As a beverage in the intervals, weak cold tea is allowed. When the
hæmorrhage has ceased, the following beverages are suitable: oatmeal,
cocoa, Pilsener beer (one pint daily), milk (2 to 3 pints daily), claret
(a half bottle daily). For food, the lighter varieties of meat, 200 to
300 grammes daily, sweetbread, pigeon, ham, nutrient and easily
digestible vegetables, spinach, carrots, and pea-soup, may be
recommended.
In cases of amenorrhœa or scanty menstruation, especially when due to
anæmia or to underfeeding, mental excitement, or over-exertion, warm
baths at a temperature of 28° to 29° R. (90° to 92° F.), rubbing the
body with wet towels, and warm sitz-baths, are of good service.
[NOTE: Although in this translation the English equivalents of the
measures used on the Continent have as a rule been appended in
parenthesis, this has not been thought necessary in the case of the
diet-tables, since even in English works these are commonly stated
in terms of the metric system. It may here be mentioned that, as
regards fluid measures, 250 grammes (a quarter of a litre) is
roughly equivalent to half a pint, an ordinary tumblerful or
breakfast-cupful; and that, as regards solid measures, 30 grammes
are equivalent to a very little more than an avoirdupois ounce.]
_Menstruation._
Menstruation is the name given to the process which manifests itself in
the human female after the age of puberty by the discharge from the
genital organs at regular four-weekly intervals of a mucosanguineous
secretion. This discharge is not merely the result of a local hyperaemic
condition, but is the expression of a periodic excitation of the entire
nervous system and blood vascular system, intimately related with the
whole sexual life of woman; this excitation is itself dependent upon the
process of ovulation, an incident in the series of manifestations that
arise from the periodic undulatory movement in the vital processes of
woman.
The Mosaic law regarded the process of menstruation as unclean in
nature; the menstruating woman was unclean, and must be purified in a
prescribed manner. In the fifteenth chapter of Leviticus, vv. 19–29, we
read: “And if a woman have an issue, and her issue in her flesh be
blood, she shall be put apart seven days: and whosoever toucheth her
shall be unclean until the even. * * * Every bed whereon she lieth all
the days of her issue shall be unto her as the bed of her
separation. * * * But if she be cleansed of her issue, then she shall
number to herself seven days, and after that she shall be clean. And on
the eighth day she shall take unto her two turtles, or two young
pigeons, and bring them unto the priest, to the door of the tabernacle
of the congregation.”
In a similar manner the adherents of the faith of Islam regard a
menstruating woman as unclean.
This view is found also in the earliest medical writings, alike in the
early Indian book of _Susruta_ and in the later writings of
_Hippocrates_, and it persists to the present day in the use of the
expression “monthly purification.” _Susruta_ teaches that in India
menstruation begins at the age of twelve, and recurs monthly, the flow
lasting three days. In the Jewish Talmud it is asserted (see “La
Médécine du Talmud,” by _Dr. Rabbinowicz_) that menstruation begins as
soon as the girl has two hairs on the pubic region, or at the age of
twelve, even in the absence of any growth of the pubic hair. The
menstrual blood is quite peculiar in its characters. Thus, _Raschi_
relates, the mother of the King of Persia exhibited sixty varieties of
blood, and among them _Rabba_ was able to detect which was the menstrual
blood. According to a rabbinical authority, a woman can become pregnant
as soon as she has completed her twelfth year. As signs of puberty,
_Rabbi Jossé_ mentions the appearance of a fold beneath the nipple,
_Rabbi Akiba_, the erection of the nipples, _Rabbi d’Azai_, the
appearance of a dark areola around the nipples, _Rabbi Jossé_, the
recession of the nipple under pressure followed by its gradual
protrusion when the pressure is removed, also the softening of the mons
Veneris (in consequence of the deposit of fat in its substance). As
prodromal signs of the first appearance of menstruation, the Talmud
mentions, pain in the region of the umbilicus and in the uterus,
flatulence, shivering, white flux, heaviness in the head and the limbs,
and nausea.
The blood discharged during menstruation has certain peculiar
properties. It is always fluid, and rarely contains fibrinous clots, it
is always mixed with a larger or smaller quantity of mucus, which gives
it a sticky character; the reaction is alkaline, the smell
characteristic. Only when the bleeding is very profuse are coagulated
masses evacuated. On microscopical examination of menstrual blood, we
detect erythrocytes and leucocytes, the proportional number of the
latter being greater than in pure blood; there is an admixture also of
epithelium from the genital mucous membranes, cylindrical cells from the
uterus, flattened cells from the superficial layers of the stratified
scaly epithelium of the vagina, also various micro-organisms and
granular detritus. At the beginning of each menstruation, the admixture
of mucus is greatest, so that the discharge sometimes has the appearance
of blood-stained mucus; but during the height of the discharge the
consistency is almost that of pure blood. The quantity of blood lost at
each period is said to vary from 90 to 240 grammes (about 3 to 8 fluid
ounces); but in tropical climates the average is said to be 600 grammes
(20 ounces). According to the accurate analysis of _Denis_, menstrual
fluid contains in a thousand parts:
Total solid constituents 175.00
Comprising
Fat 3.90
Blood-corpuscles 64.40
Albumin 48.30
Extractives 1.10
Salts 12.00
Mucus 45.30
—————
Water 825.00
——————
Both the quality and the quantity of the blood are subject to great
variations. Thus, for instance, _Bouchardat_ estimates the solid
constituents at 99.20 per mille, _Vogel_ at 161 per mille, and _Simon_
at 215 per mille. The amount of blood discharged during menstruation
depends upon the temperament, the constitution, and the occupation, of
the woman concerned. It is greater in vivacious brunettes than in
phlegmatic blondes, greater in southern women than in those dwelling in
the north, greater in town dwellers than in women living in the open
plains, greater in those whose mode of life is sedentary than in those
engaged in some active occupation.
Similar considerations apply with regard to the duration of each period.
The mean duration is in the great majority of cases from four to five
days, being generally the same in successive periods in the same
individual; in exceptional cases the flow may last a week or more.
Menstruation lasting more than eight days must be regarded as abnormal.
_Krieger_ has collected data relating to the duration of the individual
periods. He found the duration constant in the great majority of cases,
_i. e._, 93.285 per cent.; but variable in a small minority, _i. e._,
6.715 per cent.
The periods in which the duration was regular did not always last
precisely the same number of days, the duration in many cases being 3 to
4 days, 5 to 6 days, etc.; but the same duration recurred regularly at
each successive period, so that all these instances must be reckoned
among the periods of regular duration. The duration must be regarded as
irregular or variable in those cases in which the variation was from 2
to 4 days, 3 to 8 days, etc. Sometimes a regular three-day or five-day
period becomes transformed into an eight-day period; or conversely an
eight-day period into a four-day period.