┌───────────────┬────────────┬────────────────────────────────────────┐
│ │Quantity in │ CONTAINS OF │
│ │ Grammes. │ │
├───────────────┼────────────┼────────────┬────────────┬──────────────┤
│ „ │ „ │ Albumin. │ Fat. │Carbohydrates.│
├───────────────┼────────────┼────────────┼────────────┼──────────────┤
│ Morning: │ │ │ │ │
│Beefsteak │ 100│ 38.2│ 1.7│ ——│
│A cup of tea │ 150│ 0.45│ ——│ 0.9│
│White bread │ 30│ 2.9│ 0.2│ 18.0│
│ │ │ │ │ │
│ Mid-day: │ │ │ │ │
│Meat soup │ 100│ 1.1│ 1.5│ 5.7│
│Roast meat │ 200│ 76.4│ 3.4│ ——│
│Vegetables │ 50│ 0.8│ 0.2│ 4.2│
│White bread │ 50│ 4.8│ 0.4│ 30.0│
│Light wine │ 150│ ——│ ——│ 1.0│
│ │ │ │ │ │
│ Afternoon: │ │ │ │ │
│A cup of coffee│ 120│ 0.2│ 0.67│ 1.7│
│White bread │ 25│ 2.4│ 0.2│ 15.0│
│ │ │ │ │ │
│ Evening: │ │ │ │ │
│Roast meat │ 200│ 46.4│ 3.4│ ——│
│Vegetables │ 25│ 0.4│ 0.1│ 2.1│
│Wine │ 150│ ——│ │ ——│
│White bread │ 30│ 2.9│ 0.2│ 18.0│
├───────────────┼────────────┼────────────┼────────────┼──────────────┤
│ Total│ 1380│ 206.97│ 11.92│ 97.6│
├───────────────┼────────────┼────────────┼────────────┼──────────────┤
│Contains about │ │ │ │ │
│1300 calories. │ │ │ │ │
└───────────────┴────────────┴────────────┴────────────┴──────────────┘
For young girls at this period of life systematic gymnastic exercises
are usually valuable, not only for strengthening the muscular system and
improving the physique during these years of growth, but also for
assisting the functions of respiration, circulation, and digestion.
Beginning with the simplest and easiest exercises of chamber gymnastics,
the girl gradually proceeds to more difficult and elaborate exercises
and to the use of medico-mechanical apparatus.
The clothing of young girls at the time of the menarche must receive
attention to this extent, that all articles of clothing should be
rejected which increase the tendency already existing to hyperæmia of
the genital organs or offer any hindrance to the circulation in general.
Above all, the physician must take his part in the contest so long and
so vainly urged against the corset. But further, all tight clothing,
such as restricts the freedom of movement of the thorax and the abdomen,
tight collars, and tight garters—all these must be forbidden; moreover
excessively warm underclothing, of the lower extremities especially,
which may stimulate the genital organs, must also be prohibited.
As regards the night hours, a thick feather bed is unsuitable. The young
girl should sleep on a hair mattress, and the bed clothing should be
light. Eight to nine hours sleep is sufficient; in the words of the
English proverb, “early to bed and early to rise, is the way to be
healthy, and wealthy, and wise.”
To live by rule, with regular hours of work and suitable pauses for
rest, is of great importance. Among the well-to-do classes also care
should be taken that the adolescent girl takes moderate physical
exercise for several hours daily; she should go for a good walk, and not
spend hour after hour recumbent upon a sofa in idle reverie. Sitting for
too long a time, whether engaged in sewing or at the piano, is harmful;
working at the sewing-machine is permissible for short periods only, and
is indeed at this period of life better altogether avoided. Bicycling is
also an unsuitable exercise at this age and readily leads to
masturbation. Lawn tennis and croquet, on the other hand, are very
suitable active open-air games; in winter, skating may be indulged in if
proper precautions are taken against chill; in summer, swimming and
rowing. The reading of light literature should be kept under
supervision; equivocal novels, such as may give rise to erotic reverie
and sensual excitement, must be strictly forbidden. A watch should be
kept for any indications of the habit of masturbation; and if the habit
exists, appropriate measures should be taken.
Hydrotherapeutic procedures and baths are of great hygienic and
therapeutic importance for girls at the menarche. In healthy girls at
this period of life, a cold sponge-bath lasting one or two minutes, the
temperature of the water ranging from 10° to 20° C. (50° to 63° F.),
taken either on rising in the morning or immediately before going to
bed, is a valuable means for hardening the whole body; equally useful
are cold shower-baths, lasting from a few seconds up to half a minute.
If the girl is somewhat anæmic, it will be well for her to take a glass
of warm milk or a cup of tea half an hour before the bath, in order to
guard against too great an abstraction of heat. Cold bathing in rivers,
when available, may also be recommended. In cases in which a
considerable degree of anæmia or chlorosis is present, cold baths and
every form of strong mechanical stimulation by the use of water, douches
and the like, are to be avoided, since we have to fear both excessive
abstraction of heat and overstimulation of the nerves. In such anæmic
and chlorotic patients, either partial washing with lukewarm water or
general lukewarm baths, the temperature of which may be gradually and
cautiously lowered, either on rising or at bedtime, have a refreshing
and stimulating effect.
In girls who are in other respects healthy, but in whom the menarche is
delayed, and in whom menstruation, when begun, has been scanty and
irregular, cold sitz-baths of short duration, the abdomen being
simultaneously douched from a considerable height, or cold shower-baths
in combination with powerful abdominal douches, are often of value.
Recently, hot air and vapor baths have been especially recommended for
girls suffering from chlorosis, at first, by _Scholz_ and _Schubert_, in
association with phlebotomy, but also without this. _Kühne_, for
example, has seen the most satisfactory results follow the simple use of
sudatory baths in cases of chlorosis; improvement was manifested by an
increase in the corpuscular richness of the blood, an increase in the
hæmoglobin-richness, and an increase in the body-weight. In cases of
chlorosis, _Traugott_ also has seen favorable results follow the use of
hot air baths and the consequent diaphoresis.
Still more recently _Dehio_ and especially _Rosin_ have recommended hot
baths for girls suffering from chlorosis. In fifty cases of chlorosis,
in which other methods of treatment had given negative results, _Rosin_
gave three times a week baths at a temperature of 40° C. (104° F.),
lasting at first a quarter of an hour, but later half an hour. After the
bath, in those strong enough to bear it, a very short cold douche or
cold sponging followed; then the patient had to lie down for an hour.
The treatment was carried out for from four to six weeks. Each bath by
itself had a notable refreshing effect in these patients, and at the end
of the course most of the cases exhibited an improvement in all their
symptoms, such as other methods of treatment had failed to produce.
The favorable influence exercised by these hot baths, as by steam
bath-cabinets, light baths, sun baths, wet packing, and similar
sudorific measures, may in part be explained by the dehydration of the
system that is thus effected; whilst those who maintain the
auto-intoxication theory of chlorosis may regard the diaphoresis as a
means for the elimination of noxious substances from the body.
Bathing in water aerated with carbonic acid may be recommended for
patients suffering from anæmia and chlorosis at this period of life, for
the reason that such baths can be tolerated at a lower temperature than
baths of ordinary water. The natural mineral waters containing free
carbonic acid, and chalybeate waters rich in carbonic acid, when used as
baths, are effective principally in virtue of the carbonic acid they
contain, which stimulates the skin; this stimulus being conducted by the
nervous system from the periphery to the nerve-centres, is reflected
thence, and by irradiation exercises a quickening effect on all the
processes of nutrition. These baths are usually taken at a temperature
progressively reduced from 32° C. to 25° C. (90° F. to 77° F.), and each
bath lasts from ten to twenty minutes; they are in most cases taken
every other day only. For young girls in whom the menarche is delayed,
also for chlorotic patients with amenorrhœa and neuralgic
manifestations, chalybeate peat baths are indicated, which influence the
peripheral nerves by the exercise of a gentle yet considerable thermic
stimulus. These chalybeate peat baths have further been shown to
increase the hæmoglobin-richness, the corpuscular richness, and the
specific gravity of the blood, transitorily after each bath, but to some
extent permanently also, a certain increase enduring after the course is
over.
Young girls suffering from disturbances of their general health
dependent upon a scrofulous or rachitic habit of body may with advantage
be sent to brine baths, especially to such as are situated in the Alps
or other mountainous regions. These weakly, lymphatic, scrofulous girls,
suffering from scanty or irregular menstruation, may also practice
sea-bathing with advantage, especially at watering places on the sea
coast, where the waves are powerful. In such cases, however, it is
advisable in the first instance to take artificially warmed sea-water
baths, before proceeding to actual sea-bathing.
If the sensibility of a chlorotic patient is so great that she can
endure neither peat baths nor carbonic acid containing mineral water
baths, we must add to the latter, in order to make their action milder,
decoctions of chamomile, wheat bran, malt, and the like.
In cases in which nervous symptoms predominate, with an apathetic,
melancholic frame of mind, aromatic herb baths are sometimes useful. For
this purpose such herbs should be employed as contain a notable quantity
of ethereal oils, such as sage (salvia officinalis), wild thyme (thymus
serpyllum), hyssop (hyssopus officinalis), wild marjoram (origanum
vulgare), rue (ruta graveolens), archangel (archangelica officinalis),
levisticum (levisticum officinale). Equally useful are the balsamic pine
needle baths, for which the fluid obtained by the distillation of pine
needles (pinus sylvestris), freshly collected day by day, is employed.
As regards the climatic conditions suitable for adolescent girls
suffering from the disorders of the menarche, from the nervous
conditions associated therewith, and from chlorosis, residence either in
the mountains or at the seaside is especially to be recommended. An
altitude of about 1,200 metres (4,000 feet) is the most suitable, being
that at which the peculiar characteristics of mountain climates are most
fully developed. The influence of such a climate on hæmatopoiesis has to
be taken into consideration, as well as its special influence on the
menstrual function.
Even though it cannot yet be regarded as fully determined whether the
increase observed by _Viault_, _Egger_, and _Mercier_, in the
corpuscular richness and hæmoglobin-richness of the blood in consequence
of residence in a mountain climate, is lasting or merely transitory, yet
it is certain that the hæmatopoietic organs are favorably influenced by
such residence, and that the good results are augmented by the
stimulating effect mountain air exercises on the appetite and the
digestion. _Lombard_ has moreover observed, that at a high altitude the
menstrual flow is more abundant and dysmenorrhœa is less common. For
young girls, therefore, suffering from irritable conditions of the
heart, increased frequency of the pulse, or increased arterial tension,
and for those also in whom the resisting power of the organism appears
deficient, a visit to a mountain health resort situated amid forests may
be recommended. For scrofulous girls a visit to the coast of the North
Sea is especially suitable. For the slighter forms of anæmia, a sea
voyage, in which the benefits of sea air can be obtained more fully, and
for a longer period, may be advised; but such a voyage is quite
unsuitable for those suffering from severe anæmia or chlorosis.
Such very weakly, intensely anæmic and chlorotic patients should spend
the winter in some southern health resort.
The skin, in which disturbances so readily occur at the time of the
menarche, requires careful attention, all the more because it is
precisely at this age that young girls have the greatest need of their
personal charms. The skin of the face, which is often disfigured by
comedones and acne, must be carefully guarded against the accumulation
of sebum in the sebaceous glands by sedulous washing with warm water and
a good soap. If the seborrhœic[30] process in these glands becomes at
all severe, ordinary soaps are unsuitable, and a potash soap must be
used, such as sapo viridis, or spiritus saponatus kalinus, which have
great power of dissolving fats.
The best way of dealing with seborrhœa is according to _Spietschka_ and
_Grünfeld_ the following: The washing is best effected in the evenings,
when the skin will not again for many hours be exposed to the fresh air,
to wind, or to dust. Pour into a basin about a pint of warm water and
add from one to two teaspoonfuls of spirit of soap (equivalent to the
linimentum saponis of the British Pharmacopœia) or as much soft soap as
can be taken up on the end of a table-knife. The water is then stirred
vigorously till a good lather is formed, and with the water and the
lather the face is thoroughly washed. The skin must then be carefully
dried, and thereafter it is well to smear it with some greasy material,
such as boric vaseline, in order to prevent the plugging of the pores
with dust, and to protect the sebum subsequently exuded from
dessication. On the next day the washing should be repeated only if the
face has become covered with sebum within an hour or two after the first
washing. If the exudation is less free, the eyes only should be washed
with fresh water, whilst the rest of the face should not be wetted, but
merely be wiped with a dry face towel lightly dusted with toilet powder,
in order to remove any accumulation of sebum.
The skin of the genital regions must be carefully cleansed, especially
in cases in which there is a tendency to hypersecretion of the sebaceous
glands, to eczema, or to herpes progenitalis; subsequently it should be
powdered, and pads of absorbent cotton-wool dusted with toilet powder
should be placed in the labial furrows.
It is of great importance that in girls at this time of life
gynecological examination should be undertaken only in cases of the
utmost need, and this restriction should be especially inflexible in the
case of girls with a neuropathic predisposition. Instances have been
observed in which a vaginal examination, the introduction of a vaginal
speculum, or the use of the uterine sound, has determined the onset of a
psychosis. Still more does what has been said hold true of local
treatment in gynecological cases. Repeated passage of the uterine sound,
cauterization of the cervix, and the manipulations of gynecological
massage, make a very deep impression upon the mind of a girl, and give
rise to morbid ideas and erotic storms, so that even in those with a
powerful constitution, various neuroses, neurasthenic states, and even
mental disorders may result. If in such cases, especially in girls of a
neuropathic temperament, gynecological treatment is quite indispensable,
a single, though energetic, operative procedure is to be preferred to a
number of successive, though taken singly less extensive, manipulations
of and in the female genital organs. The importance of this proposition
has been repeatedly established. _Saenger_, for instance, points out as
a fact to be regretted that uterine cauterization with mild caustics is
far too frequently undertaken; and _Odebrecht_ from the same standpoint
proclaims the advantage of a single curetting as compared with milder
intra-uterine impressions repeated during a course of treatment lasting
many months. On the other hand, the physician must bear in mind the
fact, established by the record of a very large number of cases, that in
women predisposed to psychoses severe gynecological operations are apt
to lead to the actual appearance of mental disorders, or to the
exacerbation of mental disorders which have previously been very mild or
have merely threatened to appear. Careful consideration is needed, on
the one hand as regards the severity of the disease of the genital
organs, and on the other as regards the resisting power, temperament,
and constitution of the girl concerned, and in many cases a consultation
between the gynecologist and the neurologist is expedient.
A very powerful influence on the physical and moral well-being of the
girl at puberty is exercised by her domestic upbringing. The general
truth of _Gœthe’s_ saying, that the circumstances into which we are born
exercise a determining influence on the whole life, being admitted, we
have to remember that this applies with especial force in the case of
girls.
The educational views which obtain at the present day among the upper
ten thousand, are by no means calculated for the production of a woman
healthy in body and sound in mind. From the time when the young girl
becomes sexually developed, the claims which society makes upon her
become pressing. Every day, by a number of stimuli, her curiosity and
her desires are directed toward sexual matters. Visits to museums,
picture galleries, and theatres, the perusal of modern romances, the
free mingling of the sexes in all places of amusement—all these combine
to awaken prematurely an instinct to which the “old fashioned” methods
of education allowed a much more prolonged slumber. In other cases, the
mother’s supervision of the developing girl is hindered and rendered
insufficient because the mother herself is claimed by her society duties
and taken much away from her home. In addition, the young brain is
overburdened with mental work, the modern idea of the equality of the
sexes in matters of love is instilled, and a desire is artificially
evoked, and is matured by a certain idle vanity, to indulge the
“natural” instincts—to manifest sexual passion and to indulge it to
excess—and thus the modesty so natural and so becoming to young girls is
completely lost. Nourished in such a soil, neurasthenic and hysterical
states, disorders of menstruation, and masturbation, cannot fail to
flourish.
In these respects also a change is requisite, and a mode of upbringing
must be inculcated from which everything likely to inflame the sexual
impulse is removed. For the adolescent girl a systematic alternation of
work and recreation must be arranged. From great entertainments where
she will mix with young men, from theatres, evening parties, and balls,
the young girl at the time of the menarche, at the period when
menstruation commences, must as far as possible be kept away, and such
pleasures must be reserved for a more advanced stage of this period of
development. Intellectual overstrain, the overtaxing of the young head,
must be avoided; the acquirement of knowledge must take place gradually
and slowly, and in a manner adapted to individual peculiarities.
Intercourse with female friends also requires supervision in respect of
the moral characteristics of these latter. Religious reverie must be
avoided, but also to be avoided is the modern nihilism in respect of
religion and good morals. Books must be carefully chosen in order that
the imagination may remain pure and in order that girlish illusions may
not be prematurely destroyed. Domestic recreations in the way of games,
music, singing, painting, and other forms of artistic culture, are of
importance for the development of a strenuous faculty for learning.
Travel in regions where the scenery is beautiful, forms a most valuable
means for the ennoblement of the intellect and the emotions.
Additional matters demanding attention are, as already mentioned, the
suitability of the diet, and proper physical exercise. All stimulating
articles of food are to be avoided, the excessive use of meat is to be
forbidden, and a sufficient mixed diet, containing both animal and
vegetable substances, is to be prescribed. Tea and coffee should be
taken as sparingly as possible, and alcoholic beverages must be
absolutely prohibited. The regulation of the bowels is of great
importance. Young girls should accustom themselves to evacuate the
bowels every day at a fixed hour, the best time to adopt being either
immediately on rising or just after breakfast. Constipation is very apt
to lead to the production of irritable conditions of the genital organs.
We can point out as a happy instance of modern progress that the
practice of certain physical exercises has actually become the fashion
for young girls. Gymnastics, with or without apparatus, swimming,
skating, and lawn tennis, involve a number of bodily movements
advantageous for the health; and in connection with most of these the
enjoyment of fresh air offers an additional favorable influence.
Bicycling, however, at this period of life is open to many objections,
not only on account of the likelihood of direct injury to the genital
organs now in course of development, but also on account of the impulse
it produces toward onanistic manipulations.
Especial attention must be paid to the clothing, regarding which the
requirements of fashion so often conflict with those of hygiene, the
victory, unfortunately, in most cases falling to the former. The period
of the menarche is indeed usually regarded as the proper time for the
young girl to begin wearing a corset, if it has not been worn before. In
this connection _M. Runge_ makes the significant remark: “As long as
bodice and skirt form the two principal articles of woman’s clothing,
the corset or some similar article cannot be dispensed with. The vicious
features in the corset are its constriction of the thorax, with the
object of giving the woman a ‘figure,’ and the introduction into its
substance of strips of whalebone or steel in order to give firmness to
the figure. The harm done by the former feature, the compression of the
abdominal viscera, the corset liver (lacing liver, constricted liver,
Ger. _Schnürleber_), the movable kidney, etc.—all are so well known that
they need not be particularly described. But the strong pressure from
above has a deleterious effect upon the internal genital organs also,
leading to passive hyperæmia and to displacements. The ‘bones’ of the
corset take part in the compression, and they replace the functions of
the muscles of the back. If a woman who has long worn a corset lays it
aside later in life, she complains that she is no longer able to hold
herself upright. In consequence of insufficient work the muscles of the
back have become incapable of keeping the back straight. The corset,
then, must neither constrict the body, nor must it contain ‘bones.’ An
article of clothing analogous to the corset is, however, required for
the support of the skirt and the petticoats that clothe the lower limbs.
These latter are usually fastened by means of bands which encircle the
body above the crest of the ilium. In order to give these bands a
sufficient hold, this region of the body is compressed by the corset.
The burden of skirt and petticoats is thus borne by a furrow, above the
pelvis and below or in the region of the asternal or false ribs, which
is in great part artificially produced. All this is bad. In order to
avoid the necessity for any constriction, the petticoats should be
fastened to the corset, and this latter should be supported from the
shoulders by means of shoulder-straps or braces crossing one another
behind. No constriction of the thorax then occurs, and if the corset has
suitable supporting pouches for the breasts, and the wearer is
accustomed to hold herself erect, the figure of a well-formed woman thus
attired is far from unpleasing, and is, above all, natural. If the
weight of skirt and petticoats is too great to be borne by the
shoulders, the burden can be divided, some being fastened to the corset,
others tied round the waist. This method is less to be commended, but
may be regarded as a permissible middle course. If chemise and drawers
are woven in one piece, as in the ‘combination’ under garment, there is
one article the less to be attached to the corset. Recently a number of
corsets and articles of clothing have been made in accordance with these
principles.
“The growing girl, then, may wear a soft corset with shoulder-straps,
made to measure, to which all the garments clothing the parts below the
waist should be made to fasten. It must unfortunately be admitted that
this rational mode of arranging the clothing cannot be adapted to the
‘low dress’ which etiquette demands on so many occasions for evening
wear, since with the latter the shoulder-straps cannot be worn.
“It is most unhygienic for women to wear, as they so often do, drawers
that are widely open. Both cleanliness and the need for an equable
warmth demand that these garments should be closed between the thighs,
not to speak of other reasons.”
In order to diminish the sexual impulse in girls at the menarche, where
this impulse has developed prematurely or is abnormally intense, and
even in later years with the same end in view, it is necessary, not
merely that the diet should be suitable and non-stimulating and that the
educational environment should be satisfactory, but above all that there
should be regular occupation and regular physical activity. _Ribbing_
rightly calls attention to his experience in dealing with animals, that
equally in the case of the stallion and of the mare, the whole of life
may without difficulty be passed in complete abstinence from sexual
gratification, provided that the diet is suitable, being neither too
rich nor too meagre, and that the animal has regular occupation of a
nature and degree adapted to its powers. In these animals a certain
amount of disquiet, of restlessness, of sulky irritability, etc., may
indeed be noticed at times, but these manifestations are to be overcome
by mingled gentleness and firmness, aided now and again also by mild
chastisement, but altogether without any severity. “Chastity,” says
_Oesterlen_, “is possible only when the mode of life is simple and
regular, and is characterized by appropriate self-command and frugality.
For this reason it is rarely encountered in palaces and similar places,
in which from youth onwards every one can do what he pleases; but just
as little is it really practicable amid conditions of lack of culture,
rudeness, and poverty.”
From the point of view of education, what _Moreau_ wrote a hundred years
ago is of importance: “In the ordinary course of nature the young woman
at the time of the first appearance of menstruation is still in full
possession of those amiable qualities of blamelessness and chastity
which we are accustomed to denote by the term _moral virginity_. To an
honorable and pure-minded man this beautiful attribute of budding
womanhood is much dearer and more estimable than physical virginity. By
libertines only is the latter regarded as a most valuable possession,
since it furnishes a powerful stimulus to their jaded imaginations. But
moral virginity and physical virginity are not always and necessarily
associated, for either can be present in the absence of the other.
Physical virginity may be destroyed by diverse forms of violence, and
yet moral virginity may remain pure and uninjured amidst its ruins. Thus
the two are widely different one from the other, widely different also
are they in value and significance.”
What _Eulenburg_ says regarding the prophylaxis of sexual neurasthenia
in general is true regarding the sexual life of the girl at this period
of life. “What is needed,” he writes, “is the control of educational
influences with these ends in view, that, on the one hand, the sexual
excitability of developing youth shall be diminished and kept within
bounds, and that nevertheless, on the other, the urgently needed
enlightenment shall be afforded to the young people at the proper time
and in a suitable form. How these aims are to be effected cannot be
explained in generally applicable propositions. It is a matter which
must be left to the tact of the parents and of other members of the
family, who will be guided by the insight they have acquired into the
mental life of those concerned. * * *. Children inclined to onanism must
be carefully supervised by day and by night; they must be protected from
all stimulating things and from bad company; in boarding-schools it is
the common dormitories that require the most strict, most careful, and
most continuous control. In the case of auto-onanists, female as well as
male, we must enquire into the possible existence of local stimulating
influences, among which, in both sexes, oxyuris must be mentioned—but in
truth it is rare for such local conditions to be the exciting cause of
masturbation. A healthy mode of life in respect of clothing, sleep, and
diet, and the systematic practice of bodily exercises to the point of
considerable fatigue, are the most effectual means of counteracting the
noxious propensity to onanism.”
A high degree of freedom permitted to girls from a very early age is, as
_Rousseau_ already maintained, by no means favorable to the preservation
of virginity.
A wise mother or a wise instructress can do much towards the
preservation of physical and moral virginity, by enlightening her
daughter or pupil at the right time and in a proper manner as to the
nature of the sexual processes, and their significance for the whole
life of woman. Ignorance in this respect, equally with pseudo-knowledge,
entails many dangers. I regard it as indispensable that the adolescent
girl should in good time learn from her mother the nature of
menstruation, lest she should first receive enlightenment in an
unfitting manner from some more experienced female friend. The mother
should explain that the impending flow of blood is a natural process,
unattended by danger, but indispensable to the sexual life, and a
characteristic part of the process of “growing up.”
The knotty and important topic of how the young girl may best receive
sexual enlightenment from her mother, is discussed by _E. Stiehl_ in her
notable work “A Maternal Duty.”[31] The authoress points out that this
enlightenment must not take place suddenly and without apparent motive,
but that the mother must in a gentle and gradual manner introduce to her
child the secrets of nature. A beginning may be made by teaching the
child to observe the nature and growth of plants; then she may be led to
interest herself in the family life of animals; and thus an easy way is
found to answer the questions connected with reproduction—to answer them
in a manner at once true and befitting.
Let the mother indicate to her child the methods employed by nature for
the preservation of the life of the young plant; let her demonstrate in
a flower the stamens and the pistil as male and female organs
respectively; and let her explain how when the pollen-grain reaches and
fertilizes the tiny ovule in the ovary, this ovule becomes capable of
development into a large seed containing an active rudimentary plant,
which latter itself enlarges to become a new full-grown specimen of its
kind. The opportunity may then be seized to draw attention to the
resemblance between the little ovules in the ovary of the flower and the
minute ova by means of which all animal life reproduces its kind.
Proceeding further, an earnest and thorough introduction to the sanctity
and responsibility, the perils and duties, of the sexual life, is
urgently required by the young girl before she proceeds either to
marriage or to an economically independent mode of life.
Not only in America and England, but now also in Germany, there exist
excellent books which may actually be put into the growing girl’s own
hands, by means of which she will be introduced in an intelligent manner
to a knowledge of the method of reproduction in the human species.
Often enough, when the mother is lacking in intelligence or sympathy, it
will be the duty of the physician to give this enlightenment to the
young girl. The interpreter of such tidings at the time of love’s
dawning will be the family doctor, to whom the girl and her family have
been confidently accustomed to turn for information regarding the bodily
state and well-being. He is accustomed to remove many a veil without any
offense to maidenly modesty. Many sexual disorders and much sexual
aberration may thus be prevented.
Certain definite hygienic rules must now be prescribed. First of all,
the strictest cleanliness must be observed, not only in the intervals,
but also during menstruation. The prejudice against changing the under
linen during the flow must be overcome, and care must be taken that at
this time the external genitals are washed twice daily with water at a
temperature of 26° C. to 28° C. (about 80° F.), and a wad of absorbent
cotton-wool or a piece of clean linen (sponges are not to be used for
this purpose); any article of underclothing that becomes soiled with
blood must be changed. Most useful are the so-called “sanitary towels,”
made of sterilized absorbent cotton-wool, fastened to a linen band which
surrounds the waist, or simple pads of absorbent material may be used,
kept in place by means of a bandage. During menstruation, full baths,
warm or cold, are to be avoided, likewise long walks, riding, long
journeys by rail, gymnastics, with or without apparatus, skating, lawn
tennis, and bicycling; dancing, above all, must be prohibited, since it
involves a combination of several noxious influences—the very active
movement, which produces hyperæmia of the genital organs, sexual
excitement, loss of sleep, long hours spent in close rooms, prolonged
voluntary retention of urine, and the risk of a chill. Singing, also,
must be discontinued during menstruation, since otherwise an injury to
the voice is very likely to result. A certain limitation in respect of
physical and mental activity is indicated as a general precautionary
measure during menstruation, but this measure must not be pushed to
excess, so that the habit is acquired of resting completely during the
period, passing the days on a sofa. The favorite practice, in cases of
scanty menstruation, of taking hot foot-baths is to be rejected. At the
conclusion of each menstrual period, however, a tepid bath should be
taken. The knowledge we have now acquired of the rhythmical “menstrual
wave” process (see p. 19 _et seq._) points to the practical conclusion
that the physician should not direct his attention to the actual
menstrual period only, but also, and more than has hitherto been
customary, to the premenstrual period, in which temperature,
blood-pressure, and excretion of urea attain their acme; especially
should this be done, with the aim of prescribing suitable hygienic
precautions, in cases in which the menstrual discharge is very profuse
or in which nervous manifestations accompany menstruation.
Important is it also for the physician to take precautions against the
practice by young girls of unduly prolonged voluntary retention of the
urine, resulting in over-distension of the bladder; also against the
performance of very active movements and against powerful muscular
efforts when the bladder is in a distended state. All of these are
liable to result in displacements of the uterus.
During menstruation the diet should be sufficient, but free from
stimulating elements. When the menstrual flow is greatly in excess,
strong tea and coffee, wine, and beer should be forbidden; conversely,
when menstruation is scanty, an invigorating diet is especially
indicated, and the use of strong wines. According to the investigations
of _T. Schrader_, in order to maintain the nitrogenous balance during
menstruation, it is necessary to give the following daily diet,
representing a heat value of 2,013 to 2,076 calories:
125–150 grammes of fowl.
100 grammes of butter.
125–140 grammes of white bread.
150 grammes of brown bread.
70–80 grammes of eggs.
600 grammes of coffee.
600 grammes of soup.
560 grammes of Seltzer water.
20 grammes of salt.
For chlorotic girls the following diet may be recommended during
menstruation. Before rising a pint of milk should be taken slowly, in
sips, during a period not exceeding half an hour; for the first
breakfast (see note to p. 112), tea or coffee with an abundance of milk,
a considerable portion of meat (roast beef, cold fowl, cutlets, or
beefsteak); for the second breakfast, a tumbler of milk, bread, butter,
and a couple of eggs; for mid-day dinner, a good helping of fresh meat
so cooked as to be easily digested, green vegetables, potatoes,
farinaceous pudding, stewed fruit, and a glass of burgundy or claret; at
4 P. M., coffee and bread and butter, or a tumbler of milk; at 7 P. M.,
a similar meal to the mid-day dinner, but lighter; no supper. In this
diet-table, which represents a heat-value of about 2,200 calories,
albumin and fat are present in abundance (182.8 grammes albumin and 763
grammes fat), but carbohydrates in small quantity only (176.9 grammes).
For those chlorotic patients who find it difficult to digest much
butcher’s meat, the necessary quantum of albumin must be supplied by
increasing the amount of milk, soup, and the white varieties of flesh
(chicken and the like), giving also a considerable amount of the more
easily digested vegetables, with fruit, beer, and a little claret. For
such cases _Desqué_ has drawn up the following diet-table, representing
3,290 calories and containing 150 grammes of albumin, 110.7 grammes of
fat, and 449.6 grammes of carbohydrate; meat is given once a day only:
7.30 A. M.— Half a pint of milk, 50 grammes roll, 10 grammes butter.
10 A. M.— 300 grammes apples, strawberries, or cranberries, 50
grammes roll, 10 grammes butter.
12.30 P. M.— 200 grammes of beefsteak, 100 grammes of macaroni, 300
grammes of bread, 400 grammes of spinach, 200 grammes
of stewed apples or gooseberries.
4 P. M.— 200 grammes vegetable-peptone-cocoa, 50 grammes roll, 10
grammes butter.
7.30 P. M.— 200 grammes rice-broth, 500 grammes buttermilk, 100
grammes bread, 10 grammes butter, 200 grammes salad,
300 grammes uncooked pears, 40 grammes curds.
In cases of profuse metrorrhagia in girls, _von Winckel_ recommends in
addition to rest in the recumbent posture, a diet containing large
quantities of fluid, and much easily assimilable albuminous nutrient
material, all stimulating articles and those likely to cause nausea and
vomiting being avoided. He gives the following diet-table: