WOMEN 



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date. Our reasons for so doing are because he may be the only 

 medical practitioner to examine the candidate before the tropics 

 are reached. 



We feel that it is in the interests of employer and employee that 

 every opportunity should be given for the selected candidate to 

 keep fit until he reaches the local medical officers. 



Check Examination. — ^We are of the opinion that a check 

 medical examination by the local medical officers immediately upon 

 the arrival of the new official is advisable, in order to see whether 

 entry into the tropics has induced any changes in his health, and 

 also for the purpose of giving him local medical advice. 



This check examination is very necessary, as we know that persons 

 have arrived slightly indisposed, and have allowed these slight 

 symptoms to become serious owing to lack of knowledge. 



WOMEN. 



European and American women proceeding to the tropics are 

 usually either married or about to be married, or, because of the 

 scarcity of white women therein, are very likely to be married fairly 

 soon, although they may start as nurses, missionaries, etc. 



We therefore consider that all women proposing to live in the 

 tropics should be medically examined in the same way as men, and 

 should be specially tested as to their ability to stand quinine 

 therapy; and if this is found wanting, should be educated up to a 

 necessary quinine standard, by regulated small doses, before 

 being allowed to begin their new life. 



Our experience makes us agree with Mrs. Scharlieb that the 

 medical examination of women should include the bony pelvis and 

 the organs contained therein when practical. 



Often women have to live in out-stations far from medical aid, 

 and it is little short of criminality not to take the external measure- 

 ments of the pelvis, and if necessary to investigate the condition 

 of the internal pelvic organs by means of a rectal examination. If 

 abnormalities are discovered the woman or her husband, or both, 

 should be warned as to the possibilities of such abnormalities. 



At such an examination care should be taken to see that there is 

 no obvious cause for dyspareunia, as it may cause trouble to the 

 examinee and her husband. This has been brought home to us in 

 our long experience of tropical practice. 



Moreover, the woman should be warned as to the possibility of 

 menorrhagia (or the much less common amenorrhoea), which may 

 begin after arrival in warm climates, and should be given advice as 

 to clothing. 



The necessity of having the urine examined on the occurrence of 

 pregnancy should be impressed upon the wife and her husband, as 

 well as the requirements of diet, exercise, rest in the warmer hours 

 of the day, etc. 



White men, as a rule, require at regular intervals visits to temperate 

 climates if their health, strength, and mental vigour are to be 



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