of fevers, give occasion to something like periodicity at intervals of seven days;-for example, Mr. Roberton, of Manchester, England, asserts, that of 100 women, the catamenia returned every fourth week in 68; every third week in 28; every second week in 1; and at irregular intervals in 10; these varieties usually existing as family and constitutional peculiarities.

It is scarcely necessary to notice the visionary speculations of those who have regarded menstruation as a mechanical consequence of the erect attitude; or the opinion of Roussel, that it originally did not exist, but that being produced artificially by too succulent and nutritious a regimen, it was afterwards propagated from generation to generation; or, finally, that of Aubert, who maintained, that if the first amorous inclinations were satisfied, the resulting pregnancy would totally prevent the establishment of menstruation. The function, it need scarcely be repeated, is instinctive, and forms an essential part of the female constitution.

M. Gendrin, and others, have revived a view entertained by Mr. Cruikshank, Dr. Power, and others, that menstruation is dependent upon changes occurring periodically in the ovary. Many cases have been related by Cruikshank, Robt. Lee, Gendrin, Négrier, Bischoff, and others, in which,

Fig. 297.

whence it has been inferred, that during the whole of that period of life when the capability for conception continues, there is a constantly successive developement of vesicles and their contained ovules in the ovary, and that, at each epoch of menstruation, a vesicle having

Edinb. Med. and Surg. Journal, xxxviii. 237.

b Système Physique, &c., de la Femme, p. 13, Paris, 1809. Traité Philosophique de Médecine Pratique, Paris, 1838-9. d See Brit. and For. Med. Review, Oct. 1840, p. 592.

An Essay on the Periodical Discharge, &c., London, 1832.

f M. Négrier, cited in Dunglison's Amer. Med. Intelligencer, July 15, 1840, p. 121. See, also, Dr. Robt. Lee, art. Ovaria, Cyclopædia of Pract. Medicine, Amer. edit., by the author, Philadelphia, 1845; Dr. Laycock, on the Nervous Diseases of Women, p. 42, London, 1840; and Dr. R. Willis, in note to Wagner's Elements of Physiology, p, 69, London, 1841.

Churchill, Theory and Practice of Midwifery, 2d Amer. edit. by Prof. R. M. Huston, p. 70, Philad. 1846.

reached the surface of the ovary becomes the seat of a peculiar organic action, in which all the organs of generation participate; and that the result of this action is the rupture of the vesicle, and the loss of the infecund ovum, either by expulsion from the uterus or by destruction in the ovary. More recently, M. Raciborski, has maintained, as the result of his researches on menstruation-First. That there exists the most intimate connexion between the Graafian vesicles and menstruation. When these vesicles arrive at their full developement, menstruation commences, and when they are destroyed, it ceases. Secondly. At each menstrual period, a follicle projects like a nipple on the surface of the ovary, where it afterwards bursts, without requiring for that purpose any venereal excitement. Thirdly. The rupture of the follicles in general appears to take place at the period when the menstrual discharge is stopping; and Fourthly. The ovaries do not act alternately, as has been affirmed: in this respect not seeming to be under any fixed law. In a still more recent work he asserts the doctrine, that the catamenia are but a secondary phenomenon in menstruation properly so called, and that the capital phenomenon is the maturation and periodical discharge (ponte) of ova; and hence, that a woman may give birth to several children without ever having seen the catamenia. Of late, much attention has been given to this subject, and especially by Dr. Ritchie. As before remarked, this gentleman affirms, that even during the period of childhood, there is a continual rupture of ovisacs, and discharge of ova at the surface of the ovarium. About the period of puberty, he states, a marked change usually takes place in the mode in which the ovisacs discharge their contents; but this change does not necessarily occur simultaneously with the first appearance of the catamenia. The ovaries now receive a much larger supply of blood, and the ovisacs exhibit a great increase in bulk and vascularity, so that when they appear at the surface of the ovary, they resemble pisiform turgid elevations; and the discharge of their contents leaves a much larger cicatrix, and is accompanied by an effusion of blood into their cavities. It would appear, however, from Dr. Ritchie's observations, that although this discharge takes place most frequently at the menstrual period, yet the two occurrences are not necessarily coexistent; for menstruation may occur without any such rupture; and on the other hand, the maturation and discharge of mature ova may occur in the intervals of menstruation, and even at periods of life when that function is not taking place, as before the age of puberty. The essential condition of menstruation itself would seem to be the increased turgescence of the vessels of the uterus, and

Bullet. de l'Académ. Royal. de Méd., Jan. 1843; and Edinb. Med. and Surg. Journ., April, 1843.

See, on this subject, Mr. Girdwood, London Lancet, March 4, 1843, p. 825; and also, Mr. Paget, Brit. and For. Med. Rev., Jan. 1844, p. 270.

c De la Puberté et de l'Age Critique chez la Femme, et sur la Ponte des Mammifères, &c., Paris, 1844.

London Medical Gazette, 1843; Lond. and Edinb. Monthly Journal of Med., Aug. 1845, or Amer. Journal of Med. Sciences, Oct. 1845, p. 431, and Jan. 1846, p. 185.

the appearance, on its inner surface, of a fresh wall of deciduous villous vessels, which may remain for at least two weeks."

It has been much urged of late, as it was formerly, that there is a striking analogy between menstruation and the rut or period of heat in animals; and so far as regards the maturation of ova, and the periodical secretion from the genital organs, in both conditions, there may be ground for the analogy; but in other respects it is forced, and unsatisfactorily supported. Heat in animals means "venereal heat"-ardor venereus-and at this time only does the female admit the male; whilst the human female receives him at all times. It has been attempted, indeed, to show that the human female, during menstruation, has the same increase of venereal ardour, and that the capability for impregnation is at this time at its acme. But this is surely contrary to exact observation. Müller, Burdach, and others, have denied the greater sexual feeling during the flow; and the author, after careful inquiry, has met with nothing to confirm it. After the menstrual period, it can be readily understood, that more feeling may exist, owing to sexual intercourse having been for a time interrupted; yet it would appear, that impregnation frequently occurs immediately before the last catamenial discharge. "The fact," says Dr. Carpenter, that conception often takes place before the last appearance of the catamenia (and not after it, as commonly imagined), is one well known to practical men." He is one of those who think "there is good reason to believe that in women the sexual feeling becomes stronger at that epoch [the menstrual]; and it is quite certain," he says, "that there is a greater aptitude for conception immediately before and after menstruation, than there is at any intermediate period."

46

It would be strange, however, if the period of greatest aptitude for conception should be the one at which there is and always has been a repugnance to sexual union on the part of both sexes. Bischoff and Mr. Girdwood, consider this repugnance to be the result of habit, and the natural delicacy of the sex, rather than of actual disrelish; but this is by no means proved: on the contrary, facts would seem to establish the reverse. As confirmatory of the view, it has been affirmed by M. Raciborskis-who is, by the way, an ardent and enthusiastic observer-that the exceptions to the rule, that conception occurs immediately before, or immediately after, or during menstruation, are not more than six or seven per cent.; and that "of fifteen women, who specified accurately [?] the period of their latest menstruation, as well as the dates of the connubial act, five conceived from coitus taking place from two to four days previous to the period at which the catamenial discharge was due; in seven, conception was dated from coitus occurring two or three days after menstrua

b

Carpenter, Principles of Human Physiology, 2d edit., p. 688, London, 1844.
Physiology, by Baly, p. 1482.

Die Physiologie als Erfahrungswissenschaft, i. 250, 2te Auflage, Leipz. 1835.

Moser, art. Menstrua, in Encyclop. Wörterb. der Medicin, Wissenschaft, xxiii. 133, Berlin, 1840.

Op. cit.

f London Lancet, Dec. 7 and 14, 1844.

• London Lancet, Jan. 28, 1843, and in op. cit.

tion; in two, it took place at the actual period of the catamenia; and in only one so long as ten days after menstruation." Even in the exceptional case-we are told-the catamenia made their appearance shortly after the coitus, which took place at about the middle of the interval between the two regular periods.

These statements may be taken for what they are worth. They are, even if the facts were accurately observed, of which doubt may be entertained, numerically insufficient to enable any positive conclusions to be drawn: certainly we are not justified in inferring, that excepting within a short period before and after menstruation, the female is not likely to conceive, when-as hereafter shown-it has been sufficiently proved, that she is throwing off from the ovary infecund ova at other periods than the menstrual. All that we are perhaps justified in admitting from recent observations is the connexion of menstruation with the condition of the ovaries:-that ova are at this time, as at others, maturated and discharged into the Fallopian tubes; and that changes occur in the lining of the uterus accompanied by a peculiar discharge;-the ovarian and uterine changes being simultaneous, and perhaps the latter being consequent on the former; but we have not approached, in the slightest degree, to a knowledge of the purpose served by the periodical catamenial secretion. If the periodical discharge of ova be menstruation, why is it, that the catamenial flow does not always accompany the maturation and discharge of ova?

The bearings of these views on impregnation and the formation of corpora lutea will be seen hereafter.

The age, at which menstruation commences, varies in individuals and in different climates. It has been esteemed a general law, that the warmer the climate, the earlier the discharge takes place, and the sooner it ceases; but there is reason for doubting the correctness of this prevalent belief. With us, the most common period of its commencement is from thirteen to seventeen years. Mahomet is said to have consummated his marriage with one of his wives, "when she was full eight years old." Of 450 cases, observed at the Manchester Lying-in Hospital, in England, menstruation commenced in the eleventh year in 10; in the twelfth in 19; in the thirteenth in 53; in the fourteenth in 85; in the fifteenth in 97; in the sixteenth in 76; in the seventeenth in 57; in the eighteenth in 26; in the nineteenth in 23; and in the twentieth in 4. Menstruation commonly ceases in the temperate zone at from forty to fifty years. These estimates are, however, liable to many exceptions, dependent upon individual differences. In rare cases, the catamenia have appeared at a very early age, even in childhood; and again, the menses with powers of fecundity have continued, in particular instances, beyond the ages that have been specified: some of these protracted cases have had regular catamenia; in others, the discharge, after a long suppression, has returned. Of 77 individuals, they ceased in 1 at the age of 35; in 4 at 40; in 1 at 42; in 1 at 43; in 3 at 44; in 4 at 45; in 3 at 47; in 10 Raciborski, op. cit., p. 17. b Dr. A. Thomson, op. citat. p. 442. d Roberton, op. citat.

Prideaux's Life of Mahomet, p. 30, London, 1718.

at 48; in 7 at 49; in 26 at 50; in 2 at 51; in 7 at 52; in 2 at 53; in 2 at 54; in 1 at 57; in 2 at 60; and in 1 at 70. Of the 10,000 pregnant females, registered at the Manchester Hospital, 436 were upwards of 40 years of age; 397 from 40 to 45; 13 in their 47th year; 8 in their 48th; 6 in their 49th; 9 in their 50th; 1 in her 52d; 1 in her 53d; and 1 in her 54th. Mr. Roberton asserts, that as far as he could ascertain, and especially in the three cases above 50 years, the catamenia continued up to the period of conception."

The following table has recently been published by M. Brière de Boismont. It is founded on the results of 2352 cases. It will be seen from it, that by far the greatest number of women begin to menstruate during the 14th or 15th year.

Dr. Guy has furnished some valuable statistics in regard to the period at which the function commences and ceases amongst females in England. From observations on 1500 cases, he found, that the greatest number first menstruated at the age of 15; the 14th year came next in order; then the 16th: whilst the number at 13 and 17, at 12 and 18, and at 11 and 19, approximated very closely to each other. Before the 11th, and after the 19th year, the numbers were very small. In more than half the cases, the menses made their first appearance at 14, 15, and 16 years of age. The earliest period was 8, and the latest 25. In regard to the period at which menstruation ceases, he deduced from the results of 400 cases, that it might occur independently of disease, at any period from the 27th to the 57th * See Montgomery, on the Signs and Symptoms of Pregnancy, p. 160, London, 1837. De la Menstruation, &c. Paris, 1842.

a

For a similar table, formed from 5062 cases, see Dr. W. A. Guy, Principles of Forensic Medicine, part i. p. 79, Lond. 1843. See, also, Dr. Murphy, in London Lancet, Nov. 30, 1844, from Dublin Journal of Medical Science.

d Medical Times, Aug. 9, 1845; cited in Ranking's Abstract, vol. i. part ii. p. 248, New York edition, 1846.