n \ y>\ Irty^f THE INFLUENCE OF DRESS IN the PRODUCTION OE DISEASE IN EEMALES; READ BEFORE THE CHENANGO COUNTY MEDICAL SOCIETY, JUNE 10 th, 1817, BY DR. WILLIAM D. PURPLE, ip^h ALBANY: PRINTED BY JOEL MUNSELL. 1848. • '/ INFLUENCE OE DRESS. There is no truth more apparent to the medical practitioner, than the gradual and almost imperceptible change in the pa- thological characteristics of a given period of time. It is true that some of the great outlines of nosology are applicable to man, in all countries and under all circumstances. It is also true that epidemic and endemic diseases may present them- selves in different localities and at different times; but, inde- pendent of these well known facts, every person who has taken a more general survey of the phenomena of health and disease of the human family, has discovered a very great disparity in the pathological characteristics of different periods. It is the imperative duty of the members of the profc to note these changes, and in their associated capacity t vestigate their causes; to enquire how far they depend on ex- ternal agents beyond oTir control, or are chargeable to the habits and customs of society. It is a maxim no less trite than true, that " man is a bundle of habits," and that those habits' are fleeting and transitory, and so far as they can be relied upon, as causes of pathological characteristics, so far will dis- eases be found ever varying, ever changing. There is no more potent sovereign over human habits and actions than fashion. It is true that man is a philosophical be- ing, and a large majority of our sex are controled by the prin- ciples of comfort and convenience in our dress, and although there may be a few who " ape the ape," and bow implicit obedience to the laws prescribed by fashion, yet they are not allowed to contravene the utilitarian standard so far as to in- terfere with pathological characteristics. But the " fickle fair" of this genius Homo is gregarious in all her habits; with her'no sacrifice is too great at the shrine of fashion ; her whole soul is engaged in her devotion, and she not unfrequently of- fers her " body as living sacrifice" to the god of her idolatry. The spring and fall costume of Paris or Broadway, has entire control over her—no matter how grotesque she may appear— no matter how it may burlesque the " human form divine"— ion in- 4 no matter what may be their present inconvenience, or their permanent influence on health, the rules prescribed by a few interested dress makers, must be implicitly followed. It would be truly interesting to enter a gallery composed of female figures, habited m the various fashions that have pre- vailed for the last fifty years. Nor would it be*less amusing than instructive to the pathological enquirer. We should see as the representative of the commencement of this period, a lady dressed in what was delicately called a " petticoat," made of flannel, barely large enough to go around the body, and enable her to walk with the measured pace which was then requisite to good breeding ; it is pinned loosely around the body under the arms and supported by short suspenders or shoulder straps. The calico gown, or what was called a "short gown," loose and free, tied with a few tape ties, completes the dress of this representative of our grandmothers in the mild seasons of the year. Then the body had a natural shape, that which an allwise Architect gave it—the several cavities were fitted in size to contain in their natural position, the va- rious organs. Then there was in ladies, as pertains in gentle- men, a cylindrical form, whose circumference was nearly the same in the throracic abdominal and pelvic regions—then the functions of the viscera were duly performed, and all moved in Jftrmonious concert. The heart beat freely, the lungs were duly expanded, the stomach and bowels were circumscribed by muscles whose province it is to promote free, general and peristaltic motion—the pelvic viscera hmd ample room for all their healthy action, and were not compelled to seek less circumscribed quarters to manifest their various functions. The representative of a modern lady shows us that a change has come over this native simplicity and natural form. An edict has gone forth from the throne of fashion, that art must usurp the prerogative of nature. Not content with her legiti- mate sphere of controling in all their endless variety the ha- biliment of tne sex, she advanced a step farther than she even ventured before with reasoning mortals, and declared that the female must be moulded into a more angelic form, and be made to approximate by an hour-glass contraction the sylph- like form of the ant upon the mole-hill* The mechanical arts were immediately brought in requisi- tion, and the combined powers of the screw, the wedge and the taekle were had in requisition to abridge the work-shop of the vital and animal functions. This was no difficult task. Habit stimulated by pride of personal appearance, at first made the requisite effort—the slow and gradual yielding of the flexible parts at a young and tender age, stimulated the votary to perseverance. The stimulus of pressure became 6 more and more tolerable, until like other bad habits, it became to a certain extent essential to personal convenience. Every anatomist knows that the internal organs of the body receive originally the germ of a specific amount of physical development—that the cavity that contains them is adapted in size to their "full and healthy expansion—that the shell of the fish is controlled by the growth of the soft parts—that the scull in man is moulded in its capacity to the volume of the cere- bral mass—and that the chest, and the parieties of the abdo- minal cavity, receive their dimensions from the necessity of their respective contents. It is equally known to every physiologist, that the health of an organ very much depends on its free and unrestrained ac- tion. Thus the functions of the brain are destroyed by a very slight compression. The free admission of air to every part of the lungs, so that their cells maybe fully distended at each inspiration, is essential to their healthy action, and a due aeration of the blood,on which every function of the system so entirely depends. It is the province of the bony and mus- cular walls of the chest to adapt themselves to the wants of the lungs. This is noticed in the spacious chest of the trum- peter and the facility with which the ribs adapt themselves to a collapsed lung. These and numerous other examples fur- nish indubitable evidence that nature not only abhtf^ a vacuum, but repudiates the slightest compression. The thoracic, abdominal and pelvic cavities, are so inti- mately blended, that any pressure on one, necessarily in- volves the whole internal viscera—the functions of each and all are in a degree affected by it. The heart, the arteries and veins—the lungs, the stomach and bowels—the nervous sys- tem, the liver and the pelvic viscera, all and each proclaim in language that cannot be misunderstood, that they require room. Not such room as the caprice of a ridiculous fashion may chance to allow, but such space as their due development and functional action will make for themselves—and who- ever turns a deaf ear to their voice will find a physical de- monstration of the sentiment that the " way of the transgres- sor is hard," will find that there is no atonement made for those who sin against nature's laws, will find that they shall reap the fruit of their doing, in the shape of lingering disease, or premature death. The following are among the most prominent symptoms that present themselves in a very large number of the females that apply to us at the present day, representing that they la- bor under weakness and debility ; there is difficulty of breath- ing, palpitation of the heart, weakness of the voice, hectic flush of the face, gone sensation at the pit of the stomach, 6 pain in the sides, in the region of the uterine ligaments, tor- pid slate of the bowels, prominence in the lower portion of the abdomen, obstruction of the bowels from mechanical pressure, tenesmus'and hemorrhoids, sudden stoppage of urine, prolap- sus, leucorrhea, numbness of the thighs, and oedemotous deposit in the lower extremities. In addition to these symptoms, there is not unfrequently excessive weakness of the back, se- vere pain at the lower extremity of the spine, with most of the symptoms usually denominated spinal irritation; these symp- toms are usually accompanied by a sense of pressure upon the lumbar nerves,"described as a dragging or falling sensation, as though the pelvic contents were about to escape. These symptoms are emphatically modern in their advent. That they "might have existed in some rare cases fifty years ago, I am not prepared to deny, but they were not sufficiently common to attract any very considerable attention at that pe- riod ; nor am I prepared to deny that they may occasionally exist from causes beyond our control; but in almost every in- stance they depend entirely on the influence of mechanical pressure over some portion of the body. It is certain they have presented themselves with the fashion of taper waists, and I doubt, not they stand in the relation of cause and effect. Ste pathological condition of the vital organs, in conse- qj^pce of compression of the chest, has already been alluded to^ I will further add, that by the yielding of the cartilages Uiat form the anterior articulation of the ribs, they are often found jutted over the sternum in a manner that shows a great diminution of the cavity of the chest. The pressure over the ensiform cartilage, and around the floating ribs, so diminishes the size of the body as to prevent the descent of the dia- phragm in the act of inspiration. This occasions a heaving of the shoulders in respiration, as the abdominal muscles have little agency in that act. Hence the difficult breathing that uniformly exists when the respiratory muscles are para- lyzed in their action, and are "held and firmly bound" in a state of quietude. In this condition there" is a di- minished quantity of air received into the lungs, and the blood is not properly arterialized. This impure blood has more direct influence on the nervous system than any other— hence the train of neuralgic symptoms that supervene. And, in addition to this, we all know the effect of a gentle blow over the nervous center, and there cannot be a doubt that long continued pressure over the same part must diminish the ac- tion of all those viscera that receive their nerves from this point. Phis more directly falls on the digestive organs, and the torpid state of the stomach and bowels is a universal ac- companiment. 7 The frequency of consumption in the human family is truly alarming, and in the region of my personal observation it is evidently on the increase ; indeed, statistics exhibit the fact that about one-fourth of the adult deaths are from this fell de- stroyer, and also, that a very large proportion are females from eighteen to thirty-five; and there is no doubt that the " tight chest" produced by the "tight dress," is the cause of a large proportion of our modern cases of " quick consump- tion." But a change has come over the spirit of fashion within the last few years, and already we see its pathological effects. Pressure about the chest is less common than formerly, but an equally pernicious practice has succeeded it. The corset has to a certain extent been superseded by the large and heavy skirt, and the supporting bandage is girted around the abdo- men instead of the chest. It is the order now to have as large a circumference of clothing about the hips and lower extremi- ties as is possible. To make a mammoth-like appearance be- low the pit of the stomach, while all above is as small as a tight fit can exhibit. This griffin-like appearance is the sine qua non of modern fashion, and the extent to which it is car- ried, in the higher circles, can hardly be computed. Each quilt has almost twelve yards of cloth in it, and filled with from three to four pounds of wadding, and two or JWre are frequently worn at a time; and I doubt not, on inquiry, we shall find the weight suspended by a quilt around the up- per part of the abdomen, is from six to ten pounds. Now, I ask, what must be its physical effects ? Let any gentleman suspend even half that amount in like manner, during an hour's walk, and 1 doubt not he would seek relief by finding some more convenient mode of carrying the burthen. We all know the influence of voluntary effort with the abdo- minal muscles to produce alvine evacuations; we know the power of constant effort in removing costiveness, and its ten- dency to producgyhernia where there is a weakness in the walls of the pelvis ;/also, that pressure on the abdominal muscles greatly aids parturient efforts, and there is not a doubt that many of the symptoms we are now considering depend on the same cause, unremittingly applied for a series of years, at an age when the system can least resist its influence. The physical condition of the female of our species is dif- ferent from that of any other animal that bears their young; her vertical position requires her to have a small pelvic outlet, and this firmly guarded by ligamentous and fasceous struc- tures, fitted to bear the weight of all her viscera, with the ad- dition of the gravid uterus. She is, more than any other ani- 8 mal, emphatically doomed to " bring forth her young in sor- row';" but it was never intended she should be " .------So doubly desperate, To join against herself with fate," and place an additional burthen, and a great excitant to mus- cular contraction, and thereby weaken the very part where she most requires strength. But such is the result of this modern fashion. This great weight, worn for weeks, months, and years, must stimulate to oreater exertion the abdominal muscles, it must increase their power of pressure on the contents of the abdomen and pelvis, and its whole burthen,thus sustained, must constantly produce a depression of all the movable viscera of these cavities. There is a subhernial state of the pelvic organs, the perineum is dis- tended to its utmost tension, the pelvic outlet is invaded by the protrusion produced by the pressure from above. The uterus is impacted between the rectum and urethra, and a mechanical obstruction of one or both of those passages is the result. There is a pressure of the lumbar nerves, producing severe and constant pain in the back, with numbness of the lo^gr extremities. These sensations are more severe when fi^resuming a vertical position, after resting in a recumbent prjPure. Hence the subject suffers much for the first hour in the morning, when the parts resume their wonted forced posi- tion. The most severe suffering often exists on an effort to pro- duce fcecal evacuation, in consequence of the accumulation above the point in the rectum compressed by the uterus; eve- ry effort forces that organ to a narrower pass in the pelvis, and thereby increases the lateral pressure on the bowels—this causes an accumulation in the colon, and adds to the torpor of the bowels—from well known sympathy there exists much pain in the head, and the general train* of neuralgic symptoms that usually supervene on habitual costiveness. Dysmenor- rhea often presents itself; leucorrhceal and other debilitating discharges are universal accompaniments. In a word, the foundation is laid for a long train of neuralgic symptoms, from their mildest form, to that fashionable disease, " spinal irrita- tion." ' v It is often difficult to detect this state by examination. The condition of the uterus in relation to external integuments is about the same as in health; the whole pelvic viscera, with the perineal integuments are displaced in an equal degree. it is only by reference to the location of the organs in relation to each other, and the osseous rim of the pelvic outlet, that 9 the mechanical influence of the displacement can be duly ap- preciated. That this influence is the cause of nearly all the above symptoms is clearly proved by the fact that in almost every instance they entirely subside when the gravid uterus can no longer be confined to the pelvis, but co#mpels the sub- ject to loosen the ligature about her body, and suffer it to escape for a time from the imprisonment it has, in common with the other pelvic viscera, been chained by the tyrant fashion. I have, in these remarks, confined myself almost entirely to the mechanical influence of displacement in the production of these symptoms. But it cannot be denied that pressure on the living organs, independent of this, must necessarily have a very great influence over their functional action. What its peculiar effects are, it is difficult to explain, but so universal is the law, that a group of organs require and receive at the hand of nature a certain amount of pressure, that it cannot be doubted that any increase or diminution of it would seriously disturb their functions. The delicate functions of the sto- mach, the liver, and.,the whole chylopoetic viscera, doubtless require the amount of support the abdominal muscles yiel(T, and an increase of it would produce all the above mentioned symptoms that do not flow legitimately from displacement I am aware that early rising from a recumbent posture, amer parturition, may often produce the above symptoms; but, as they were seldom known before the advent of the fashion of tight lacing, I think this even may be regarded in the light of a concurrent cause, that would seldom exist, if the ligaments and fascice of the pelvis had not previously been weakened by long continued external pressure. Can I be mistaken in the charge that this general displace- ment, and the consequent symptoms, are produced by the pres- sure of the modern style of dress? Is there a doubt that a large proportion of these cases are mainly or entirely charge- able to external pressure ? Why do not these symptoms oc- cur in the male ? Can there be a doubt that similar sensa- tions would, in him, follow the same abuse ? These symp- toms are not confined to the uterine system ; they are not the result of uterine action ; they do not belong to its physiologi- cal or pathological characteristics, and yet all grades and classes are affected by them, and perhaps not one in five is entirely free from their influence. The higher circles of soci- ety, those most subservient to fashion's control, are the most exposed to all these symptoms; they exsit for years unknown to their most intimate friends: « " They are deep and hidden griefs, That come from sources that admit of no complaint, From things of which she can not, dare not speak;" 10 and hence they become chronic, under the nursing care of the cause that produced them. . Thh abuse of the system is insidiously introduced. It is interwoven in the very formation of society. The subjects themselves know not its influence over their physical health, and like the deluded votary of the intoxicating bowl, they are the unconscious authors of their own abject wretchedness. It is true that some can endure it with impunity, but others, oi a lax muscular fibre, are greatly affected by it. Hence we see all varieties and grades of disease from this cause, from slight nervous irritability, to the confirmed bed-ridden subject. If the subject is alluded to bv a medical adviser, a broad de- al is the usual reply, and the subject is evaded, as delicate ,. they — strung." The habit is commenced in early youth, when the system is growing, and although after the attainment of a cer- tain age, it may be gradually diminished, yet the organs have an artificial position, and its effects exi&t in many instances through life, and may, and doubtless in some instances do, transmit its deteriorating influence to posterity. The ordinary modes of treatment, when successful, confirm thf pathological views here taken. The pessary, the support- er, and lace, all, to a certain extent, exert a counteracting me- chanical influence, and relieves momentarily the hernial ten- dency. But while the cause remains, they only serve to compress the viscera into a still smaller ccrmpass, increasing many of the symptoms without relieving the remainder. The curative indication is to remove the cause ; to remove every obstruction to the due development of the internal or- gans, and a healthy discharge of their functions. Let them, as nature designed, control their own space, and their own ap- propriate position in the animal economy, and a healthy and vigorous action will be the result. These symptoms are, as I have endeavored to show, the creatures of fashion, are entire- ly of modern origin, and are not among the " ills that flesh it heir to;" and when the cause is removed, by restoring the female form to its legitimate proportions, they will entirely cease from among us. In connexion with this subject, I must allude, before I close, to the very imperfect manner the skin is protected by the fashionable dress of the females of our country. Whoever regards with a physiological eye the functions of the skin, and takes into consideration its very delicate texture, the extraor- dinary amount of its excretion, and its very intimate sympa- thy with the functions of the uterus, cannot but be convinced 11 that the health of the female very nuch depends on its being well protected from sudden changes of temperature. The warm stove rooms of our modern houses, form a very great contrast with " the peltings of the pitiless storms without," in this our northern climate. The dress of our ladies bears no proportion to the rigor of the colder seasons of the year, nor to that worn by the more hardy sex. It is true, if they are to ride, more care is taken; but if their daily avocations call them to the open p.ir, they are found with the body but feebly protected ; the chest with a thin, tight fit; the neck bare, the arms with but a. single thickness of calico, their feet with the thin soled slipper; the ample folds of their skirts so carefully removed from the body that the wind '* bloweth where it list- eth," and although we " cannot tell from whence it cometh," yet ii is no difficult task to tell " whither it goeth." It finds ample room to revel in all its " wanton wildness" on three- fourths of the surface of her body. Clothing, in order to guard the delicate functions of the skin, requires to be in ac- tual contact with it; and the style, imposed by fashion, of the female dress, doubtless lays the foundation of much of the weakness of the " weaker vessels" of our species. It is our duty to awaken attention to these subjects; to ex- pose the " folly of fashion" in our daily professional avoca- tions, and to attack the cause of many of the diseases and weaknesses incident to females; to explain the reason why our ladies are not as healthy as their grandmothers were, and are becoming every year more and more effeminate. In re- ply to their complaints, we should endeavor to convince them that medicine will have little or no effect, unless the cause is removed; we should appeal to mothers, to let na- ture mould " the human form divine." We should cry aloud and spare not, until the galling bonds of fashion shall cease to drag our ladies to the dust; then, and not till then, will they breathe more freely, and posterity assume a more hardy character, and award the meed of praise to those who closed this prolific source of some of the most dangerous and uncomfortable diseases that have in these .modern times es- caped from Pandora's box.