choose between developing mind or body let her by all means choose nourishment for her physical growth. The mental expansion can come later, but the physical perfecting has no second chance. If there is lack of development or unbalanced development at this time she is pretty sure to endure suffering for the best part of her life. From careful investigation of the physical condition of a large number of girls it has been found that from "65 to 70 per cent, enter the higher institutions of learning and business with menstrual suffering of some sort." In some occupations the rate of suffering is as high as 91 per cent.

And the girl may be called upon to bear other sorrows harder than pain for a woman to endure. The injury from arrested development may not appear at once, though flat chest and narrow hips may suggest it; but when life demands of the woman that she do a woman's work she is unequal to it and is broken down in her attempt. Dame Nature, herself the representative mother, has her own idea of the function of women in the scheme of things. When they are fulfilling her purposes she gives them marvelous protection, but woe to those who try to stand against her!

Just as soon, then, as signs of change appear in the girl she should have especial care. To quote from Dr. Engelmann, "She should have personal talk and explanation from a woman who has learned the meaning of wifehood and maternity." To supplement from President Hall, "The quality of motherhood has nowhere a more crucial test than in meeting the needs of this epoch." In general the girl should have at this time no mental or nervous strain to divert nourishment from her physical development. At best, if she is strong, does her work without worry and "normalizes her lunar month" promptly, she may stay in school without much danger provided she take her two days of rest periodically. I am inclined to believe that this is in all cases worth while until the end of the high-school course, although it is always impracticable to make general rules. A number of women who consider themselves perfectly well so far as sex weakness is concerned have told me that they believe their health due to their year of complete rest at puberty and that they did not find the need of monthly rest after the first years.

I am coming to be convinced, somewhat against my wish, that there are many cases when the girl ought to be taken out of school entirely for some months or for a year at the period of puberty. This course is supremely worth while if she shows irregularity of function or decreasing vitality, and it is at this time that there is profit in such an especial vacation.

I do not speak with ill-considered lightness of taking the girl out of school for a year. It is a serious matter to her at a time when she is likely to take all her life too seriously and when she should feel as free as possible from annoyance. She is naturally disturbed at leaving her class, especially if she is likely thereby to lose a grade. It is worth while to take considerable pains to minimize her distress. If she enjoys a pleasant visit out of town until the term is well under way, then returns to private lessons with her mother or some other wise teacher, lessons determined in time and length by her physical condition, she may endure her enforced vacation from public school without much fretting. The anxieties of this period ought to be borne for her as far as possible; that she should become anxious about her own health would defeat the very end in view. She can be assured that days out of school now are pretty sure to remove the necessity of days or weeks or months out of school later in her course. Similarly two days out of school every month the first year that she is in the high school in order that she may not suffer are really much better worth while than two days out of school the last of the course because she is not able to be present. These days of rest are not in the least incompatible with good work in school; a girl so cared for may be expected to accomplish more in a year than she who has no such restraint. Mothers protest again and again that such a custom is entirely incompatible with modern school demands, but I have never known a teacher to say that it was not quite practicable, and I have seen school work done under this regime to the entire satisfaction of all concerned. It is perhaps worth while to record here the questions of one grammar-school teacher—"Why will not mothers tell me when the critical period begins for their daughters? Many times I can determine for myself, but in general I could make things so much easier for the girls if I could only know when they need especial indulgence."

No, the objection to periodical rest does not come from the teacher nor primarily from the mother, but from the girl herself. Yet if our thoughtful mothers could be convinced that "the health of a girl for her whole life depends upon her normalizing the lunar month," to employ a phrase of President Hall's that I have quoted before, they would bring about the best order of things. But most mothers honestly believe that no great care is necessary. They expect their daughters to get along about as well as they did and they suppose that about so much pain is necessary for women. Mothers could hardly escape being convinced of the great responsibility that is upon them at this time if all the evidence that exists on the subject could be brought to their attention.

It is undoubtedly true that each month in a woman's life is a continuous wave with a regularly recurring succession of phases and this continuity of change makes an ingenious argument that a woman does not need especial rest at any particular time of the month. But my own observation would have convinced me that it is supremely worth while to guard an adolescent girl from nervous strain during the days when the wave of her vitality is at its lowest point even if physicians and educators had not spoken so strongly in favor of the custom. Dr. Mary Putnam Jacobi, in the monograph which she wrote to show that there is nothing in the physical nature of the adult woman to incapacitate her periodically for work, says nevertheless, "In adolescence and during the first years that the reproductive wave of nutrition is being formed mental work exacted in excess of the capacity of the individual may seriously derange the nutrition"; and elsewhere in the same paper she says, "It is curious to note how the effects of misery and the effects of luxury during the childhood of a girl are found so often to result in an identical mode of stunting during adolescence."

Much that has been written on the subject of puberty in girls has been printed only in medical and educational journals. Perhaps some women of delicacy may say that the discussion of such a matter is properly confined to medical journals. To a certain extent this is undoubtedly true; the trouble is that the average mother does not have easy access to those files. Therefore it seems worth while to quote at some length in this paper.

The idea that a girl needs especial care at her time of maturing is not a new fad of educators. In the time of Hippocrates it was noted that the period of puberty was very critical for the development of the nervous system. The rites enjoined by Moses provided for the care of the girl at this crisis and a similar provision appears in the code of Zoroaster. Savage nations today prescribe and protect by their superstitions definite observances for the woman at every period of her sex-life from the beginning to the end. The women of the North American Indians, always regarded chiefly in reference to their utility, nevertheless have assured to them by custom from three to five days every month so long as the monthly law rules them.

With the present increased attention to the study of preventive medicine, students of gynecology have come to believe that the diseases of women are in good part due to their "ignorance of functional hygiene." In 1901 Doctor Engelmann gave as his president's address at the annual meeting of the American Gynecological Society a paper, "The American Girl of To-day" which entirely covers this subject from the physician's point of view. In brief his opinion as there expressed is: "Adolescence is the most important period of a woman's life, the period during which the foundations of future health are laid. It is in this period of school, the beginning of social life, the period of learning in trades that the nervous energies of the female are most fully engaged and her activity is concentrated on the brain to the detriment of other functions, above all the developing sexual function, the central and most important and at that time the most easily disturbed."

Dr. Wylie has expressed his opinion that "The American horse receives on the average better treatment than the young women of America from the time of early girlhood until the age of development is passed."

President Clark and Professor Tyler have studied systems of education with especial reference to the physical development of children. In his book 'Adolescence,' President Hall devotes a long chapter to the subject of 'Periodicity.' He is himself convinced that the health of a woman for her whole life is determined in her days of adolescence, and he cites so many witnesses, ancient and modern, learned and savage, that the most unbelieving reader can but be convinced while she reads.

Professor Tyler, as a student of biology and education, has considered what bearing the laws of growth have upon the proper arrangement of courses of study. In his lectures on 'The Physical Basis of Education' given last winter in Boston before the Twentieth Century Club he said, concerning the development of girls during their school years, "At the critical period of puberty almost every organ in the girl's body is affected. [The girl's] pubertal period is much more likely to be stormy than the boy's and her rate of morbidity is considerably higher. Her future health and happiness, if not her life, depend upon the successful completion of the metamorphosis."

A valuable addition to our knowledge of schoolgirls has been made by Dr. Helen Kennedy. She collected statistics of the habits and the health of girls from a large city high school; her article includes her questions and the answers of the students, so that we may draw our own conclusions. We note that while nearly all the girls report themselves as growing no worse during their high-school course, 97 out of the 125 say that they suffer to a greater or less degree. All Dr. Ken Kennedy's results are interesting and full of suggestion, and much, light upon the health of our women would come from further investigations along these lines. From her data and that of others, it is to be noted that most girls between sixteen and twenty suffer more or less; and that alike for students and working girls the percentage of sufferers increases during that time.

My belief that most girls have the foundation of their suffering laid before they are sixteen may be unwarranted, but I have found no data that contradict it. Quoting again from Professor Tyler, "The critical period in a girls life is evidently the years between ten and fifteen, earlier than most of us think. Most of our care and thought is devoted to locking the barn door after the horse has been stolen." And once more, in the phrase of Dr. Engelmann, "the younger the girl, the nearer the period of puberty, the more impressionable the system, the more susceptible to influence for good or evil and most harm is wrought in the first year of functional life." I quote much from Dr. Engelmann, but where can I find better authority, especially in this particular phase of gynecology?

I have given a large part of my discussion of the health of our girls to a consideration of the demands of sex at adolescence, but perhaps this extent in treatment is not disproportionate to its importance in their lives. "When a girl is safely guided" through the breakers of puberty we have some reason to expect for her life-long vigor and the power to do. But she needs also through the rest of her school days intelligent direction in other respects. It sometimes seems to the teacher that she does not get quite as much as she needs.

The teacher is expected to see all that goes on in the schoolroom; in addition to this she does see evidences of a great many things that go on outside the schoolroom, things which, though they largely affect the results of her work, she has little power to modify. The personal habits of a girl determine to a great extent what she is able to gain from her course of study. If it is important that her nourishment be directed at all times to the most immediate needs of her body, surely it is no less important that there should be sufficient nourishment to satisfy these needs.

Every girl knows that this sufficiency of nourishment is impossible unless she assimilates plenty of food, but she does not always make her knowledge evident in her habits. Very often the high-school teacher is asked to excuse from the session, on account of headache, some girl who admits when questioned that she has eaten no breakfast that morning. It is possible for the teacher to point out to the girl the folly of starting a locomotive for a day's run without providing fuel, but the girl must have some pressure brought to bear upon her at home if she is to take sufficient time for her meals. Insufficient breakfast is often due to late rising; if the girl has not time enough to dress and to eat, it is not the dressing that is hurried.

With the usual five-hour high-school session the girl needs at recess a proper luncheon. If the school has a lunch counter where only suitable food is provided, then it is well, but in case the luncheon comes from home the teacher often wonders whether the mothers are accessory to the mince and lemon pies and the fruit cakes that make the daughters unfit for study. At the end of the long session the girl comes home with little appetite or power of digestion. In a working-man's family dinner was served more than an hour before, and the plateful of food that has been kept warm for the daughter is hardly palatable; probably she makes her meal chiefly out of the dessert. It is tremendously worth while for the mother to preside personally at this meal of her daughter and always to have tempting, nourishing and easily digestible food ready for her when she comes home from school.

The blame for a high-school girl's dyspepsia is often attributed to the one-session system; and under that system a bad order of things is easy, as we have seen. On the other hand, with one session very much better conditions are possible than with two if the best use is made of the time out of school. It ought to be possible for the greater part of the pupils to work under better conditions at home than in most schoolrooms; and when they are in school until four there is little time for being out of doors in the sunlight during most of the school year.

The girl who is insufficiently nourished craves abnormal things and eats sweets and sours in unsuitable proportions. With all these sins against her digestion much of her food is not assimilated. Very often the waste is not properly eliminated; the girl does not realize that this condition is a menace to her health and so her whole system is poisoned. Constipation is a disease and the cause of many others; it is entirely incompatible with perfect health or good work in school.

At least one strong article has been written—by a physician—to maintain that women's mode of dress is a sufficient cause of all their physical distress. Undoubtedly it has been responsible for great injury, though present conditions are much improved, so far as tight or long clothing is concerned. We appreciate, however, that women are still handicapped when we see how their ordinary clothing hampers them in gymnastic work. Just at present school girls expose themselves to the cold in a way unsuitable to this climate. Even in winter they go to school bareheaded, in lingerie waists with light undergarments, cotton hose and low shoes. The toughening process is valuable to a certain extent, but such exposure as this means an expensive strain upon vitality. School girls are notably careless of wet clothing and wet feet. Mothers have difficulty in persuading them to overshoes and rain-coats, and teachers find them unwilling to go home when skirts and stockings are wet through. To sit in wet clothing is dangerous even for an adult woman.

This paper is intended to deal especially with those elements of a girl's life that are detrimental to her health, yet are usually overlooked. It is hardly necessary to include much discussion of the need of sleep. Every one understands that a girl needs about nine hours of sleep in pure air. At present there is a general enthusiasm among young people for outdoor air. If they do not take sufficient sleep it is not because they do not know the need of it.

The recreation of a girl ought to do something toward her recreation, not leave her more exhausted than all her work. But those who have studied the physical development of the girl tell us that the excitement and nervous strain of society and late hours are much more exhausting than hard study for a young girl. This does not mean that she should give all her time to her lessons, only that her amusement be something less wearing than study. She ought to have good times, she is the better for parties if they are limited to reasonable hours and to suitable companions. One element of a high-school girl's life which is seldom mentioned, but is often noted by her teacher, is the detriment that comes to her from social intercourse with those who are a few years older than she, especially with older men. If a girl spends one or two evenings a week in the cultivation of such friendships as these and reads a romantic novel every week it is to slight profit that she spends the rest of her time "over her books." It is pretty nearly impossible for her to concentrate her mind on her work.

It is a very common criticism that there is too much social life in the school itself. It is admitted, at least in this country, that children need some amusements. If other social distractions could be omitted what could give a school girl more harmless pleasure than the class dances and parties, under the direction of a teacher-chaperone, parties that include only people of her own age and experience and that close at a proper hour?

A girl's real re-creation is her out-of-door sports and she should receive every encouragement to those that she most enjoys. The implements of such sports—golf-sticks, tennis racquets, boats and skates—are better investments for parents' money than even pretty clothes, if there must be a choice of expenditures. Housework is one of the best possible forms of exercise if done in well-ventilated rooms; it might be profitably taught by mothers under the name of physical culture.

Music study is, I believe, hardly to be classed as a recreation, even though it happens that the pupil enjoys it so much that it does not appear a burden. It is mental work requiring close attention, memory and some eye strain. It makes about the same demands as an extra course in school, and if it seems best for the girl to continue much piano-prictise during the term, she should take five years for her high-school course. Often a collapse in school that seems inexplicable to the teachers is due to a pupil's adding an hour or two a day of piano-practise to an already full school course. It is worth while for the girl to take music lessons during the summer if she is within reach of piano and teacher; the discipline and regularity are a good thing during these weeks of complete freedom.

Many pupils suffer from eye-strain; every possible care should be taken at home to minimize this, both for the sake of the eyes and for the direct influence upon the mind and temperament. Study before breakfast is very likely to aggravate eye-strain; if there must be early study the pupil should bathe her eyes in cool water and take some food, that the congestion of the eyes may be relieved. A proper light lessens the fatigue of the eyes. By day the student should not face the window and at night her lamp should have an opaque shade. Often the change from a white to a dark-green shade relieves long-continued pain in the eyes.

Reference has been made to a girl's spending time "over her books" and the phrase is sometimes especially accurate. Instructors of college freshmen complain that boys and girls go through preparatory school without having learned how to study. The teachers may be responsible for a part of this, but there are some conditions that the most devoted teacher can not govern. She can regulate a pupil's work in school, but when much of the study must be done at home the home must help in establishing good habits of work. A student needs a well-lighted workroom reasonably free from interruption. It is not necessary that the window have an extended outlook; a girl is likely to establish herself for her afternoon's study where she can get a wide view of the street. With a little attention the daughter of the house may be helped by her surroundings at home to a concentration upon the work at hand that will lessen marvelously the hours that she must spend with her books and give her more time for recreation.

Elements internal and external, elements physical and mental, have been treated together in this discussion and inevitably so, for they are almost indistinguishably interwoven in the life of the girl. How much her health of body depends upon her health of mind no one can venture to say. One feminine characteristic becomes especially evident in the adolescent maiden which has considerable influence upon her health. This is the narrowness of mind that causes her to give undue importance to really minor elements of her life. She comes to believe that there are only two or three things in the world that are really important; if she is an only child she may decide that there is only one.

It is undoubtedly desirable that a girl stand well in her class and wear attractive gowns, but there are other things just as essential. When she sees that it is worth while to hold fast to "a taste for simple pleasures" and to promote the happiness of her family and community, and supremely worth while to make herself an able woman physically, she is well on the way to the attainment of a poise of mind essential to her health and to her breadth of thought. Much of her narrowness may be eliminated by the public school and that very effective education which a child's companions supply. But there are certain chambers of a maiden's mind especially suitable for her mother's furnishing; in the most intimate relations of a girl's life she must naturally find her direction at home.

And is not this the conclusion of the whole matter? Undoubtedly the girl does need "the complementary wisdom of school and home," and sometimes when every precaution is taken at home the school work may be too hard for the girl at some particular time. In this case the parents must lay the matter before the teachers; in some way the work must be lessened, so that a growing girl does not come through each week exhausted. But in most cases it is found that it is not the work that exhausts.

The American girl needs the public school. She needs it for its democratic influence, really a powerful element in the mutual understanding between women, which alone can solve the "servant problem"; she needs the acquaintance with boys of her own age which banishes sentimentality; she needs the broadening influence of men-teachers. It does not seem on the whole that there are many points in which the school can do more for the girl than it is doing; it is not in general conditions that she needs more consideration. For it is true that "the teacher has to deal with the average; the parent must accommodate the particular," and that "it is to the parent that the child must look for his (and her) individual protection and care."

In brief, as soon as a girl comes to manifest her difference of sex, she needs especial and intelligent protection at home to free her from strain mental and physical. And when her health and future fulness of life are thus established, they must be guarded by continued oversight of her food and clothing and exercise and recreation and sleep. Her mental and nervous strength must be conserved by guiding her into orderly ways of thought in the personal and intimate matters that obviously do not belong to the public school. When these elements of her life are properly administered at home the American girl can in ordinary cases complete the course of study in the public schools without injury to her health.

The articles to which especial reference has been made are:

"Rest during Menstruation": Dr. Mary Putnam Jacobi.
"The American Girl of To-day": Dr. George J. Engelmann.
Article in New York World: Dr. W. Gill Wylie.
"Adolescence": President G. Stanley Hall.
"Effect of High-school Work on Girls during Adolescence": Dr. Helen Kennedy.