CHAPTER III

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.