the history of savage and civilized nations, concerning the safety with
which childbirth and its attending circumstances may be endured by
persons in the lower walks of life, it becomes a very important
practical question as to what may be accomplished in the higher grades
of society. To prove that there is need of a great and thorough reform,
both in the habits of society generally, and in the practice of the
healing art, I will bring forward some facts, which have occurred in my
own experience as a healer of the sick during the past seven years. It
has fallen to my lot to study the subject of midwifery with more
earnestness and satisfaction to myself, than any other with which my
mind has been engaged. It was, moreover, necessary for me to strike out
a course of my own, a course which has been attended by a degree of
success which has far exceeded the most sanguine expectations of my
younger years.
LETTER II.
OF MENSTRUATION.
Puberty—The Menstrual Discharge—The Marriageable Age.
I am now to write you on a most important subject; I mean that which
refers to puberty—the menstrual function, and what we call the
marriageable age. I think you will agree with me in thinking that there
is no period of the whole life of the female which should give a parent
more anxiety and solicitude than the one of which I am now to speak. I
trust, therefore, that you will give good attention to all I may say on
so important a matter, and learn all that you can about it, from
whatever source.
Puberty, or the marriageable age of woman, occurs at a somewhat
different age in different parts of the world. In temperate climates,
the period of puberty may be reckoned as being at from the twelfth to
the sixteenth year. In tropical climates it appears to be considerably
earlier, as from eight to twelve; and in the frozen regions later than
all, from fifteen to twenty years. It has been said that the Turkish
women are capable of becoming mothers at the age of seven or eight
years; but of this there is at least room for doubt.
There are other circumstances than those of climate that influence the
coming on of the period of puberty. Those that lead habitually an
inactive life, a life of leisure and luxury, so called; those who,
without sufficiently attending to physical and out-door exercise,
practice much the imitative arts, such as painting and music; those who
frequent theaters, balls, and parties, late at night; read novels and
other works that powerfully excite the imagination and feelings; and
especially such as are so unfortunate as to have access to obscene
pictures and books, arrive at the season of puberty earlier than others.
So also the use of rich, concentrated, and highly stimulating food and
drinks, render the young, of whichever sex, far more precocious, in
regard to puberty, than a plain and unstimulating diet. Temperance and
frugality, with simplicity of manners, especially if the individual lead
a rural, or country life, are always more favorable in reference to the
coming on of this important period.
Previously to the period of puberty, the general organization of the
male and female progresses very much alike. The tastes and habits,
however, vary. The little girl is fond of her doll-babies and
play-houses, while the boy exhibits a liking for more manly sports.
There is, however, no great difference, up to this time, in the physical
frame of the two sexes; but as the period of puberty approaches, there
is manifested a great difference in the two beings. In the language of
an eloquent writer, Velpeau, “the young girl becomes more timid and
reserved, her form becomes rounded, her voice alters but to take on a
softer and more harmonious tone, and her bosom is developed; the
cellular tissue extends from the front of the breast and the
hypogastrium, as from two centers, toward the neck, while at the same
time it proceeds to form a soft cushion for the upper part of the limbs.
Her eyes, which are at once brilliant and languishing, express
commingled desires, fears, and tenderness; the sensations she
experiences, and the sense of her own weakness, are the reasons why she
no longer dares to approach the companions of her childhood but with a
downcast look. On the other hand, the gentle modesty that animates her
countenance, and the engaging graces of her demeanor, soon disclose a
power, the existence of which she never suspected, and which renders it
true to say that the marriageable age in the softer sex is the
spring-tide of nature, and the season of the pleasures. But a new
function—the catamenial—the absolute compass of good or bad health in
woman—is established, with more or less difficulty, in the midst of this
great revolution; and by the disorders and accidents which it involves,
sometimes dashes with bitterness those happy seasons to which it should
naturally serve as a prelude. Such are the changes that go on in the
female constitution at one of the most important and critical seasons
that can occur in the female’s life.”
The period at which woman may be said truly to arrive at her womanhood,
is certainly, in the present state of artificial life, fraught with many
dangers to the future health. But, on the other hand, we have proof the
most positive and indubitable—the proof of facts—that if young girls are
brought up in a simple, judicious manner, and if all their
habits—social, moral, physiological, and hygienic—be correct, there can
be, as a general law, no danger at the coming on of puberty. With
judicious management throughout, the girl will pass through this change
with as little difficulty, as little danger and derangement of the
general health, as occurs at any other season of her whole life.
Although the change is a great one, it is yet within the order of
nature, a fact which we should always bear in mind.
The foregoing remarks on puberty lead me necessarily to speak of the
menstrual function.
AGE AT WHICH THE MENSES COMMENCE.
In Greece and other hot countries, it is said that the menses appear
usually at nine or ten years of age. In the more temperate climates
generally, as in Great Britain and our own country, the average age at
which menstruation commences is from fourteen to fifteen years.
Habits of life, also, have something to do with the evolution of this
function. “The early or late appearance of the menses,” says Dr. Denman,
“may depend upon the climate, the constitution, the delicacy and
hardness of life, and upon the manners of those with whom young women
converse.” High living, the use of stimulating food and drinks, living
in populous cities, the habit of frequenting balls and theaters, and of
being taught early in the habits of civic life, have all, doubtless, a
considerable effect in rendering girls precocious as to menstruation. In
Paris, girls are occasionally observed to become regular at ten, eleven,
and twelve years. Velpeau knew one that menstruated at nine and a half
years; another at ten and a half; and one young woman who at fourteen
was as tall and robust as the majority of women at twenty, and had been
entirely in a state of puberty since she was eight and a half years old.
On the other hand, a country life and occupation, simplicity of manners,
and frugal regimen, appear to be circumstances which procrastinate, to a
greater or less extent, the coming on of the menstrual function. It is
said that with the North American Indians this epoch does not commence
until from the eighteenth to the twentieth year.
A table showing the ages at which the menses appeared in 450 cases, as
quoted by Dr. Maunsel, of Dublin, as having been given by Mr. Robertson
in the Edinburgh Medical and Surgical Journal, is as follows:
10 first menstruated at 11 years
19 „ 12 „
53 „ 13 „
85 „ 14 „
97 „ 15 „
76 „ 16 „
57 „ 17 „
26 „ 18 „
23 „ 19 „
4 „ 20 „
———
450 total.
According to this table, it will be seen that with the largest number,
namely, 97, menstruation commenced at the age of fifteen; and nearly as
many at sixteen as fourteen; so that we are to regard the average age in
such a climate as Great Britain, Germany, France, and the United States,
as being from fourteen to fifteen years.
Dr. Meigs, of Philadelphia, gives a table on the authority of Drs.
Boismont, of Paris, and Lee, of London, showing the ages at which 1,781
women began to menstruate, in France and England, as follows:
110 first menstruat. at 11 years
144 „ 12 „
256 „ 13 „
860 „ 14 „
366 „ 15 „
284 „ 16 „
144 „ 18 „
72 „ 19 „
40 „ 20 „
————
1776 total.
At what age the remaining five first menstruated, the table does not
show. On the whole, its results may be regarded as very similar to those
of Mr. Robertson’s table, before given.
Dr. Guy, of London, gives a table of the ages at which menstruation
commenced of 5,062 cases, 2,905 being of England, 1,825 of France, 332
of Germany; the total numbers being as follow:
1 first menstruat. at 5 years
1 „ 7 „
2 „ 8 „
15 „ 9 „
48 „ 10 „
263 „ 11 „
368 „ 12 „
554 „ 13 „
839 „ 14 „
926 „ 15 „
751 „ 16 „
574 „ 17 „
379 „ 18 „
173 „ 19 „
111 „ 20 „
29 „ 21 „
14 „ 22 „
10 „ 23 „
4 „ 24 „
There is one topic connected with this subject which I cannot here
enlarge upon, but which I will simply refer to by quoting the remarks of
a certain author who has given much attention to the subject.
Dr. Ray, author of a work on the “Medical Jurisprudence of Insanity,”
observes, “that the evolution of the sexual functions is very often
attended by more or less constitutional disturbance, especially in the
female sex, is now a well-established physiological truth. The shock
seems to be felt chiefly by the nervous system, which experiences almost
every form of irritation, varying in severity from the slightest
hysteric symptoms to tetanus, St. Vitus’ dance, and epilepsy.” “And when
we bear in mind, also, that general mania is sometimes produced by this
great physiological change,” continues this author, “it cannot be deemed
an extraordinary fact that partial mania, that partial acts, inciting to
acts of incendiarism or murder, should be one of its effects.”
LETTER III.
OF MENSTRUATION.
The Menses—Names—Source—Commencement—Periodicity—Nature—Quantity of the
Menstrual Discharge.
In my last letter, speaking of the menstrual discharge in females, I
omitted to mention the several names and expressions by which the
function is known. Those by which it is more commonly designated are
“_menses_” (meaning a month), _monthlies_, _monthly discharge_, _show_,
_being regular_, _regular discharge_, _flowers_, _turns_, _monthly
turns_, _regular periods_, _monthly periods_, _courses_, _monthly
courses_, _catamenia_, _catamenial discharge_, etc. We read in the Bible
that Rachel said to her father, “Let it not displease my lord that I
cannot rise up before thee, _for the custom of women is upon me_.” And
we also read of Sarah, that a son was promised to her when “she was old
and well stricken in age, and when it had _ceased to be with her after
the manner of women_.”
Menstruation, then, commences at puberty and ceases with fecundity, and
generally during the period of giving suck. As a general fact, women who
experience no menstruation can never bear children.
COMMENCEMENT OF THE MENSTRUAL DISCHARGE.
This is usually preceded by more or less disturbance of the general
system. There may be a general excitement or a depression, or the two in
alternation. There is often experienced a sense of weight in the loins,
accompanied sometimes by a feeling of tension in the epigastrium, or pit
of the stomach, with pain in different parts of the body. There is also
general uneasiness, lassitude of the body, and irritableness of the
temper and feelings. With these symptoms, a mucous discharge, more or
less yellow, takes place. This, after a time, becomes streaked with
blood; yet many experience no particular symptoms at this time, and
such, doubtless, would generally be the case were the laws of life and
health habitually obeyed. In general, menstruation does not become
regular until after some months have elapsed from its commencement.
The health should be carefully guarded at the coming on of menstruation.
Perhaps at no one period of woman’s life is attention to the laws of
health more requisite than here. A little mismanagement may now lay the
foundation for life-long suffering and disease.
Bathing, a full share of exercise in the open air, particular attention
to diet, and, in short, all the hygienic means that can be brought to
bear in keeping up a good condition of the general health, is the course
to be pursued. Cheerfulness, contentment, and a pleasing frame of mind,
are very desirable at this time. Severe study and unpleasant discourse,
of whatever kind, should not now be undertaken.
Neither should parents be too tender of their daughters at this period.
Especially should the reading of novels and books of an exciting nature,
the attendance of balls, parties, theaters, etc., be avoided; and
persons of whatever sex should be particularly careful to treat those of
this age with the utmost kindness in every respect. One unkind look, one
harsh expression, or one angry word from a parent or near friend, may be
the means of affecting severely the individual’s health.
It has been a question with some, as to whether menstruation is strictly
a natural function to the human system. So far as we know, it has
occurred in all climates and in all periods of time. We read in the
Levitical law, “If a woman have an issue of blood in her flesh, that she
be put away seven days, and that whoever toucheth her shall be unclean.”
The cases of Rachel and of Sarah every one may recollect. Naturalists
tell us, too, that some of the monkey tribes, or species of animals
nearest resembling man, have symptoms of this kind. Still there have
been those who believed that this function has come upon the human race
in consequence of great and long-continued physical transgressions,
continued, perhaps, through ages and ages, until at length it took on
the form of an apparently natural function.
SOURCE OF THE MENSES.
From whence comes the menstrual discharge? This has been a question
which has caused a good deal of dispute on the part of some.
The majority of writers, of all ages, agree in regarding the menstrual
flow as coming from the womb; yet some have held that it issues only
from the vagina and more external parts. This latter supposition cannot
hold good except, possibly, now and then, as an exception to the general
rule. Blood may exude from any part of the body, from the vagina and
external organs of generation, as well as from the womb. But this organ,
beyond doubt, is the great and principal source of the menstrual
discharge.
PERIODICITY.
The periodicity of this function is remarkable. With those who are
regular, menstruation occurs every twenty-eight or twenty-nine days, or
once a lunar month. There is, however, considerable variation from this
rule. Some having menstruation twice a year appear to enjoy very good
health. Some have asserted that the frequency of menstruation varies
considerably according to climate. Linnæus, it seems, saw women in
Lapland who menstruated about once a year. Dr. Denman speaks of the
inhabitants of Lapland, where women do not menstruate till they arrive
at mature age, and then only in small quantities and at long intervals,
and sometimes only in summer. But if they do not menstruate according to
the genius of their country, it is said they suffer equal inconvenience,
as in warmer climates, where the quantity discharged is much greater and
the period shorter.
NATURE OF THE MENSTRUAL DISCHARGE.
The question as to the nature of the menstrual discharge, has attracted
a good deal of attention among physiologists and others. Savage nations,
and perhaps some others in the world who would claim a higher place in
the range of human civilization and improvement, have entertained
singular notions concerning it.
Superstition has been carried so far in this matter, that if a man
should meet with the great misfortune of dropping his pipe, and breaking
it, the accident would be imputed to its having been lighted at the hut
of a female who was at the time menstruating.
So, also, it has been regarded that if a woman, during this period,
should walk three times around a garden, all the flowers would be
destroyed, and the caterpillars killed in it.
A North American Indian, according to Dr. Gooch, said that if the saliva
of a menstruating virgin were applied to the bronchocele of a male, it
would cure it.
Every one has read the strict regulations recorded in the Old Testament
concerning this function. Thus in the Levitical law we read:
“And if a woman shall have an issue, and her issue in her flesh be
blood, she shall be put apart seven days; and whoever toucheth her,
shall be unclean until the evening.
“And every thing that she lieth upon in her separation shall be unclean:
every thing also that she sitteth upon shall be unclean.
“And whoever toucheth her bed shall wash his clothes, and bathe himself
in water, and be unclean until the evening.
“And whoever toucheth any thing that she sat upon, shall wash his
clothes, and bathe himself in water, and be unclean until the evening.
“And if it be on her bed, or on any thing on which she sitteth, when he
toucheth it, he shall be unclean until the evening.
“And if any man shall lie with her at all, and her flowers be upon him,
he shall be unclean seven days; and all the bed on which he lieth shall
be unclean.
“And if the woman shall have an issue of her blood many days out of the
time of her separation, or if it shall run beyond the time of her
separation, all the days of the issue of her uncleanness shall be as the
days of her separation: she shall be unclean.
“Every bed on which she lieth all the days of her issue shall be to her
as the bed of her separation; and whatever she sitteth upon shall be
unclean as the uncleanness of her separation.
“And whoever touches those things shall be unclean, and shall wash his
clothes, and bathe himself in water, and be unclean until the evening.
“But if she shall be cleansed of her issue, then she shall number to
herself seven days, and after that she shall be clean.”
Thus we see how particular, in regard to the menstrual function, were
those good old people of the Mosaic time. No doubt many at this
_enlightened_ age would say that they carried things to an extreme.
I cannot but think, however, that it would be a great improvement if our
modern ladies, some of them, at least, would be one half as careful in
regard to cleanliness as the Jewish people were.
The Romans believed the menstrual fluid to be endowed with the most
noxious qualities. It was, in short, regarded as a dangerous poison, the
exhalations of which alone are sufficient to turn all the sauces of a
whole kitchen, the cheeses of a whole dairy, and make a whole family
sick, and wilt all the flowers of a parterre.
If the ancients went to an extreme on one side in this matter, there is,
perhaps, equal danger with the moderns of going quite as far in the
opposite way. Certain it is, that too great pains cannot be taken in
reference to this period. It is generally true that old proverbs have at
least some truth on which they were originally founded. There was wisdom
in the Levitical law, so strict in regard to the purification of women
at this period.
Does the menstrual discharge consist of blood? This is a question
concerning which physiologists, both ancient and modern, have put forth
many speculations, and many experiments have been instituted to settle
the matter.
Hippocrates regarded the menstrual fluid like the blood of a slaughtered
animal, or, in other words, blood.
Aristotle was of the same notion, comparing it to the blood which flows
from a simple wound. It may be a question whether pure blood is
discharged; but that the fluid contains the most important properties of
blood, is a fact settled beyond dispute.
QUANTITY.
The quantity of menstrual discharge has been a matter of inquiry on the
part of medical men.
It would be a very difficult task, if indeed, not impossible, to
determine in any given case the precise amount of menstrual fluid
discharged at a single period. An approximation to the general rule is
all that can be reasonably looked for in investigations of this kind.
In cold regions, the discharge is more scanty; in hot, more profuse; and
in temperate climates, a medium quantity is observed.
Dr. Gooch, in his “Treatise on Midwifery,” quotes De Haen as having made
inquiries among poor women, who told him that they used only one cloth
at the period, which, when wet, was dried, and then applied again. He
then took a similar napkin, dipped it in blood, dried it, and applied
the same. This experiment he tried repeatedly, and from it he deduced
that from four to eight ounces, rarely ten, and most commonly about six,
of the menstrual fluid, are lost at each period.
When we consider the great difficulty in ascertaining accurately the
amount of menstrual fluid at a given period, and the great _show_ which
a comparatively small quantity of blood or menstrual fluid makes upon
white, or light-colored clothing, it is not at all surprising that
observers should have varied so much in regard to the true amount.
Hippocrates believed that the Greek women lost twenty pounds of blood at
each menstrual period.
Galen estimated the quantity at eighteen ounces.
Haller computed it at six, eight, or twelve ounces for the German women.
According to Smellie it amounts to four ounces.
Astruc says that in England it varies from eight to ten ounces.
Magendie thinks it is often very great among the French women, and may
amount to several pounds.
It need hardly be said that the quantity of menstrual discharge often
varies greatly in the same individual according to the condition of
health, general habits, and a variety of circumstances too numerous to
mention. It may be so slight as to be scarcely perceivable, or, on the
other hand, it may be so very profuse as to amount to several pounds.
I have no doubt but that the amount of this discharge varies a good deal
with the same person at different times, and that, even, when the health
is good. At all events, I advise you to take no trouble in reference to
it, provided you can manage to keep clear of pain and other derangement
of the general health. Keep up a good degree of strength, observing, at
the same time, all good hygienic rules, and you have nothing to fear in
regard to the quantity of blood you may lose. In other words, _take good
care of the system, and the system will take good care of itself_.
In the next, I shall speak of an important matter connected with this
subject. I refer to what is termed the _change of life_, or the period
at which the menstrual function ceases. I need not add that this is a
matter of importance to each and all of you, for I am persuaded that you
already regard it as such.
LETTER IV.
OF MENSTRUATION.
Cessation of the Menses—Turn of Life—Management at this Period.
In every department of nature we see the most unquestionable evidences
of design.
Who but an Almighty Hand could have created a being so complex, and a
body so admirably adapted in every respect to his wants, as that of man?
Every part of this great piece of God’s handiwork is most accurately
fitted to its place, and every function is performed for some important
end.
Menstruation and child-bearing are, as we have seen, intimately
connected with each other. Suppose a woman could bear children at any
period of her life she might choose, what a premature offspring would
that be which she would bring forth in childhood, and what a feeble,
decrepid one in old age.
But it is not so. Nature has set up bounds which all the art and
ingenuity of the whole combined world cannot pass.
It was the benevolence of the Creator that formed her body in this way;
for if it had been left to the choice of us poor erring mortals, women
would bear children at those times when it would be very improper to do
so. And this benevolence extends equally to both mother and child.
Menstruation commences, as we have seen, usually at the age of from
fourteen to fifteen years.
AGE AT WHICH THE MENSES CEASE.
The age at which the menstrual function ceases is somewhat various. The
average has been regarded in this country as being at about forty-four
or forty-five years of age. It is, at least, so with the community at
large. In seventy-seven cases quoted by Dr. Maunsel, of Dublin, the
period was as follows:
1 at the age of 35 years.
4 „ 40 „
1 „ 42 „
1 „ 43 „
3 „ 44 „
4 „ 45 „
3 „ 47 „
10 „ 48 „
7 „ 49 „
26 „ 50 „
2 „ 51 „
7 „ 52 „
2 „ 53 „
2 „ 54 „
1 „ 57 „
2 „ 60 „
1 „ 70 „
Dr. Guy gives a table showing the ages at which 443 persons ceased
menstruating, 337 having been collected and communicated to him by Dr.
James Reed, and 106 by himself. The table is as follows: