FUNCTIONAL PERIODICITY--MENSTRUATION
Menstruation, or the monthly flow of blood from the genital organs,
which manifests itself in the human female from the time of puberty,
is but one evidence of a periodic excitation that affects her whole
organism.
The phenomenon particularly reacts upon the entire nervous system,
blood-vascular system, and internal chemistry, and through these
processes, all the organs and tissues feel the impress of the periodic
movement.
The menstrual period in itself, as has been recognized in more recent
years, is but the climax of a monthly physiological cycle which
influences throughout the month the whole of woman’s physical and
psychic organization. As Havelock Ellis has stated, whatever organic
activity we investigate daily with any precision, we find traces of
this rhythm. “While a man may be said, at all events relatively, to
live on a plane, a woman always lives on the upward or downward slope
of a curve. This is a fact of the very first importance in the study
of physiological or psychological phenomena in women. Unless we always
bear it in mind we cannot attain to any knowledge of the physical,
mental or moral life of woman.”
It is perhaps natural that reference to the incident of menstruation in
the life of woman should be found as far back as there exist records
of human speculation. The very earliest ideas on the subject were
based on the assumption that menstruation was an indication of woman’s
inferiority, and stigmatized her as “unclean.”
These notions generally were due to man’s lack of knowledge concerning
this process of periodicity. The closely interrelated superstitions,
taboos, mythological concepts and religious ideas of primitive and
ancient times caused the moral leaders to dogmatize over the subject,
to the extent that women are still hampered by the traditions that
began at a very ancient, and possibly prehistoric, period.
Thus in the fifteenth chapter of Leviticus, 19-30, we are told: “And
if a woman have an issue, and her issue in her flesh be blood, she
shall be in her impurity seven days; and whosoever toucheth her shall
be unclean until the even. And everything that she lieth upon in her
impurity shall be unclean. Every bed whereon she lieth all the days of
her issue shall be unto her as the bed of her impurity. 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 turtle doves, or two young pigeons, and bring them unto
the priest, to the door of the tent of meeting. And the priest shall
offer the one for a sin-offering, and the other for a burnt offering;
and the priest shall make atonement for her before Jehovah for the
issue of her uncleanness.”
This feature of the Mosaic law was also followed by the Mohammedans,
who likewise regarded a menstruating woman as unclean, and who remained
unclean for a certain number of days after the flow ceased, or until
she had been cleansed by ecclesiastical influence.
It is to be expected, of course, that the earliest medical writings,
under the social and religious influence of the times, should also
evince a similar feeling toward the subject. The early Indian book of
_Suśruta_, and the subsequent writings of Hippocrates, gave evidence of
this attitude.
Many savage races regard the first appearance of the menstrual flow as
the only certain sign of puberty, and among them this is the occasion
of peculiar ceremonial rites. The advent of puberty in savage tribes
is often solemnized by the seclusion of the girls from the time of the
first menstruation. They fast during the period of seclusion, which
sometimes terminates in an elaborate ritual of purification. (Thus, we
again meet the old belief of woman’s innate uncleanliness.)
FIRST APPEARANCE OF MENSTRUATION
As we have observed, climate has a definite influence on the sexual
development of woman, and therefore on the age when menstruation
begins, signifying the beginning of puberty. In the torrid zone,
menstruation appears at a very early age, on the average from 11 to 14;
in the temperate zone it appears later, on the average from 13 to 16;
and in the frigid zone later still, on the average from 15 or 16 to 20.
The altitude above sea level and the distance from the coast are also
known to have a certain influence. These factors are probably caused,
to an extent at least, by the scarcity of iodine in its natural food
form in high altitudes and particularly away from the coast. In salt
water fish and marine foods this important element, which influences
the bodily metabolism, is present in liberal quantities, while in all
the foods prevalent away from the coast and in mountainous regions,
there is a lack of natural iodine that often has an injurious effect
upon the system. For some reason or other, women seem to be the greater
suffers from this deprivation, and the incidence of goitre is often
traced to this cause.
Race and constitution also have a decided influence upon the appearance
of puberty. In women of the Semitic races it occurs earlier than in
woman of the Aryan races. The average age at which menstruation begins
in Jewish girls is from 14 to 15; in Magyar (Hungarian) girls from 15
to 16; in girls of the Germanic races, from 16 to 16-1/2, and in the
Slavonic girls from 16 to 17 years.
Generally speaking, puberty manifests itself earlier in girls of a
sanguine, lively temperament and a strong constitution than in those of
a phlegmatic temperament and a weakly constitution. Furthermore, other
things being equal, menstruation appears earlier in brunettes, girls
with black hair, thick skin, dark eyes and a dark complexion, than it
appears in blondes, girls with light hair, thin skin, blue eyes, and a
fair complexion.
Social circumstances and conditions of life are also influencing
factors. According to Kisch, in the higher classes of society, and
among the well-to-do, whose mode of living is luxurious, and whose
social circumstances allow free play to the imagination, menstruation
appears earlier than among women of the laboring classes who are
compelled to exert themselves for a bare living.
In cities and large towns, too, menstruation is observed to appear
earlier than in the small towns, while in the open country it is still
further delayed.
The initial appearance of menstruation is commonly preceded by
various symptoms, among which are: A dragging sensation in the loins;
an indefinite feeling of pressure in the lower part of the pelvic
regions, especially in the neighborhood of the uterus and the ovaries;
alternating sensations of heat and chilliness, sometimes accompanied by
actual though slight change of temperature. Not infrequently there are
also disturbances in the intestinal evacuations and urinary secretion,
and in the functional activity of the gastro-intestinal canal. A
commonly observed symptom is an increased irritability of the entire
nervous system, with a tendency toward melancholy and indefinite
amorous desires.
The nervous irritability usually asserts itself before the incident of
the menstrual flow by headache and moodiness, nervous irritability, and
low spirits. There may be further slight changes in the facial aspect,
dark rings around the eyes, spontaneous blushing, uneasy sensation,
loss of appetite, a sensation of pressure in the abdomen, palpitation,
vertigo, feeling of weakness and numbness in the lower extremities, etc.
Courty enumerates the following symptoms which are observed in the
majority of girls before the first appearance of menstruation: Swelling
and tenderness of the breasts, sensation of fullness and weight in
the gastric region, gas in the intestines, a watery-mucous vaginal
discharge, finally, an itching sensation in the genital organs.
These manifestations may also assume a morbid character, taking
the form of violent abdominal or pelvic pains, general fatigue and
weakness, dyspepsia and diarrhea, various kinds of neuralgia, and
sometimes a degree of moral aberration.
After the first menstruation, two or three months may elapse before
the girl menstruates again, but after a year the flow usually recurs
at quite regular periods. Sometimes the early periods are very violent
and happen with more than ordinary frequency, every twenty days, for
instance.
It is interesting to note that some traces of a menstrual period are
found among the higher mammals, such as the mare and cow, and also
the bitch. Among monkeys and apes in their wild state there is a
well-marked menstrual discharge.
In the higher apes, when they do not suffer from captivity, the flow
is said to be sometimes quite as copious as in women. Some species
of monkeys become swollen and brilliantly pigmented, and give other
characteristic evidences of their condition.
As a general rule, however, menstruation, in its fully developed form,
may be considered a human characteristic. Not only is the flow more
marked as the mammal approaches Man, but among the lower races of human
kind it is less pronounced than among the higher races. Dr. Holder has
found, for instance, that the American Indian women menstruate for two
days only.
Ellis remarks that in the early history of the race menstruation can
but rarely have occurred; the greater part of woman’s sexual life
having been taken up by pregnancy and very prolonged lactation. Pinard
observed that, as menstruation is the expression of the abortion of
an unfertilized ovum, “under natural conditions a healthy woman would
never menstruate.” _Natural conditions_, of course, imply that woman
would always either be in a pregnant state, or nursing a child, so that
between the two, there would be no opportunity to menstruate.
SYSTEMATIC CHANGES DURING MENSTRUATION
I have remarked that the menstrual period is but the climax of a
monthly physiological cycle. However, this climax has more far-reaching
results in some women than in others.
Sensitive women, with high-strung nerves, or more particularly of
unstable organization, are apt to feel the effects in a very pronounced
manner. But even normal, healthy women, under conditions of modern
life, experience the reactions to a greater or lesser degree.
Kisch, after citing the purely pathological cases, states: “Finally, we
may have to do with isolated sporadic occurrences in which the exciting
influence of menstrual processes may be traced. Thus, for the outbreak
of a periodical menstrual psychosis (insanity), an especially temporary
predisposition must exist, connected with the great development epoch
of the sexual life.
“There is, for instance, a group of transitory states occurring during
menstruation, and taking the form of disorders of the intelligence or
of explosive emotional states; such may be witnessed, not in those
suffering from psychopathic predisposition, but in quite healthy
individuals.”
Menstruation throughout the course of the sexual life may, like
the first menstrual flow, but with less intensity, give rise to
manifestations of nervous and mental disorders. Many women who
are otherwise healthy, suffer during menstruation from nervous
irritability, ill-temper, low-spiritedness, neuralgia, and even
hysterical and epileptic attacks. These disturbances occur chiefly on
the first and second days of the flow, and disappear toward the end of
the period.
The manifestations are more extreme in individuals weakened by
inordinate losses of blood, or by deep-seated disorders in various
organs. They are also severe in those predisposed to such disturbances
from neuropathic inheritance, and more severe in women chronically
troubled with painful or excessive menstrual flow.
In his work on the influence of the so-called menstrual wave on the
course of mental disorders, Schule observes that the mental equilibrium
even of a perfectly healthy woman is not a stable one, but is subject
to a series of oscillations. The menstrual period, he continues, has a
distinct influence on woman’s mental equilibrium.
Even in those who are possessed of a healthy nervous system,
menstruation evokes a state, now of depression, now of excitement; in
neurotic women on the other hand, menstruation may give rise to nervous
diseases which may equally exhibit the characteristics of depression or
the characteristics of excitement.
In nervously predisposed women, the influence of regularly established
menstruation, even when the circumstances are favorable, is pretty
much the same as the influence of menstruation when it first makes its
appearance; the influence is merely somewhat weaker insofar as the
woman has learned to endure and to be patient. The menstrual state, in
nervously predisposed women evokes the particular neurosis to which
the individual happens to be liable. The disorders most commonly met
with in this association are hysteria, hemicrania (neuralgia on one
side of the head), swimming of the head, epileptic paroxysms, toothache,
and neurasthenia.
The characteristic form of neuralgia is especially frequent. Sometimes
it may begin a day or two before menstruation, and may accompany its
whole course, becoming however, less severe toward the end of the
flow. Hysteria most commonly manifests itself on these occasions by a
depressed emotional state, by tearfulness, by complaints made without
sufficient grounds, sometimes by muscular spasms, but very rarely by
epileptic seizures.
There are also numerous other evidences of variation from the normal
state, but not observable to the untrained eye, or in many instances
without special tests. For instance, Cullen discovered long ago that
the pulse rate rises at the approach of the periods. Stephenson found a
monthly cycle with respect to arterial tension and pulse rate. Giles’
investigations showed the greatest blood pressure on the first two days
of menstruation and the day preceding.
Thirst is often present, and urination more frequently than usual.
There is also a tendency to pigmentation; the pigmented circle around
the nipple usually becomes darker, the complexion is changed, losing
its clearness, and a dark ring may sometimes be perceptible around the
eyes.
According to various authorities, the temperature is at its highest
point a few days before actual menstruation. Silva makes the
interesting observation that the alkalinity of the blood is reduced
during the period, and the vasomotor system reacts to stimuli in the
same way as in states of fever.
Havelock Ellis thinks there is little doubt that a daily examination of
any of the senses would show a monthly rhythm. He is only acquainted
with one series of observations on this point, namely those of
Finkelstein of St. Petersburg, who studied the functional activity
of the eye during menstruation in twenty healthy women, aged between
nineteen and thirty-three.
Finkelstein found that during the period there is a concentric
narrowing of the field of vision, beginning one, two, or three days
beforehand, reaching the greatest intensity on the third or fourth day
of menstruation, and gradually disappearing on the seventh or eighth
day after its appearance. The narrowing of vision is more pronounced in
those women in whom menstruation is associated with headache, cardiac
palpitation, and other nervous symptoms, as well as in those who lose
large quantities of blood.
Not only the field of vision for white, but also the visual fields for
green, red, yellow and blue undergo a regular diminution. Perversion of
perception of green (which is seen as yellow) is observed fairly often
(in 20 per cent of all cases).
It would be fair to assume that careful observation of the other sense
organs would yield similar proof of monthly periodicity.
Lennox Browne, a prominent specialist, wrote to Havelock Ellis, as
follows, on the influence of normal menstruation on the voice: “With
regard to singers, I believe that the pitch of the voice is often
lowered at the menstrual epoch, although I have not found this to be
universally admitted by patients to whom I have spoken on the subject.
Many have told me that they have a disposition to sing flat, and in two
cases in my recollection the patients, who suffered from dysmenorrhea
(painful menstruation), told me that they sang sharp, of which they
were conscious--probably from information, for of course you know that
those who sing sharp are not generally sensible of the defect. It is,
however, generally agreed that the timbre and tone-quality is impaired,
the voice being decidedly thinner and poorer during the epoch.”
So well is this fluctuation of the voice recognized that in Continental
Europe, it is not considered desirable for public singers to appear
during the menstrual period. In fact, it is the custom on the
Continent, when making engagements with female singers, to provide for
the suspension of duty during the menses, but this does not apply in
English or American contracts, although the =impresario= is in practice
obliged to recognize it.
To bring the subject from the realm of art down to the more prosaic
sphere of the household, Clouston thinks it probable that the
superstitions regarding the evil influences exercised by women at
their periods on foods, etc., which they prepare, are based on the
actual decreased success in such operations at this time, due merely to
a physiological decrease in energy and skill.
The organic character of menstruation is well sustained by these many
widely diversified evidences of its manifestations. The incident of
vicarious menstruation, however, throws a further interesting light on
the subject.
Vicarious menstruation has been observed in cases in which, as a
consequence of morbid conditions of the uterus, or of the organism as
a whole, the menstrual flow has at the time of puberty either failed
entirely to appear or has been exceedingly scanty. When conditions
of this kind have prevailed, hemorrhages from other organs have,
since ancient times, been witnessed and are regarded as vicarious
menstruation.
As the congestion that occurs during menstruation is not limited to the
genital organs, when the flow of blood from the uterus fails to occur,
the organism seeks another outlet, in order to restore the disturbed
equilibrium of blood distribution. Vicarious flowing of blood, in these
instances, may take place from the mouth, the nose, the intestines, the
anus, the gums, the breasts, the ears, the lungs, or even the eyes.
These evidences of true vicarious menstruation must not, of course,
be confused with hemorrhages due to genuine organic disease, such as
tuberculosis, gastric ulcer, etc.
Numerous authorities have collected data regarding this phenomenon.
Puech found, in the cases he collected, that vicarious menstrual
hemorrhage occurred from the stomach thirty-eight times, from the
mammary glands twenty-five times, from the lungs twenty-four times,
and from the nasal mucous membranes eighteen times. In all cases
menstruation had been long in abeyance. The regular monthly recurrence
of the vicarious discharge is often marked.