The Four Epochs of Woman's Life - Chapters I-V



PART I.-- MAIDENHOOD.

CHAPTER I. PUBERTY.
Sexual Development; Age of Puberty; Physical Changes at Puberty; First 
Onset of Menstruation; Psychic Changes at Puberty.

"Self-reverence, self-knowledge, self-control, 
 These three alone lead life to sovereign power." 
 --"Oenone."

Sexual Development.-- Sexual development goes on during all the years of 
childhood, but is not complete in the female sex until between the twenty-
second and the twenty-fifth year. If the child has no inherited taint, and 
has been properly educated morally, physically, and intellectually, it 
must follow that the structural development of the pelvic organs has been 
normal; and normal organs always perform their functions perfectly. 

The commencement of the ovarian function does not cause any more profound 
change in the system and habits than does dentition. The various epochs of 
life are generally spoken of as if they were paroxysmal-- as though they 
were separated by some tremendous chasm, which had to be leapt over or 
fallen into. Nature makes no such egregious blunders; preparations for 
every change in life have been going on for a very long time before the 
evidences of such change become manifest. 

In a healthy girl the psychic and physical changes incident to puberty 
occur so gradually as to escape the girl's own notice. The first and, if 
the girl has not been properly prepared for it, always startling change is 
the appearance of the menstrual flow. The mother who has not told her 
daughter of this coming change in her life before it is due has committed 
a serious error; it is no uncommon occurrence for girls who know nothing 
of this function to get into a tub of cold water to stop the flow; and if 
they stay in long enough, it generally does stop, and the girl's health 
may be ruined for life. 

The opinion of Dr. Ely van de Warker is that "if healthy ovulation is the 
outcome of healthy childhood, the function will obey the law of 
periodicity year by year, and all this time the young woman will be able 
to sustain uninterrupted physical and intellectual work as well as the 
young man. Not that the laws of health may be violated with impunity at 
puberty or any other time of a woman's life; but a law of health is no 
more binding upon a young woman than it is upon a young man; and there 
really is no such thing as one law for women and another for men." 

Age of Puberty.-- In the temperate regions the age of puberty is reached 
between the ages of twelve and fourteen years. The girl is then said to be 
nubile; that is, as soon as menstruation appears it is possible for her to 
bear children; but she is by no means sufficiently developed to do so, as 
she herself will not be completely developed physically or mentally before 
the age of twenty-two or twenty-five years. 

Physical Changes at Puberty.-- The physical changes that gradually take 
place, beginning at the time of puberty, are: the breasts, pelvis, and 
neck enlarge; hair develops over the pubis and in the arm-pits; the voice 
alters. As a rule, women continue to grow in stature until the twenty-
fifth year. It is said that brunettes develop sooner than blondes, and 
that large women develop more slowly than women of small stature; city 
girls develop younger than girls brought up in the country. Whatever 
stimulates the emotions causes a premature development of the sexual 
organs; as children's parties, late hours, sensational novels, loose 
stories, the drama and the ball-room, talk of beaux, of love and marriage, 
and children being surrounded with the atmosphere of riper years. It is 
generally believed that early stimulation of the sexual instincts leads to 
the premature establishment of puberty, as do also spiced foods and 
alcoholic beverages. 

First Onset of Menstruation.-- Sometimes the first menstrual discharge 
appears suddenly, lasts for a few days, and then stops; it may appear 
after an interval of two or three weeks, or not for several months. If for 
several months the flow appears at the regular time, and the quantity is 
about the same as the first, the menstrual habit may be said to be 
established. The mode of onset varies considerably within the limits of 
health. So long as the general health remains good, no anxiety need be 
felt in regard to the establishment of the menstrual function. 

In other cases there may be a discharge of blood at the first period, and 
none afterward for several months; in other words, menstruation may be 
established suddenly, intermittently, or gradually. It must be remembered 
that certain pathologic conditions cause many disturbances connected with 
the onset of puberty. 

Psychic Changes at Puberty.-- The angular, gawky feeling gradually 
disappears; the girl becomes self-conscious; new impulses arise, and she 
gives up many of the hoydenish ways of childhood. The girl's imagination 
is more lively, and just at this time mathematics form an excellent 
subject for mental occupation. The girl now begins to question the whys 
and wherefores, and demands reasons for the course that is laid out for 
her, and is full of ideas of her own; so that while as a child she had 
accepted almost unquestioningly the commands of her parents, she can be 
managed now only through the power of reason. And this is just as it 
should be, for the girl has reached the years of discretion, and now is 
the time when her reason and judgment are capable of rapid cultivation. 



CHAPTER II.
HYGIENE OF PUBERTY.
Home Life; Corsets; Shoes; Underwear; Nutrition; Diet; Water; 
Constipation; School Life; Spinal Curvature; Exercise; Walking; Running.

"Every man is the architect of his own fortune." 
--PSEUDO-SALLUST. 

Home Life.-- With beginning menstruation the equilibrium of the body is 
very easily disturbed, so that even in the case of the healthy girl some 
precautions should be taken and a rational regime should be adhered to; 
while in the case of the delicate girl a still more careful attention will 
have to be directed toward her weak points, in order that she may develop 
into a healthy woman. 

For every girl at this time of life home is preeminently the place; so 
that she may not only have the benefit of a mother's watchful care, but 
also lead a life as free from conventionalities and as much in the open 
air as possible. No girl should be sent away to school at this period of 
rapid growth and development; nor should girls of the working classes, 
when it can possibly be avoided, be sent out to fill positions as clerks 
in illy ventilated stores, in factories, or as domestics. If a girl can be 
kept at home until she is eighteen years old, she will be a much stronger, 
healthier woman than would otherwise be possible. 

Corsets.-- At this period of life it is particularly necessary that the 
clothing should be warm and at the same time sufficiently loose to prevent 
the constriction of any part of the body. And whatever the adult woman may 
elect to do in the matter of wearing corsets herself, she does her young 
daughter an irreparable injury by constricting and moulding her growing 
body in these corset-splints. Corsets placed on the young girl interfere 
with the functions of circulation, respiration, digestion, and of the 
pelvic organs, also with muscular development. In addition to all this, 
the girl is handicapped in taking all outdoor exercises and athletic 
sports. 

The lungs, heart, and great blood-vessels are placed in and completely 
fill an air-tight, distensiblecage, which is most distensible at its base. 

The least chest girth of the adult woman-- that is, the under-arm girth 
around the chest-- that is consistent with health is twenty-eight inches; 
and this girth must be enlarged three inches in forced inspiration. In 
ordinary respiration the waist expansion should be one-half to one inch, 
while during great muscular activity it should be from one and a half to 
three or four inches. One-third of the lungs lie below the point of 
beginning corset pressure, so that with tight corsets this amount of lung 
substance must be more or less useless. 

It is self-evident that any restriction placed about the waist, by 
preventing the full expansion of the ribs and the descent of the 
diaphragm, will further embarrass the heart's action by diminishing the 
amount of room it has to work in, at the same time that it diminishes the 
amount of oxygen which is inspired. Fresh air is by far the most important 
part of the daily food. It is in the lungs that the blood throws off its 
carbonic acid and other impurities; but it is able to do this only when 
the lungs are supplied with an abundance of oxygen. Every inch which a 
woman adds to her chest measure adds to the measure of her days. 

Great physical injury has followed women playing lawn-tennis while tightly 
corseted. And although dancing is a much milder exercise, since it 
frequently takes place in an overheated and poorly ventilated room, fatal 
results occasionally occur from the same cause. 

Standing erect calls into action almost all the muscles of the trunk, 
neck, and lower extremities. So long as the line of gravity falls within 
the area of the feet, the muscular effort required is so slight that it is 
little more than the tonicity contained in all living muscle. The greater 
the displacement of the line of gravity, the greater the muscular effort 
required to maintain the equilibrium of the body. Up to a certain extent, 
exercising the muscle develops the strength and size of the muscle. On the 
other hand, when a muscle within the body is unused, it wastes; when used 
within certain limits, it grows. But when the corset splint is applied to 
the body of the young girl, it supplants the functions of the abdominal 
and back muscles, which is to hold the trunk erect, and these muscles 
gradually grow weak and waste. And so the liability to the various spinal 
curvatures is increased. 

The original object of the corset was to give greater prominence to the 
hips and abdomen. But fashions change! In "the French figure" or straight-
front corset now in vogue the pelvis is tilted forward, producing a 
sinking in of the abdomen and a marked prominence of the hips and sacrum, 
necessitating a compensatory curve of the spine which increases the 
curvature forward at the small of the back-- a deformity which, a few 
years ago, women were going to orthopedic surgeons to have corrected. In 
this attitude the line passing through the centre of gravity strikes the 
heels, the knees are hyper-extended, and the muscles of the calves and 
thighs are rendered tense. 

By interfering with the muscular development and digestion, the girl is 
very apt to become angular, flat-chested, anemic, and to have a muddy 
complexion. And so the corset really defeats the object for which it was 
put on-- that of giving the girl a good figure and enhancing her beauty. 

There is no objection to girls wearing any of the various forms of 
hygienic waists now on the market. 

Shoes.-- The feet are the part of the body to come in contact with the 
greatest degree of cold, whether on the floor of the house or the pavement 
of the street. Hence it is a matter of prime importance to the entire body 
that the feet should be properly clad. 

The thick-soled, flat-heeled shoes which became popular with bicycling and 
golf are most hygienic, and it is highly desirable that this style of shoe 
should be adhered to for outdoor exercise. 

Underwear.-- In our cold and changeable climate the most suitable 
undergarment is the "combination" woolen undersuit, which reaches from 
neck to ankles and has long sleeves. Much greater warmth is afforded when 
the undersuit is moderately tight fitting. Such a suit should be worn the 
entire year, the grade of weight being adapted to the season. 

Nutrition.-- The nutrition of the body is dependent on the food supply, 
digestion and excretion. The growing girl should eat more than the adult 
woman, because of her more active life and of the fact that the food which 
she takes must not only replace the worn-out material of the body, but 
also provide new material needed for growth. Insufficient food and food of 
defective quality and composition work proportionately for more harm 
during the growing age. 

The full adult weight is not attained before the twenty-fifth year. When 
the final growth of the body and development of the vital organs is 
completed, the function of food is simply to replace waste with new 
material and to furnish material for the development of force. 

Diet.-- The diet should be a mixed one, consisting of the various kinds of 
fresh meats, fish, milk, eggs, poultry, vegetables, fruit, and fat in the 
shape of cream, butter, and the fat of beef and mutton. Animal food 
improves the condition of the muscles, which are made firmer than they 
would be through a vegetable diet. Meat in general has a more stimulating 
effect upon the system and is more strengthening than vegetable food, and 
it gives rise to a sensation of energy and activity. The common estimate 
is that meat should occupy one-fourth and vegetable food three-fourths of 
a mixed diet. 

Common salt in moderate quantity is essential, but all highly spiced or 
seasoned foods should be avoided, also pickles and vinegar. All "sweets" 
are harmful, because they destroy the appetite for other things and upset 
the digestion. Tea and coffee should be tabooed, as well as all alcoholic 
beverages. 

Good digestion depends for the most part on serving the meals at the same 
hour every day, eating leisurely, and masticating the food well. There is 
a great tendency on the part of the school girl to sleep late in the 
morning, then "bolt" her breakfast in order to get to school in time. 
Nothing could be more pernicious to the digestion, unless it is the 
eternal nibbling of candy. 

A healthy girl needs nothing between meals. A delicate girl will be the 
better for a glass of milk in the middle of the morning and at bed-time; 
or pure beef juice may be given instead. 

Water.-- Water is needed to keep the kidneys properly flushed. The amount 
of urine secreted during the twenty-four hours should be three pints. Of 
course it will be less than this if the quantity of water is insufficient. 
In addition to the urine about ten ounces of water are lost from the 
surface of the lungs, and eighteen ounces from the skin, making a total of 
about five pints; and this quantity of water must be taken daily in order 
to maintain the equilibrium of the body. The solid food of a mixed diet 
contains from fifty to sixty per cent. of water, so that about twenty-five 
ounces of water are taken into the system daily as an integral part of the 
food. In addition, three pints more should be taken as plain water. The 
bladder acts as a reservoir for the urine, and should be emptied at least 
three or four times a day. 

Constipation.-- In order to keep the digestive system in good condition, 
the refuse matter which collects in the lower bowel must be evacuated 
every day. And in order to secure this regular bowel movement, regularity 
in the time of going to the toilet is a prime necessity. And now is the 
time when the habits of a lifetime are being formed. If a tendency to 
constipation exists, it can almost always be overcome by increasing the 
amount of fruit and vegetables eaten, also by eating cracked wheat, 
oatmeal, corn and graham bread; all of which increase the peristaltic 
action of the intestines. The small amount of water taken by girls and 
women is another fertile source of constipation. 

School Life.-- When it is considered that fully one-half of the girl's 
waking hours are spent in school or in study preparing for school, it 
becomes evident that the girl's attitude at her desk should be the correct 
one. The malpositions at the desk are the most frequent cause of lateral 
curvatures, round shoulders, and flat chests. And these deformities are 
more common in girls than they are in boys. 

The common faults of the desk and seat leading to these malpositions are 
unsuitable shape of the back of the seat, too great a distance between the 
seat and the desk, and the incorrect slope of the desk. 

The edge of the desk should slightly project over the edge of the chair. 
The top of the desk should incline downward about ten degrees toward the 
student, and be low enough to allow the forearm to rest on it without 
raising the shoulder. The seat should be sufficiently deep to support 
almost the entire thigh, and close enough to the floor to allow the soles 
of the feet to rest firmly on it. The back of the chair should be arched 
so as to support the hollow of the back, and should reach just above the 
lower part of the shoulder-blades, and so make it easy and comfortable for 
even a weakly child to sit upright. 

If the seat is too high, the feet do not rest on the floor, and so the 
girl does not get the proper aid from the legs and feet to maintain an 
erect position. If the desk is too high, the elbow can rest on it only by 
curving the spine and raising the shoulder. The work is brought too close 
to the eyes and causes extra strain. If the desk is too low, the child 
stoops over it and becomes round-shouldered, and there is a tendency to 
become short-sighted. 

The pupil should sit erect with the weight equally borne by both buttocks; 
the legs should be straight before the trunk, and the feet firmly resting 
on the floor. The book should be held about twelve inches from the eyes. 

Spinal Curvatures.-- It should be distinctly borne in mind that lateral 
curvature of the spine is a distortion of growth. The deformity appears 
and is developed during the growing years. It is more common in girls than 
in boys, for two reasons: that at the age when lateral curvature is first 
seen, girls grow more rapidly than boys; and their muscular system is less 
well developed. 

In most early cases the faulty attitudes are clearly the result of 
muscular weakness. The growth in size has not been accompanied by a 
corresponding development of the muscles. This condition is most 
frequently met with in rapidly growing girls, and it is one of the most 
common causes of lateral curvature. In these cases proper gymnastics are 
indicated, but they should be prescribed and carried out with much care. 

It is upon the erectness, suppleness, and strength of the spinal column 
that most of the power and grace of the body depend. 

Lack of ventilation is a fertile cause of headache, anemia (or an 
impoverished condition of the blood in iron and oxygen), and dyspepsia. 
All these are rare before but common after twelve years of age. 

Exercise.-- In physical culture the object aimed at should be the 
symmetrical development of all the muscles of the body. Hence the 
necessity for bringing every individual muscle into play, at first for its 
development, and later for its maintenance. 

The tendency of almost all forms of exercise is to develop some portion of 
the body at the expense of the rest. The most perfect form of exercise is 
therefore that one which will most nearly call into play all the muscles 
of the body. 

Walking.-- Walking is the only form of exercise which may be said to be 
universal. In walking the muscles of the chest get little exercise, and 
those of the spine and abdomen even less. In walking the arms should swing 
easily at the sides, both from a physiological and an esthetic point of 
view. If the girl is weak or is unaccustomed to take any exercise, the 
guide for the amount of exercise taken at any one time must be this: At 
the first sense of fatigue, stop at once and rest, otherwise positive harm 
instead of good may be accomplished. The girl who depends on walking for 
her outdoor exercise should walk at least three miles every day, and walk 
at the rate of three miles an hour. 

After acquiring as great a walking speed as is consistent with a graceful 
and easy carriage, the running exercise should be begun, gradually 
increasing the distance, but not the rate of speed. 

In exercising, all tight clothing about the neck, chest, and waist must be 
removed. Pure air and full breathing are required during and after 
exercise. Full breathing not only promotes the change of air in the lungs, 
but also quickens the functions of the circulation and digestion. Eating 
must be avoided shortly before or shortly after any considerable exercise, 
as it impairs digestion. 

Running.-- Running is the best exercise for developing the breathing 
capacity. While brisk walking is allowable, fast running is not. The rule 
for running is to begin slowly, run moderately for perhaps fifty feet, 
then increase the speed gradually; but in running for exercise, never 
speed to the utmost. A five-mile gait is quite sufficient. The run should 
be closed with the same moderation with which it was begun, and the girl 
should never stop short, as this sudden arrest of action gives a most 
undesirable shock to the heart. 

In beginning to take any form of exercise the intensity and duration of 
the movements practiced must be increased very gradually, or positive harm 
instead of good will be done. As soon as fatigue is appreciable, the 
exercise should be discontinued and at once be followed by complete rest. 
Rapid respiration, palpitation or dizziness, headache, the face becoming 
pale or pinched or flushing suddenly, a feeling of great heat or excessive 
perspiration, are all danger signals showing that the exercise has already 
been carried too far and should cease at once. Continued over-exertion 
carried to a point of exhaustion leads to an obstinate irritability of the 
heart as well as to organic lesions. 

Mountain-climbing, rowing, and bicycling call into play almost all the 
muscles of the body. Of all the outdoor exercises for girls, swimming is 
one of the most perfect. It not only calls into vigorous action most of 
the muscles of the body, but spares many of those muscles that are so 
commonly overworked, the most of the work being performed by muscles that 
are so little used as to have become flabby and weak. 

Swimming and sea-bathing must be avoided by girls who have weak hearts and 
in whom the reaction after a plunge into cold water is never established; 
also by girls with heart disease or kidney disease. 

The principal outdoor games are croquet, archery, golf, tennis, cricket, 
foot-ball, and base-ball. Of these, croquet is the mildest, and is for 
that reason a good beginning exercise. Croquet, archery, golf, and tennis 
are all defective in that they cause a greater development of the right 
than of the left side of the body. 

As the greater majority of these outdoor exercises can only be indulged in 
for seven months of the year, they should be supplemented by exercises in 
the gymnasium for the remaining five winter months. 

There should be the greatest variety possible in the kinds of exercise 
taken, not only to develop the body symmetrically, so as to obtain 
strength, vigor, grace, celerity, and accuracy of movement, but also 
because there is no such potent cause of fatigue as monotonous repetition 
of the same act, whether physical or mental. 

It has been repeatedly proven that physical deterioration can be overcome 
by exercise, and that by so doing the mental capacity is greatly 
increased. 



CHAPTER III.
ANATOMY OF THE GENERATIVE ORGANS.
The Vulva; the Hymen; Condition, of the Hymen as a Proof of Virginity; the 
Bladder; Vagina; Uterus; Respiratory Movements of the Uterus; Fallopian 
Tubes; Ovaries.

"He that respects himself is safe from others; 
 He wears a coat of mail that none can pierce." 
-- LONGFELLOW. 

The Vulva.-- The female generative organs consist of three groups-- the 
external, the intermediate, and the internal. The vulva, or external 
generative organs, comprises all those organs which are external to the 
body. 

The vulva is pierced by two openings, the smallest and most anterior of 
which is the external opening of the urethra, or excretory duct of the 
bladder. This opening is surrounded by a slight eminence and has a 
somewhat puckered aspect. 

The larger opening is the vaginal orifice. In the virgin this is partially 
closed by the hymen. About one inch back of this is the anus, or the 
external orifice of the large bowel. This part of the bowel is known as 
the rectum. 

The Hymen.-- The hymen consists of a thin duplicature of mucous membrane 
strengthened by fibrous tissue, and is stretched across the posterior part 
of the vaginal orifice, which it partly occludes. Rupture of the hymen 
usually, but not always, occurs during the first sexual intercourse. In 
rare cases it is found intact at the time of the birth of the first child. 
In women who have borne children the vaginal orifice is surrounded by 
small irregular elevations; these are the remains of the ruptured hymen, 
but are usually present only after labor has taken place, since the torn 
hymen is converted into eminences as the result of the pressure incident 
to child-bearing, and not to coitus. 

The Condition of the Hymen as a Proof of Virginity.-- Formerly much stress 
was laid on the condition of the hymen as a proof of virginity. The hymen 
tightly closed, barely admitting the tip of a small index-finger, is 
positive evidence of virginity. But the hymen may lose its tone by a local 
catarrhal condition or by a general muscular relaxation; it may then 
become so relaxed that the only positive evidence rendered by the intact 
hymen is that the woman has not borne a child. 

In a paper on the preservation of the hymen, Dr. Hannah M. Thompson 
writes: "Further, if the hymen was intended as a guarantee of moral 
character, and for moral protection, either of man or woman, would we not 
have some reason for reflecting on the wisdom and righteousness of a 
Creator who has failed to make equal provision, and to give a like 
guarantee of an uncorrupted manhood? As physicians, we know too well that 
where one woman enters the marriage relation tainted in body there are 
thousands of men reeking with disease; and there is no demonstrable test 
to distinguish these, no proof for the young woman of the virginity or 
virtue of the young man." 

The Bladder.-- The female bladder is relatively broad and capacious, and 
is also highly distensible. When the bladder is allowed to become 
overdistended, it is carried backward and tends to cause a backward 
displacement of the uterus. The urethra, or excretory duct of the bladder, 
is about an inch and a half long, and lies firmly imbedded in the anterior 
vaginal wall. 

The Vagina.-- The intermediate organ is the vagina. This is a musculo-
membranous canal which connects the external with the internal organs of 
generation. The vagina lies in relation with the bladder and the urethra 
in front, and with the rectum behind. The vagina is sufficiently 
distensible to allow of the passage of so large a body as the child. 

The Uterus.-- The internal organs of generation are the uterus, the 
ovaries, and the Fallopian tubes. Of these, the ovaries and the uterus are 
the essential female organs of generation. The virgin uterus is a small, 
hollow, muscular organ, somewhat pear-shaped, whose cavity is about one 
and a half inches deep. The uterus is divided by a natural constriction 
into a body and a neck. The neck, or cervix, is somewhat spindle-shaped, 
and has a canal running through its center which opens by a small 
aperture-- the so-called external orifice,-- into the vagina. In the 
virgin uterus the apposition of the anterior and posterior walls reduces 
the cavity to little more than a longitudinal cleft. With the advent of 
old age the whole organ suffers marked atrophy. 

The uterus is situated in the middle of the pelvic cavity, between the 
bladder and the lower bowel. It is held in place by broad elastic bands 
which go to different sides of the pelvis; it is also in part supported by 
the structures below and above it. But so loosely is the uterus held that 
it is easily pushed about-- as, for instance, by a full bladder or a 
packed bowel. And persistently allowing the bladder to become overfull, 
and failure to have a daily evacuation of the bowels, are prolific sources 
of displacements of the womb. 

Respiratory Movements of the Uterus.-- When no constrictions are placed 
about the waist, the uterus moves freely up and down with every 
respiration. So distinctly and with such regularity do these movements 
take place that an operator by watching the movements of the uterus can 
tell the effect that the anesthetic is having on the patient's breathing. 
These so-called respiratory movements play a very important role in the 
circulation of the uterus, and in the return of the venous blood to the 
heart. 

Anything which interferes with these movements, as the use of corsets, or 
of tight bands around the waist, prevents the free return of the venous 
blood. The uterus becomes congested, and through the constant abnormal 
weight of the organ itself, as well as the pressing down upon it from 
above of the superincumbent organs, the uterus is pushed down below its 
normal position, the ligaments whose duty it is to hold it up become 
relaxed, and the unhappy woman suffers all the agonies that are attendant 
on the "falling of the womb." For this reason the disorder is frequently 
met with in women who have never borne children as well as in those who 
have. 

The Fallopian Tubes.-- The Fallopian tubes extend from the upper, rounded 
angles of the uterus, within and along the free margin of the broad 
ligaments, for a distance of about two inches, to the vicinity of the 
ovaries, where each one terminates in a funnel-shaped orifice surrounded 
by a series of fringed processes. The lumen of the tube is narrowest at 
its inner end, where it opens into the cavity of the uterus by a minute 
orifice which scarcely admits a bristle; the diameter of the canal 
gradually increases until it reaches its ovarian extremity. The mucous 
lining of the tube is clothed by a single layer of hair-like epithelium, 
whose current sweeps from the ovarian toward the uterine end of the tube; 
and it is these movements which propel the ovum from the ovary to the 
uterus. 

The Ovaries.-- The ovaries are two small bodies of an almond shape, and 
lie on either side of the uterus. The bulk of the entire organ consists of 
connective tissue, in which lie imbedded the Graafian follicles or 
ovisacs, in which the ova are contained. These follicles or ovisacs are 
minute cells which are packed immediately beneath the surface, where they 
occur in all stages of development. With the increase in size which 
accompanies their development the follicles pass toward the surface, where 
they form a distinct projection, and at this point will occur the final 
rupture of the sac and the escape of the ovum. It is supposed that the 
ovum is grasped by the fringe-like extremity of the Fallopian tube and is 
carried through it by the movements of the ciliary epithelium to the 
uterus. 

The formation of new follicles continues only for a short time after 
birth, when the Graafian follicles are the most numerous; the entire 
number contained within the ovaries of the child being estimated at over 
70,000. In view of the unquestionably large number of follicles in very 
young ovaries, and the relatively small number of ova which reach 
maturity, the degeneration of many follicles after reaching a certain 
degree of development seems certain. 



CHAPTER IV.
PHYSIOLOGY OF THE FEMALE GENERATIVE ORGANS.
Ovulation; Etiology of Menstruation; Uterine Nerve-supply; the Function of 
the Uterus; Stages of the Menstrual Cycle; Average Duration of the 
Menstrual Flow; Character of tahe Flow; Relation of Ovulation to 
Menstruation; the Menstrual Wave; Definition of Menstruation; Premomitory 
Symptoms of the Flow; Hygiene of Menstruution.

"Toil and grow strong; by toil the flaccid nerves 
 Grow firm, and gain a more compacted tone." 
-- ARMSTRONG. 

Ovulation.-- At birth the formation of the ova is nearly completed; the 
production of' new cells probably ceases after the second year. The 
ovaries of the child of two years contain, therefore, the full quota of 
ova, although the vast majority of these cells always remain immature and 
undeveloped. While it is probable that a variable number of the immature 
ova undergo partial development before puberty, yet the advent of sexual 
maturity at that time marks the establishment of the regular development 
of the Graafian follicles and their contained ova, accompanied by the 
attendant phenomena of menstruation. 

During the entire child-bearing period, or from about the age of fifteen 
to forty-five years, the development of the Graafian follicles and the 
discharge of the ova are continually taking place. The liberation of the 
ova usually takes place at definite times, which in general coincide with 
the menstrual epochs, one or more ova being set free at each period; but 
this is by no means invariable. 

The ripe human ovum or germ cell is a spheric cell, about 0.2 mm. in 
diameter, consisting of granular protoplasm, in which lies a nucleus which 
contains the germinal spot. The proper cell-wall is a structure of great 
delicacy, outside of which is a secondary envelope. 

Menstruation.-- The etiology of menstruation has been variously explained 
at different epochs. The chief theories have been that of plethora, and 
the ovulation, the tubal, and the nerve theories. 

First, the Theory of Plethora.-- From the time of Hippocrates to 1835 the 
theory prevailed that in the female body the formation of blood is 
sufficiently rich to provide every four weeks for an overflow of the same, 
the evacuation of which becomes a necessity. It was believed that this 
excess of blood depended on an excess of formative power in the woman. 

Second, the Ovulation Theory.-- This was distinctly formulated about 1845. 
It construed the menstrual hemorrhage as a subsidiary phenomenon, entirely 
dependent on the periodic dehiscence of ovules. The changes supposed to 
take place in the Graafian follicles at each menstrual period were 
believed to involve a peculiar expenditure of nerve force, which was so 
much dead loss to the individual life of the woman. The growth of the 
Graafian vesicle and its contained ovum was supposed to cause an 
irritation of the nerves of the ovary, which was reflected to the entire 
nervous system. The gradual accumulation of this irritation finally caused 
a reflex action which determined an afflux of blood to the uterus and 
ovaries, which constitutes the catamenial flow. 

The ovulation theory was refuted by the following facts: Ovulation may and 
does occur without menstruation; women who have never menstruated may 
conceive; conception may occur during lactation, without the menses having 
returned since the last parturition; children at birth have many ovules 
contained within the ovaries; ovulation may persist for a time after the 
menopause, and even pregnancy has occurred, although very rarely after 
this time; the menses may continue regularly after the removal of the 
ovaries and Fallopian tubes; this is exceptional, and, as a rule, the 
periods only continue for two or three years at longest. 

Third, the Tubal Theory.-- Lawson Tait thought that thorough removal of 
the tubes was far more essential in determining the menopause, and that 
cases of periodically recurring hemorrhage after the removal of the 
ovaries were to be explained by the fact that the tubes had not been 
sufficiently removed. As an anatomic and surgical fact, the tubes can 
never be wholly excised unless the upper part of the uterus is also 
amputated. 

Fourth, the Nerve Theory of Menstruation.-- This is based upon the 
following views: 

1. That menstruation is a process directly controlled by a nerve-center 
situated in the lumbar region of the spinal cord. 

2. That the menstrual impulses reach the uterus through two sets of 
nerves. 

3. That menstruation is the result of nerve irritation, vascular 
congestion, and the subsequent relief of these by hemorrhagic discharges. 

4. That hemorrhage from the uterus is the result either of a local uterine 
condition, or of influences outside of the uterus acting directly on the 
center. 

5. That the removal of the appendages arrests menstruation by preventing 
the propagation of uterine influences to the center. 

Uterine Nerve Supply.-- One set of nerves causes contraction of the 
muscular fibers of the uterus, while the other set transmits impulses 
which bring about its vascular engorgement; and they are probably 
concerned in bringing about the determination of blood to the uterus and 
its appendages, which is so marked a feature of the menstrual process. 

As the result of long-continued investigation, Johnstone has come to the 
conclusion that the lining membrane of the uterus belongs to that class of 
organs whose function it is to replace organic waste. "Menstruation is a 
periodic wasting away of those corpuscles that are too old to make a 
placenta." He has further found that, as compared with the uteri of very 
many of the lower animals, the human uterus is very scantily supplied with 
lymphatics, and the only way to rid the uterus of the overripe, and 
therefore consequently useless, tissue is to wash it out through the 
vagina by a blood-stream. The tough wall of the human uterus and the 
increased blood-pressure caused by the erect position cause the difference 
between menstruation in the human female and rut in the lower animals. 

The strong light of recent investigations has necessitated the laying 
aside of many time-honored theories; and as the close of the nineteenth 
century has seen the emancipation of the uterus from the thralldom of the 
ovary, so we may believe that the twentieth century will find women of 
such fine physique as to prove the error of the popular fallacy that the 
cause of woman's weakness lies in the performance of her functions. 

The Function of the Uterus.-- The function of the uterus is to provide a 
favorable place for the reception of the product of conception, where it 
may be protected and nourished during the period of its development. The 
purpose of menstruation is to keep the uterus in suitable condition for 
the reception of this product of conception at any time. It is now known 
that the menstrual flow is not the whole of menstruation, and that the 
changes going on in the uterus are almost as continuous as the process of 
digestion. The whole of the reproductive life of woman has been divided 
into cycles of twenty-eight days each; these cycles have been divided into 
four stages. 

Stages of the Menstrual Cycle.-- The first or constructive stage is one of 
preparation for the reception of the ovum. During this stage the preparing 
of a decidua takes place, or building a nest for the expected egg; there 
is a swelling of the mucous membrane, an enlargement of the uterine 
glands, and an increase in the connective tissue. It is thought that this 
stage lasts for one week; when pregnancy does not occur, it is followed by 
degenerative changes. 

The second or destructive stage is marked by destructive changes which 
give rise to the usual phenomena of the menstrual period; there is a 
discharge of blood, mucus, and disintegrated mucous membrane. The actively 
growing cells of the uterine lining membrane undergo rapid destructive 
changes, the fabric of the half-formed decidua tumbles to pieces, the 
turgid capillaries burst and pour out the menstrual flow, which sweeps 
away all the useless debris. The irritation sets up reflex uterine 
contractions, and so the blood is squeezed out of the distended 
capillaries and washes away the degenerated cells. 

The third or reparative stage, as its name indicates, is one of repair, in 
which by constructive changes the epithelial lining which was thrown off 
is replaced by new, which is formed in from three to four days. 

The fourth or quiescent stage includes the remaining twelve or fourteen 
days of the menstrual cycle, and represents the quiescent period prior to 
the initiative changes which mark the beginning of the next period. 

Average Duration of the Menstrual Flow.-- The average duration of the 
menstrual flow is five days, although the variations are considerable in 
healthy women. A flow lasting any place from two to six days is perfectly 
consistent with health; but a flow continuing less than two or more than 
six days generally indicates local or general disease. 

Character of the Menstrual Flow.-- For the first few hours, or perhaps for 
the first day, the flow is usually slight in quantity and light in color; 
on the second and third days the flow reaches its height, and is profuse 
and dark, but it should never be clotted; after this it gradually ceases. 
The amount of the flow varies from five to ten ounces. If less than five 
or six or more than eighteen napkins are pretty well saturated through, 
the amount may be considered abnormal. 

Relation of Ovulation to Menstruation.-- It has not yet been decided just 
in what relation the processes of ovulation and menstruation stand to each 
other. It is supposed that the transit of the ovum to the uterus occupies 
at least one week. It has been thought that the decidua of a particular 
menstrual period is related, not to the ovum discharged at that period, 
but to the ovum discharged at the preceding period. 

The menstrual wave, or the wave of "supplementary nutrition,"(*) upon 
which the menstrual process ultimately depends, was first established by 
Dr. Mary Putnam Jacobi in the Boylston prize essay for 1876; showing that 
menstrual life is associated with a wave of well-marked vital energy, 
which manifests itself in a monthly fluctuation of the tempera ture of the 
body, in the daily amount of the excretion of urea and of carbonic acid, 
and of the rate and tension of the pulse. The wave attains its maximum 
during the week preceding menstruation, and slowly falls to its minimum, 
which is reached the week after menstruation. 

(* Dr. Goodman and Dr. Stephenson have since written on this subject, and 
the "wave" is often known as the Stephenson wave.)

This wave indicates a periodic variation in the bodily metabolism, and is 
probably directly influenced by the rhythmic activity of the menstrual 
center. This observation would seem to be nullified by the fact that the 
phenomena referred to have been found to occur in men as well as in women; 
and that the lower animals also seem to show the same periodic variations. 
"It is therefore evident that the phenomena belong not to the function of 
menstruation, but to a general law of vital energy." 

Definition of Menstruation.-- Menstruation may, then, be defined as the 
periodic discharge of blood from the uterus, accompanied by the shedding 
of the epithelium of the body, as well as that of the uterine glands near 
their orifices. 

The sanguineous discharge is due partly to the oozing of blood from the 
surfaces denuded of epithelium, and partly to active congestion. The 
discharge from the uterus is largely augmented by mucus secreted in 
increased quantity at this period from the enlarged uterine glands. 

The tubes take some part in the process of menstruation; their mucous 
membrane is swollen, the epithelium is shed in places, and they are filled 
with a thin bloody fiuid, containing blood-corpuscles and cast-off 
epithelium cells. 

The menstrual wave continues from puberty to the menopause; it is a 
nervous phenomenon. Ovulation is a progressive, non-periodic process; it 
begins before birth and continues till the ovarian tissue is atrophied or 
worn out. 

Premonitory Symptoms of the Flow.-- The premonitory symptoms of the 
monthly flow should not be so marked as to cause the individual any 
discomfort. The first indication of the return of the period should be the 
appearance of the flow. There is generally a feeling of abdominal fulness 
with some lassitude, and sometimes slight headache. The temperature is 
lower and the pulse is slower than at other times. This lowered tone of 
the system is an additional reason for increased care against exposure in 
wet or cold weather. 

Hygiene of Menstruation.-- During the menstrual periods all cold baths 
must be strictly prohibited, whether tub-baths or cold sponges. The reason 
of this is that the application of cold to the surface causes a driving in 
of the blood from the exterior of the body to the internal organs; and at 
the menstrual periods there is already a congested condition of the pelvic 
organs, and it must be remembered that congestion is the first stage of 
inflammation. 

Hot or warm sponge-baths may be taken throughout the period; and the vulva 
should be bathed with warm water twice a day through the entire period of 
the flow, as this not only removes the clotted blood before it decomposes 
and becomes the source of irritation, but also removes other irritating 
matters, and prevents the nervousness that is caused by a local 
irritation. 

It is strange how women who are scrupulously neat in all other respects 
will allow the smegma to collect in and about the vulva; as a matter of 
fact, for the purpose of cleanliness it is much more necessary that the 
external genitals should be washed twice a day with soap and water all 
through life than that the face should be washed that often. 

Another question which is still sub judice is the necessity for and the 
frequency with which vaginal douches should be taken; all physicians are 
agreed that a vaginal douche taken immediately after the menstrual period 
is beneficial, as it removes all the debris of the flow, which is 
sometimes very irritating. 

Exercise.-- A moderate amount of exercise should be taken every day; this 
is needed now quite as much as at any other time, and only good can result 
from it. And no harm comes of a woman going out in the rain or in cold 
weather; as has been shown, the menstrual process is going on for a large 
part of the time, and the flow is only the external appearance, but during 
the time of the flow the woman must be unusually careful not to get her 
feet wet or to sit down with damp clothing on. Violent exercise of all 
kinds is to be prohibited at this time, as dancing, rides on the bicycle, 
gymnastics, and walks of over three miles. The reason for this is very 
obvious; the uterus has now reached the height of its turgescence, and is 
heavier than at any other time, hence the danger that displacements or a 
very profuse flow would be caused by any kind of violent exercise. 

Treatment.-- If the woman has been so unfortunate as to get caught out in 
a heavy rain so that her clothes have been wet through, or if in the cold 
weather she should come into the house thoroughly chilled, the best thing 
to do is to take off her wet things as quickly as possible, be well rubbed 
down with hot, rough towels, drink a cup of hot tea, go to bed at once and 
place a hot-water bag over the abdomen. She should remain in bed until the 
next morning, to the end that the circulation may regain its equilibrium 
as quickly as possible by the immediate relief of the pelvic congestion. 
If this exposure should have caused the sudden cessation of the flow, a 
hot mustard foot-bath should be taken. One tablespoonful of mustard is 
used to a gallon of water as hot as can be borne; the pail should be made 
as full as can be without running over, and a blanket wrapped around the 
pail and woman, so as to cause a profuse perspiration; this should be kept 
up for ten minutes; if the water cools off, hot water may be added. 



CHAPTER V.
THE ANOMALIES OF MENSTRUATION.
Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea; Leuchorrhea; 
Pruritus Vulvae.

"Defer not till to-morrow to be wise, 
 To-morrow's sun on thee may never rise." 
-- CONGREVE 

Menorrhagia and Metrorrhagia.-- By menorrhagia is meant an excessive or 
too profuse menstrual flow; by metrorrhagia, a flow of blood between the 
menstrual periods. Neither one constitutes a disease by itself, but is a 
symptom of some pathologic condition. 

It has already been stated that the excretory organs, by constantly 
eliminating from the system the worn-out material, keep the machine 
healthy and in good working order. Kept within natural limits, this 
elimination is the source of strength and health; beyond these limits, the 
menstrual flow becomes an actual hemorrhage that, by draining away the 
life, becomes the source of weakness and disease. 

No physician would dare to bleed a man or woman once a month, year in and 
year out for thirty years; but, through ignorance or folly, this is what 
many girls do for themselves. 

This excessive flow, aside from actual local disease, is brought about by 
excessive muscular exercise during menstruation; by the use of all 
stimulants, whether alcoholic beverages or quinin; as well as by the 
thinness of the blood. 

When the flow is excessive, it must be considered a pathologic condition, 
which needs the physician's attention. Rest in the recumbent position is 
the first essential; the diet must be plain and unstimulating, and 
attention must be paid to the condition of the blood. 

The general diseases which generally cause this condition are anemia, 
Bright's disease, malaria, the early stages of tuberculosis, and heart 
disease. 

The local causes may be reflex, as powerful emotions; or due to local 
disease of the uterus and its appendages, as the various inflammations and 
displacements of the uterus, fibroid tumors, polypi, and cancer. 

Dysmenorrhea is painful menstruation. The most frequent forms are due to 
uterine congestion; to mechanical causes, as a narrowing of the cervical 
canal, particularly at its internal opening, or to a constriction caused 
by the bending over of the uterus at the junction of the body and the 
neck; or to ovarian irritation. 

The pain varies in intensity from slight discomfort to the most intense 
uterine colic, which is experienced in the lower part of the abdomen. In 
severe cases the general health becomes undermined, the nervous system 
gives way, and hysteria and other disorders of the nervous system result. 

The congestive variety usually occurs in patients who have previously 
menstruated painlessly. The pain comes on suddenly with the flow and 
ceases when the flow stops; it is very severe and is generally accompanied 
by a diminution or a cessation of the flow. There is severe headache, 
marked diminution in the secretion of the kidneys, and general 
restlessness. The patient frequently experiences pain in walking, is 
easily fatigued, has leucorrhea and an irritable bladder. 

In ovarian dysmenorrhea the pain precedes the flow for several days and 
ceases when a free flow is established. The pain is of a dull aching 
character, and may be felt on one or both sides of the abdomen, according 
as one or both ovaries are involved. 

Amenorrhea.-- In amenorrhea the menstrual flow may not appear for some 
years after it is normally due; or the flow may cease after some months or 
years of continuance; or the flow may be abnormally scanty or even absent. 

The menstrual flow is much later in appearing in some families than in 
others, so that this may be considered as a family idiosyncrasy; and if 
the girl's health is good, it need cause no anxiety. If, on the contrary, 
the girl has severe headaches, or suffers in any way, the physician should 
be summoned at once, as the absence of menstruation may be indicative of 
some serious pathologic condition, 

A scanty flow is often indicative of thinness of the blood; on the other 
hand, serious anemias often lead to profuse menorrhagias or metrorrhagias, 
as has already been stated. The cause of the profound anemia itself may be 
insufficient nutrition, overwork, or lack of exercise. 

Scanty menstruation is often seen to occur in fevers, in the later stages 
of consumption, in advanced Bright's disease, in malaria, or in any other 
very serious disease. In these cases it seems to be a conservative process 
on the part of nature in the run-down state of the system. As consumption 
progresses menstruation generally ceases absolutely, never to return 
again; and in this case nothing should be done to try to induce a return 
of the flow. 

Great shock sometimes causes a sudden cessation of the flow; and sometimes 
a sea-voyage, followed by the change of habitat, will cause an obstinate 
form of amenorrhea. 

But it cannot be too well understood that, after the menstrual flow has 
been regularly established, it continues with the greatest regularity 
throughout the child-bearing period, unless the exposure to wet or cold 
has been sufficiently severe to cause great indisposition on the part of 
the woman. In this case it is possible that, if the exposure took place 
just previous to the time of the expected flow, one period may remain out. 
But except in case of serious illness,-- as for example, typhoid fever,-- 
two or more periods do not fail to appear except in the case of pregnancy. 

Leucorrhea.-- Leuchorrhea, or "whites," is a mucous or mucopurulent 
discharge from the vagina; it may be a symptom of uterine or vaginal 
disease. 

Immediately after the menstrual flow there is a well-marked vaginal 
secretion which is whitish in appearance; it may be transparent or of a 
milky color, and is sometimes very acrid. This secretion may also precede 
the flow, and there is nothing abnormal in this. But any discharge 
occurring between the periods sufficient to stain the clothing-- the so-
called whites or leucorrhea-- is abnormal, and is caused by an 
inflammation of the vagina or the neighboring parts. In addition to the 
discharge there is heat and swelling of the parts, more or less local 
distress, and generally intense nervousness. 

If the disease is not cured, it may become chronic. The pain, heat, and 
scalding disappear, but a copious discharge continues, and in this stage 
the disease may be very obstinate and greatly reduces the strength. The 
constant drain breaks down the system, producing pallor, debility, pain in 
the back, palpitation, indigestion, and so forth. 

The character of the discharge in leucorrhea varies considerably, from a 
whitish or mucous secretion, to a yellowish or mucopurulent secretion, and 
is debilitating in proportion as it is profuse. It is to be remembered 
that this is not in itself a disease, but indicates a disease of some of 
the pelvic organs; and that all such inflammations left to themselves 
incline to grow worse. 

A severe leucorrhea is generally attended with frequent and finally 
painful micturition; pain in walking in the lower part of the abdomen, 
which may become so severe as to compel the patient to go to bed. 

Pruritus Vulva.-- This is an intense and persistent itching of the vulva, 
and is a symptom rather than a disease. It is not an infrequent result of 
leucorrhea, the acrid discharge of the latter leading to an irritation of 
the parts; this causes rubbing of the parts until a veritable inflammation 
is produced. 

Other causes of pruritus vulvae are: The local congestion, such as occurs 
at the menstrual period, or in certain cases of pelvic inflammations, or 
in early pregnancy; constipation; sedentary habits; congestion of the 
liver; incontinence of urine, and diabetes. When dependent on the latter, 
the malady is most obstinate in yielding to treatment. Indigestible foods 
or drinks, the rubbing of the clothes, the friction of walking, and the 
heat of the bed act as exciting causes in those predisposed to it. 

The essential treatment here is to at once ascertain and remove the cause; 
aids in the treatment are vaginal douches and cooling lotions.