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Co-Education of the Sexes in Medicine

1867 — Woman’s Club of Chicago, Chicago IL

 

Like an inspiration comes back to me my first vision of an old city, more ancient than Rome, that lies sleeping at the foot of the Appenines, like a tired warrior at rest-rest from great victories won for humanity; a city which deserves above all others to be called the City of Woman; that has dedicated its greatness, past and present, to the genius of woman — the city of Bologna. There is music in the very names of Bettesia Gozzadini, Novella Andrea, Novella Calderina, Madalina Buonsignora, Dorotea Bocchi, Laura Bassi, Anna Manzolini, Gaetana Agnise, Christina Roccati, Clotilde Tambroni, Maria Dalle Donne, Zaffira Ferati, Maria Sega, Madalina Noe, some of the illustrious honored women who graduated and taught in that grand old university —graduated and taught as doctors of philosophy, medicine and law, while, as if sacredly to preserve this dedication to the genius of woman, Raphael’s immortal St. Cecelia is to-day the guardian angel of Bologna.

Then came the honored names of Pavia, Ferrara and Padua, till it seemed that for every star that shone above me in that soft southern sky I found in history an answering star. Was it all a mistake? Were these illustrious women deluded and disgraced?

Contradictory as it seems, the whole continent of Europe is more liberal in its education of women, especially in the study of medicine, than either Great Britain or America.

Famous physicians of our sex have gone forth from Salamanca, Cordova, Alcala, Heidelberg, Gottingen, Girssen, Wurtzberg, Utrecht, Montpellier, Paris, Vienna and St. Petersburg. In the latter city, especially, women of noble rank crowd the universities. There were at one time four hundred in attendance.  There a lady is proud to add to her already titled name the title of M. D. — is proud to be employed in a work so noble. Quite a commentary this upon the manner in which some of our society women elevate their pencilled brows at the mere mention of a woman physician, and have even been known to refuse an introduction to such an one, while the facts in the case were, the physician was a lady by birth and education — had rank by virtue of inheritance-if that means anything, while the would-be lady held her rank by virtue of her husband’s purse.

A friend, now studying in Zurich, writes as follows: “I wish we had something like this university over there. I think it a shame that here in Europe, where prejudice against woman’s emancipation is much stronger than in America, that here a mixed school for medicine exists in perfect harmony with good taste and order. Why is it that we cannot have such a thing in our country, where they pretend to respect women more than anywhere else?” Why is it? Why, too, does England, that owes so much of her civilization to woman, whose most illustrious eras of history are those of Elizabeth, Anne and Victoria, why does she allow herself to be thus put to shame by continental civilization?

Woman in medicine, to our mind, is not so open to question as man in medicine; nor can it become such till women make specialties of the diseases of men as men do now of the diseases of women. Then, indeed, will there be ground for argument; then, and not till then, may we question the propriety of women in medicine, and until then the question of propriety is on the other side entirely.

However, so long as the question is raised in the minds of many, it becomes us to look at the arguments, such as they are. The question means, shall women study medicine at all? For, as we shall see, if she studies she must study with men, and the final analysis of the question is, Shall women study anything?

Now one of two things must be true: woman has or has not the right to study medicine, and that right includes the best possible way. We do not mean right in the sense of that Boston sage who tried to be witty when he said, woman had the right to sing bass if she wanted to; we mean right, not only in the sense of free will, but the conditions provided for the carrying out of that will, both structure and environment. We have no conception of possessing any possibility whose conditions are not provided.

Before considering the right of woman to study medicine, let us consider the right of woman to study at all, for this is the logical starting-point of the whole question.

It is almost an axiom in physiology that the presence of an organ presupposes a function. There are two great classes of functions, voluntary and involuntary. Physiologists further classify them as functions of animal and vegetative life. By vegetative functions, we mean those only that are essential to existence. Respiration, circulation, digestion and reproduction can go on perfectly without any brain at all. It is true there are some anatomical forms in the body which have been supposed to have no special use, but are simply the remains of some lower or pre-existing animal form; but we are hardly prepared to call woman’s brain a remnant, though woman, herself, is often called a relict.

The highest function of brain is the production of thought. Now it is in the order of things that perfect function depends upon perfect development, and this development depends upon the activity of the part. Inactivity not only arrests growth, but it wastes away that which is already grown.

Any one of us can demonstrate this for himself by placing any part of the body in a state of absolute rest. It is demonstrated in disease, by the failure of nervous supply to a part, thus making motion impossible; hence the gradual wasting away of parts that are paralyzed. Not only is activity a physiological law, but the amount of activity is a part of that law. There are certain limitations in the very nature of things.

“Thus far shalt thou go, and no farther,” contains two commands. “Thus far” is as full of meaning for us as “no farther.” Not enough is as guilty as too much, when applied to the activities which develop form and function. The physician is as often baffled by underdoing as by overdoing.

The highest exercise of the brain is the production of thought. Each brain has its limitation, as each body has its stature. Up to a certain point, nature provides without consulting the will of the individual. There is an instinctive motion of the mind and muscles, and we have yet to learn that the instinctive activity of the female has any narrower limitations than that of the male. It is only when the will begins to preside that we find a restraint imposed upon female activity. The source of this restraint is a traditional sense of propriety, growing out of the original condition of woman, viz., slavery. In primitive times, women were bought or captured; in either case they were the slaves of men. The beautiful, were favored and protected, while the ordinary were the victims of servitude in the most abject sense.

We may well ask ourselves how this came about. If woman originally was the equal of man, how did it become possible for him to enslave her? We must admit physical inferiority, but with an important modification, viz., the inferiority is one of quantity, not of quality. The motor system, that is, the muscles and bones, of men is larger and stronger than the motor system of women, but the muscles and bones of women may be just as perfect, even more perfect. An elephant is larger and stronger than a horse; so is an ox; but it is the quality of the motor apparatus of the horse which makes him preferred to either as a beast of burthen. To consider the last argument of this avoirdupois question, the brain of man weights heavier than that of woman; therefore woman is mentally inferior. To answer this question, it must be remembered that what is called brain is composed of two essential substances — the white and the gray matter. The gray matter is made chiefly of fibres, which conduct message to and from the gray matter.  Then there is a quantity of tissue, in which the cells and fibres are packed. Now, curiously enough, the amount of gray matter need not in the least affect the circumstances of the head, because of the peculiar anatomical formation of a well-developed brain. The platings or foldings called sulci may be very numerous and deep without adding greatly to the size of the brain.

It is not difficult to understand, then, that a brain may be large and heavy by reason of the packing, which may be in excess of the thing packed. Man being more active than woman, having a larger motor apparatus, we find a corresponding increase in the motor part of his brain, viz., white fibres and motor cells.

Curiously enough, while men have been ‘weighing and measuring the female brain, they have forgotten to measure and number the sulci, in which so much gray matter may be hidden away.

Judging from the amount of gray matter in the brain of woman, we should say it was placed there to be used, and the only limitation to its use is the law under which this organ of thought is constructed. The first mental exercise that the master, man, allowed the servant, woman, was in the direction of art, by way of making her more interesting to himself, while the science of all art was kept not only closed but padlocked. The arguments of woman’s mental inferiority always contain this stereotyped question: “Why are there no great composers and artists among women, when music and art have always been open to them?” When we have learned to fathom the depth of the meaning of the word accomplishment, we shall be able to fathom the depth of woman’s knowledge of any study in which she has been allowed to indulge.

It is only when we attack a subject with the intent to wring from it some great need of our own life, that we can in any sense say we have studied it, much less that we have mastered it. If the secrets of things were possessed of intelligence, they could not more successfully combine against amateurs. The question arises: Is it in the nature of women thus to study? No. The mistake the masters made was in ever placing the cup of knowledge to the lips of their slaves. For a while they were content with sipping, that their lips, perchance, might be more beautiful.

But the sipping has excited a great thirst, that will not be satisfied till the cup is drained to its dregs. The slaves were not satisfied with the A, B C; they have reached out after the combination into words, thoughts, books, science, principles, till the whole vast realm of the kingdom of intellect has been captured! And how was it done? Simply by making a beginning. A little knowledge proved a dangerous thing. By allowing the mind to be exercised at all, it exercised all. Nature can never be so repressed, so transformed by artificial forces, but that it recognizes and uses its own whenever and wherever found. The wild animal may lie in your arms and peacefully lick your hand, but not for your life dare you let the smell of blood come to his nostrils. So has the mind of woman slept, lulled by the narcotics distilled by a sensual life, and now the reaction of the awakening is terrible in some of its manifestations.

Granted the right to study, we must also grant the right to study in the best possible way.

First, we lay down the broad principle that man and woman were made for each other, physically, mentally and morally, and we would maintain this principle, not by mesmerism or spiritualism, nor any species of moral infidelity, but by science.

Nature makes no provision for the separation of the sexes at any period of their existence. They begin life in the same family, frequently at the same birth; their environment is precisely the same. The closest analysis has never been able to discover any distinctively female air or sunshine. So far as the researches of physiology have gone, no special male food has as yet been discovered, unless tobacco and alcohol be such. If boys and girls may feed their bodies with the same things, from the same table, by what logic can we separate the same boys and girls in the process of mind-feeding? Upon the same principle there should be female churches; if the mind can not bear mixed education, much less can the soul. It is true the Jews and the Roman Catholics in some places fence off their women by curiously constructed pens and bars; nevertheless they feed them the same strong theological meat, and if a woman breaks the law of Sinai there is no law of sex in the penalty. And their women have been the conservers of the religious power in both Jewish and Catholic church. Any distinctively feminine or masculine institution is morbid in its tendency.

The idea that men and women are to be kept apart originates in the lowest conceptions of the relation of men and women, viz: the sexual. It gives to sex undue prominence by keeping it uppermost in the minds of the young. The female boarding school is, in the very nature of things, the hot-bed of morbid influences. Half the vices of men are the direct offspring of the unnatural education of men. The monasteries and convents that Protestants lave reared for their children are worse than those of the Catholic, because they lack the religious enthusiasm of the Catholic. If any doubt the truth of this let them investigate the popular fashion called “smashing,” as it is practiced in certain colleges.

Men and women were made for each other, in all the higher and spiritual as well as the lower and physical relations of life, and when you separate them at any time of their lives, in all the higher you rob them of their birthright.

Why is an American girl capable of taking care of herself among the wicked men that congregate in the European capitals, where a native-born girl must be doubly guarded? Because, to use plain English, the American girl is not continually thinking of her sex. She is so accustomed to the companionship of the other sex at home, in school, and wherever she goes, that she has natural, not morbid, thoughts; she thinks of herself simply as a human being, and man as another; she escapes insult by not expecting it. Not so with the girl just let loose from the restraint of a convent-Protestant or Catholic. The frame of mind that anticipates insult courts it. Every institution departs from healthy normal development just in proportion to its exclusiveness. If reproduction were the only end of woman’s existence, we have seen that it is provided for without the intervention of the intellectual faculties at all; but we find not so much as a cell wanting in the cerebral development of woman, notwithstanding the lethargy in which centuries of tyranny have steeped her; hence her mind must be as capable of companionship as is her body. Whether or not woman had from the beginning more personal chastity than man, we are not prepared to say. If not, then the results of unchastity falling so heavily and unequally upon her have reacted upon her character, so that now she is really more virtuous than man. The fact exists, whether the condition be original or acquired. But along with this personal purity comes a sort of selfishness or narrowness. The woman’s idea of right is personal, a something that belongs exclusively to her, while the man’s idea is so impersonal that he frequently leaves himself entirely out of the question. We have known women to arise from an ecstasy of prayer, having supplicated for mercy with the tongue of an angel, and deliberately go to work and plan an act of gross injustice. Of the two evils, man’s inhumanity to man is preferable to woman’s inhumanity to woman. The exclusively womanly or the exclusively manly organizations are always lacking. The general and the special need to unite their forces, and thus individual character shall be both comprehensive and personal in its righteousness. Woman needs less personality; man more. George Sand had the typical man’s view of life, which is, to say the least, very unbecoming in a It is this constant concentration of thought upon herself that forms the basis of that hydra-headed disease hysteria, a disease which the doctors may well pray to have continued, for if ever it be concluded they will have less to write about, and still less to do. It is true that hysterical women are the support of a large number of physicians, and it is notoriously true that these patients invariably prefer gentlemen physicians, though the disease is not one that requires man’s superior skill in medicine.

Lying between the spinal cord and the brain Proper are a series of bunches of nerve cells, which are capable of feeling and acting, but which are not capable of elaborating the impressions they receive into ideas. In the lower animals we find these bunches or ganglia highly developed, much larger than the brain itself.

In idiots also they are well made, while the cells of the brain substance proper are very poorly made, mostly not made at all. The point of application is this: We can predicate a kind of mentality of the spinal cord, though perfectly automatic; a still higher mentality to the middle brain, or these ganglia which we have mentioned, a mentality into which feeling enters, the consciousness of pleasure or pain. Impressions received from without may stop here, and never give rise to anything but an emotion, a feeling; or they may pass on to the upper brain cells and give rise to the highest intellectual conceptions. Music furnishes us with a good illustration of the separate and combined function of these three nerve centers. The mechanism of music is performed almost entirely by the spinal cord. The emotion of pleasure or pain excited by the sound has its origin in the ganglia, while the intellectual conception of music, the power that creates an oratorio, lies in the cerebral cells, and the real musician is an embodiment of this triune power. The ideal human being is one in which the automatic, the emotional and the ideational are perfectly harmonized. By inheritance and education the emotional centers become unduly developed in woman; hence she acts from feeling instead of judgment, according to the time-honored standard — it is womanly to be emotional ; and indeed the typical woman has very little need of a cerebrum at all, and the fact that she has one is only another proof of the conservative power of nature, the power by which all things, when once created, maintain their identity. The companionship of the sexes in the higher departments of learning can not help but establish a better equipoise of character for each. The emotions and the passions find their true level ; instead of controlling they are controlled by an educated will. Thus we may declare the attempt at co-education in this country a practical, successful fact, and the only difficulty that has ever arisen in its way has first arisen in the mind of some bigot, who has attempted to twist facts into a proof of his theory. Witness: Dr. Clarke’s “Sex in Education.”

Now, as to the specific question before us, shall women be educated with men in medicine? This is equivalent to asking shall she study medicine at all, for as we shall see, if she studies, she must study with men. The argument is set forth with a formidable number of negatives: incompetent, improper, unwomanly, etc. Woman has proved beyond a doubt her competency to learn medicine, by passing the most rigid examinations and capturing more than her numerical share of prizes. It is singularly true that the women who apply for examination in the European universities are never plucked. We should be sure to hear of it if they were. And this means a great deal when you add to a cruelly rigid examination the prejudice which some of the professors are sure to have against a woman who is thus flying in the face of providence, and the dissent of one professor can prevent the candidate from passing. Still the opponents argue that while a woman may learn medicine, she can not practice it, and the back-bone of this opposition is periodicity and maternity. It remained for a woman to revive the theory held by the fathers in medicine, viz.: that the periodicity is a physiological and not a pathological process; that whatever of disease is in it is the result of abuse, as dyspepsia is not digestion, though it often takes the place of that important function; and this same woman has done more than the fathers did in that she has proved the theory by scientific facts. The truth is, the period is one of increased rather than of decreased power; instead of a source of weakness it should be a source of strength, and would be if the nervous system were not out of balance with the other forces of the body. But be the theory what it may, the facts are, women by thousands are at work everywhere, in all countries, at all hours, every week and every month, at all times in the month, who know nothing of the theory; they only know that they must earn their bread, and they do it. Industry is no new thing for women, but high-priced industry is, and that is the kind of industry that is injurious to females. Women in the profession, of medicine, who now rank by hundreds instead of tens, do not lose one week every four, though Dr. Clark and others have so instructed them. If women physicians were thus incapacitated they would still be able to compare time favorably with the majority of male physicians who are suffering from divers diseases. We have in mind several of the leading lights in the profession who are daily fighting tuberculosis, dyspepsia, kidney and intestinal disease, to say nothing of those who are troubled with chronic alcoholism. But dyspepsia and delirium tremens in men are only eccentricities. The main difference now between the practice of medicine by men and by women is that the mistakes of women are not tolerated; our sex have not earned the privilege of making mistakes, a privilege that comes only with long practice.

If periodicity is thus answerable, maternity is not. It has been my lot to know something of life in hotels and fashionable boarding-houses. I have observed that the women who expected to become mothers were exposed in what seemed to me the most cruel manner, attracting far more attention than any physician could attract at her daily work, while as to the amount of work performed no physician could have exchanged places with them. If shopping, calling, dressing and dancing, unflinchingly pursued up to the day of confinement, if these are not hard work we do not know the meaning of the word. But the same women would be shocked, horrified, were you to put some useful occupation upon them, even though it expended far less of their vitality in its performance, and the world too would cry out, how unwomanly!

Just so long as woman’s work is aimless, useless, she can brave any exposure up to death itself, and it will all be charged to the amiability and sweetness of the feminine mind; but if she die in the harness of a useful occupation, this comes from departing from the path of duty assigned her by providence. I have, observed, also, the habits of the poor during the child-bearing period. They wash, sew, bake and scrub up till the last moment. I have known the poor housewife to finish enough washing and baking to last through her illness, and give her floor a farewell scrub, all after the first labor-pains were upon her. If the poor creature had been engaged in a lucrative pursuit, whereby she was earning enough to pay for proper care during her confinement, providence and the path of duty would have received another sentimental shock; but because she is earning nothing, no strong male voice warns her against the violation of the laws of her being; no strong male arm is uplifted to protect her. We see, then, that women do work hard and long all through periodicity and maternity, and the only reason that the work is not questioned is that it is unpaid.

Granting all that is predicated of both conditions, we must remember there are still from twenty-five to thirty years of a woman’s life entirely free from the influences of both conditions. And we have yet to learn from any scientific standpoint why a woman at forty years of age should not be in the prime and rigor of her womanhood. Such she would be were she not made to believe that the sexual function is the principle function of her existence, and when that fails she must fail.

It is time that thoughtful women were asking, “Need these things be so?”

The physical disabilities being thus conquerable, we approach the question of propriety and fitness. I confess to having had scruples in this direction, but they all vanished at my first clinic in diseases of women.  A woman was the subject stretched upon the operating table; a woman was the servant, the nurse that stood by the table performing the menial part of the operation; men were the physicians who were profiting by the operation. We reasoned thus: if it is proper, and we have never heard that it was not, for a woman to lie there as a patient; if it is proper, and we have never heard that it was not, for a woman to stand there as a nurse, why is it not proper, and we have heard that it is not, for me to stand there as a physician? Why is peerage more unbecoming to women than vassalage? If it is indelicate for a woman to be a physician, much more is it indelicate for her to be a nurse, and thrice over is it indelicate for her to be a patient.

The longer I practice medicine the more I am assured that there is a great moral question involved in certain kinds of practice. I forbear to discuss it; but I must say in justice to professional men that they deserve a great deal of credit whenever they maintain a high standard of honor. They certainly sustain a strain upon their morals to which human nature in its present development should not be subjected more frequently than is absolutely necessary.

The inevitable result of mental development is the amelioration of the condition of the human being. It is an advantage man possesses over all his brother animals. They must submit to the situation, be it ever so unfavorable; he may modify the most untoward situation by sheer force of mind. Women are just as much in need of this ameliorating, modifying power as are men, because the misfortunes of life fall even more heavily upon women than upon men, and nature has endowed her with the power of mind to overcome these misfortunes. But, it is feared, if women use this power it will revolutionize society, especially in its domestic relations. To many, the self-dependence of women means no more homes, no more wives, no more mothers. A Platonic Republic is the logical outgrowth of woman’s independence.

I have observed two things: First, that the ordinary oak usually becomes very tired of the ordinary vine. Secondly, if there is one thing above another for which human beings constantly maintain a wholesome respect, it is a pocket-book. Judging from these personal observations, I believe there is no one thing which could so favorably modify domestic life as to make women self-supporting.

Successful occupation is the cure for many, many sins. The ordinary practice of medicine is one of the most natural and appropriate means of self-support for woman.

There are many men, and good men, too, that cannot conceive it possible for a woman to practice medicine and at the same time be womanly. They forget that the essence of womanliness, as of manliness, is born, not bred. It is intuition, the predestinated disposition, if you please, of the ultimate atoms, not mere education; it is inspiration, not inflation, and if this primordial, foreordained essence be wanting you’ll find coarse-mindedness, though the subject may never cross the threshold of her own boudoir.

A real woman becomes all the more womanly in ameliorating the sufferings of others. All the more delicate and sacred to her becomes the great mysteries of life and death, when she becomes the ministering priestess, as she has ever been the ministering servant of both.

If, then, women may study medicine, the question arises, How shall she study it? alone, or with men? She cannot study entirely with her own sex, for as yet there are not a sufficient number of women of brains and experience in the profession to do the teaching. For years to come men must be their teachers. The question. naturally asks itself if women may learn of men, why may they not learn with men? To make the argument of co-education consistent with itself, our medical teachers should all be women — a result which, however competent women may become, we hope never to see.

With the possession of the best teachers is also the possession of the best colleges. The educational curse of this country to-day is the multiplication of educational institutions, and the rearing of separate colleges for women is but adding to the difficulty. The cheap schools of this country, medical and otherwise, need boiling down. The money which we spend in our separate schools had far better be spent in opening the doors of the old institutions. If thought necessary, there may be separate lectures on certain branches, as is the plan at some schools now, but we think the necessity a species of mock modesty; there should not be, and there really is no sex in science. We think there is no comparison in the moral effect on the sexes of a day’s work in the dissecting-room and a night’s revelry in a ball-room.

There is, perhaps, no mother who would not feel proud to send her daughter to the Queen’s drawing-room. That is, certainly, the very top of the scale of social life. But there is far more exposure of the person, far more to bring the blush to a modest cheek, in one such exhibition than in a whole medical course in a mixed college. Modesty is a relative virtue, custom regulates it. The tribes that go naked have no feeling of shame; neither have the half-dressed women of society. Why should the students of science feel shame, or think of shame, when only the highest faculties of mind are engaged, not the emotional centers, as in the dance. Then, too, we must consider all the appointments of the ball-room; their influence is sensuous to the last extreme.

Chas. Reade says: pedants who object to promiscuous botany never think of objecting to promiscuous dancing, which, in some of its belongings, the custom of ages has failed to render decent.”

I am prepared to make this statement: There is no medical subject that may not be lectured upon in the most refined and modest manner. The nomenclature of medicine gives the lecturer the power to lift delicate subjects up from the plane in which vulgar language places them. No young man can afford to have the morale of his nature spoiled by hearing these subjects described in indecent language, and if the entrance of women into male colleges is going to make the professors and students more refined, all hail the day. That such is the result, we find upon inquiry to be true in the few colleges that admit women. The professors themselves say they will do everything to encourage the presence of women, if only for that purpose alone.

Foreign schools have no difficulty in educating the sexes. “How do the students treat you?” I inquired of one who has recently returned from Zurich. “Just as students,” was the sensible reply. “There is never the least offense offered; neither, on the other hand, are they intrusive in their politeness.”

Finally, I believe in co-education, because really all the medicine we know is learned at the clinic. Our system of educating women is thus rendered ludicrous. We go off by ourselves in the separate college to listen to didactic lectures containing no word offensive to the most fastidious, while the great bulk of our practical knowledge, indeed all of it that relates to general diseases, must be obtained in mixed classes, because all the important hospitals are under the control of the male colleges. The only objectionable part of the study, then, is learned by woman here, just as on the Continent, while the harmless laboratories are all locked and barred against us. Fortunately for women, they know how to get nourishment out of crumbs even. They are so used to picking up what is left, and making use of the pickings to the best advantage, that some of them have already made most brilliant reputations from chances most meager.

To sum up, I believe in education, first because woman has a brain, and the presence of an organ presupposes some use for it. The female part of the race needs the uplifting, the modifying power which is the outcome of mental development.

I believe in the medical education of women because it opens up an honorable occupation peculiarly fitting to women. I think it better that she should perform a scientific instead of an ignorant kind of service under precisely the same circumstances — especially when the scientific is the more lucrative.

That it is a lucrative means of support is to be remembered, for women are in great need of financial self-dependence. Dependence is the mother of many, many crimes.

I believe in co-education, first, on the broad principle that there is no sex in science, or in any of the higher departments of learning; that exclusiveness in education is unnatural and morbid in its tendency, giving too much prominence to the lower part of our nature, because that is really the basis upon which the separation is made. It is in itself a gross insinuation. I believe the reflex influence of co-education upon character is good and healthful. Secondly, because our teachers must be men. Thirdly, because of the perfect success of the co-educating schools of medicine. Fourthly, from a financial point of view. We cannot afford to support more institutions than we already have. Cheap, ill-appointed medical schools are already the curse of the profession.

Finally, I believe in co-education, because, practically, we are thus getting our education. The only place to learn medicine is in the hospital — our separate education is purely theoretical.

 

 

Source: The Physiology of Woman, Embracing Girlhood, Maternity and Mature Age, by Sarah Hackett Stevenson (Chicago: Fairbanks, Palmer & Co.,) 1883, pp. 143-170.