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Full text of "The sexual life of woman in its physiological, pathological and hygienic aspects"

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THE 

SEXUAL LIFE OF WOMAN 



IN ITS 



PHYSIOLOGICAL, PATHOLOGICAL 
AND HYGIENIC ASPECTS 



BY 

E* HEINRICHiKISCH, M, D. 

Professor of the German Medical Faculty of the University of Prague ; Pfiysician to 
the Hospital and Spa of Marienbad ; Member of the Board of Health, Etc., Etc. 



ONLY AUTHORIZED TRANSLATION INTO THE ENGLISH LANGUAGE FROM 

THE GERMAN BY 

M. EDEN PAUL, M. D* 



WITH 97 ILLUSTRATIONS IN THE TEXT 




NEW YORK 

REBMAN COMPANY 

U23 BROADWAY 



Copyright, 1910, by 
REBMAN CO., NEW YORK 



All Rights Reserved 



Printed in America 



H o ^ u 



y 



TO MY ONLY SON 
FRANZ KISCH, M* D- 

AS A TOKEN OF PATEI^NAL AFFECTION 
I DEDICATE THIS BOOK 



1 25384 



PREFACE. 



The sexual life of woman — the appearance of the first mdica- 
tions of sexual activity, the development of that activity and its 
culmination in sexual maturity, the decline of that activity and its 
ultimate extinction in sexual death — the entire process of the most 
perfect work of natural creation — has throughout all ages kindled 
the inspiration of poets, aroused the enthusiasm of artists, and sup- 
plied thinkers with inexhaustible material for reflection. 

In the following pages, this sexual life of woman will be con- 
sidered both in relation to the female genital organs, and in relation 
to the feminine organism as a whole ; in relation both to the physical 
and to the mental development of the individual ; and in relation 
alike to the state of health and to the processes of disease. Thus 
from the standpoint of clinical investigation and of practical experi- 
ence, the book will be a contribution towards the solution of the 
sexual problem, nowadays recognized as one of supreme importance. 

It is thirty years since I published a work on the histological 
changes that occur in the ovaries during the climacteric period 
(Archiv. fiir Gynecologie, Vol. xii, Section 3) ; and ever since that 
time, the influence exerted upon the general health of women by the 
physiological and pathological processes occurring in their repro- 
ductive organs, has been to me a favourite subject for observation 
and experiment. The result of these studies is incorporated in my 
monographs, "The Climacteric Period in Women" (Erlangen, 
1874), "Sterility in Women" (2nd Ed., Vienna, 1895), "The 
Uterus and the Heart" (Leipzig, 1898), and in various contributions 
to medical periodicals. Inow have a welcome opportunity of draw- 
ing a general picture of sexual activity in women, and of illuminating 
this picture both by the light of my own experience and by numerous 
references to the works of other authors. In passing, I have de- 
voted considerable /attention to questions of education and per- 
sonal hygiene, both of which are greatly influenced by the processes 
of the sexual life. Thus, I hope, the work will be rendered more 
interesting to the physician, and the general picture it is intended to 
convey will be more fully characterized by contemporary actuality. 

Natural divisions of the subject are, I consider, furnished by the 
three great landmarks of the sexual life of woman: the onset of 
menstruation — the menarche: the culmination of sexual activity — 

[V] 



yi Preface, 

the menacme; and the cessation of menstruation — the menopause. 
These several sexual epochs are differentiated by characteristic 
anatomical states of the reproductive organs, by the external con- 
figuration of the feminine body, by functional effects throughout 
the entire organism, and, finally, by pathological disturbances of 
the normal vital processes. 

Thus in separate chapters a description is given of sexual proc- 
esses, a detailed exposition of which will be vainly sought in the 
textbooks of gynecology, yet which are none the less of far-reaching 
importance in relation to the physical, mental, and social well-being 
of women, and in relation also to the development of human society; 
such topics are, the sexual impulse, copulation, fertility, sterility, the 
employment of means for the prevention of conception, the determi- 
nation of sex, sexual hygiene. To the topics of pregnancy, parturi- 
tion, lying-in, and lactation, since these are adequately discussed in 
works on midwifery, but little space has here been allotted. 

It is my earnest hope that physicians and biologists may derive 
benefit from the book equal in amount to the pleasure I have gained 
in the work of writing it. 

E. HEINRICH KISCH. 



lABLE OF CONTENTS. 



PAGB 

The Sex jal Life of Woman — Introduction i 

T. The Sexual Epoch of the Menarche 37 

First Appearance of Menstruation 45 

Anatomical Changes in the Female Genital Organs at the Period 

of the Menarche 50 

Menarche Praecox et Tardiva 78 

Precocious and Retarded Menstrual Activity 78 

Pathology of the Menarche " 82 

Anomalies of Menstruation 83 

Inflammatory Processes 87 

Disorders of Haematopoiesis 89 

Cardiac Disorders 94 

Diseases of the Nervous System 99 

Masturbation 104 

Disorders of Digestion 107 

Diseases of the Respiratory Organs 107 

Diseases of the Organs of the Senses 108 

Hygiene during the Menarche in 

Menstruation 128 

Pathology of Menstruation 143 

Amenorrhoea, Menorrhagia, and Dysmenorrhoea 160 

Vicarious Menstruation 164 

The Sexual Impulse 166 

Nymphomania, Anaesthesia and Psychopathia Sexualis 184 

II. The Sexual Epoch of the Menacme 200 

Anatomical Changes in the Female Genital Organs in the Period 

of the Menacme 209 

Pathology of the Menacme 218 

Dyspepsia Uterina 227 

Cardiopathia Uterina 235 

Nervous Diseases Secondary to Diseases of the Genital 

Organs 243 

Competence for Marriage of Women suffering from Disease 250 

Hygiene during the Menacme 261 

Copulation and Conception 284 

Copulation 2 84 

Conception 304 

Pathology of Copulation 323 

Vaginismus t^t,'] 

Cardiac Troubles Due to Sexual Intercourse, 344 

Dyspareunia 347 

Fertility in Women 363 

The Restriction of Fertility and the Use of Means for the 

Prevention of Pregnancy 388 

The Determination ot Sex 420 

I. Statistical Investigations 422 

II. Anatomical Investigations 446 

III. Experimental Investigations 452 

Sterility in Women 462 

Incapacity for Ovulation 470 

Interference with Conjugation, Conditions Preventing Access 

of the Spermatozoa to the Ovum 487 

"Diseases of the Ovaries and the Fallopian Tubes 489 

Diseases of the Uterus 494 

Pathological Changes in the Cervix Uteri 501 

[viil 



viii Table of Contents. 

II. The Sexual Epoch of the Menacme — Continued. 

Sterility in Women — Continued. Page 

Displacements of the Uterus 515 

Myoma of the Uterus 523 

Diseases of the Vagina and the Vulva 526 

Secretions of the Genital Organs 528 

A. Absolute SteriHty 540 

B. Relative Sterility, 540 

Sexual Sensibility in Women 542 

Incapacity for Incubation ot the Ovum 549 

Only-Child-Sterihty 561 

Operative Sterility 563 

Table Showing the Causes of Sterility in Women 569 

III. The Sexual Epoch of the Menopause 571 

The Menopause 571 

■ Changes in the Female Reproductive Organs at the Menopause. 583 

The Time of the Menopause 593 

The Age at which the Menopause occurs 593 

1. Race 594 

2. The Age at which the Menarche Occurred 595 

3. The Woman's Sexual Activity 597 

4. The Social Circumstances of the Woman's Life 599 

5. General Constitutional and Pathological Conditions 599 

6. Premature, Delayed, and Sudden Onset of the Meno- 
pause 600 

Pathology of the Menopause 608 

Diseases of the Genital Organs 608 

Diseases of the Organs of Circulation 620 

Diseases of the Digestive Organs 630 

Diseases of the Skin 632 

Disorders of Metabolism 635 

Diseases of the Nervous System 637 

Climacteric Psychoses 643 

Hygiene during the Menopause 653 



LIST OF ILLUSTRATIONS (Kisch). 



Fig. . . Page 

1. Curve of the sexual life of woman from the tenth to the sixtieth . 

year of life 4 

2. Portion of the pelvic viscera in the female, etc 9 

3. The distribution of the pudic nerve in the female perineal and 

pubic regions 1 1 

4. The distribution of the lateral sacral arteries, etc 14 

5. Curve of menstrual cycle IQ 

6. Curve of rhythmical variations 20 

7. Curve of beauty of woman 24 

8. Internal genital organs of newborn female infant 51 

9. Reproductive organs of a newborn female infant 52 

10. Internal genital organs of a girl aged eight years 52 

11. Reproductive organs of a girl aged ten years 53 

12. Female external genital organs of a virgin 54 

13. The external genital organs of a virgin 55 

14. Sagittal section of the female pelvis 56 

15. Primitive follicles 5^ 

16. Ripening fcl'icles 61 

17. Graafian follicles 62 

18. Annular Hymen 64 

19. Annular Hymen - 64 

20. Semilunar Hymen 65 

21. Annular Hymen with Congenital Symmetrical Indentations 65 

22. Fimbriate Hymen 65 

23. Deflorated Fimbriate Hymen 65 

24. Septate Annular Hymen 67 

25. Septate Semilunar H3'men 67 

26. Extremely tough Annular Hymen with an obliquely disposed 

Septum 67 

27. Septate Hymen with Apertures of unequal Size 67 

28. Septate Hymen with Apertures of unequal Size 68 

29. Hymen with rudimentary Septum 68 

30. Hymen with posterior rudimentary Septum 68 

31. Labiate Hymen with posterior rudimentary Septum 68 

32. Hymen with anterior rudimentary Septum 69 

S3. Hymen with anterior rudimentary Septum projecting in a opini- 

form Manner 69 

34. Hymen with anterior and posterior rudimentary Septa 69 

35. Hymen with filiform Process projecting from the anterior 

Margin 69 

36. Hymen in which there are two symmetrically disposed thinned 

Areas. The left of these is perforated 69 

37. Very unusual form of Hymen 70 

38. Semilunar Hymen with cicatrized Lacerations in its Border 70 

39. Deflorated Semilunar Hymen with laterally disposed symmetrical 

Lacerations 70 

40. Deflorated Annular Hymen with several cicatrized Lacerations.. 70 

41. A. Septate Hymen in which defloration has been effected through 

one of the Apertures. U. Urethra. CI. Clitoris. H. Cicatrized 

Margin. C. Septum. B. Lateral view of Septum 70 

42. Deflorated Septate Hymen 71 

tix] . 



X List of Illustrations. 

Fig. ^ Page 

43. Hymen with larger anterior and smaller posterior Apertures.... 71 

44. Carunculai Myrtiformes in a Primipara 71 

45. Vaginal Inlet of a Multipara, without Carunculae Myrtiformes. 

Slight Prolapse of Anterior and Posterior Vaginal Walls 71 

46. The breast of a virgin aged eighteen years ys 

47. Plorizontal section through the female breast 75 

48. The female pudendum, or vulva, with the labia majora 204 

49. Vestibule of the vagin-a, with the labia mxinora or nymphse, etc. . . 205 

50. The uterus, the left Fallopian tube and the left ovary, etc 207 

51. Female internal genital organs in the fully developed state 208 

52. Sagittal Section through the Cervix Uteri of a Woman twenty-six 

years of age. Dendriform branched glands 217 

53. Cervix of a Woman seventy-two years of age, with glands that 

have undergone cystic degeneration 217 

54. Sagittal Section through the Cervix Uteri of a Woman sixty-five 

years of age. The glands have undergone cystic degeneration. 217 

55. First Stage. A. Entrance of a Spermatozoon into the Ovum of 

Ascaris Megalocephala. B. After preparations by M. Nuss- 
baum. (Half of the ova only are depicted) • • 306 

56. Ovum of Asterahanthion ten minutes after Fertilization 306 

57. Fusion of Male Pro-nucleus and Female Pro-nucleus to form the 

Segmentation Nucleus of the Fertilized Ovum 306 

58. Passage of Spermatozoon through the Zona Pellucida of the 

Ovum of Asterakanthion 307 

59. Ovum of Scorpsena Scrofa Thirty-five Minutes after Fertilization.. 307 

60. Male Pro-nucleus and Female Pro-nucleus in Fertilized Ovum 

of Frog, prior to the Formation of the Segmentation Nucleus. 307 

61. a. b. c. Prostatic calculi from normal semen, d. Spermatozoa. 

e. Large and small cells, some containing granules, as morpho- 
logical elements of semen, f. vSpermatozoon distorted by im- 
bibition of water, g. Crystals (after Bizzozero) 311 

62. Normal Semen 311 

6^. Semen consisting chiefly of spermcrystals, cylindrical epithelium, 

and small granules exhibiting molecular movement — but con- 
taining 110 spermatozoa 315 

64. Oligozoospermia. a. Living Spermatozoa, b. Dead Spermato- 

zoa, c. Pus Corpuscles, d. Erythrocyte, e. Seminal granules.. 317 

65. Septate Hymen, the septum having a tendinous consistency 324 

66. 

67. Lipoma of the Right labium majus, including the Vaginal Inlet. 328 

68. " Hottentot Apron " in an adult Woman, hanging down" between 

the thighs (after Zweifel) 329 

69. Elephantiasis of the Labia Majora 330 

71. Congenital Atrophy of the Uteras (after Virchow), oi, Ostium 

internum ; oe, Ostium externum 500 

71. 

'72. Normal Shape of the Portio Vaginalis 503 

73. Conoidal Shape of the Portio Vaginalis 503 

74. "Apron-Shaped Vaginal Portion, a. Greatly elongated anterior 

lip; b. Shorter posterior lip of the cervix 504 

75. "Beak-Shaped" Vaginal Portion. Posterior aspect 504 

^6. Simple Hypertrophy of the Portio Vaginalis, which projected 

from the Vulva 506 

yy. Elongated Cervix, bent upwards 506 

78. Cervical Polypus, originating from an Ovulum Nabothi 510 

79. Ectropium in a Case of Bilateral Laceration of the Cervix (after 

A. Martin) 514 

80. Anteflexio Uteri (after A. Martin) 518 

8.1. Retroflexio Uteri (after A. Martin) 520 



List of Illustrations. xi 



Fig. Page 

82. Mucus from the Cervical Canal, taken one hour after_ sexual in- 

tercourse, from a woman suffering from chronic endometritis. 
Among the epithelial cells, pus cells, and finely granular 
masses, we see a few motionless, dead spermatozoa 531 

83. Uterine Mucous Membrane in Endometritis (after A. Martin).. 554 

84. Sagittal section through the ovary of a girl aged sixteen 583 

85. Sagittal section through the ovary of a woman aged seventy-two 

years 584 

86. Diagrammatic Representation of the Graafian Follicle 585 

87. Ovary of a Girl aged nineteen years (Normal Size) 585 

8S. Ovary of a Woman seventy-two years of age (Normal Size).... 585 

89 ,. 586 

90 , 587 

91 : . • ' -^ • . •. 588 

92. Sagittal Section through the Cervix of a Woman twenty-six 

years of age. Dendriform branched glands 588 

93. Sagittal Section through the Cervix of a Woman sixty-five years 

of age. Glands which have undergone Cystic Degeneration. 589 

94. Cervix of a Woman seventy years of age. The Cervical Glands 

have undergone Cystic Degeneration 589 

95. Ovula Nabothi in the Portio Vaginalis 590 

96. Vesicle (Ovula Nabothi) from the Uterine Mucous Membrane.. 591 

97. Mucous Glands undergoing Cystic Degeneration 592 



THE SEXUAL LIFE OF WOMAN. 



By the sexual life of woman we understand the reciprocal action 
between the physiological functions and pathological states of the 
female genital organs on the one hand and the entire female organ- 
ism in its physical and mental relations on the other; and the object 
of this book is to give a complete account of the influence exercised 
by the reproductive organs, during the time of their development, 
their maturity, and their involution, on the life history of woman. 

From the earliest days of the medical art this sexual life of 
woman has aroused in the leaders of medical thought the highest 
interest, and for this reason great attention has been directed, not 
only to the anatomy of the genital organs and to the diseases of 
the reproductive system, but also to the individual manifestations of 
sexual activity and to the influence exercised by these on the female 
organism as a whole. 

Several works by Hippocrates are extant on this subject, among 
which may be mentioned : Ttepi Tovaix^ai^ <I>oato^^ a treatise on the 
physiology and pathology of woman; -^^pi A^'opcov^^ which discusses 
sterility in women; Tttpt napOzvuov ^ a treatise on the pathological 
states of virgins. These writings of Hippocrates contam some 
very remarkable observations on the influence exercised by disorders 
of the reproductive organs on the general health of women. 

Aristotle wrote at some length on the functions of the female 
genital organs. In the writings of Aretccus and Galen on the dis- 
eases of women we find striking observations, as for instance, in 
Galen's De Locis Affectis* which contains a " Statement of the 
Similarity and Dissimilarity of Man and Woman." Another notable 
work is that of Alhertiis Magnus, entitled De Secretis MulierumJ* 

The numerous works on the diseases of women published in the 
sixteenth century consisted for the most part of a repetition of the 
observations of ancient writers. The gynecological treatises of the 

* Concerning the Feminine Constitution. 
2 Concerning the Barren. 

^ Concerning Virgins. 

* On the Diseases of Regions. 

^ On the Secret Parts of Women. 



2 The Sexual Life of Woman. 

eighteenth century, however, bore witness to an increased knowl- 
edge of the anatomy of the female reproductive organs, and were 
illumined by Mailer's researches on the functions of these organs. 

The subject with which we are especially concerned is discussed 
in a work by B oireaii-Laff ecteur , Essai siir les Maladies Physiques 
et Morales des femmes,^ Paris, 1793; and also in Marie-Clemenfs 
Considerations Physiologiques sur les Diverses Epoques de la Vie 
des Eeimiies,'' Paris 1803. In the same connection we must men- 
tion von Humboldt's treatise, Ueber den Gesehlechtsunterschied und 
dessen Einfluss auf die organische Natur.^ The first comprehensive 
work in which an exhaustive inquiry was made into the functional, 
disorders of the female genital organs and the relation of these 
disorders to the female organism as a whole and to the physical 
and mental peculiarities of woman was Busch's: Das Geschlechts- 
leben des Weibes,^ Leipzig, 1839. 

Li the second half of the nineteenth century a very large number 
of monographs were pubHshed, investigating and describing the 
reflex disturbances produced alike in the individual organs and in 
the nervous system as a whole by changes in the uterus and its 
annexa. Many of these works will be mentioned more particularly 
in the course of this treatise. 

The sexual life, based upon the purpose, so important to every 
creature, of the propagation of the species, possesses in the female 
sex a vital significance enormously greater than sexual activity 
possesses in the male. From the very beginning of sexuaHty, when 
the idea of a bisexual differentiation dawns for the first time in the 
brain of the little girl, down to the sexual death of the withered 
matron, who laments the loss of her sexual potency, physical and 
mental activity, work and thought, function and sensation, arise for 
the most part, wittingly or unwittingly, from that germinal energy 
which is the manifestation of the unalterable law that the existing 
organism endeavors to reproduce its kind. 

Every phase of the sexual life of woman, from the threshold of 
puberty to the extinction of sexual activity, the first appearance of 
menstruation, the complete development of the sexual organs, the 
act of copulation, conception, pregnancy, parturition, and the puer- 
perium, finally the involutionary process which accompanies the 
cessation of menstruation at the climateric period- — every one of 

^ Essay on the Physical and Mental Diseases of Women. 
■^ Physiological Considerations on the Diverse Epochs of the Life of Woman. 
8 Concerning Sexual Differentiation, and Its Influence on Organic Nature, 
^The Sexual Life of Woman, 



Introduction. 3 

these sexual phases entails consecutive physiological processes and 
pathological changes alike in the individual organs and in the nu- 
tritive condition of the entire organism, in the functions of the 
cardio-vascular apparatus, of the brain and the nerves, of the skin 
and the sense-organs, in the processes of digestion and general meta- 
bolism. Herein we see a striking illustration of the old saying of 
von Helmont, propter solum uterum mulicr est quod est :^^^ also 
of the similar aphorism of Hippocrates, uterus omnium causa mor- 
horiun qui muliercs infestant ;^'^ a conception summed up by Goethe 
in the words of Mephistopheles : 

. " Es ist ihr ewig Weh und Ach 
So tausendfach 
Aus einem Punkte zu kurieren." 

Just as in a tree the process of growth is made manifest to the 
superficial observer by the pleasure he feels at the sight of the buds 
and blossoms, by the refreshment he obtains from the fruit, and by 
the sadness which the withering of the leaves causes him, so in the 
sexual life of woman there are landmarks which no one can pos- 
sibly overlook, by means of which three great epochs are distin- 
guished. These are: puberty (the menarche), recognized by the 
first appearance of menstruation and the awakening of the sexual 
impulse; sexual maturity (the menacme), in the fully developed 
woman, characterized by the functions of copulation and reproduc- 
tion ; and sexual involution (the menopause), in which we see the 
gradual decline and ultimate extinction of sexual power and all its 
manifestations. In all these three epochs the sexual life of woman 
not only affects the hidden domain of the genital organs, but con- 
trols also all the vegetative, physical, and mental processes of the 
body, and is clearly and incontestably apparent in all vital manifes- 
tations. What Madame de Stael said of love is indeed true of the 
entire sexual life of woman: I' amour n'est qu'une episode de la vie 
de I'homme ; c'est I'histoire tout entiere de la femme}^ 

The sexual life of woman is coextensive with the peculiar vital 
activity of the female sex, for it endures from the moment when 

^0 On account of the womb alone is woman what she is. 

11 The v/omb is t^/i cause of all the diseases from which women suffer. 

12 " Love is an episode merely in the life of man ; of woman, it is the 
entire history." But this epigram of Madame de Stael's will, to English 
readers, be more familiar in the form in which it was cast by Byron {Don 
Juan, canto i, stanza 194) : 

" Man's love is of man's life a thing apart; 
'Tis woman's whole existence." 



4 The Sexual Life of Woman. 

individuality first begins to develop out of the Indifferent stage of 
childhood until the decline into the dead-level of senility. 

To illustrate this fact, I have drawn up a curve of the sexual life 
of woman, making use of the statistical data available in central 
Europe regarding the age at which menstruation first appears, the 
age at which maidens marry, the age at which the largest number 
of women give birth to a child, and the age at which menstruation 
ceases ; and reducing the figures to averages. '^ denotes the fif- 
teenth year of life, as the average age at the menarche ; ** denotes 
the twenty-second year of life as the average age at marriage; 
*'^* denotes the thirty-second year of life, in which woman exhibits 
her maximum fecundity ; **** denotes the forty-sixth year of life 
as the average age at the menopause. (Fig. i.) 




Fig. I. — Curve of the sexual life of ^woman from the tenth to the 
sixtieth year of life. 



Not in this respect alone, however, is the sexual life of woman 
of paramount importance ; it is, in addition, the mainspring of 
the well-being and progress of the family, of the nation, of the 
entire human race. In the evolution of man from the primitive 
state in which he existed merely for the performance of vegetative 
functions up to the highest stage of contemporary culture, in the 
history of all races and of all times, the sexual life has been a most 



Introduction. S 

potent determining factor. With that Hfe, rehgion, philosophy, 
ethics, natural science, and hygiene, have been most intimately re- 
lated; for that life, they have furnished precepts and laws. The 
history of the sexual life is identical with the history of human 
culture. 

In a primitive condition of society, among people living in a state 
of nature and among the lower races of mankind, the sexual life of 
woman possesses no great general interest, the female being merely 
a chattel ; the ownership of this chattel, moreover, being often 
temporary and transient. The investigations of anthropologists 
have shown that among primitive people this form of property is 
neither highly esteemed nor carefully safeguarded. In such so- 
cieties no restraint is imposed on the sexual impulse, which is grati- 
fied without shame and without formality. No hindrance is offered 
to the mutual intercourse of the two sexes. Chastity in the females 
is not prized by the males, nor do the latter compete for the favors 
of the former. Procreation is no more than a gregarious impulse 
of the masses among whom the common ownership of all booty is 
a matter of tribal custom. The woman has no disposing power 
over that which every one desires and which every one has the right 
to demand. Very gradually, however, a change takes place in 
this respect, so that in every period of social life since the very 
earliest, the modesty of young girls, the high valuation put upon 
the preservation of virginity, the ethical approbation of chastity in 
the wife, respect for the duties and rights of the mother, the rever- 
ence felt for the matron — all these, throughout the sexual life of 
woman, have had a civilizing, ennobling, and elevating effect. 
Thus, as family life has become developed, and as love and 
marriage have been more highly esteemed, woman has become 
the much-prized embodiment of all that is beautiful and good, 
of all that is summed up in the idea of the '' housewife," and 
her sexual life has been more completely, more ideally admired. 
The danger is not remote, however, that the leveling tendencies of 
the present day, and an inclination to despise the sexual life of 
woman, far from resulting in a further elevation of the social 
status of womanhood, will result rather in its abasement. 

The Bible, as we may expect from the patriarchal relationships of 
the women of that time, bears witness to the worth of woman, and, 
whilst esteeming childbearing, refers to yet higher duties. Precise 
religious and social precepts are furnished for all the phases of 
sexual life. 



6 The Sexual Life of Woman. 

In classical antiquity, also, we see that woman rose to some extent 
above the low position she had previously occupied in the family 
circle and in society at large. Both among the Greeks and among the 
Romans, there was open to women a more intimate place in social life 
and a more influential role in the life of the family, than would have 
been their portion regarded merely in relation to their childbearing 
activity. Amongst the Germans in the very earliest times, chastity 
gave rise to purer and more moral sexual relations ; whereas among 
the Slavonic peoples the conception of woman as the childbearer 
continued to dominate these relations. 

In consequence of the diffusion of Christianity, woman became 
man's companion and equal, and her life, the sexual life included, 
acquired a deeper significance, owing to the stress which that re- 
ligion laid on chastity as a virtue, and as a result of the educational 
influence of woman in the family circle. 

With the progress of civilization the sexual life of woman comes 
to exhibit its activities only within the bounds of morality and law, 
which in human society have replaced the crude rule of nature, and 
have supplied regulations adapted to the changing phases of sexual 
vital manifestations. The wise adaptation of these regulations re- 
quires, however, a full understanding of the mental and physical 
processes, an exact recognition of the bodily states and intellectual 
sensibilities, of woman regarded as a sexual being. 

Modern culture and the social organization of the present day, 
in association with the resulting sexual neuropathy of women, have 
exercised on their sexual life an influence as powerful as it is un- 
favorable, manifesting itself in the overpowering frequency of the 
diseases of women. In one of the most thoughtful books ever writ- 
ten on the subject of woman, Michelet's L' Amour, ^^ the author re- 
marks that every century is characterized by the prevalence of cer- 
tain diseases : thus, in the thirteenth century, leprosy was the domi- 
nant disease ; the fourteenth century was devastated by bubonic 
plague, then known as the black death ; the sixteenth century wit- 
nessed the appearance of syphilis ; finally, as regards the nineteenth 
century, '' se siccle sera nomme celui des maladies de la matrice}^ 
It is certain that the education and mode of life of the modern 
woman belonging to the so-called upper classes are, as far as sexual 
matters are concerned, in direct opposition to those that are agree- 
able to nature and those that the laws of health demand. 

13 On Love. 

1"* " This century will be known as the centurv of the diseases of the uterus." 



Introductio]^. 7 

Even before sexual development begins, before the physical ripen- 
ing of the reproductive organs to functional activity, the imagination 
of young girls is often prematurely occupied with sexual ideas in 
consequence of unsuitable literature, owing to visits to theatres and 
exhibitions, or on account of social intercourse with young men 
who are not overscrupulous in the selection of topics for conversa- 
tion. From the time of puberty up to the time of marriage the 
growing woman is under the influence of the now awakened sexual 
impulse, which experiences ever-renewed stimulation. A sedentary 
mode of life, unsuitable nutriment, and the early enjoyment of alco- 
holic beverages, exhibit their inevitable result in the frequency with 
which, in this epoch of the sexual life, chlorotic blood-changes, neu- 
rasthenic conditions, and diverse symptoms of irritation of the genital 
organs, make their appearance. Thus, when marriage, so often un- 
duly postponed in consequence of the condition of modern society, 
does at length take place, it is apt to find the woman not only fully 
enlightened as regards sexual matters, but often in a state of 
nervous weakness from sexual stimulation, one of the type whose 
characteristics have been happily summed up by the French writer 
Prcvost in the expression dcmi-vierge}^ The conjunction of this 
state of affairs in the bride with the frequent partial impotence of 
the bridegroom, who has already dissipated the greater part of his 
virile power before entering upon marriage, leads often to the 
appearance of vaginismus and other sexual neuroses in young mar- 
ried women. Even more disastrous in its consequences as regards 
the future sexual life of the wife is the ever-increasing frequency 
of gonorrhoeal infection in the first days of marital intercourse, with 
all the evil results of that infection. On the other hand, an ever- 
larger proportion of girls belonging to the " middle and upper 
classes," abstaining alike from the good and the evil results of mar- 
riage, falls under the yoke of sexual impulses denied satisfaction or 
gratified by abnormal means, and suffers in consequence both phy- 
sically and mentally. Further sources of injury arising from the 
conditions of modern social life are to be found in the neglect by 
women of the well-to-do classes of the duty of suckling their chil- 
dren, and in the ever-increasing frequency with which the women 
of these classes, after giving birth to one or two children, resort to 
the use of measures for the prevention of pregnancy, which result in 
serious consequences as regards both the nervous system and the 
genital organs of the women concerned. Thus there comes an 
accelerated ebb in the sexual life, leading to a premature appearance 
.1^ Half-virgin. 



8 The Sexual Life of Woman. 

of the general phenomena of senility, with a cessation of the men- 
strual flow. The modern wife, who claims the right to lead the life 
that best pleases her, will be more rapidly overtaken by sexual death. 

For the elucidation of the manifold reflex and other processes 
Vv^hich are dependent upon or accompany the sexual phases of 
woman, we must in the first place consider the anatomical changes 
and physiological functions of the female reproductive organs char- 
acteristic of the several periods of sexual life which have already 
been distinguished. We must not fail also to take into consideration 
the mental states which accompany and characterize these respective 
phases. 

The anatomical changes which occur in the female genital organs 
during these different phases of sexual life give rise to a number of 
manifold local stimuli, increasing and decreasing, varying greatly 
in intensity and area of distribution, upon which depend the reflex 
effects and remote manfestations in the sphere of the nervous and 
circulatory systems. 

We must first consider the changes in the ovaries, which play an 
etiologically important part. At the onset of puberty, the follicular 
masses of the ovary exhibit a more active growth, the follicles in- 
crease in size, with their contained ova they approach the surface, 
and finally, by the bursting of the follicles, the ova are extruded. 
Then, in the life-phase in which conception occurs, and under the 
influence of the hypersemia of all the pelvic viscera that accompanies 
this process, a notable development of the corpus luteum takes 
place, this latter body reaching its maximum size in the eleventh 
week of pregnancy, subsequently undergoing involution and lead- 
ing to the formation of a considerable scar. Finally, in the critical 
period of life in which the menstrual flow ceases, a continually in- 
creasing growth and new formation of connective tissue-stroma 
takes place in the ovaries at the expense of their cellular constituents, 
and a regressive metamorphosis of the graafian follicles occurs. 

In association with these sexual processes there ensues a series 
of striking changes in the shape and consistency of the ovaries, af- 
fecting both the surface and the parenchyma of these organs, and 
capable of stimulating the nervous ramifications in their tissue. 
In this connection it is worthy of note that the branches supplying 
the ovaries from the spermatic plexuses of the sympathetic contain 
a considerable proportion of sensory fibres. 

Quite as significant, moreover, as the changes in the ovaries, are 
those which, in the course of the sexual life, the uterus undergoes, 



Introduction. 



Visceral peritoneum covering V 
the posterior or intestinal 
surface of the uterus 



Paiietal peritoneum of the 
lateral wall of the pelvis 



Visceral peritoneum-,^ 



Ureter 



Sacral promontory 



Sigmoid flexure of the 
colon 



Utero sacral liga-*" 
ment or fold of 
Douglas 



Extractor uteri - 
muscle in trans- 
verse section 



Pouch of Douglas 
or rectovaginal 
pouch 



Sacral curve of the^ 
rectum 



Tip of coccyx 






''Sigmoid meso- 


^^^^L 


colon 


;^^^ 




^^mm 


pp^''' Suspensory 


m^^^^^ 


^Mk ligament of 


'^^M 


^1 the ovary 


bB ^^ Fallopian 


xja 


a|y tube 


^9 


r' Mcsome- 


^^m 


^'V"" tnum 


^^^ 


Parametrium 


t^^. 


Round liga- 


-'' 


ment of the 




, ''■"' uterus 


i/. ?^'"'^--' 


T^^x Uterovesi- 


K'^'^ 


' cal pouch 


// 


"'' Lateral 


L' '' 


false liga- 


1 


ment of 


^ 


-- the 


m^'' 


bladder 



Vagina 

Levator an 

Anus • 
External or superficial sphincter of the anus 

Perineal curve of the rectum 



Pub s 
I' 

Wisceral peritoneum 

^Body of the bladder 

\Urethra 

Erectile tissue of the urethra 
I Urogenital diaphragm 
Vaginal bulb, or bulb of the vestibule 
Bartholin's gland 



Fig. 2. — Portion of the pelvic viscera in the female, and their relation to the muscles of the 
pelvic outlet (or perineal muscles), shown in the left half of the pelvis, seen from the right 
side.^The parametri-um. (From Toldt: Atlas of Human Anatomy. — Rebman Company, 
New York.) 



10 The Sexual Life of Woman. 

in shape and size, in its muscular substance and mucous lining, and 
in its vascular and nervous supply. 

At the time of puberty the infantile uterus undergoes changes 
affecting both its external form and the shape of its interior cavity. 
The body of the uterus enlarges to the size characteristic of sexual 
maturity, and its mucous membrane becomes the seat of periodic 
changes. This waxing and waning growth and transformation of 
the uterine mucous membrane continues throughout the period of 
menstrual activity, the most superficial layers of the membrane 
being shed during menstruation, a process followed by regeneration, 
which is itself succeeded by the premenstrual thickening. When 
conception occurs, still more extensive changes ensue, the fertilized 
ovum- becoming imbedded in the uterine mucous membrane, and the 
pregnant uterus, in shape and structure and in the respective re- 
lations of the body and neck of the organ, in the increasing dis- 
tension of its veins and the increasing size of its nerves, becoming 
adapted to the important functions it has now to fulfil. When these 
have been fulfilled, and, parturition having taken place, the uterus 
is empty once more, the organ again adapts itself to altered cir- 
cumstances by the process of involution. Later, in the climacteric 
period, a slow regressive process occurs, the outward manifestation 
of which is the cessation of the menstrual flow, characterized ana- 
tomically by atrophy of the muscular tissue of the uterus and of 
its vascular apparatus, by the dessication of its mucous membrane, 
by obliteration of the lumen of the uterine cavity, and ultimately by 
senile degeneration and atrophy of the now entirely functionless 
organ, so that it becomes an insignificant, cicatrized, solid body. 

Next to the ovaries and the uterus, it is the pelvic fascia which 
in its entire architectonic structure as well as in its individual parts 
undergoes the most notable changes in consequence of the proc- 
esses of generation. 

A short account of the nerves and blood vessels of the female 
genital organs appears indispensable, to facilitate the comprehen- 
sion of the manner in which sexual processes are influenced by the 
nervous system, and to demonstrate the intimate connection be- 
tween the blood-supply of the genital apparatus and the general 
circulation. 

The complex nervous network of the female sexual organs is 
supplied by spinal as well as by sympathetic fibres, the fibres from 
the two systems anastomosing in a very intimate manner. 

The greater number of the spinal nerves distributed to the 



Introduction. 



II 



Coccygeus mns( le 



Gluteus maximus muscle 



External or superficial 
sphincter of the anus 

Levator am muscle v 



Ischiorectal fossa 



Anococcygeal or subcaudal nerves 

Inferior haemorrhoidal nerve 
Perineal nerve 




Constrictor or com- /' 
pressor urethrae or^ 
transversus perinei 
profundus muscle 

Ischiocavemosus or 
erector penis muscle 



Bulbocavernosus or ejac- 
ulator penis muscle 



Branches of the 
inferior puden 
dal nerve 



Long 1-ibial ner\ci 



Labium majus^ 

Glans clitoridis 



Dorsal nerve of the clitoris 



Mons Veneris 



Fig. 3.— The distribution of the pudic nerve, n. pudendus, in the female perineal and pubic 
regions. The trunk of the pubic nerve, n. pudendus, is covered by the gluteus maximus muscle. 
On the right side of the body the branches of the inferior pudendal nerve, rami perineales, nervi 
cutanei fermoris posterioris have been dissected out ; but the branches of this nerve to the labium 
majus have been cut short. The formation of the anococcygeal or subcaudal nerves, nn. anococcy- 
gei, out of the posterior primary division of the coccygeal nerve and out of the perforating 
branches which arise from the anterior primary divisions of the fourth and fifth sacral nerves and 
the coccygeal nerve. (From Toldt : Atlas of Human Anatomy. — Rebman Company, New York.) 



12 The Sexual Life of Woman. 

genital organs arise from the lumbar portion of the spinal cord, 
pass as rami communicantes to the first four lumbar ganglia of the 
great sympathetic cord, whence they proceed to the series of 
symmetrical (paired) and asymmetrical (azygos) sympathetic 
plexuses in front of, and adjacent to the abdominal aorta, which 
already contain afferent and efferent spinal fibres derived from the 
pneumogastric, phrenic, and splanchnic nerves. A small number 
only of coarse nerve-filaments, a larger number of fine nerve- 
filaments, derived from the sacral nerves, proceed direct to the 
internal genital organs ; many of these fibres enter the lower ex- 
tremity of the pelvic or inferior hypogastric pleans, some pass to 
the cervical ganglia of the uterus. Below the bifurcation of the 
aorta and in front of the sacral promontory, a large number of the 
uterine nerves, both of spinal and of sympathetic origin, unite to 
form an azygos plexus which has been shown by experiment to 
possess great functional importance. Anatomically this consti- 
tutes the upper undivided portion of the hypogastric plexus, which 
is the downward continuation of the abdominal aortic sympathetic 
plexus; but inasmuch as it is the principal channel of nervous im- 
pulses to the uterus it is often known at the present day as the 
great uterine plexus {plexus iiterinus magniis). The nerves to 
the ovary and Fallopian tube (ovarian nerves) are derived from 
the spermatic (ovarian) plexus, an offshoot of the renal plexus; 
as the spermatic plexus descends, it is reinforced by branches from 
the abdominal aortic plexus, these branches often arising from 
a small ganglion (spermatic ganglion). The hypogastric or great 
uterine plexus, single and median above, divides below into the 
paired pelvic or inferior hypogastric plexuses, which pass down- 
ward and forward on either side of the rectum ; these plexuses are- 
reinforced by spinal elements derived from the sacral nerves. 
Before the terminal expansions of the pelvic or inferior hypogas- 
tric plexus enter the tissues of the internal genital organs, the 
bladder, and the rectum, small masses of ganglionic matter are inter- 
spersed among the nerve fibres. 

To the above general sketch, which has been based on the 
synoptical description of Chrobak von Rosthorn, must be added 
a more detailed account of the innervation of the ovaries, this 
branch of the subject being of especial importance. The nerves of 
the ovary are derived from the sympathetic system, in part from 
the spermatic ganglion, in part from the second renal ganglion, 
and in part from the superior mesenteric plexus. The nerves of 



Introduction. 13 

the ovary are for the most part vascular nerves, which unite before 
entering the ovary to form the ovarian plexus, and then pass into 
the hilum with the vessels, envelop the vessels of the medullary 
laver, and thence pass to the follicular region; exceedingly 
numerous, they form a close-meshed network, surrounding all the 
vessels up to the finest capillary ramifications; those fibres which 
terminate in the capillary walls and those also which reach the 
follicles are regarded by Riese as sensory. The great trunks of 
the uterine nerves are transversely disposed in relation to the great 
lateral vessels of the uterus, and passing inward toward the mucous 
membrane they break up into pencils of filaments; the uterine 
nerves proper are distributed for the most part to the muscular 
substance. In the Fallopian tubes, the nerves form arches around 
the lumen of the tube; some fibres also pass to the longitudinal 
folds of the mucous membrane. 

This expansion of the nerves of the cerebrospinal and sympa- 
thetic systems in the female reproductive organs manifests the 
multiple interconnection of the two systems in this region, and 
proves beyond doubt that the sensory nerves of the genital organs 
have manifold connections with the motor tracts of the whole 
organism on the one hand and with the sensory ganglia of the central 
nervous system on the other, and in addition with the vasomotor 
centres and with efferent motor and secretory fibres. 

As regards the vascular system of the female genital organs, the 
latter are supplied by the internal iliac artery. One of the two 
terminal branches of the common iliac, the internal iliac artery, 
descends into the pelvis over the sacro-iliac synchondrosis. Its 
branches may be arranged in four groups: anterior group, the 
hypogastric, iliolumbar, and obturator arteries; posterior group, 
the lateral sacral, gluteal, and sciatic arteries; internal group, the 
inferior vesical, uterine, and middle haemorrhoidal arteries ; in- 
ferior group, comprising a single artery only, the internal pudic; 
the uterine artery supplies the uterus and the vaginal fornices; the 
ovarian artery supplies the ovary, the Fallopian tube, and the broad 
ligament of the uterus; the vaginal, cervicovaginal, or vesicova- 
ginal artery supplies the vagina; the internal pudic artery suppHes 
the vestibule and the clitoris ; the superior and inferior external 
pudic arteries (branches of the femoral artery) supply the labia 
majora. The veins of the female genital organs correspond in 
general to the arteries in their course and nomenclature, and empty 
their blood into the internal iliac vein. 



14 



The Sexual Life of Woman. 



Left common, iliac artery 



^ Superior haem- 
orrhoiclal ar- 
tery 




Left external iliac artery 
Left mternal iliac artery 
Obliterated hypogastric artery 
Left uterine artery 



Left ovary n 
Ovarian artery (m the suspen- 
sory ligament of the ovary) "^^ 



Me:>osalpynx 

Ovarian branch of the > 

uterine artery ^ AC' 

Fallopian tube ^ / 

Tubal branch of 
the uterine artery 



Round Hga 
ment of the ' 
uterus 

Visceral peri- 
toneum of the ^' 
urinary bladder 
Dorsal artery of 
the clitoris 
Artery of the cor- 
pus cavernosum 
of the clitoris 
Divided anasto- 
moses of the vagi- 
nal bulb, or bulb of the 
vestibule with the cor- 
pora cavernosa of the 
clitoris 

Urethra 
Deeplayerof the trian 

gular ligament of 

the urethra ^ 

Artery of the bulb 
Vaginal bulb or bulb of 

vestibule 

Offset of the internal pudic 
artery to the urogenital dia- 
phragm and to the urethra 



^>. Left ureter 
Vagina 
Levator am muscle 



Internal pudic artery (artery 
of the clito is) 



Bartholin's gland 



Fig. 4. — The distribution of the lateral sacral arteries, the superior hacmorrhoidal 
or superior rectal artery, the uterine artery, the ovarian artery and the _distal portion 



of the internal pudic artery. 
pany, New York.) 



(From Toldt : Atlas of Human Anatomy. — Rebman Com- 



Introduction. 15 

Attention must also be paid to the extremely rich lymphatic 
vascular system of the female genital apparatus. The body of the 
uterus and the annexa of that organ, the neck of the uterus and 
the vaginal fornices, the middle segment of the vagina, the lower 
segment of the vagina, the vestibule and the external genital 
organs — each of these possesses an independent set of lymphatic 
vessels, leading moreover to independent groups of lymphatic 
glands. It may be said that the lymph from the vulva passes to 
the inguinal glands, that from the vagina and the neck of the 
uterus to the internal and the external iliac lympathic glands, that 
from the up^er part of the uterus and also that from the ovaries 
and Fallopian tubes to the median group of lumbar lymphatic 
glands (also known, from their position in front of the aorta and the 
vena cava, as the aortic lymphatic glands) (Chrobak von Rost- 
horn). 

The important influence which the genital processes exercise on 
the female organism as a whole is established not only by the 
anatomical relations just described but also by a number of physio- 
logical investigations and experiinents and by the result of opera- 
tions on the female genital organs. 

Thermic and mechanical stimulation of the female genitals has, 
as my own experiments have sliown, a notable influence on the 
heart and the general circulation. In these experiments, when 
uterine douches were given at temperatures of 4° C. (39° F.) and 
45° C. (113° F.), the reflex nervous impulse which resulted from 
these manipulations had a two-fold influence on the circulation, 
manifesting itself first by an immediate and considerable augmenta- 
tion in the functional activity of the heart, the frequency of which 
was increased in a degree proportional to the nervous sensibility 
of the individual, and secondly by a notable rise in blood pressure. 
With a view to determining the influence of stimulation of the 
ovary on blood-pressure, Rolirig carried out some experiments on 
bitches, from which it appeared that electrical stimulation of the 
ovary invariably produced .a remarkable increase in the general 
blood-pressure, an increase ranging from twelve to twenty-four 
millimeters of mercury. It further appeared in the course of these 
experiments that toward the end of the period of stimulation the 
rise in blood-pressure was always followed by a decline ; to which, 
however, a renewed rise of blood-pressure succeeded after the 
stimulation was discontinued, provided the duration of this had not 
been excessive. Only after this second rise was the normal mean 
blood-pressure regained. Finally it was established that the pro- 



i6 The Sexual Life of Woman. 

nounced phenomena of vagus-irritation exhibited by the curve 
during and immediately after the stimulation of the ovary were 
invariable concomitants of the rise of blood-pressure produced by 
such stimulation. 

According to the observations of Federns, the blood-pressure 
undergoes a rhythmical change between one menstrual period and 
the next, the pressure curve being normally at its lowest at the 
time of the commencement of the flow, and at its highest at some 
time during the two days immediately preceding the flow. This 
rhythmical change of blood-pressure manifests itself also some 
time before the first onset of menstruation, when the approach of 
puberty is indicated only by the menstrual molimina.* 

Observations made by Kretschy in a patient with a gastric fistula 
have proved the influence exercised on gastric digestion by the 
physiological processes occurring in the female reproductive organs. 
In this patient, his attention was especially directed to determining 
at what period of digestion the secretion of acid by the stomach 
attains its maximum, and how that secretion increases and 
diminishes. He observed that the digestion of breakfast was com- 
pleted in four and one-half hours, the acid-maximum occurring in 
the fourth hour, and the reaction of the gastric contents becoming 
neutral one and one-half hours later. This apparently constant 
acid-curve began, however, to become irregular as soon as the 
first symptoms of the approach of menstruation became apparent. 
When the flow had actually begun, he found that the reaction 
of the gastric contents remained acid throughout the entire day. 
As soon as the flow was over, the normal acid-curve was im- 
mediately reestablished. 

These observations have been confirmed by Fleischer. This 
investigator carried out his researches in menstruating women 
with normal stomachs, and found that with the appearance of 
the catamenia the process of digestion was almost always notably 
retarded, but that with the diminution and cessation of the flow 
digestion returned to the normal. 

By stimulation of the central segment of the divided hypogastric 
or great uterine plexus, Cyon was able to provoke vomiting, a con- 
firmation of the well-known physiological fact that irritative disturb- 
ances of the female reproductive organs have a reflex influence on 
the vomiting centre. 

It is also clearly established that diverse stimulation of peri- 
pheral nerves, those for instance of the mammary gland, of the 
internal genitals, or of the epigastrium, is capable of affecting the 
motor centre of the uterus. 

Worthy of note also are Strassmann's experiments, showing that 



Introduction. 17 

rise of pressure in the ovary causes swelling and structural 
changes in the uterine mucous membrane. 

Striking also are Neusscr's discoveries that during menstruation 
there is an increase in the eosinophil cells of the blood, and that 
by the intermediation of the sympathetic nervous system the 
ovaries exercise an influence on the haematopoietic function of 
the red marrow of the bones. Most noteworthy is the connection 
between the functional activity of the ovaries and osteomalacia. 
In this disease of metabolism we have to do, according to Fehlings 
now generally accepted assumption, with a trophoneurosis of the 
bones, a stimulation of the vasodilator nerves oithe osteal vessels, 
dependent on a reflex impulse from the ovaries. The connecting 
path between the ovaries and the bones Neusser finds in this case 
also in the sympathetic nervous system. 

The reflex influence exercised on the heart and the general cir- 
culation has been shown also by the results of operations on the 
female genital organs. In cases in which the ovaries have been 
removed, or in which these organs have been roughly handled, 
Hegar has noticed a great diminution in the frequency of the 
pulse, sometimes even cessation of the heart's action. In similar 
circumstances Chaiuponicre also observed as a rule diminished 
frequency of the pulse, but in some cases increased frequency. 
Mariagalli and Negri have described tachycardia following lap- 
arotomy and the extirpation of double pyosalpinx. Bonvalot has 
published cases in which, in consequence of vaginal or intra-uterine 
injections, in consequence of simple examination, and in conse- 
quence of the performance of version, sudden death has resulted 
from cardiac syncope. 

The psychical influences which proceed from the female genital 
organs in the dift'erent periods of sexual life have also great signi- 
ficance for the organism as a whole. Manifold impulses both 
stimulating and depressing arising in the reproductive organs afifect 
the workings of the mind. The maiden at puberty is affected by 
the knowledge of sexuaHty; the sexually mature woman, by the 
desire for sexual satisfaction, and by the yearning for mother- 
hood ; the wife, by the processes of pregnancy, parturition, and 
suckling, or, on the other hand by the distressing consciousness of 
sterility ; the woman at the climacteric period, by the knowledge of 
the disappearance of her sexual potency. The mind is further 
sympathetically influenced by the stimulation of the terminals of 
the sensory nerves in the genital organs. Through the increase 
of such stimulation, through its spread to adjacent nerves and 
nerve tracts and to the entire nervous system, the mind is affected, 

9 



i8 The Sexual Life of Woman. 

directly by irradiation, or indirectly by vasomotor processes and 
spinal hyperaesthesia. 

Psychical manifestations and the nervous states associated with 
these are somewhat frequently, and even actual psychoses occa- 
sionally, encountered in the various phases of the sexual life of 
woman, sometimes taking the form of violent sexual storms, which 
may indeed, as ordinary menstrual reflexes, accompany every cata- 
menial period. 

Of great interest are the facts which have, in recent times espe- 
cially, been scientifically established, pointing to a certain periodicity, 
to an undulatory movement of the general bodily functions of the 
female organism, dependent upon the sexual life. The observations 
of Goodman, Jacobi, von Ott, Rabutcau, Rcinl and Schichareff, 
have shown that in woman the principal vital processes pursue a 
cycle made up of stages of increased and diminished intensity, and 
that this periodicity of the chief general processes of vital activity 
finds expression also in the functions of the reproductive organs. 
Goodman has compared this play of general vital functions to an 
undulatory movement. According to this writer, a woman's life 
is passed in stages, each of which corresponds in duration with a 
single menstrual cycle. Each of these stages exhibits two distinct 
halves, in which the vital processes are respectively ebbing and 
flowing: in the latter we see an increase of all vital processes, a 
larger heat production, a rise in blood-pressure, and an increased 
excretion of urea; in the former we see, on the contrary, that all 
these vital processes display a diminished intensity. The moment 
when the period of increased vital activity is at an end, the moment 
when the ebb begins, corresponds, according to Goodman^ to the 
commencement of the catamenial discharge. 

Goodman sought for verification of this undulatory theory of the 
sexual life of woman in certain data regarding the bodily tem- 
perature and the blood-pressure. A more extensive research was 
undertaken by Jacohi, who, as the result of her observations, came 
to the following conclusions. In eight cases 'she noticed in the pre- 
menstrual epoch a rise of temperature ranging from 0.05° C. to 
0.44° C. (0.09° F. — 0.79° F.) ; and during the catamenial discharge 
a gradual fall of 0.039° C. — 0.25° C. (0.072° F. — 0.45° F.), never 
less, that is to say, than a quarter of a degree Centigrade ; but in the 
majority of cases the temperature did not, while the catamenia lasted, 
regain the normal mean. She further observed in the generality 
of cases an increased excretion of urea during the premenstrual 
epoch ; and a notable fall in blood-pressure during menstruation. 

ReinVs observations on healthy women, in whom menstruation 
ran a normal course, showed that in the great majority of cases in 



Introduction. 



19 



the premenstrual epoch the temperature was elevated as compared 
with that of the interval, that in eleven out of twelve cases the 
temperature gradually declined during menstruation, to fall in three- 
fourths of the cases below the mean temperature of the entire inter- 
val, and exhibiting in the post-menstrual epoch a still further depres- 
sion, giving place, however, to a somewhat higher mean temperature 
during the first half of the interval. In the second half of the in- 
terval a higher mean temperature was observed than in the first 
half. 

If we make a graphic representation of the mean differences in 
temperature commonly observed throughout the various stages of 
an entire menstrual cycle, we see that the curve does in fact take the 
form of a wave. That drawn by Reinl is shown in the following 
figure: (Fig. 5.) 

I Premenstrual epoch 



Menstruation 



First half 



Post-menstrual epoch 




, Fig. 5. 

The rising portion of the wave, the beginning of the tidal flow, 
corresponds to the second half of the interval ; the height of the tidal 
flow, the crest of the wave, corresponds to the premenstrual epoch. 
As the flow gives place to the ebb, as the wave begins to decline, 
we come to the actual period of the catamenial discharge ; later in 
the ebb is the post-menstrual epoch, and the lowest portion of the 
declining wave corresponds to the first half of the interval. Rhyth- 
mic changes corresponding to those observed in the temperature 
have been recorded — at least in isolated stages of the menstrual 
cycle — afifecting the blood-pressure by Jacohi and by von Ott, affect- 
ing the excretion of urea by Jacohi and by Rabuteau, and affecting 
the pulse by Hennig. It is evident that the vital activity of the 
organism attains its maximum shortly before menstruation ; and 
that with or immediately before the appearance of the catamenial 
discharge, a decline of that activity commences. 

Schradcr, through his researches on metabolism during menstrua- 
tion in relation to the condition of the bodily functions during this 
process, has established that immediately before menstruation the 
elimination of nitrogen in the faeces and the urine is at its lowest, 
a fact which indicates that at this period of the menstrual cycle 
the disintegration of albumen in the body is notably diminished. 



20 



The Sexual Life of Woman. 



Von Ott found in thirteen cases out of fourteen that at the be- 
ginning of the catamenial discharge or just before a considerable 
fall in blood-pressure occurred, and that throughout the flow the 
pressure almost always remained below the mean, no rise taking 
place till menstruation was finished ; this fall in blood-pressure dur- 
ing menstruation was more considerable than could be accounted 
for by the moderate haemorrhage. The same author, in conjunction 
with Schichareff, examined fifty-seven healthy women in respect 
of heat-radiation, muscular power, respiratory capacity, expiratory 
and inspiratory power, and tendon-reflexes. He found that the 
energy of the functions of the female body increased before the 
beginning of menstruation, but declined with or immediately before 
the appearance of the catamenial discharge. He exhibited this 
rhythmical variation in the vital processes by means of the follow- 
ing curve, in which the line A B represents these physiological varia- 
tions, whilst on the abscissa line c e, the days of observation are re- 
corded, and the interval m n represents the menstrual period. 
The degree of intensity of the united functions is indicated by the 
numbers o — lOO on the ordinate. 



^0 



75 



50 



25 





















/ 






\ 


















- 


















/ 


/ 








\ 


/ 




















i. 




^ 




.^ 


^ 


y 














/ 

/ 




/ 


^ 


■^ 




^ 


-- 




J 


























m 


1 
































































1 


2 


3 


A. 


5 


e 


7 


8 


3 


10 


11 


12 


13 




20 


21 


22 


23 


Z(k 


25 


2<> 


27 


2fi 



Fig. 6. 



Still another point of view from which the influences affecting 
the female organism as a whole may be regarded has very recently 
become apparent in consequence of the doctrine of Brozmi-Scqnard 
relating to the internal secretions of ductless glands. As regards the 
female reproductive glands, which in consequence of their structure 
must be referred to the group of ductless glands, and yet owing to 



Introduction. 2I 

their secretory function must be classed among secreting glands 
(so that the nature of the ovary is that of a secreting gland without 
an excretory duct), it would appear that these glands are not con- 
cerned only with the specific female reproductive functions of men- 
struation and ovulation, but that they also exercise a powerful in- 
fluence on the nutritive processes, on metabolism and hsematopoiesis, 
and on growth and development in their mental as well as their 
physical relations. 

It is supposed that these glands under normal conditions en- 
rich the blood with certain substances, which in part assist in 
haematopoiesis, and in part by regulating the vascular tone in the 
various organs are concerned in the normal processes of assimilation 
and general metabolism. According to Etienne and Demange, 
ovariin possesses an oxidising power similar to that possessed by 
spermin. Thus it becomes easy to understand how disturbances in 
the functions of the ovaries give rise to disturbances in the 
processes of general metabolism and of assimilation. Some go 
even further, though in doing so they leave the ground of assured 
fact, suggesting that the ovary in certain circumstances pro- 
duces toxins, or that the normal ovary possesses an antitoxic func- 
tion, and speaking of an occasional ovarian auto-intoxication of the 
body or of a menstrual intoxication. Thus, chlorosis is by some 
regarded as a disturbance of haematopoiesis, dependent on an ab- 
normal condition of the female reproductive organs during the 
period of development, and referable to a disturbance of the internal 
secretion of the ovaries {Charrin, von Noorden, Salmon, Etienne, 
and Demange). And it is now generally assumed, the assumption 
being based on the observations recently made concerning the or- 
ganotherapeutic employment of the chemical constituents of the 
ovary, that many of the disorders, and especially those connected 
with the vasomotor system, common during the climacteric period, 
are dependent on the deficiency of the products of the internal 
secretion of the ovary that accompanies the cessation of the menses. 

Recent experimental investigations on this subject have shown 
that the interconnection between the female genital organs and the 
organism as a whole, between the functions of the reproductive 
organs and the functions of other organs, does not depend on 
nervous influences only, but that in this interconnection the blood 
vascular system and the lymphatic vascular system also play their 
parts. Goltz has proved by actual experiment that the nervous in- 
fluence on menstruation and ovulation is not the only determinant. 
In a bitch, he divided the spinal cord at the level of the first lumbar 
vertebra, and observed, as soon as the animal had recovered from the 
operation, the appearance of the usual signs of heat ; the bitch was 



22 The Sexual Life of Woman. 

impregnated, and gave birth to one living and two dead puppies; 
Jactation and sucking took place as in a normal animal. When the 
bitch was killed and the body examined it was found that no reunion 
had taken place in the severed spinal cord. The experiments of 
Halban gave similar results. He found that in apes, if the ovaries 
are removed from their normal situation and successfully trans- 
planted to some region remote from the genital organs, the animals 
remain capable of menstruating. But if the ovaries, which have 
been transplanted beneath the skin or beneath the peritoneum, are 
subsequently entirely removed, menstruation, which has continued 
regularly after the first operation, ceases altogether after the second. 
It follows from these experiments that the cessation of the menstrual 
process may be considered to be brought about through the inter- 
mediation of the lymphatic or blood-vascular system, by the ab- 
sence of a kind of internal secretion. 

Loezvy and Richter have further proved by experiment that in 
vSpayed bitches the consumption of nitrogen is less by about 20 
per cent, and the entire gaseous interchange less by about 9 per 
cent., as compared with what takes place in normal animals, and 
that this change in respiratory metabolism lasts for a long time 
after the oophorectomy, for as much as nine to twelve months. If 
dried ovaries are given to such animals in their food, the gaseous 
interchange rises to the former level and even higher. 

The undulatory movement of the vital processes in woman is 
apparently in some way dependent on ovulation, though the nature 
of the connection has not hitherto been fully elucidated. This view 
is confirmed by the fact that no such rhythmic variation in the 
bodily functions can be detected either in girls under thirteen years 
of age, or in women from fifty-eight to eighty years of age in 
whom menstrual activity has entirely disappeared. The menstrual 
rhythm begins at puberty and ends when ovulation ceases. 

A further contribution to the doctrine of the undulatory move- 
ment of the vital processes in woman is to be found in my own 
observations that pathological symptoms which have become mani- 
fest before and at the time of the first onset of menstruation, and 
have given but little trouble throughout the period of developed 
and regular sexual activity, are apt when menstruation ceases to 
recrudesce, and to become as prominent as they were at the com- 
mencement of the sexual life. Women who at the time of puberty 
suffered from cardiac troubles, from digestive disturbances, or from 
various forms of nervous irritation, and in whom as they grew up 
these disorders passed more or less into abeyance, are apt at the 
climacteric period to exhibit, as I have frequently been able to 
observe, a violent return of these symptoms, in the form, as the 



Introduction. 23 

case may be, of tachycardia, of dyspeptic troubles, or of psycho- 
neuroses. In this connection we may mention an observation of 
Potain's, who distinguishes a pecuHar form of chorosis, occurring in 
individuals of delicate constitution, which, though apparently cured, 
reappears at the menopause. 

Related to the sexual life of woman is another attribute, one in- 
timately connected with the idea of the female sex, and one which 
since the primeval days of humanity has filled men with delight and 
poets with inspiration — the attribute of beauty. 

The beauty of woman, a prominent secondary sexual character, 
makes its first appearance at puberty, when the girl's form, hitherto 
undifferentiated in its external bodily configuration, begins to as- 
sume a soft and rounded appearance, when the features become 
regular, the breasts enlarge, and the pubic hair begins to grow — 
when, in short, to the primary sexual characters already existing, 
the secondary sexual characters are superadded. 

Feminine beauty continues to increase until the attainment of 
sexual maturity. In her third decade woman arrives at the acme 
of her sexual life and at the same time attains the perfection of her 
beauty. 

The ensuing sexual phases, pregnancy, parturition, and lactation, 
entail a decline in beauty, not rapid indeed, but advancing gradually, 
with the slow yet sure-footed pace of time. The organic revolutions 
accompanying these processes leave traces recorded upon the sur- 
face of the body in conspicuous and indelible characters. The ill- 
nesses, also, which so often accompany the fulfilment of sexual 
functions, in injuring health impair also beauty. 

A woman who has given birth to and nursed an infant begins to 
lay on fat, afid this tendency to obesity becomes more pronounced 
as the climacteric period approaches. The breasts become inelastic 
and pendent, the abdomen becomes ungracefully prominent ; the 
tonicity of the entire organism gradually declines, and, in conse- 
quence of the loss of elasticity in the subcutaneous cellular tissue, 
the dreaded wrinkles make their appearance and the features be- 
come wizened. Beauty is a thing of the past. With the cessation 
of the sexual life the external secondary sexual characters disappear, 
and the old woman is even farther removed than the old man from 
our conception of beauty. 

As Mantegazza insists, the beauties peculiar to women are one and 
all sexual ; they depend, that is to say, upon the peculiar functions 
that nature has allotted to woman in the great mystery of procrea- 
tion. One of the most vivid and poetical descriptions in ancient or 
modern literature of these secondary sexual characters on which 
feminine beauty depends is to be found in the Song of Solomon. 



24 



The Sexual Life of Woman. 



In the following figure (Fig. 7) the curve of beauty of woman 
is given as drawn up by Stratz. In one case it may rise very 
quickly, to decline with equal quickness — the so-called bcaute du 
diable;'^^ in other cases, again, the curve rises very slowly, and 
declines also very slowly, the culmination of the curve being in 
this case attained later, and when attained being absolutely higher, 
than in the case of the steeper curve. 

The age at which the maximum of beauty is attained is a very 
variable one. In the southern races this often occurs as early as 
the fourteenth or fifteenth year of life; but in the peoples of the 
Teutonic stock, Germans, Dutch, Scandinavians, and English, not 
as a rule before the twentieth year^ and it may be even later. Strata 




Fig. 7. 

has known cases in which women did not attain the prime of 
their beauty until the thirtieth and even the thirty-third year. The 
same author, a most competent authority as regards the subject 
of feminine beauty, affirms that a beautiful woman is most beauti- 
ful w^hen the period of maximum beauty coincides in her case with 
the first month of her first pregnancy. With the commencement 
of pregnancy the processes of nutrition are accelerated, all the 
tissues are tensely filled, the skin is more delicately and at the same 
time more brightly tinted owing to the greater activity of the cir- 
culation, the breasts become firmer and more elastic. Thus the 
attractive characteristics of beauty at its fullest maturity become 

*<* Beauty of the devil. 



<!. I 



ll 



Introduction. 2$ 

enhanced, but for a short time only, since the enlargement of the 
abdomen in the further course of pregnancy impairs the harmony 
of the figure. Finally we must point out, before dismissing this 
subject, that women of the so-called better classes arrive as a rule 
at maturity later, and remain beautiful for a longer period, than 
women of the working classes. 

The degree to which the female organism as a whole is in- 
fluenced by the processes of the sexual Hfe that occur in the genital 
organ depends upon many of the characteristics that combine to 
make up the individuality. Inherited characteristics, tempera- 
ment, and race, play a great part in this connection; and not less 
important than these are the social conditions, the environment, in 
which the women under consideration pass their life. Thus, 
among women belonging to the poorer, labouring classes, the reflex 
manifestations in other organs dependent upon the processes of 
the genital organs are less frequent and less intense than among 
women belonging to the well-to-do strata of society and to the 
cultured classes; less also in the country than in large towns. In 
phlegmatic individuals, such manifestations exhibit less intensity 
than in those of an active,, ardent temperament ; they are less fre- 
quent in persons with a powerful constitution than in those en- 
dowed by inheritance with an unstable nervous system. Finally, 
they are less often encountered among families whose upbringing 
has aimed at hardening the constitution and at inculcating the 
control of instinctive impulses, than among those in whom from 
early childhood sensibility and impulsiveness have been given a 
loose rein. 

Extremely variable also are the sympathetic disturbances and 
morbid states which depend on the processes of the sexual life of 
woman. " Le cri de I'organe soufifrant ne vient pas de Tuterus, 
mais de tout I'organisme," ^^ says Conrty. And a large number of 
isolated observations has shown how complex are the relations 
between the healthy and unhealthy female genital organs and the 
other organs of the body as well as the organism as a whole. 
Precise and incontestable proofs exist of such relations between 
the female genital organs and morbid changes in the eye and ear, 
the skin, the respiratory organs, and the vascular and nervous 
systems. 

The influence exercised by the reproductive system on the gen- 
eral vital processes of woman is indicated also by the general 
statistics of mortality and .the incidence of disease. Mortality in 
women, the earliest years of childhood being left out of considera- 

'■^"The cry of the suffering organ comes not from the uterus but from the 
entire organism." 



26 The Sexual Life of Woman. 

tion, is at Its highest precisely during the great sexual epochs, 
namely at the time of puberty, during pregnancy, during the puer- 
perium, and at the cHmacteric period. The complete performance 
of the reproductive functions entails a higher proportion of ill- 
nesses and death; and statistical records show that the mortality 
of married women between twenty and forty years of age, during 
the period, that is to say, in which in consequence of marriage 
they fulfil the duties of sexual intercourse and procreation, and are 
exposed to the dangers connected with these sexual acts, is much 
higher than the mortality of unmarried women of corresponding 
ages. Infection with the gonococcus and wnth the virus of syphilis, 
chronic salpingitis, metritis, and parametritis, the manifold dis- 
eases of pregnancy, the diseases of the puerperium, the various dis- 
placements of the uterus, osteomalacia — all these are pathological 
states the dependence of which upon the sexual life of the married 
or at any rate sexually active woman is indisputable. But the 
complete renunciation of sexual activity appears also to exercise 
an injurious influence on the health, and to give rise or at least 
predispose to morbid manifestations. Hysteria, for instance, 
chlorosis, uterine -myomata, and various neuroses, have long been 
supposed to depend in part upon such renunciation, though the 
causal connection cannot be regarded as yet fully established. 

Especially true as regards woman, indeed, is that which Ribbing 
says concerning the sexual life in general: *' Since all human life 
and being has its origin in sexual relations, these sexual relations 
may be regarded as the heart of humanity. We may work day and 
night for the good of humanity, we may sacrifice for that good 
our time and our blood, but all this w^ork and all this sacrifice 
appear to me to remain useless if we neglect and despise the sexual 
life, the eternally self-renewing elementary school of true altruism." 

From the vital phase in which, marked by the visible manifesta- 
tions of puberty and by the first appearance of menstruation, 
ovulation is assumed to begin, the sexual life of woman continues 
to the period of life in which, marked by the climacteric cessation 
of menstruation, ovulation also ceases. The total duration of this 
sexual period in woman's life is usually about thirty years ; but it is 
subject to great variations, from six to forty-six years according 
to the available statistics, these variations depending upon climate, 
race, constitution, and the sexual activity of the person under 
consideration. 

The duration and the intensity of the sexual life of woman de- 
pends upon a series of external conditions affecting the individual, ' 
but especially upon the inherited predispositions, upon the consti- 
tutional conditions, upon the varying vital power of the individual. 



11 



Introduction. 27 

My own observations have led me to formulate, as a general law, 
that the earlier a woman (climatic and social conditions being 
similar in the cases under comparison) arrives at puberty, the 
earher, that is to say, that menstrutation first makes its appearance, 
the greater will be the intensity and the longer the duration of 
sexual activity, the more will the woman in question be predisposed 
to bear many children, the more powerfully will the sexual im- 
pulse manifest itself in her, and the later will the menopause 
appear. It seems that in such women a more intense vitality ani- 
mates the reproductive system, bringing about an earlier ripening 
of ova, a more favorable predisposition on the part of these ova 
to fertilization by the spermatozoa, a livelier manifestation of 
sexual sensibility, and a longer duration of ovarian functional 
activity. 

My general views on this subject are embodied in the following 
propositions: 

1. The duration of sexual activity is less in the women belong- 
ing to the countries of southern Europe than in those belonging 
to the countries of northern Europe. It would appear that in 
those climates in which ovulation begins sooner and menstruation 
first appears at an earlier age, the menopause also appears earlier ; 
but that, on the contrary, in those climates in which puberty is 
late in its appearance, the decline of sexual activity is similarly 
postponed. 

2. Women in our mid-European climates, in whom puberty 
appears at an early age, the first menstruation occurring between 
the ages of thirteen and sixteen, exhibit a more prolonged dura- 
tion of the sexual life, of menstrual functional activity, than women 
in whom menstruation begins late, between the ages of seventeen 
and twenty. Extremely early appearance of the first menstrua- 
tion — so early as to be altogether abnormal — has, however, the 
same significance as abnormally late onset of menstruation; both 
indicate that the sexual life will be of short duration. 

3. Women whose reproductive organs have been the seat of a 
sufficient amount of functional activity, who have had frequent 
sexual intercourse, have given birth to several children, and have 
themselves suckled their children, have a sexual life of longer dura- 
tion, as manifested by the continuance of menstruation, than women 
whose circumstances have been just the opposite of these, unmar- 
ried women, for instance, women early widowed, and barren women. 
Sexual intercourse at a very early age, however, accelerates the 
onset of the climacteric period and the termination of the sexual 
life. The same result follows severe or too frequent confinements. 

4. The sexual life has a shorter duration in the women of the 
laboring classes and belonging to the lower strata of social life, as 



28 



The Sexual Life of Woman. 



compared with upper class and well-to-do women. Bodily hard- 
ships, grief, and anxiety also hasten the onset of sexual death. 

5. Women who are weakly and always ailing have a shorter 
sexual life than women who are powerfully built and always in 
good health. When irregularities and disorders have appeared in 
the various sexual phases, the decline of sexual activity occurs 
earlier than in women whpse functions have in this respect been 
normal. Certain constitutional conditions, such as extreme obesity, 
certain acute diseases, such as typhoid fever, malaria, and cholera, 
and certain diseases of the uterus and its annexa, chronic inflam- 
matory conditions for instance, bring about a notable shortening of 
the duration of the sexual life. 

In 500 cases that have come under my own observation, the 
women concerned belonging to very various nationalities, the dura- 
tion of the sexual life, as witnessed by the continuance of menstrua- 
tion, was as follows : 

Menstruation continued for: 



6 years 


in 


I 


woman. 


22 


years 


in 


20 


women. 


ZZ 


years 


in 


31 


women. 


7 years 


in 


I 


woman. 


23 


years 


in 


24 


women. 


34 


years 


in 


26 


women 


9 years 


in 


2 


women. 


2.4 


years 


in 


18 


women. 


35 


years 


in 


12 


women 


II years 


in 


4 


women. 


25 


years 


in 


16 


women. 


Z^ 


years 


in 


12 


women 


15 years 


in 


6 


women. 


26 


years 


in 


25 


women. 


37 


years 


in 


10 


women 


16 years 


in 


8 


women. 


-^1 


years 


in 


26 


women. 


38 


years 


in 


8 


women 


17 years 


in 


12 


women. 


28 


years 


in 


29 


women. 


39 


years 


in 


6 


women. 


18 years 


in 


15 


women. 


29 


years 


in 


36 


women. 


40 


years 


in 


2 


women. 


19 years 


in 


9 


women. 


30 


years 


in 


22 


women. 


43 


years 


in 


2 


women. 


20 years 


in 


6 


women. 


31 


years 


in 


Z^ 


women. 


45 


years 


in 


I 


woman 


21 years 


in 


18 


women. 


Z^ 


years 


in 


49 


women. 


46 


years 


in 


I 


woman 



Thus we see that the duration of the sexual life varies from 6 to 
46 years. The most frequent duration is one of 32 years, next to 
this one of 29, next again, 31, 33, and 37 years, respectively. In 
6 women only did the duration of the sexual life exceed 40 years, 
and in 4 only was it less than 11 years. In half of all my cases the 
duration of the sexual Hfe was between 2y and 34 years, and from 
these figures we obtain an average duration of about 30 years. 

For North Germany, Krieger gives data from which it appears 
that in this region the average duration of the sexual life is 30.49 
years. In more than half of the 722 cases recorded by this writer 
the duration was between 31 and 37 years. In isolated cases the 
duration was very short, not exceeding 8, 9, or 10 years, or, on the 
other hand, as long as 47 years ; whilst the number of cases in- 
creased fairly regularly up to the duration of 34 years, and there- 
after again diminished. 

As regards Austria, Smikits has collected information in the 
case of 269 women, and found, in these, that the duration of the 
sexual life varied from 12 to 45 years. The average duration was 



Introduction. 



29 



29.16 years; in more than half of the women, the period 
activity lasted from 21 to 30 years; the shortest period 
was 12 years, the longest 45 years. 
The period of sexual activity lasted : 



of sexual 
observed 



12 years 


in 


2 


women. 


25 years 


in 


7 women. 


35 years 


in 


18 


women. 


14 years 


in 


I 


woman. 


26 years 


in 


13 women. 


. 36 years 


in 


19 


women. 


15 years 


in 


2 


women. 


27 years 


in 


5 women. 


2^'j years 


in 


14 


women. 


17 years 


in 


3 


women. 


28 years 


in 


26 women. 


38 years 


in 


9 


women. 


19 years 


in 


3 


women. 


29 years 


in 


18 women. 


39 years 


in 


8 


women. 


20 years 


in 


17 


women. 


30 years 


in 


17 women. 


40 years 


in 


I 


woman. 


21 years 


in 


10 


women. 


31 years 


in 


8 women. 


42 years 


in 


I 


woman. 


22 years 


in 


7 


women. 


32 years 


in 


8 women. 


43 years 


in 


I 


woman. 


23 years 


in 


5 


women. 


33 years 


in 


13 women. 


44 years 


in 


2 


women. 


24 years 


in 


17 


women. 


34 years 


in 


8 women. 


45 years 


in 


2 


women. 



In Poland, according to Raciborski, the duration of sexual activity 
is in Jewesses 23 years, but in women of Slavonic blood 31 years. 

In France, according to Cotirty and Puech, the usual duration of 
the sexual life is from 28 to 30 years. 

According to Puech, among 10 women menstrual activity lasted : 



2,3 years m 2 women. 
35 years in i woman. 



39 



years m 2 women, 
vears in 2 women. 



43 years m 2 women. 
44>^ years in i woman. 



Brierre de Boismont gives the following particulars of the dura- 
tion of menstrual activity in 178 Frenchwomen: 



5 years 


in 


I 


woman. 


23 years 


m 


12 


women. 


34 years 


in 


7 


women. 


6 years 


in 


I 


woman. 


24 years 


in 


8 


women. 


35 years 


in 


5 


women 


8 years 


in 


I 


woman. 


25 years 


in 


8 


women. 


36 years 


in 


10 


women. 


II years 


in 


I 


woman. 


26 years 


in 


II 


women. 


2>7 years 


in 


6 


women. 


16 years 


in 


4 


women. 


27 years 


in 


7 


women. 


38 years 


in 


5 


women. 


17 years 


in 


4 


women. 


28 years 


in 


6 


women. 


39 years 


in 


2 


women. 


18 years 


in 


I 


woman. 


29 years 


in 


7 


women. 


40 years 


in 


7 


women. 


19 years 


in 


3 


women. 


30 years 


in 


13 


women. 


41 years 


in 


I 


woman. 


20 years 


in 


3 


women. 


31 years 


in 


13 


women. 


42 years 


in 


3 


women. 


21 years 


in 


4 


women. 


2)2 years 


in 


9 


women. 


44 years 


in 


2 


women. 


22 years 


in 


3 


women. 


Z2> years 


in 


9 


women. 


48 years 


in 


I 


woman. 



For England, Tilt gives the mean duration of menstrual activity, 
as observed in 500 women, as 31.21 years; it varies between ii 
and 47 years ; there are more cases with a period of 34 years 
than with any other integral number of years. Tilt found the dura- 
tion to be : 



II years 


in 


I 


woman. 


25 


years 


m 


22 women. 


37 


years 


in 


16 


women. 


13 years 


in 


I 


woman. 


26 


years 


in 


II women. 


38 


years 


in 


15 


women. 


15 years 


in 


3 


women. 


27 


years 


in 


25 women. 


39 


years 


in 


15 


women. 


16 years 


in 


I 


woman. 


28 


years 


in 


29 women. 


40 


years 


in 


6 


women. 


17 years 


in 


2 


women. 


29 


years 


in 


35 women. 


41 


years 


in 


4 


women. 


18 years 


in 


4 


women. 


30 


years 


in 


Z6 women. 


42 


years 


in 


7 


women. 


19 years 


in 


I 


woman. 


31 


years 


in 


33 women. 


43 


years 


in 


5 


women. 


20 years 


in 


3 


women. 


32 


years 


in 


38 women. 


44 


years 


in 


3 


women. 


21 years 


in 


6 


women. 


2>?> 


years 


in 


35 women. 


45 


years 


in 


I 


woman. 


22 years 


in 


II 


women. 


34 


years 


in 


49 women. 


46 


years 


in 


I 


woman 


23 years 


in 


II 


wornen. 


35 


years 


in 


33 women. 


47 


years 


in 


3 


women 


24 years 


in 


10 


women. 


36 


years 


in 


26 women. 













30 



The Sexual Life of Woman'. 



For London the average figure is 34 years ; for Paris, 30 years ; 
for Vienna, 29 years; and for Berlin, 34 years. 

From the data of various observers obtained froiii diverse na- 
tionaHties, the following table has been compiled, exhibiting the 
mean duration of the sexual life : 



Comparative Table Shonnng the Duration of the Sexual Life in 
Va rio us Natio nalitics. 





Germany. 


Austria. 


France. 


England. 


Denmark. 


Norvk'ay. 


Russia. 


Number of 

Cases.. 


722 


265 


178 


500 


312 


391 


100 


Mean duration 
of menstrual 
activity, in 
years 


30.4 


29.1 


29.1 


31.8 


27.9 


32 


31 


Observers' 

names. . 


Krieger, 
L. Mayer. 


Szukits. 


Brierre de 
Boismont. 


Whitehead. Hannover. 

i 


f^J-,^ Licvc. 



In the temperate zone the sexual Hfe of woman lasts longer than 
in the colder and subarctic regions. Still more favorable is the con- 
trast between the temperate zone and the countries of the tropics, in 
which the duration of the period of menstrual activity is limited to 
eighteen or twenty years. According to some isolated observations 
the duration of sexual activity in Arabian women in Africa was as 
little as nine years. 

A certain influence on the duration of the sexual life is exercised 
by the commencement of menstruation at an earlier or later age than 
the average. The total duration of menstrual activity is more 
varial)le in women who begin to menstruate early than in vv^omen 
who begin to menstruate late, in whom the duration of the sexual 
life is a more regular one. In those women who begin to men- 
struate early the mean duration of the sexual life is about thirty- 
three years, in those who begin to menstruate late it is about twenty- 
seven years. 

The following data, based on the observation of 250 cases, are 
published by W. Guy, regarding the duration of the sexual life, 
that is to say of menstrual activity, in women beginning to men- 
struate early and those beginning to menstruate late, respectively : 

Menstruation began Duration of the sexual life. 

In 5 cases in the 8th to the loth year Averaging 36.60 years. 

In 70 cases in the nth to the 13th year Averaging 33.65 years. 

In no cases in the 14th to the i6th year Averaging 30.85 years. 

In 56 cases in the 17th to the 19th year Averaging 28.35 years. 

In 9 cases in the 20th year or later Averaging 20.45 years. 



Introduction. 31 

A further analysis of these 250 cases is given by Guy in the fol- 
lowing table : 

Average age at ivhich Duration of 
menstruation ceased, menstrual 

First appearance of menstruation, in years. activity. 

In I case in the 8th year 42 34 years. 

In 2 cases in the gth year 46 37 years. 

In 2 cases in the loth year 47 S7 years. 

In 10 cases in the nth year 47- 10 36. 10 years. 

In 29 cases in the 12th year 45-34 33-34 years. 

In 31 cases in the 13th year 46.16 33.16 years. 

In 39 cases in the 14th year 45-33 31-33 years. 

In 40 cases in the 15th year 46.30 31 -30 years. 

In 41 cases in the i6th year 46. 14 30.14 years. 

In 26 cases in the 17th year. 45- 18 28. 18 years. 

In 19 cases in the i8th year 46.87 28.87 years. 

In II cases in the igth year 46. 18 27. 18 years. 

In 5 cases in the 20th year 40.80 20.80 years. 

In 3 cases in the 21st year 41 .66 20.66 years. 

In I case in the 23d year 41 18 years. 

Hannover also gives data respecting the relation between the dura- 
tion of menstrual activity and the early or late appearance of men- 
struation. These data are tabulated as follows : 

Average age at zvhich Duration of 
menstruation ceased, menstrual 

First appearance of menstruation. in years. activity. 

In 5 cases in the 12th year 47.80 35 -So years 

In 10 cases in the 13th year 45 

In 50 cases in the 14th year 44 

In 34 cases in the 15th year 45 

In ^S cases in the i6th year 44 

In 36 cases in the 17th year 43 

In 49 cases in the i8th year 44 

In ss cases in the 19th year 44 

In 38 cases in the 20th year 45 

In 10 cases in the 21st year 44 

In 4 cases in the 22d year 43 

In 3 cases in the 23d year 44 

In 4 cases in the 24th year 39 



89 32 . 89 years. 

98 30.98 years. 

56 30-56 years. 

13 29.13 years. 

00 26.00 years. 

96 26.96 years. 

79 25.79 years. 

36 25.36 years. 

10 23.10 years. 

50 21.50 years. 

33 21.33 years. 

50 15.50 years. 



Totals : In 412 cases the average age at the menopause was 
44.82, and the average duration of menstrual activity was 27.973 
years. 

From the tables of L. Mayer, Krieger has instituted a compari- 
son between the duration of menstrual activity in loi women who 
began to menstruate early and 180 women who began to menstruate 
late, finding in the case of the former a mean duration of 33.673 
years, and in the case of the latter a mean duration of 27.344 
years, showing therefore a sexual life longer on an average by 6.429 
years in those in whom puberty was early as compared with those 
in whom puberty was late. 

From the tables of Tilt, based on the observation of 164 cases, 
76 women in whom menstruation appeared early and 88 in whom 



32 The Sexual Life of Woman. 

it appeared late, we learn that among the former the shortest dura- 
tion of menstrual activity was i8 years, among the latter 12 
years ; among the former the longest duration was 37 years, among 
the latter only 33. The majority of those who began to menstruate 
early continued to menstruate for 28, 31, 32, 33, 34, 35, 36, 38, or 
39 years; those who began to menstruate late, for 23, 27, 28, 30, 
or 31 years. The mean duration of the sexual life in those who 
began to menstruate early was 33.66 years ; in those who began 
to menstruate late it was 28.28 years. Since the average duration 
of the menstrual function is given by Tilt as 31.33 years, those who 
began to menstruate early exceeded this average by 2.33 years, 
while those who began to menstruate late exhibited a duration of 
menstrual activity of at least three years less than the average. 

In addition to climate, nationality, and the age at which menstrua- 
tion begins, the sexual activity of women also exercises an influ- 
ence on the duration of their sexual life, and of especial import- 
ance in this connection are the number of children born, and exer- 
cise or neglect of the function of lactation. From my own observ- 
vations on this matter it appears, that in women who are healthy 
and of powerful constitution, whose reproductive organs have been 
sufficiently exercised, who have given birth to several children 
and have suckled these children themselves, the duration of men- 
strual activity is in general notably longer than in women whose 
circumstances have been just the opposite in these respects. Among 
the women in my own series of cases in whom menstrual activity 
lasted longest, of the 177 women in whom menstruation ceased be- 
tween the forty-fifth and the fiftieth year of life, i only was un- 
married, 2 were married but childless, 32 married with i or 2 
children only, and 142 married and with more than 2 children; of 
the 89 women in whom menstruation ceased between the fiftieth 
and the fifty-fifth year of life, none were either unmarried or child- 
less, 19 were married with I or 2 children, 17 married and with 
more than 2 children ; of the 17 women in whom menstruation 
ceased later than the fifty-fifth year of life, there were 2 only with 
less than 2 children, but 10 who had each given birth to from 6 to 8 
children. A similar influence is exercised by the function of 
lactation. Among 40 women who had not suckled their children, 
the average duration of menstrual activity was 4 years less than ihe 
general mean. 

As regards the conditions of life, L. Mayer affirms that the dura- 
tion of sexual activity among well-to-do women is on the average 
a year and a half longer than among women of the working classes. 

Metschnikoif has drawn attention to the remarkable disharmony 
in the development of three of the phases of the sexual life of Ij 



Introduction. 33 

woman, inasmuch as the sexual impulse, the union of the sexes, 
and the capacity for procreation, which, considering their nature 
and purpose, might have been expected to be attuned so as to act 
in harmony, exhibit as a matter of fact no such relation; the dif- 
ferent factors of the sexual function develop independently and 
unharmoniously. In a child not yet fitted to fulfil the function of 
procreation, the sexual impulse will none the less make its appear- 
ance, and be liable to misuse. In the girl the pelvis does not attain 
that complete development which fits it for the process of parturi- 
tion until toward the age of twenty, whilst puberty occurs at the age 
of sixteen. **A girl of ten is capable of aspiring to play the part of 
a woman, but not before the age of sixteen is she fitted to play that 
part, nor indeed fitted to become a mother before the age of twenty. '^ 

In general, we may say, regarding the women of our own part 
of the world, that in those who are healthy, who lead a regular 
life, are well fed, free from the pressure of anxieties, with their 
sexual functions sufficiently exercised, the duration of the sexual 
life is longer than in women whose circumstances are the reverse 
of those just enumerated. It is a sign of decadence when women of 
the well-to-do classes, leading a life of ease, manifest a diminished 
duration of the sexual life. The greatest physical power and the 
highest ethical development are associated with a lengthening of 
life in general, and associated also with a lengthening alike in the 
sexual life of woman and the sexual potency of man. A decline in 
morals and culture entails a diminution of sexual vital capacity, 
this being true alike of individuals, of families, and of nations. 
Woman is venerated and valued the more, the longer the duration 
of her sexual life ; a woman in whom the sexual life is short quickly 
loses value and significance, both in domestic and in social circles. 

The social significance of the sexual life of woman is dispropor- 
tionately greater and farther reaching than the sexuality of the male, 
as the former is concerned with the fundamental principles of human 
social life, influencing the constitution of the family, and controlling 
the good of the coming race. Sexual purity, which to the youth is a 
romantic dream, is to the maiden a vital condition of existence ; adul- 
tery, in the husband a pardonable transgression, is in the wife an 
overwhelming sin committed against family life. To the freedom 
of the male in afifairs of love is opposed the strict restraint of the 
female, based on monogamic marriage. The sexual needs and 
desires of the female are transformed in an ideal manner by means 
of the feeling of duty of the wife and mother ; the violent pressure 
of the sexual impulse is restrained by the opposition of ethical 
forces. When this restraint fails, the running ofT the rails that en- 
sues has a far profounder influence in the case of the female than 



34 The Sexual Life of Woman. 

of the male, an influence not limited to her own personality, but 
dragging down the whole family into the abyss of consequences, 
into the depths of moral and physical destruction. 

Though in nature everywhere the same, the sexual life of woman 
exhibits in the various gradations of social life different outward 
manifestations, from the brutal sexual congress that does not greatly 
shun publicity, to the modern would-be philosophical free love. And 
throughout all variations the two darkest points remain, the illegiti- 
mate child and venereal infection, both of which entail upon the 
woman the most unspeakable anxieties and the greatest possible 
misery, whilst the man who is in either case to blame passes com- 
paratively unscathed. 

The social sexual position of woman suffers most at the present 
day from the mature age at which under existing social conditions 
men are alone able to marry and from the ever-increasing number of 
cases of venereal infection. In both these directions social science 
and medical skill must work hand in hand for the amelioration of 
the sexual life of woman. 

On the twentieth century falls the duty of furnishing a solution 
for these problems. Contesting voices are heard on all sides. Tol- 
stoi's rigid demand for complete sexual abstinence, the exhortation 
of the professors of the German universities to their students in 
favor of moral purity, the associations for the official prevention 
of venereal diseases, the agitation among young men in favor of 
abstinence from sexual intercourse before marriage, finally, the 
clamorous voices of the supporters of women's rights — all these 
are influences within the sphere of sexual morality, which must lead 
slowly but surely to extensive social changes in the sexual life of 
women. 

The discussion of the sexual life of woman, which for many 
centuries was concealed by a thick veil from the eyes of the profane, 
or was viewed only through the frosted glass of poetical metaphor, 
has in recent times assumed a quite revolting character. Not only 
have the acquired liberties and the social aims of the present day 
a tendency to give to women in general a freer and higher position, 
to emancipate them from the bonds in which owing to the conditions 
of family life they have so long been shackled, but some members 
of the women's rights party go even farther, and demand for 
women greater freedom in the sphere of sexual activity. 

With this end in view the sexual life of woman is used as the ful- 
crum of the lever, and is withdrawn from the twilight into -the 
open light of day, or indeed too often into a dazzling and altogether 
false illumination. Women writers especially, who have hitherto 
been accustomed to delude themselves and the world with sen- 



Introduction. 35 

satioiial representations of the feminine soul, of feminine modesty, 
and the fineness of feminine sensibiHty in matters sexual, now find 
their greatest joy in unveiling themselves and their sisters before 
the face of all the world, and in discussing in the plainest language 
the most intimate processes of the genital organs. In writings 
exhibiting but little good taste, though all the more temperament, 
they emphasize again and again one side only of the sexual life, 
to-wit, the sexual impulse, the force of which is intentionally ex- 
aggerated to a high degree, so that it is described as a mighty cur- 
rent of passion, which may with great pains be held in check for a 
season, but must ultimately break loose, and with devastating rage 
must overwhelm everything which has hitherto been regarded as 
discipline and good morals. Young girls, even, step down into the 
arena to take part in the contest concerning the reform that is 
to take place in the relations between men and women. Especially 
sensational in this connection was Eine filr Vide, Aiis dcm Tage- 
btiche eines Mddchens von Vcra,^^ a book which, totally ignoring 
the biological differentiation of the sexes and their diverse sociologi- 
cal course of development, goes so far as to insist that from the 
man entering upon marriage, as from the woman, sexual purity 
and virginity are to be demanded. (The heroine of the book com- 
mits suicide because her lover has in earHer years had experience of 
sexual intercourse.) 

From a mistaken standpoint other supporters of women's rights 
oppose the ideal method in sex-relations, life-long monogamy, and 
the ideal of sexual sensibiHty, motherhood, and they put forward 
quite new sexual pretensions on behalf of women, as belonging to 
them by natural right. Upon these pretensions it is the duty of 
physicians, who truly know and truly prize womanhood, to pass their 
judgment, and that judgment, which will find ample justification 
in the ensuing descriptions of the individual phases of the sexual life 
of woman, is that the modern movement on behalf of the emancipa- 
tion of women goes much too far. We do not, however, mean to 
imply that this movement is totally unjustified. 

The growing girl must not, as has hitherto been the case, be kept 
in a state of ignorance (which is indeed in most cases apparent 
merely) regarding the sexual processes of her own body, she must 
no longer, when she asks to be informed concerning these matters, 
be put oflf with conventional lies and prevarication. But her en- 
lightenment must not be eflfected in such a manner as to lead to 
excitement and excessive stimulation, to the awakening of slumber- 
ing feelings, and to the conversion of fantasy into a devouring 
flame. Sexual enlightenment must not be made an excuse for the 

18 " One for Many. Leaves from the Diary of a Maiden of Vera." 



36 The Sexual Life of Wom^an. 

unchaining of sensibility. When about to be married, a woman 
should certainly be instructed regarding her sexual duties and 
rights, and enter as one well informed into the act in which she is 
to play a leading part. But she ought not, with the excessive 
valuation of herself attained in recent times, to regard the man 
as her enemy, as one whom she is always justified in fighting and 
always ready to fight with the equal weapons of sexual transgres- 
sion. It cannot be doubted that the ideal of '' pure marriage " at 
an early age is one greatly to be prized as the foundation of a 
powerful future generation ; but the real nature of the male must 
not be overlooked, nor must his sexual honor be put to. too difficult 
a test. We regard as reasonable the modern demand of woman 
that in marriage her individuality should not be buried, and that 
space should be given for the development of her personality; but 
every sober-minded person will reject the " moral demand " for 
" ideal passion " in accordance with " entire mutual freedom " in 
the sexual relation between man and wife, and will regard such 
free love as social insanity and as a barbaric retrogression toward 
the rude sexual habits of savage peoples. Further, in view of the 
continually increasing intensity of the struggle for existence and in 
view of the difficulties of the task of rearing children, we cannot 
fail to recognize that it is not right for women to be overburdened 
with the task of reproduction, and that she does not live simply 
and solely for the bearing of children — but those rush to the other 
extreme who undervalue motherhood and the duties of maternity, 
who speak scornfully of the woman who is '* a mother, and a 
mother only," who despise women whom they regard merely as 
" means for the production of children," and who employ all possible 
methods to free women from the pressing claims of nature and 
of society. 

In all social circumstances, and in all times the great principle of 
sexual morality must dominate the sexual life of woman. As the 
ethical characteristics of the three great epochs in that sexual life 
we recognize the purity of the maiden, the faithfulness of the wife, 
and the love of the mother. But within the limits imposed by these 
demands it is still possible to satisfy the modern claim for a free 
development of the personality, and to accommodate the circum- 
stances of the sexual life to the individual vital needs and vital 
claims of the present day. 



I. THE SEXUAL EPOCH OF THE MENARCHE. 



(puberty.) 

The term menarche {m^, a month, a/?/^', the beginning) was 
introduced by me into medical Hterature to denote the period of 
hfe in which, as a sign of puberty, menstruation first makes its ap- 
pearance. 

The age at which this occurs is subject to variations depending 
upon race, occupation, hereditary tendencies, and chmate ; but in 
Germany and Austria the average age at puberty is 14 or 15, the 
extreme Hmits being 12 to 19. 

Until about the age of 13, the physical differentiation of the 
sexes, except for the anatomical peculiarities of the genital organs, 
is in our climates a trifling one. But at puberty the important 
changes occur by which the sexes are so strikingly differentiated. 
Whereas in the growing boy all physical change takes the form 
of increasing strength and energy, in the development of the girl, 
we note the appearances of the rounded outlines so characteristic 
of womanhood. At the same time the voice alters, becoming less 
sharp, with a softer quality, and yet a fuller tone ; and we may 
observe that young brunettes have commonly a contralto voice, 
young blondes, more often a soprano. The intellectual changes un- 
dergone by the girl at puberty are no less extensive and characteristic 
than the physical changes. In brief, the undifferentiated, neuter 
girl is transformed into a young woman, endowed with all the at- 
tributes, mental and bodily, characteristic of femininity. 

As regards the age at which the menarche usually occurs, and 
the manner in which its occurrence is anticipated or retarded by the 
various influences already mentioned, the following propositions may 
be put forward, based on the available statistics and observations : 

I. Climate is an important factor. In the torrid zone, menstrua- 
tion appears at a very early age, on the average from 11 to 14; in 
the temperate zone, it appears later, on the average from the age of 
13 to 16; in the frigid zone, later still, on the average from the age 
of 15 to 18. The mean temperature of the atmosphere appears to 
have a direct influence on the age at which menstruation begins, 
the hotter the climate, the earlier being the menarche. The height 
of the place of residence above the sea level and its distance from 
the coast also have a certain influence. 

[37] 



38 The Sexual Life of Woman. 

2. Race and constitution have a distinct influence upon the age 
at which menstruation makes its appearance. In women of the 
Semitic races the menarche occurs earher than in women of the 
Aryan races. The average age at which menstruation begins is 
in Jewish girls, from 14 to 15; in Magyar girls from 15 to 16; in 
German girls from 16 to 16^ ; and in Slavonic girls from 16 to 17. 

In general the menarche is earlier in girls of a sanguine, lively 
temperament and a powerful constitution than in girls of a phlegma- 
tic temperament and a weakly constitution ; further, other things 
being equal, menstruation appears earher in brunettes, girls with 
black hair, thick skin, dark eyes, and a dark complexion, than it ap- 
pears in blondes, girls with Hght hair, thin skin, blue eyes, and a fair 
complexion. 

3. The age at which menstruation begins is also affected by the 
conditions of life and the social circumstances. In the higher 
circles of society, in the upper, well-to-do classes, menstruation 
appears earlier than among women of the laboring classes, who 
are compelled to strive for their daily bread. Amongst upper- 
class girls the menarche occurs at the age of 14 in one-fourth of 
their number, whereas among lower-class girls barely one-sixth 
begin to menstruate at the age of 14. 

In large towns, again, menstruation appears earlier than in small 
towns, whilst in the open country the menarche is still further de- 
layed. In the women of Paris the average age at the menarche is 
14 years and 6 months, in the women of smaller French towns it is 
14 years and 9 months, in French countrywomen it is 14 years and 
10 months. 

How far the mode of nutrition is concerned in the production of 
these results is not yet determined. 

4. The time of the menarche appears to be influenced by inherit- 
ance to this extent, that the daughters of women who began to 
menstruate early begin themselves to menstruate at an early age, 
whereas in other families we observe that both mothers and 
daughters began to menstruate late. But this relation is by no 
means a constant one. 

Ploss has collected observations made in various countries and 
towns regarding the age at which menstruation begins, and the 
mean results of these observations are given below. 

The average age at which menstruation began was: 

In Swedish Lapland 18 years, o months, days. 

In Christiania 16 years, months, 25 days. 

In Copenhagen 16 years, 9 months, 12 days. 

In Munich 16 years, 5 months, 12 days. 

In Gottingen 16 years, 2 months, 2 days. 

In Vienna 15 years, 8 months, 15 days. 

In Berlin 15 years, 7 months, 6 days. 



I 



The Sexual Epoch of the Menarche. 



39 



In Stockhclm 15 years, 

In Manchester 15 years, 

In Warsaw 15 years. 

In London, between 15 years, 

and 14 years, 

In Paris, between 15 years, 

and . 14 years. 

In Madeira . . 14 years, 

In Montpellier 14 years, 

In Corfu 14 years, 

In Marseilles 13 years, 

In Calcutta 12 years. 

In Eg>'pt 10 years, 



6 months, 22 days. 

6 months, o days. 
I month, 23 days. 

1 month, 4 days. 
9 months, 9 days. 

7 months, 18 days. 

5 months, 17 days. 
3 months, o days. 

2 months, o days. 
months, days. 

II months, 11 days. 

6 months, o days, 
o months, days. 



The collective results of the investigations of French authors 
regarding the average age at which menstruation first appears are 
given in the following table : 



I. In Temperate Climates : 

Observer. Place. 

De Soye Paris 

Dubois Paris 

Raciborski Paris 

M. Despines Paris 

Arau Paris 

Courty Montpellier 

Puech Nimes . . . . 

M. Despines Toulon , . . 

M. Despines Marseilles . , 

Puech Toulon . . . 

Grey London . . 

Lee & Murphy . . . . London . . 

Torisiano Corfu . . .. 

Lebrun Warsaw . . 



No. of Cases. 
1,000 
600 
200 
85 
100 
600 
941 

43 

25 

144 

, 1,498 

, 1,719 

33 
100 



from these observations we obtain an average 



Average 
15 years, 
15 years, 
14 years, 

14 years, 

15 years, 
14 years, 
14 years, 
14 years, 
14 years, 

14 years, 

15 years, 
15 years, 

14 years, 

15 years, 

of 15 years. 



Age. 

months. 

months. 

months. 

months. 

months. 

months. 

months. 

month. 

month. 

month. 

months. 

months. 

months. 

month. 



II. In Cold Climates : 
Observer. Place. No. of Cases. 

I^avn Copenhagen 3,840 

Frugel Christiania 157 

Dubois Russia 600 

Faye Norway 100 

Lundborg Esquimaux 16 

Wistrand Stockholm 100 



Average Age. 
16 years, 9 months. 



16 years, 
16 years, 



6 months. 
8 months. 



15, years, 6 months. 
15 years, 6 months. 



15 years, 7 months, 
from these observations we obtain an average of 16 years and 3 

months. 



III. In Hot Climates: 
Observer. Place. No. of Cases. 

Goodeve. Calcutta 239 

Lith Deccan . . , 217 

Roberton Calcutta 540 

Webb Calcutta 39 

Dubois Asia 600 

from these observations we obtain an average of 12 years and 7 
months. 



Average Age. 

12 years, 5 months. 

13 years, 5 months. 
12 years, 6 months. 
12 years, 5 months. 
12 years, 11 months. 



40 



The Sexual Life of Woman. 



In 6,550 cases collected by Krieger menstruation first appeared 



At the age of: 






At the age of: 






9 years in 


I 


instance. 


20 years in 


281 


instances 


10 years in 


7 


instances. 


21 years in 


III 


instances 


II years in 


43 


instances. 


22 years in 


55 


instances 


12 years in 


184 


instances. 


22, years in 


15 


instances 


13 years in 


605 


instances. 


24 years in 


15 


instances 


14 years in 


1193 


instances. 


25 years in 


I 


instance. 


15 years in 


1240 


instances. 


26 years in 


4 


instances 


16 years in 


1026 


instances. 


27 years in 


2 


instances 


17 years in 


758 


instances. 


28 years in 


I 


instance. 


18 years in 


582 


instances. 


29 years in 


I 


instance. 


19 years in 


425 


instances. 









From these figures it appears that in the 6,550 cases under con- 
sideration, the age 15 was that at which the first appearance of 
menstruation was most frequently observed, namely in 1,240 
instances, or 18.9 per cent. The age 14 comes next, with 
1,193 instances, or 18.2 per cent. The case in this series in which 
menstruation appeared earliest, namely in the ninth year, was ob- 
served by Mayer, the girl being a blonde of average height, good 
family, and German descent; the case in which menstruation 
appeared latest, namely in the twenty-ninth year, was that of a 
woman living in Berlin, who was sickly and chlorotic up to the 
time of her marriage, and in whom menstruation did not appear 
until some years after that event. 

As regards climatic influences, all the data at our disposal prove 
that the hotter the climate the earlier the menarche. According 
to Marc d'Espine the age at puberty varies in an almost geometri- 
cal ratio with tlie mean annual temperature. 

The dependence of the menarche upon climatic influences is 
clearly shown by the statistical data collected from various regions 
of the world. We append the general compilation of Gchhard 
dealing with this question. 

A. Europe. 

For Europe the data furnished by Ploss are grouped by Geh- 
hard in the following manner. 



I. Northern Europe. 

The average age at which menstruation first appears, according 
to the older statistics, is in Swedish Lapland 18, in Norway, 16.12. 
In Copenhagen it is 16.75, i" St. Petersburg 14.5. 

More recent statistics for Finland are furnished by Engstrom. 



The Sexual Epoch of the Menarche. 



4t 



Among 3,500 women of pure Finnish descent, he found that men- 
struation beg^an : • 



At the age of: 

8 years in 

9 years in 

10 years in 

11 vears in 



2 nistances. 

2 instances. 

4 instances. 

41 instances. 



12 years in 178 instances. 

13 years in 458 instances. 

14 years in 715 instances. 

15 years in 778 instances. 

16 years in 614 instances. 

17 years in 369 instances. 



At the age of: 

18 years in 195 instances. 

19 years in 91 instances. 

20 years in 31 instances. 

21 years in 8 instances. 

22 years in 10 instances. 

23 years in 2 instances. 

24 years in I instance. 

25 3^ears in instance. 

26 years in i instance. 



Thus, in nearly half of all Finnish women, menstruation begins 
with the completion of the fourteenth and fifteenth years. The 
statistics include women of all classes of society. 

At the Pirogoif Congress Grusdeff furnished particulars of the 
first onset of menstruation in Russia among 10,000 women. Men- 
struation began : 



At the age of: 
9 years in 

10 years in 

11 years in 

12 years in 

13 years in 



I instance. 

4 instances. 

31 instances. 

244 instances. 

864 instances. 

14 years in 1641 instances. 

15 years in 1795 instances. 

16 years in 2012 instances. 

17 years in 1692 instances. 



At the age of: 

18 years in 

19 years in 

20 years in 

21 years in 

22 years in 

23 years in 

24 years in 
32 years in 



910 instances. 

498 instances. 

183 instances. 

65 instances. 

19 instances. 

5 instances. 

3 instances. 

I instance. 



In women of German race living in Russia puberty was earliest, 
occurring at the average age of 15.16 years; in Finnish women 
it was latest, occurring at the average age of 16.17 years. 



2. Middle Europe. 

In Germany, according to the tables of Krieger and L. Mayer, 
who have recorded 11,500 cases in all, menstruation begins most 
commonly (in 18.931 per cent, of the cases) at the age of 15; the 
next most frequent age is 14 (18.213 per cent, of the cases). 

For Berlin, in a number of cases collected from the lower classes 
of society, we find the average age for the first appearance of men- 
struation to be 16.18 years. 

Notwithstanding the more northerly situation of Berlin, the 
average age at puberty is somewhat less than in Munich, situated 
4i degrees to the southward, for the reason that the retardation de- 
pendent upon ahitude makes itself manifest in the latter town, which 
is situate about 500 metres (1,640 feet) higher above the sea level. 
Whereas in Berlin 18 per cent, of all cases begin to menstruate at 
the age of 14, and 19 per cent, at the age of 15, in Munich the two 



42 The Sexual Life of Woman. 

leading years are 15 with a percentage of 17^, and 16 with a per- 
centage of i8|. 

In Great Britain, according to Krieger, the average age at which 
menstruation begins is 15 years, I month, and 5 days. For Man- 
chester the age given is 15 years, 6 months, and 2;^^ days. In France, 
according to the calculation of Bricrre de Boismont, the most fre- 
quent age for the first onset of menstruation is 16. In Paris the 
average age is 14 years, 6 months, and 14 days. Bohemia, Upper 
and Lower Austria, and Moravia have an average age of 16 years 
and 2 to 3 months. 

3. Southern Europe. 

In Southern Europe the influence of the higher mean temperature 
manifests itself. The average age at which Spanish girls begin 
to menstruate is 12. In Northern and Middle Italy the most fre- 
quent age is 14; in Southern Italy, 13. In Lyons the average age 
at which menstruation begins is 14 years, 5 months, and 29 days ; 
in Marseilles and Toulon it is 13 years and 10 months. For Hun- 
gary, Doktor gives the statistics of 9,600 cases. In 22^/3 per cent, 
menstruation began at the age of 15 ; in 20J per cent, at the age of 
16, and in 10 per cent, at the age of 17. The earliest age among 
these cases was 8 years; the latest, 33 years. (The latter must no 
doubt be regarded as pathological.) 

B. Asia. 

In Palestine puberty most commonly occurs at the age of 13; 
in Turkey even as early as 10. Rouvier calculated the average of 
742 cases observed in Syria to be the age of 12. As regards Persian 
women, the data vary between the age of 14 for the northern part 
of the country and the age of 9 or 10 for the southern. According 
to Joiibert's data in 46.4 per cent, of the indigens of India, menstrua- 
tion begins at the age of 12 or 13, Similar figures are given for 
Ceylon and for Siam. In Japan menstruation most frequently be- 
gins at the age of 14, sometimes as early as 13; mothers of 15 are 
by no means rarities in this country, but for menstruation to begin 
before the age of 12 is considered a very exceptional occurrence. 
According to a table dealing with 584 women of Tokio menstrua- 
tion began : 

At the age of: At the age of: 

11 years in 2 instances. 16 years in 228 instances. 

12 years in 2 instances. 17 years in 68 instances. 

13 years in 26 instances. 18 years in 44 instances. 

14 years in 78 instances. 19 years in 10 instances. 

15 years in 224 instances. 20 years in 2 instances. 

The data available regarding China are so exceedingly variable 
that little importance can be attached to them. 



The Sexual Epoch of the Menarche. 43 

■ C. Africa, Oceania, and America. 

The average age at which menstruation begins in the negro 
women of Africa is from 10 to 13. In Algeria puberty occurs at 
q or 10 years. Among the AustraHan indigens, menstruation com- 
monly begins as early as 8 years, and at the very latest at the age 
of 12 years. The data available concerning the indigens of the 
Oceanic Archipelago are extremely variable and inexact, but we 
cannot go far astray in stating the age of puberty among these to 
be from 10 to 13. In tropical South America girls begin to 
menstruate from the age of 9 to 14 years. The Indian women of 
North America begin to menstruate at the ages of 12, 13, 14, or 
even as late as 18 or 20. In the Arctic zone of North America and 
in Greenland the onset of menstruation is delayed till 17 and even 
till 23 years. 

As regards the position in life and the upbringing years it has been 
shown by numerous observers that among the well-to-do classes, 
whose mode of living is luxurious, and whose social circumstances 
allow free play to the imagination, menstruation begins at an earlier 
age than among the working classes, whose life is one of want and 
privation. According to the statistical data of Mayer s regarding 
6,000 women, menstruation began : 

In women of 
the upper classes. 

At the age of 13 years 1 1 • 73 per cent. 

At the age of 14 years 23.90 per cent. 

At the age of 15 years 22 . 83 per cent. 

At the age of 16 years 14. 10 per cent. 

At the age of 17 years 9 . 60 per cent. 

From this table we learn that in nearly one-fourth of the girls 
of the upper classes puberty occurs at the age of 14, whilst in girls 
of the lower classes barely one-sixth begin to menstruate at this 
age. The average age at the first menstruation in girls belonging to 
the upper classes is seen to be 14.69 years, but in girls belonging 
to the lower classes, 16.00 years. According to other observers the 
average age at the first menstruation is : 

Brier re de 

Boismont. Tilt. Krieger. Ravn. 

(Paris.) (London.) (Berlin.) (Copenhagen.) 
Amongst gentle folk and 

the rich 13 y. 8 m. 13 y. 5^ m. I4y. im. 14 y- 3 ni. 

Amongst the well-to-do 

middle classes 14 y. 5 m. I4y. 31/^m. 15 y. 5 m. I5y. 5^m. 

Amongst the lower 

classes 14 y. 10 m. 16 y. 8 m. i6y. 5^m. 

Comparative observations on women living in towns and women 



In 


women of 


the lower classes. 


7 


06 per 


cent. 


13 


33 per 


cent. 


14 


56 per 


cent. 


16 


53 per 


cent. 


13 


33 per 


cent. 



44 The Sexual Life of Woman. 

living in the country show also that in the former, menstruation 
begins on the average at an earlier age. According to Brierre de 
Boisinont, the average age at the first menstruation is : 

In Paris 14 years, 6 months. 

In small towns 14 years, 9 months. 

In country districts 14 years, 10 months. 

Similarly it was found by Ravn that menstruation first occurred: 

In Copenhagen at the average age of 15 years, 7 months. 

In industrial towns 15 years, 4 months. 

In country districts 16 years, 5 months. 

Mayer states that the average age at which the first menstruation 
occurs is : 

In townswomen 15 • 98 years. 

In countrywomen 15-20 years. 

In Italy, according to C alder ini, in a thousand instances, menstrua- 
tion begins at the age of 14 in 280, at the age of 15 in 219, at the 
age of 13 in 205, at the age of 12 in 116, at the age of 16 in 89, at 
the age of 17 in 55, at the age of 18 in 14, at the age of 11 in 7, at 
the age of 10 in 6, and at the age of 20 in 6 instances. In girls at- 
tending town schools, the first menstruation most commonly oc- 
curs in the months of June and August ; but in girls attending 
'country schools most commonly in the spring months. 

A certain hereditary predisposition is so far determinant in the 
matter of the early or late onset of the first menstruation, that 
from a knowledge of the age at which menstruation began in the 
mother, we are able with great probability to predict the age at 
which it will begin in the daughter. Among fifty cases which I in- 
vestigated with this point in view, I found forty-one in which the 
daughters of mothers who had begun to menstruate early began 
themselves to menstruate early, usually indeed in about the same 
year of life ; or conversely that when the mother had begun to 
menstruate late, late onset of menstruation w^as usually to be ob- 
served in the daughter also. Tilt relates a case in which a woman 
began to menstruate at the age of fourteen, and her daughter and 
granddaughter both began to menstruate at the same age. Coiniy 
observed a mother who began to menstruate at the age of eleven, 
and whose eight daughters all began to menstruate at the same age. 

Gynecologists agree in stating that girls of sanguine temperament 
and powerful constitution begin to menstruate earlier than weakly 
and phlegmatic individuals. Tilt describes a peculiar ovarian tem- 
perament, in which menstruation begins early; such women have 
as a rule striking nervous sensibilities, with a dark complexion and 
glistening, longing eyes, always surrounded by dark rings. 



The Sexual Epoch of the Menarche. 45 

The opinion is general that in girls with black hair, dark eyes, 
thick skin, and dark complexion, menstrnation begins earlier than 
in blondes with blue eyes and delicate white skin. Brier re de Bois- 
inont states in this connection that not fair hair only, but also chest- 
nut-tinted locks, indicate a late onset of menstruation. L. Mayer 
found that : 

Of blondes. Of brunettes. 

17.20 per cent. 18.84 per cent, began to menstruate at the age of... 14 
16.89 per cent. 18.02 per cent, began to menstruate at the age of... 15 
15.14 per cent. 16.59 per cent, began to menstruate at the age of... 16 

According to the same author, the average age at which men- 
struation begins is : 

In blondes 15-55 years. 

In brunettes 15 • 26 years. 

As regards race, it is well known that in Jewesses menstruation 
begins at an early age. According to Joachim the age of puberty 
varies very greatly among the different races inhabiting Hungary. 
The first menstruation appears : 

In Slavonic girls between the ages of 16 and 17 

In Magyar 15 and 16 

In Jewish 14 and 15 

In Styrian 13 and 14 

First Appearance of Menstruation. 

The first appearance of menstruation is commonly preceded by 
various symptoms dependent on the increased flow of blood to the 
genital organs. Such symptoms are : Sacrache ; dragging sensa- 
tion in the loins ; an indefinite feeling of pressure in the lower part 
of the belly, especially in the region of the uterus and the ovaries, 
which region is sometimes also tender on pressure ; a sHght feeling 
of weariness in the lower extremities ; sudden flushings or pallors ; 
alternating sensations of heat and chilliness, sometimes accompanied 
by actual though slight change of temperature. In many cases also 
there are disturbances in the intestinal evacuations and urinary se- 
cretion, in the process of cutaneous transpiration, and in the func- 
tional activity of the gastro-intestinal canal. A frequently observed 
symptom is an increased irritability of the entire nervous system, 
with an inclination to melancholy and indefinite amorous desires 
— symptoms which Tilt denotes by the term " ovarianismus," Em- 
met by the term " erection," Lecal by the term '' phlogose 
amoureuse," and the older writers by the term *' molimina men- 
strualia." 

The nervous irritability manifests itself already before the ap- 
pearance of the menstrual flow by headache and moodiness, weari- 



46 The Sexual Life of Woman. 

ness, nervous irritability, and low spirits ; further, by slight changes 
in the facial aspect, dark rings round the eyes, spontaneous blushing, 
uneasy sensations, epigastric pain, loss of appetite, a sensation of 
pressure in the abdomen, palpitation, vertigo, dragging sensa- 
tions passing from the loins to the thighs, feeling of weakness and 
numbness in the lower extremities — symptoms which often endure 
for several months and in such cases tend to lower the resisting 
powers of the organism. 

Courty enumerates as prodromal symptoms which are observed 
in the majority of girls before the first appearance of menstruation : 
swelling and tenderness of the breasts, sensation of fulness and 
weight in the hypogastric region, moderate intestinal meteorism, 
sacrache, aqueo-mucous vaginal discharge, finally, an itching sen- 
sation in the genital organs. These manifestations may also as- 
sume a morbid character, taking the form of violent abdominal and 
lumbosacral pain, general fatigue and weakness, dyspepsia and 
diarrhoea, cephalalgia, various kinds of neuralgia, some degree of 
moral aberration. After the first menstruation, two or three months 
may elapse before the girl menstruates again, but after the lapse of 
a year the flow usually recurs at quite regular periods. Sometimes 
the early periods are very violent and recur very frequently, every 
twenty days, for instance. 

The greatest increase in size and weight occurs in the female 
sex at the time of the menarche. Amongst the poorer classes the 
greatest development in size and strength occurs between the ages 
of 13 and 15 years, whereas in the upper classes of society, those 
who ultimately attain the same weight exhibit their greatest growth 
at the ages of 12, 13, and 14 years. According to Pagliani the 
greatest growth in the female sex always precedes puberty, so that 
for example a girl who begins to menstruate at the age of 12 will 
grow most rapidly in the year preceding this, whereas a girl who be- 
gins to menstruate at a more advanced age will not undergo her most 
rapid phase of growth so early as the age of 11. According to 
the observations of Bozvditch, A. Hey, Lombroso, Pagliani, and 
PIoss, up to the age of 11 or 12 years the growth of girls exceeds 
that of boys, but whereas in girls growth ceases suddenly at the age 
of 14, in boys growth proceeds regularly up to the age of 16 years. 
At birth boys are on the average i cm. (f") longer than girls; 
but during puberty the female sex catches up the male in height, 
or even surpasses it. According to Ploss, a girl of 16 or 17 years 
is as tall as a young man of 18 or 19 years. 

The earlier development of the female as compared with the 
male at the time of puberty is a constant phenomenon, to be ob- 
served in all races, in every climate, and in all strata of society. 



TiiK Sexual Epoch of the Menarche. 47 

According to the statistical data published by the authors just 
quoted, the age of greatest development in the respective sexes is : 

In the female. In the male. 

As regards weight at the age of 12 to 14 years. 14 to 17 years. 

As regards height at the age of 12 to 13 years. 12 to 15 years. 

As regards respiratory capacity at the age of. 12 to 15 years. 15 to 17 years. 

As regards muscular strength at the age of.. 12 to 14 years. 14 to 15 years. 

Puberty occurs in the female on the average about two years 
earlier than in the male, and upon this difference the observed dif- 
ferences in growth also depend. 

The menarche in the wider signification of the term includes the 
development which occurs at the time of puberty, and continues 
through a period of several months, and even years, before complete 
sexual maturity is attained ; and includes also the time, which may 
be considerable, following the first appearance of the menses and 
before the regular rhythm of the menstrual function is established 
and the full development of the female genital organs is at- 
tained. This time, which forms a notable phase of the sexual life 
of woman, is characterized by great changes in the genital organs 
and in the vital processes connected therewith, by a strong tendency 
to suffer from a series of very various pathological changes and 
disorders of function in the principal organs, and a lessened general 
resisting power to disease — a change which finds its most definite 
expression in the well-established fact that in this period of life 
the mortality among females is much greater than among males of 
corresponding age. According to the statistical data of Qiictelet 
and Smits, from the age of 14 to the age of 18 (the period of the 
menarche) there are 128 deaths of females for every 100 deaths of 
males; and even in the four succeeding years, from the age of 18 
to the age of 22, the unfavorable conditions peculiar to sex are 
witnessed by 105 deaths of females to every 100 deaths of males. 

Many authors draw a distinction between the age of puberty 
(from the Latin piihes, puhcris), when the growth of the pubic hair 
occurs as an external sign of sexual development, and the age of 
nubility (from the Latin miberc) , when the individual becomes 
fitted for marriage. The distinction is a partial one only, inasmuch 
as capacity for copulation is attained already at puberty. The law, 
however, maintains such a distinction, the Austrian Penal Code, 
for example, regarding intercourse with a female less than four- 
teen years old as rape, and the German Code likewise punishing 
carnal knowledge of a girl under fourteen. 

The signs of puberty in girls were noticed and explained in very 
early times. From the anthropological studies of Ploss and Bartels 
we take the following data regarding this matter. In the Bible we 
read (Ezekiel, xvi, 7) : " Thy breasts are fashioned and thine hair 



48 The Sexual Life of Woman. 

is grown, whereas thou wast naked and bare." The early Indian 
physician, Susruta, refers only to the regular recurrence of men- 
struation as a sign of puberty. That a woman is menstruating may 
be known by the fact that her face is swollen and bright. In the 
Roman Empire Justinian ordained that all young women should be 
examined as to the growth or absence of the pubic hair in order to 
ascertain if they were ripe for marriage. The early Chinese phy- 
sicians recorded that in every woman at the age of fourteen or fif- 
teen years a monthly flow of blood from the genital organs began, 
the period of recurrence being thirty days. The physicians of the 
Talmud express themselves variously regarding puberty in women. 
In one place they advance as a sign of puberty the growth of the 
hair on the genital organs ; in another they speak of the notable en- 
largement of the breasts, and mention as a sign of more complete 
sexual development that the nipples become elastic. Other Tal- 
mudists refer to the appearance of a dark brown coloration in the 
areola and to the enlargement of the mons Veneris as signs of 
puberty. Savage races regard the first appearance of the men- 
strual flow as the only certain sign of puberty, and among many such 
races this is the occasion of peculiar ceremonial rites. The attain- 
ment 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. 

For two reasons in particular, the period of the menarche is a 
time of storm and stress to women, first on account of the de- 
velopmental processes in the genital organs, and secondly on account 
of the intellectual changes that occur at this period. 

The local cause is to be found in the extensive transformation of 
the ovaries and the uterus, by means of which a peculiar and power- 
ful stimulus, the menstrual stimulus, is elaborated, which has a re- 
flex influence upon heart and brain, vascular and nervous systems^ 
and secretory and nutritive processes. Since we know that in every 
premenstrual period by the growth of the follicles hyperaemia is 
excited in the ovary, by means of which the liquor folliculi is in- 
creased in amount, we can well understand that at the time of the 
menarche the ripening of the graafian follicles is accompanied by a 
considerable degree of hypersemia of the ovaries and of the whole of 
the genital organs, now undergoing their fullest development, and 
we can easily see how this hypersemia may result in manifold reflex 
disturbances. But in addition to these reflex disturbances, we have 
once more to take into consideration the as yet imperfectly known 
chemical processes which are associated with the ripening and de- 
velopment of the graafian follicles, and an abnormal course of 



u 



The Sexual Epoch of the Menarche. 49 

which may give rise to a disordered constitution of the blood, mani- 
festing itself as chlorosis or in other ways. In connection with the 
growth and ripening of the ova, extensive and novel demands are 
made on the organism, and these may well endanger metabolic 
processes which are not established on a very secure foundation. 

The other cause is to be found in the intellectual processes which 
occur at this time in the youthfully receptive, highly sensitive 
organ of mind, the brain. The girl growing into womanhood, who 
with astonishment and stress has witnessed the visible changes in 
her body, the outward signs of puberty, as they gradually make 
their appearance, receives powerful psychical stimulation which 
cannot fail to exercise an influence upon the entire nervous system 
and its complex interlacements, alike in the sensory and in the 
motor sphere. 

The degree to which these influences radiating from the genital 
organs make themselves manifest is chiefly dependent upon the 
resisting power of the nervous system as a whole, upon the tem- 
perament, the inherited constitution, and the mode of education of 
the young girl. In children belonging to families noted for sensi- 
bility and irritability, in dwellers in large cities who have attended 
high schools for girls and have at an early age lifted the veil that 
covers the sexual processes, the reflex disturbances of the 
menarche will be more manifold and will manifest themselves with 
greater intensity than in children brought up in country districts, 
whose sensibilities are chiefly ^physical and whose mind is less 
susceptible to the influence of external stimuli. 

A further important consideration is the time at which the 
menarche occurs, and whether on the one hand it is at or near 
the average age, or whether on the other, as precocious menstrua- 
tion, it is unusually early, anticipating the general bodijy develop- 
ment, or again as retarded menstruation it is unduly delayed. In 
some cases of retarded menstruation, the external genital organs 
are thoroughly well developed, and it is menstruation only that 
remains in abeyance ; but in other cases the external genitals are 
also backward in development, the pubes and mons Veneris being 
but sparsely supplied with hair, and the breasts remaining very 
small. 

In addition to these abnormal temporal relations of the men- 
arche, certain other irregularities at the commencement of men- 
struation are Avorthy of note. Thus, the first menstruation may 
be normal, but thereafter amenorrhoea may persist for several 
months, or if the flow occurs it may be exceedingly scanty, or very 
pale in color; on the other hand, menstruation may be very profuse, 
lasting many days. 



50 The Sexual Life ctf WoMan. 

The environment in which the young girl is placed during the 
period of her sexual development has a great influence on the proc- 
esses of the sexual life and on the pathological disturbances that 
affect these processes. 

In working-class families the immoderate physical strain often 
thrown upon girls, in many cases continuous movements of the 
upper extremities whilst the lower extremities and the pelvis are 
absolutely quiescent, or conversely, an excessive employment of 
the muscles of the lower extremities — these circumstances in con- 
junction with insufficient nutriment, night-work, association when 
at work with persons of the opposite sex, and the frequent prem- 
ature sexual stimulation, will combine to have a most deleterious 
effect. 

Amongst country-folk, indeed, the girl has the enjoyment of 
fresh air, and as a rule nutritive food, moreover, there are not so 
many occasions of nervous stimulation; puberty therefore arrives 
more slowly and gives rise to less disturbance ; but the ignorance 
of the girls very frequently leads to an early experience of coition, 
the natural and unnatural consequences of which have then to be 
taken into account. 

Amongst the better classes of townspeople such hygienic regula- 
tions and educational measures are in common employment that 
young girls during the } ears of development usually receive reason- 
able care and attention — but very frequently, intercourse with 
older girls, association with young men, visits to theatres, evening- 
parties, and balls, and the perusal of stimulating literature, form 
unfavorable features of urban life which exercise their inevitable 
effects in the sexual sphere. In some cases, fortunately suffi- 
ciently rare, the stimulation of the sexual impulse and the longing 
for its satisfaction are so intense, that a kind of dcmi-vicrge is 
brought into being, a young woman who is concerned only to 
preserve the physical token of virginity, but whose thoughts and 
fancies are anything but maidenly. It is to be feared that in con- 
sequence of the excessive freedom in education and the emanci- 
pated independence of feminine youth, these '' half-virgins " are 
increasing both in number and in intensity, a fact which cannot 
fail to increase also the number of sexual maladies and perversions. 

Anatomical Changes in the Female Genital Organs^ in the Period 

of the Menarche. 

The female reproductive organs, which in childhood were in a 
comparatively quiescent state, now become powerfully active, as is 
witnessed by the changes that occur in the external genitals. 



Ill 



The Sexual Epoch of the Menarche. 



51 



The soft, hairless vulva of the child becomes enlarged at the 
time of the menarche by the deposit of fat, and its substance be- 
comes tough and elastic. Some time before puberty, fine, pale 
hairs make their appearance here and there, but not until puberty 
does the hairy covering of the pubic region become more or less 
thick. The growth of the denser pubic hair begins with the ap- 
pearance of hairs along the middle of the mons Veneris and at the 
margins of the labia majora. Early sexual development is com- 
monly indicated by an early and thick growtn of the pubic hair. 
In the virgin this hair is smoother and less curly than in the later 
course of the sexual life. In certain tribes of negroes it is the 
custom for the young unmarried girls to shave off the pubic hair, 
which is not allowed to grow freely until after marriage. In some 
of the tribes of South Sea Islanders it is customary at puberty to 
tattoo the external genitals and the surrounding skin. 



Fallopian tube 
Ovary 



Body of the uterus 



Neck of the uterus 




Broad ligament of the uterus r^?"^ 
Vaginal portion of the cervix 
Vagina (mucous membrane) 



Fig. 8. — Internal genital organs of a newborn, powerfully developed 
female infant. (From Toldt: Atlas of Human Anatomy.— Rebman Com- 
pany, New York.) 



In young virgins the rima urogenitalis or vulval cleft is closed 
by the accurate opposition of the labia majora ; the labia minora or 
nymphse are delicate in texture, rose-red in color, hairless, free 
from fat, and completely covered by the labia majora; whilst tlie 
ch'toris is likewise concealed. The sebaceous glands of the labia 
minora secrete a smegma which collects especially around the 
glans clitoridis, and as it undergoes decomposition diffuses a 
peculiar odor, resembHng that of old cheese. A wing-Hke elonga- 
tion of the labia minora in young girls, with free secretion and a 
generally moist appearance, leads to a suspicion of the practice of 



5^ 



The Sexual Life of Woman. 



masturbation. In the virgin the orifice of the vagina is covered bv 
the hymen. -' 



Suspensory ligament of the ovarj*-- 
Ovary ^-^^ 
Neck of the uterus 



^''Fallopian tube 

^Body of the uterus 




Peritoneum 



/ / / Urinary bladder 



~ Urethra 



Vestibule of the vagina 
Hymen 



, Fig 9.— Reproductive organs of a newborn, powerfully developed female 
infant in median sagittal section. (From Toldt: Atlas of Human Anatomy 
— Kebman Company, New York.) ^' 



The entrance to the vagina in the virgin is rounded, the posterior 
border of the aperture being deeply concave, whilst the anterior 
border is often slightly convex backwards. Where this feature is 



Ovary. 



Fallopian tube 
Ligament of the ovary \ 




Vaginal portion ci the 
cervix 

Vagina (posterior -— \l 
wall, turned out- 
wards) 

Fig. 10. — Internal genital organs of a girl aged eight years. Seen from 
behind. (From Toldt: Atlas of Human Anatomy. — Rebman Company, 
New York.) 



The Sexual Epoch of the Menarche. 



53 



strongly marked, the orifice has a semi-hmar shaj)c. The posterior 
concave border projects forward in the form of a fold, continuous 
above with the posterior vaginal wall ; this fold is the hymen. 



Infundibulum of the Fallopian tubo 



Ovary 
Body of the uterus 



Suspensory ligament 
of the ovary 



Fallopian tube 
---- Mesobalpynx 

-- Neck of the uterus 
Utercsacral ligament 
Ur nary bladder 




Anus, 



Perineum /' 



Glans clitoridis 
Labium mmus or nymphf 
Labium majus 
External orifice of the urethra 



Hymen 



Fig. II. — Reproductive organs ol a girl aged ten years in median sagittal 
section. Left half. (From Toldt: Atlas of Human Anatomy. — Rebman 
Company, New York.) 



The infantile uterus is so proportioned that its neck (collum vel 
cervix uteri) constitutes the larger part of the organ, as much 
indeed as two-thirds. Owing to the small size of the body {corpus 
uteri), the whole uterus is very flat, and its borders ascend in a 
direction almost parallel to each other, diverging somewhat 
abruptly into the Fallopian tubes, recalling in some degree the two- 
horned embryonic form of the organ {uterus bicornis). The pHcae 



54 



The Sexual Life of Woman. 



Fraenum of clitoris 




Urethral ridg; 



Posterior vagina 
column 



Anterior vagina 
column 



Transverse rugae of 
the vagina 

Posterior wall of the 
vagina 



Vaginal fornix 



Supravaginal portion of the 
cervix 



Mons Veneris 



,T^abium majus 



External orifice of the 
urethra 



.-'Oiifice of Skene's 
tubule 



Orifice of the duct of 
Bartholin's gland 



Bartholm's gland 

-Mucous membrane of the 
vagina 

Muscular coat of the vagina 
Anterior wall of the vagina 



^- Anterior lip of the cervix 
~ Os uteri externum 
Posterior lip of the cervix 



Fio. 12.— Female external genital organs of a virgin, attached to the 
vagina which has been isolated and opened, and a portion of the cervix 
uteri, Hymen, etc. (From Toldt: Atlas of Human Anatomy.— Rebman 
Company, New York.) 



1 



The Sexual Epoch of the Menarche. 



55 



W 



U." 





Fig. 13. — The external genital organs of a virgin, drawn apart transversely 
(after yon Preuschen). c. Clitoris, f. c. Fraenum of the clitoris. n. Nymphae. 
1. Labia majora. o. u. Urethral orifice, h. Hymen, f. n. Fossa navicularis. 



56 



The Sexual Life of Woman. 



palmatse on the surface of the cervical canal, which make up th€ 
arbor vit.x uterina, are strongly developed; the median longitudinal 
ridge bifurcates, and its divisions can be traced on either side 
into the uterine orifice of the Fallopian tube {ostium uterinum 
tub^). The lips of the vaginal portion of the cervix are com- 
paratively speaking very large and terminate in sharp angles. The 




Fig. 14. — Sagittal section of the female pelvis (after Breiolel). 

vaginal mucous membrane is everywhere beset with long papillae. 
The development of the uterus shortly before puberty consists 
chiefly in the enlargement of the body of the uterus, and the growth 
of its walls in thickness. 

At the time of puberty, according to Toldt, the body of the uterus 
in the virgin has already increased till its length is half that of the 
entire organ; and at the first appearance of menstruation the body 
and neck of the virgin uterus are nearly equal, with perhaps a 
slight preponderance in size of the cervix, and the walls of the 
uterus have become convex. In consequence of this change the 
organ becomes pear-shaped, and the uterine cavity {caviim uteri) 
assumes the form of a triangle with moderately incurved sides. The 
cervical canal becomes wider in the middle ; the margin of the os 
uteri becomes smooth and rounded. The walls of the virgin vagina 



The Sexual Epoch of the Menarche. 57 

are marked with numerous dentate transverse ridges {rugce), 
especially near the lower end and on the anterior walls, the columns 
of the vagina (coliDiiiice rugaruni), from which the transverse ridges 
run to either side at right angles, extend half way up the vagina, 
and are of a hard consistence. 

The characteristic changes in the ovary at the time of the menarche 
originate in the changes undergone by the ovarian follicles. A 
large number of small separate follicles is to be found already in 
the ovary of the new-born infant. These structures, known as primi- 
tive follicles, are formed by detachment from the egg-tubes that 
grow down into the stroma from the superficial germinal epithelium ; 
they are spheroidal vesicles, enveloped by a single layer of cubical 
cells, and their interior is entirely filled by the primitive ovum or 
egg-cell. This latter consists of very finely granulated protoplasm 
with spherical nucleus and distinct nucleolus, but no trace of an 
investing membrane can as yet be discerned. The further develop- 
ment of the ovarian follicles takes according to Toldt the following 
course : A rapid multiplication of the cubical cells that form the 
wall of the follicle occurs, so that the ovum is surrounded by two, 
three, or several layers of cubical or rounded cells, and the whole 
follicle gradually increases in size. At the same time the ovum 
assumes an eccentric position in the interior of the follicle. At or 
near the middle of the follicle a slit-shaped space now appears, 
filled with a clear colorless fiuid. As this space gradually enlarges, 
the follicle^^ becomes converted into a vesicle filled with fluid, the 
wall of which is composed of small cubical cells. Simultaneously 
with the growth of the follicle a lamination of the elements of the 
surrounding stroma takes place, so that a somewhat sharply defined 
capsule is formed. In this condition these glandular structures of 
the ovary are known as graafian follicles. ^^ 

Before puberty, these graafian follicles are small vesicles of a 
diameter of one to two millimetres, containing the large unicellular 
ova. Each of these consists of an envelope, the zona pellucida (also 
known as the zona radiata, or striated membrane of the ovum) ; an 
external granular mass of protoplasm, the vitellus or yolk ; a vesicu- 
lar, spherical nucleus, the germinal vesicle ; and a nucleolus, which 
if single is large and prominent, the macula germinativa or germi- 
nal spot. As early as the second year of infancy every imaginable 
intermediate stage between the primitive follicle and the fully-de- 
veloped vesicular graafian follicle can be observed. 

19 It is by a certain abuse of terminology that the name follicle is given to these 
structures even before the appearance of fluid in their interior, the word 
folliciilus meaning properly a little bag or sack. The author's limitation of 
the term graafian follicle to the later, full-grown stage of these structures, 
though historically accurate, is not usual in England. Tr. 



58 



The Sexual Life of Woman. 



'At the time of puberty certain larger follicles are always to be dis- 
tinguished, which have moved inward toward the interior layers 
of the ovary, whereas the smaller follicles have a more peripheral 
situation; thus, according tO' Waldeycr, we observe at this time in 
a section of the ovary, proceeding from without inward, first the 
epithelium, next the fibrous tunic, next the zone of younger follicles, 
and finally the zone of older folHcles. According to Hcnle ami 
IValdeycr, at the commencement of puberty, there are in each ovary 
about 36,000 ova, giving a total for the two of 72,000. 

In the further course of development of the graafian follicles at 
this period, the most advanced now reapproach the surface of the 
ovary, so that a fully-matured follicle comes to occupy almost the 
entire thickness of the cortical substance, and may even give rise 



- ^^.^M^^^Ht'-^^ 


■ . 


: ^mM 


miJ^M.'r 




-■^^^W^ 


^M-^^^mA 


.fi'^'^M^^'.^m^^^'m^Ai 








■HhH^kI^ 




■ -/'^^^^. '--■^-^''i^^ ' h^^^^^^^^^W/^' 


^ili^'f?^'^'^:] 


\{ ^'^^^^wmi 


mm^-] 


V' '■'' ^^^:^0/iMwM^ 


'^'9hh-'-- 








V ■ '*V'."--'fSp= 


i^:' -V 







Fig. 15. — Primitive follicles. 

to a localized bulging of the surface of the organ. In such a mature 
follicle, which has attained nearly the size of a pea, we recognize 
an outermost connective-tissue investment {thcca foUiculi), consist- 



The Sexual Epoch of the Menarche. 59 

ing of condensed ovarian stroma, in which two layers are distin- 
guished, sometimes called simply outer tunic and inner tunic, some- 
times known by the names of tunica fibrosa (outer) and tunica pro- 
pria (inner), respectively; within this is the cellular layer known 
as the menibrana granulosa (or stratum granulosum) , the portion 
of which, now greatly enlarged, immediately surrounding the ovum 
is known as the discus proligerus (or cumulus obphorus) ; the inter- 
space between the discus proligerus and the membrana granulosa is 
filled with a clear fluid, the liquor folliculi. In consequence of the 
continued increase in its fluid contents, the graafian follicle ulti- 
mately bursts along the most prominent portion of the superficial 
wall, and the ovum passes out through the rupture, finding its way 
under normal conditions into the Fallopian tube and through this 
into the uterus. The follicle itself then undergoes a regressive 
metamorphosis, forming the corpus luteuni, the rent in the envelope 
of which, after the absorption of the yellowish semi-fluid contents, 
undergoes cicatrization. Contemporaneously with this development 
at puberty of the process of ovulation, menstruation also for the 
first time makes its appearance, recurring thenceforward at four- 
weekly intervals as the regular catamenial discharge. 

We append the account given by Ffannenstiel regarding the 
ovarian follicles. He writes : '' In correspondence with the especial 
function of the female reproductive gland, which is to bring to ma- 
turity and to evacuate only after the lapse of a considerable period 
and at successive intervals, the ova which it has contained from the 
very outset, we find that primitive follicles continue to exist in the 
ovary up to the very end of the period of sexual activity, though 
naturally in diminishing numbers ; and the size and shape of these 
primitive follicles remain nearly identical throughout the various 
periods of life. As the follicle ripens, the epithelium grows, the cells 
becoming cubical with a rounded nucleus, and increasing in number 
by cell-division, so that several layers are formed. As soon as these 
layers are three or four in number, a space, at first slit-shaped, forms 
in the epithelium on the peripheral surface of the ovum ; this space 
is filled with fluid, known as the liquor folliculi ; the peripheral 
layer of cells, the membrana granulosa, is thus separated from the 
mass of epithelial cells immediately enveloping the ovum, the discus 
proligerus, which is situate in the side of the follicle adjacent to 
the hilum of the ovary. By the increase of the liquor folliculi the 
graafian follicle is formed, a vesicle the envelope of which is formed 
by the multilaminar membrana granulosa, whilst in the pole of the 
vesicle directed toward the hilum ovarii is the ovum imbedded in 
the mass of cells forming the discus proligerus, a mass which has 
the form of a truncated cone. The liquor folliculi is formed by 



6o The Sexual Life of Woman. 

the epithelium, the nuclei of which disappear by chromatolysis or 
by simple atrophy, whilst the cell-bodies liquefy in consequence 
of albuminous, not fatty, degeneration (Schottldnder). Within the 
epithelium of the follicle we find the faintly glistening epithelial 
vacuoles of Fleming, likewise cells which liquefy and assist in in- 
creasing the bulk of the liquor folliculi. Tliis liquor is a thin, serous 
fluid, and contains albumin. * * * Every graafian follicle has a 
bilaminar investing membrane, which is formed by the ovarian 
stroma. * * * The ovum of the growing follicle increases in 
size very slowly indeed, attaining on the average, according to 
Nagel, a diameter of 165 to 170 p., it retains its zona pellucida, 
the greater part of the protoplasm of the cell is transformed into 
dentoplasm (food-yolk, or yolk-granules), the nucleus assumes an 
eccentric position. Between the zona pellucida and the cell-body 
a narrow perivitelline space appears. The ovum is then full-grown, 
but not yet fully prepared for fertilization ; for this, maturation is 
required, certain changes in the germinal vesicle, which occur after 
the bursting of the follicle. * * * As a rule each follicle contains 
a single ovum. But two and even three ova have beyond doubt been 
observed in one follicle." 

According to Waldeycr, the bursting of the follicle is not to be 
regarded as dependent upon a sudden rise of pressure in its interior, 
but as the result of a gradual ripening process. At the deepest 
pole of the follicle, which in the course of its development has 
now approached the surface of the ovary, an exuberant growth takes 
place in the internal layer (tunica propria) of the theca folliculi, 
with a profuse formation of new vessels. Here numerous " epith- 
elioid " cells, the " lutein-cells," make their appearance. In conse- 
quence of this proliferation of the lutein-cells, the contents of the 
follicle are gradually pressed toward the " stigma," the superficial 
pole of the follicle, and the follicle itself is pushed toward the sur- 
face until it finally comes into contact with the germinal epithelium. 
Meanwhile the follicular epithelium undergoes fatty degeneration, 
alike in the membrana granulosa and in the discus proligerus. In 
consequence of the proliferation of the lutein-cells, on the one hand, 
and the fatty degeneration of the epithelium, on the other, the follicle 
opens at its weakest point, the stigma, and the ovum is extruded, 
with the liquor folliculi, and a number of cells belonging to the 
follicular epithelium. (To illustrate these changes we have bor- 
rowed Figs. 15, 16, and 17 from the monograph, by Pfannenstiel on 
Diseases of the Ovary, in /. Veits' Handbook of Gynecology.) 

The ovaries, which in the new-born female infant are flattened, 
ribbori-Hke bodies one-half to one-centimeter (0.2 to 0.4'') in length, 
and in childhood are cylindrical, with a perfectly smooth surface, 



Jl 



The Sexual Epoch of the Menarche. 



6i 



assume at the time of puberty a more or less flattened form. Dur- 
ing the menarche they have an elongated oval sliape, flattened from 
side to side, their average length being 2.5 to 5.0 centimetres (i to 
2"), v^idth 1.5 to 3.0 centimetres (0.59 to 1.18"), thickness 0.6 to 
1.4 centimetres (0.24 to 0.55''), weight 5 to 8 grammes {'jj to 123 
grains). After the repeated occurrence of ovulation, the surface of 
the ovary becomes more and more uneven, being thickly covered 
with fossae or scar-like fissures. 




Fig. 16. — Ripening' follicles. 



The vagina during virgin girlhood is narrow, and its mucous 
surface is beset with numerous rugae, which may be plainly felt as 
well as seen. The calibre of the vagina is proportionately less the 
younger the girl. The examining finger is gripped by the vaginal 
wall as by an india-rubber tube (Maschka). The vaginal portion 
of the cervix is felt in the form of a truncated cone, with a smooth 
surface, rather dense in consistence ; the external os opens at the 
bottom of a small depression on its surface, in the form of a short 
oval, the long axis of which is transversely directed. Shortly before 
the menarche, Bartholin's glands become noticeable on either side 
of the lower end of the vagina between the sphincter muscles. 

The clitoris in many cases attains a very large size, and this is apt 
to lead to sexual malpractices. According to Hyrtl, in southern 
countries the clitoris is larger than in temperate and cold climates. 
In the women of Abyssinia and among the Mandingoes and the 
Ibboes, the size is portentous, and amongst the first-named, cir- 
cumcision of females is a customary operation. It is said that fe- 
male slaves belonging to these races are greatly esteemed by the 



62 



The Sexual Life of Woman. 



ladies of the harem, and are eagerly sought for. In the anatomico- 
pathological museum at Prague there is a preparation of the female 
genital organs with a clitoris as large as the penis of a full-grown 



man. 




Fig. 17. — Graafian lollicles. 

Sonini describes " as peculiar to women of Egyptian or Koptic 
descent, the presence of a thick, fleshy, but soft and pendent out- 
growth in the pubic region, completely covered with hair," which 
he compares to the hanging caruncle on the bill of the male turkey. 
This appendage becomes thicker and longer with advancing years. 
Sonini found such an appendage one-half inch in length in a girl of 
eight years, one of more than four inches in a woman of twenty to 
twenty-five years. Circumcision in girls consists in the removal of 
this outgrowth, which hinders copulation ; in that part of the world 
the operation is usually effected in the seventh or eighth year, just 
before puberty. 

The circumcision of girls as practiced by Mahommedan peoples 
in Africa is said by Ploss and Bartels to consist in abscission of the 
labia minora, the clitoris, and the prseputium clitoridis. Brehm is 
of opinion that the object of the operation is to diminish the in- 
tensity of the sexual impulse, so overpowering among these" races; 
but others believe that the great enlargement of the clitoris and the 



The Sexual Epoch of the Menarche. 63 

labia minora usual in those countries is regarded as a serious defect 
in beauty, a defect removed by the operation ; whilst others again 
hold that the circumcision is required for the removal of the hin- 
drance to copulation presented by the abnormally large clitoris. 
Closely related to the operation of circumcision in females, according 
to Ploss and Bartcls, is the custom peculiar to Africa of infibulation, 
wherein, after a preliminary cutting operation like that for circum- 
cision, the fresh wound surfaces are brought into accurate opposi- 
tion, either by sutures or by appropriate bandages, so that when 
cicatrization occurs the vulval cleft is closed except for a very small 
aperture. The object of infibulation is to enforce on girls complete 
abstinence from sexual intercourse. (Before marriage, the vulval 
cleft is reopened to an extent corresponding with the size of the 
genital organs of the future husband; and when pregnancy occurs, 
the opening is still further enlarged before parturition ; but after 
that event, the wound surfaces are refreshed, and the whole opening 
is once more closed). On the other hand, in many savage tribes, 
elongation of the labia minora and the clitoris is artificially under- 
taken from the earliest years of girlhood, this elongation being re- 
garded as a beauty. 

The parts of the external reproductive organs of the female con- 
cerned in sexual sensation, first described as such by Kohclt, 
are already fully developed at the time of the menarche. Of these 
parts a small portion only, the glans clitoridis, is visible externally, 
surrounded by the prseputium clitoridis, a prolongation of the labia 
minora, which passes round the front of the clitoris, and sends 
from each side a fine process behind the glans to become attached to 
its under surface, forming the frsenum of the clitoris. The erectile 
apparatus of the external genitals is formed by the corpora cavernosa 
clitoridis. As two dehcately constructed trabecular masses of 
erectile tissue, the crura of the clitoris, these are attached on either 
side to the inferior or descending rami of the pubic bones; at first 
passing upwards parallel to the bones, they subsequently curve down- 
ward as they converge and unite to form the body of the clitoris ; 
these masses of erectile tissue embrace the sides and the front of 
the lower extremity of the vagina. This erectile apparatus, when 
the supply of arterial blood is greatly accelerated and at the same 
time the outflow of venous blood is diminished, becomes distended 
with blood, enlarged and stiffened ; the process of erection plays an 
important part, as we shall explain more fully later, in the produc- 
tion of sexual excitement and sexual pleasure during the act of 
copulation. 

In the virgin and in the earlier phases of the sexual life, the 
hymen is so characteristic an organ that its more minute descrip- 
tion would seem desirable. 



64 



The Sexual Life of Woman. 



The hymen, a fold of mucous membrane, springing from the 
periphery of the vaginal orifice, separates as a perforated diaphragm 
the vagina from the vulva. Between the two epithelial layers of 
which, as a fold of mucous membrane, the hymen consists, is a sup- 
porting layer of connective tissue of variable strength; in other re- 
spects the mucous membrane of the hymen has the same structure 
as the mucous membrane of the vagina. On its inner surface the 
rugcC and folds of the vaginal mucous membrane are prolonged. 
The shape of the hymen is very variable ; most commonly its 
aperture is more or less central, so that the hymen has a ringed or 
semilunar shape. 

In the new-born female infant, the hymen has the appearance of 
a tubular stopper closing the lower end of the vagina ; according to 
Dohrn it exhibits as a rule one of three typical forms : Hymen 
annularis, denticnlatns, et linguiforniis ; the mviular, the denticulate, 
and the linguifonn (or lingidiforni) hymen. The transverse ridges 
on the inner surface of the hymen, prolongations of the rugose 
columns of the vagina, are strongly developed. During the girl's 
further growth, in association with the enlargement of the vagina, 
the hymen undergoes important changes in form and structure. 
Its border becomes thinner and more tense ; and in the virgin at the 
time of the menarche, the annular hymen is the fundamental type, 





^ 



Ym m 



Fr:. 1 8. — Annular Hymen. 



Fig. 19. — Annul ar Hymen. 



subject, however, to extensive variations. In most cases, at any 
rate, the aperture in the hymen is more or less centrally situated; 
very commonly, however, this opening is crescentic, when we have a 



The Sexual Epoch of the Menarche. 



65 



semilunar hymen, the height of the border posteriorly being much 
greater than anteriorly. The consistency of the hymen, its extensi- 
bility, and its thickness, are as variable as its shape. 




i 



Fig. 20. — Semilunar Hymen. 




Fig. 21. — Annular Hymen with con- 
genital Symmetrical IndentatioUvS. 





Fig. 22. — Fimbriate Hymen. Fig. 23. — Deflorated Fimbriate Hymen. 



In the normal position of the reproductive organs the hymen 
has very rarely the appearance of a tense membrane; as a rule it 



66 The Sexual Life of Woman. 

is folded up, and becomes plainly manifest only when the genital 
organs are stretched. The margin of the hymeneal aperture, as a 
close examination shows, is sometimes sharp and regular, sometimes 
lobulated, with small congenital notches. These congenital notches 
are to be distinguished from the lacerations resulting from deflora- 
tion by the fact that the former have a smooth border, which is of 
the same consistency as the general substance of the hymen. In some 
instances the border of the aperture in the hymen is beset with small, 
fine villi (villous hymen). 

The common varieties of the hymen are thus classified by 
Maschka: 

1. The annular hymen, in which the membrane when stretched is 
seen to have a rounded aperture, which may be central or eccentric ; 
very often, indeed, the aperture is more toward the upper half of 
the hymen, in which case it is not always circular, but frequently 
rather ovoid in shape. 

2. The semilunar or crescentic hymen, in which the aperture is 
eccentrically placed in the upper half of the membrane, in such 
a manner that the hymen exhibits a wide surface below the aperture, 
which surface narrows at either side as it passes upwards until it 
disappears, the two sides failing to reunite above the aperture. 

3. The heart-shaped or cordiform hymen, the general shape of 
which may be circular, ovoid, or even semilunar, but in which 
from the middle of the upper or lower margin a three-cornered 
tongue projects across the aperture, which is thus given the form 
of the conventional heart of a pack of cards. 

4 rhe infundih'liforni hymen has the form of a small project- 
ing funnel resembling in appearance the invaginated end of the finger 
of a glove. 

Maschka refers also to the rare condition in which the hymen 
is sometimes said to be absent. As a matter of fact, however, in 
such cases, it is represented by a very narrow annular eminence, the 
genitals being in other respects normal. The smooth character of 
the eminence will serve to differentiate it from the remains of a 
destroyed hymen. Other rare forms are : 

1. The imperforate hymen, an occlusive membrane, entirely 
blocking the vaginal orifice. In some cases, however, the hymen 
is not absolutely imperforate, a very small, punctiform aperture 
being present. 

2. The cribriform hymen, a hymen which is '' imperforate " in 
the sense that there is no opening of a size approaching the normal, 
but in which several minute apertures are present. 

3. The septate, bridged or divided hymen (hymen bifenestrattis, 
etc.), exhibits a strip of mucous membrane, most commonly running 



II 



The Sexual Epoch of the Menarche. 



67 



directly from before backward, occasionally, however, somewhat 
obliquely, across the aperture in the membrane, which is thus di- 





FiG. 24. — Septate Annular Hymen. Fig. 25, — Septate Semilunar Hymen. 




Fig. 26. — Extremely tough Annular 
Hymen, with an obliquely dis- 
posed Septum. 



Fig. 27. — Septate Hymen with 
Apertures of unequal size. 



vided into two equal or unequal parts. In some instances the 
process that bridges the aperture of the hymen is expanded in the 
vertical plane to form a septum which projects for some distance 
into the vagina. 



6^ 



The Sexual Life of Woman. 



4. The lobatc, lohulatcd, or labiate hymen, whiich consists 
of several (two to four) lobes on either side, each overlapping 





Fig. 28. — Septate Hymen with 
Apertures of unequal size. 



Fig. 29. — Hymen with rudimentary 
Septum. 



the next like the tiles in a roof, whilst the aperture between the 
two sides has the form of an antero-posterior slit (Fig. 37) ; in 





Fig. 30. — Hymen with posterior rudi- Fig. 31. — Labiate Hymen with 
mentary Septum. posterior rudimentary Septum. 



some cases the lobes of a lobulated hymen are so disposed that 
the membrane has the appearance of a fold of mucous membrane 
with a central furrow. 



The Sexual Epoch of the Menarche. 



69 



It is obvious that an imperforate or cribriform hymen, by the 
hindrance it offers to the passage of the menstrual discharge, is 





Fig. 32. — Hymen with anterior Fig. ^3- — Hymen with anterior rudi- 
rudimentary Septum. mentary Septum projecting in a 

opiniform Manner. 

Hable at the time of the menarche, and as soon as menstruation be- 
gins, to give rise to serious disorder and to pathological states. 






Fig. 34. — Hymen with ante- Fig. 35. — Hymen Fig. 36, — Hymen in which 

rior and posterior rudimen- with filiform pro- there are two symmetri- 

tary Septa. cess projecting cally disposed thinned 

from the anterior areas. The left of these 

margin. is perforated. 

The illustrations we append, showing the various forms of the 
hymen, are taken from von Hoffmann's Handbook of Medical Juris- 
prudence. (Figs. 18-45.) 



\ 



70 



The Sexual Life of Woman. 



In some cases the hymen is exceedingly thin and deHcate, so that 
it is liable to be torn if handled at all roughly ; in other cases, on 





7/v ^y 



Fig. 37, — Very un- Fig. s^. — Semilunar Hymen Fig. 39. — Deflorated Semilunar 
usual form of with cicatrized Lacera- Hymen with laterally dis- 

Hymen. tions in its Border. posed Symmetrical Lacer- 

ations. 




Fig. 40. — Deflorated Annular 
Hymen with several cica- 
trized Lacerations. 



Fig. 41.— a. Septate Hymen in which Deflora- 
tion has been effected through one of the 
Apertures. U. Urethra. Cl.CUtoris. H. 
Cicatrized margin . C. Septum. B. Lateral 
View of Septum. 



the contrary, it may be very firm, thick, and fleshy, interlaced with 
strands of connective tissue and muscle, so that it forms a veritable 
cuirass for the protection of physical virginity. 



The Sexual Epoch of the Menarche. 



71 



As signs of virginity in the female, a knowledge of which is 
required, not only for the purposes of medical jurisprudence, but 




Fig, 42. — Deflorated Septate Hymen. Fig. 43. — Hvmen with larger anterior and 

smaller posterior Apertures. 





Fig. 44.--Carunculae Myrtiformes Fig. 45. — Vaginal Inlet of a Multipara, 
in a Primipara. without Carunculae Myrtiformes. Slight 

Prolapse of anterior and posterior Va- 
ginal Walls 



»j2 The Sexual Life of Woman. 

for various other reasons, we may enumerate the following ana- 
tomical characteristics of the genital organs. The labia majora 
are elastic in consistence and are in close apposition with one an- 
other; the labia minora or nymphae are covered by the labia majora 
and are but little pigmented; the vestibule and the vaginal orifice 
are narrow, and the vagina itself is narrow, tense, and markedly 
rugose; the hymen is normal and uninjured (this, of course, is the 
most trustworthy of all the signs of virginity) ; the breasts have 
the virgin conformation. In opposition to the plea that the hymen 
can be destroyed by other causes than defloration, as by a fall, 
especially a fall which brings the external genitals' in contact with 
some hard body, or by diphtheritic, variolous, or syphilitic ulcera- 
tion, Maschka maintains that such occurrences are among the great- 
est rarities. 

On the other hand it is sufficiently well known that the presence 
of an uninjured hymen affords no certain assurance of actual vir- 
ginity. Cases enough are recorded, both in older and more recent 
medical literature, in which even pregnancy occurred in women in 
whom the hymen had remained intact, the explanation being that 
during copulation penetration of the penis had failed to occur, the 
semen being ejaculated on the vulva. Scanzoni and Zwcifcl have 
recorded cases in which the intact hymen offered a hindrance to par- 
turition. The first-named author explains these occurrences by the 
assumption that the hymeii was so stout that the penis was unable to 
rupture it. Vcit remarks that both male and female youth, in these 
days of the continued advance of knowledge, are well acquainted 
with coitus sine immissione penis, and that very frequently a woman 
who is informed that she is pregnant makes answer that this is im- 
possible, her paramour having assured her that pregnancy could not 
occur. On the other hand, cases are met with in which the aperture 
in the hymen is a very large one, so large that the penis can penetrate 
to the vagina without lacerating the membrane. 

Broudardel reports a case of rape in which the lacerated hymen 
healed so completely that an expert maintained the integrity of the 
membrane, until another pointed out the fine scar. 

In general, that we may be assured of the existence of virginity, 
we must find the hymen uninjured; and, on the other hand, we 
must regard the laceration of the membrane, unless known to be the 
result of gynecological examination or other manipulation, as a 
proof of defloration. 

In ancient times among savage races the integrity of the hymen 
was prized as a proof of virginity, and in the Bible also great stress 
is laid on this sign in connection with defloration, and its absence 
was even regarded as a ground for the death punishment (Deut. 



The Sexual Epoch of the Menarche. 



73 



xxii, 21 ). But amongst other races the hymen was held in no par- 
ticular esteem as a token of virginity. 

In ancient times, and even at the present day in the Philippine 
Islands, the Ladrone Islands, and certain other islands of the Poly- 
nesian Archipelago, also among many African tribes, the right of 
defloration belonged, not to the bridegroom, but to every man be- 
longing to the same tribe ; sometimes on the bridal night all the 
men of the tribe had access to the bride, the bridegroom coming 
last, but thenceforward having undisputed possession of his wife. 



Anterior 
fold of 
the ax- 
illa 




Nip- 
ple or 
ma- 
milla 



Areola 



Supernumerary 



Fig. 46. — Mamma, the breast of a virgin aged eighteen years. (From 
Toldt: Atlas of Human Anatomy. — Rebman Company, New York.) 



Amongst certain other tribes a similar custom prevails, differing 
however in this respect, that the rite of defloration is performed by 
a priest or by one of the chiefs of the tribe. In mediaeval Europe, 
again, the great landed proprietors exercised the well-known jus 
prinuB noctis or droit d\i seigneur. 

In girls at the time of the menarche who have long practiced 
masturbation, some of the following indications of the habit will 



74 The Sexual Life of Woman. 

be found: Elongation, redness, and general enlargement of the 
clitoris; elongation and thickening of the nymphse, which are also 
of a tough consistency and deeply pigmented ; flaccidity of the labia 
majora; redness of the vaginal orifice; flaccidity of the hymen, 
which also may exhibit lacerations, caused by the forcible introduc- 
tion of the finger or of some hard foreign body. 

Not until the time of the menarche do the breasts attain the 
hemispherical form which constitutes one of the graces of young 
womanhood, and at the same time these organs assume a firm, elas- 
tic consistency; their size of course varies in different individuals. 
The nipple now has a rose-red color, darker in brunettes than in 
blondes; it is usually small, sometimes quite inconspicuous, being 
withdrawn into a cutaneous furrow. The two breasts when re- 
garded from the front are seen to diverge from the longitudinal axis 
of the body. In some cases even in childhood, before the time of the 
menarche, the breasts are powerfully developed, being as large as 
an apple or larger. This depends on climate, race, and sexual ex- 
citement ; as regards the last of these, early sexual stimulation pro- 
motes premature mammary development. 

Although it is unusual for any secretion to appear in the mammary 
gland before the occurrence of pregnancy, cases have certainly been 
observed in which the breasts of virgins secreted a milk-like fluid, 
especially in consequence of sexual excitement or during menstrua- 
tion. Thus Maschka observed in a girl the condilion of whose 
genital organs showed her to be a vh'go intact a that pressure on the 
breast caused a few drops of an opalescent fluid having the appear- 
ance of milk to exude from the nipple. She acknowledged that 
amatory relations had long subsisted between her and a lover who 
was in the habit of handling her breasts, and that this always 
produced strong sexual excitement. Hofmann also reported that in 
two virgins "who died during menstruation he was able to express 
a drop of milk from the breast. 

The most important indication of the general changes occurring 
in the external and internal genital organs, the proof that the 
young woman has become fitted for the fulfilment of her reproduc- 
tive vocation, is the appearance of menstruation, a sanguineous dis- 
charge from the genital organs recurring every four weeks as the 
external manifestation of the internal process of ovulation. 

The anatomical changes that have already been described as 
occurring in the genital organs at the time of the menarche will 
serve to elucidate the numerous reflex processes that manifest them- 
selves at this period of life in so many departments of vital activity. 

It is especially the extensive developmiCntal processes in the ovary, 
influencing the nerves of that organ, which give rise to centri- 



The Sexual Epoch of the Menarche. 75 

petal stimuli and evoke reflex manifestations. In the working of 
the circulatory system, such influences are apparent ; and during the 
menarche, some time already before the first onset of menstruation, 
variations occur in the blood-pressure, and these during menstrua- 
tion take the form of a typical undulatory curve. 

Inner border ^^« 
Pectoral fascia*---^. 

PectoraHs major muscle 

Panniculi s adiposus 

Sk n 

Lobules of the breast 

Lobes of the brcJbt*V/ 



Nipple or mamilla 



Galactophorous or p 
mamillary ducts ^ 



Ampullae or sinuses 
of the ducts 

Body of the breast 




Outer border 



Fig. 47. — Horizontal section through the female breast, (From Toldt: 
Atlas of Human Anatomy. — Rebman Company, New York.) 

Thus it becomes comprehensible that even in healthy girls, the 
first appearance of the catamenia and likewise the expectation of 
the flow induce a certain modification and alteration \r} the whole 
nature and disposition. Girls often lose their previous cheerful and 
lively character, becoming quiet, self-absorbed, sometimes even 
melancholy ; they are disinclined for study, have a repugnance to 
all sustained physical or mental activity, become annoyed and snap- 
pish on slight occasion, are restless at night, consider themselves to 
be ailing, and so on. During the first menstruation girls commonly 
appear pale and anxious, they have blue lines beneath the eyes, the 
face has a tired aspect, the movements lack energy, and a general 
want of tone combined with an abnormal irritability may be noticed. 
Some days before the first menstruation, the vulva, the labia majora 



^(y The Sexual Life of Woman. 

and minora, and the vaginal mucous membrane, are swollen, the 
clitoris becomes conspicuous in consequence of erectile processes, a 
slight secretion appears in the genital passage, and the breasts be- 
come sensitive and slightly turgid. The urine deposits a thick 
sediment, and occasionally severe strangury is observed. In many 
cases, also, digestive disturbances occur, loss of appetite, constipa- 
tion, or a tendency to diarrhoea. 

The first menstruation usually lasts four or five days. On the 
first day the discharge is blood-stained mucus, thereafter becoming 
sanguineous. In some cases, the bleeding at the first menstruation 
is profuse and of long duration. 

It is not always after the first menstruation that the subsequent 
discharges follow at the regular intervals of four weeks. In deli- 
cate, anaemic girls the second menstruation may not occur till sev- 
eral months have elapsed after the first ; less often the second men- 
struation ensues a fortnight after the first, or even earlier. 

At the time of the menarche the sexual impulse, which has hitherto 
been dormant, becomes strongly developed. It is evoked at this time 
of life by the anatomico-physiological changes undergone by the re- 
productive glands ; the stimulus aroused by these processes in the 
ovary, being conducted to the brain, awakens passion. A.t the same 
time the observation of the growth of the hairy covering on the 
genital organs, the development of the breasts, and the appearance 
of menstruation, tend to arouse erotic presentiments. The reading 
of romances, conversations with female friends, and observation of 
the conduct of full-grown persons, convert these presentiments into 
clear ideas, and excite the impulse to the production of passionate 
sexual sensations, the sexual impulse. How far these stimuli arising 
from the reproductive apparatus are encouraged and accentuated, 
on the one hand, or repressed and diminished, on the other, depends 
on external impressions of various kinds. The environment is the 
determinant for the further transformation of the as yet undiffer- 
entiated sexual impulse into the fully-developed copulative and re- 
productive impulses. 

In his work on the Physiology of Love, Mantegassa describes the 
yearning and stress of the awakening sexual life, arising out of the 
presentiments, hazy sensations, and impulses, which are felt in the 
very earliest period of the developmental phase known as puberty. 

In general, in a young girl during the menarche, the sexual im- 
pulse manifests itself rather in the form of semi-conscious reverie, 
of platonic love. The adolescent girl exercises her imagination with 
the circumstances of her chaste love, her mind turns to this sub- 
ject when in solitude, her mood is apt to become melancholy, and 
it is the perusal of equivocal novels, or the educational assistance of 



II 



The Sexual Epoch of the Menarche. 77 

sexually experienced female friends, that transforms the sexual im- 
pulse to a vivid flame. 

Some authors believe that a sign of the awakening of the sexual 
impulse when directed toward some particular man is a change of 
color on the part of the girl when she sees this individual or hears 
him spoken of. Palpitation of the heart comes on, the pulse is in- 
creased in frequency, the respiration also, and the voice fails. In 
this manner, it is asserted, Galen discovered the love of a Roman 
lady, Justa, for the dancer, Pylades. 

The psychological reaction of the sexual impulse at the time of 
puberty manifests itself, as von Krafft-Ebing points out, in manifold 
ways, common to all of which, however, is the emotional state of 
the mind, and the need that the strange and new feelings now ex- 
perienced should find some objective centre of interest. Such ob- 
jective and emotional interests lie ready to hand in religion and 
poetry, both of Avhich, after the period of sexual development is at 
an end, and the originally incomprehensible desires and impulses 
have received an explanation, continue to have intimate relations 
with the world of sexual experience. Any one who doubts this must 
be reminded of the frequency with which religious fanaticism makes 
its appearance at the time of puberty. No less influential is the 
sexual factor in the awakening of aesthetic feelings. This world of 
the ideal opens itself at the time when the development of the sexual 
processes begins. * * * The love of early youth, continues von 
Krafft-Ehing, has a romantic, idealizing tendency. In its first mani- 
festations it is platonic, and willingly exercises itself in poetry and 
history. But as the sensibility awakens, the danger arises that this 
passion, with its idealizing power, will be transferred to persons of 
the opposite sex who in intellectual, physical, and social relations 
are by no means all that could be wished. Hence proceed misal- 
liances, elopements, and seductions, with the entire tragedy of im- 
passioned love, which conflicts with the dictates of morality and 
convention, and sometimes finds its bitter end in suicide or a double 
self-destruction. Love in which the senses play too prominent a 
part can never be a true and lasting love. For this reason, first 
love is as a rule very transitory, since it is in most cases no more 
than the first flare of passion. * * * Platonic love is a thing 
without existence, a self-deception, a false description of sexual sen- 
sations. 

Bchcl remarks that the number of suicides among women of the 
ages of sixteen to twenty-one years is an exceptionally large one, 
and he refers this chiefly to unsatisfied sexual impulse, unfortunate 
love, secret pregnancy, and to betrayal by men. 



^8 The Sexual Life of Woman. 

Menarche Precox et Tardiva. 
{Precocious and Retarded Menstrual Activity.) 

By the term precocious menarche we understand the pathological 
state in which a typical, four-weekly, sanguineous discharge from 
the female genital organs sets in at an abnormally early age, and is 
to be regarded as a symptom of a premature sexual development. 
Very commonly such children with precocious menstruation and 
premature sexual development, exhibit a comparatively high body- 
weight, great development of fat, early dentition ; they look older 
than their years ; and they have genital organs that also develop 
very early, with hair on the pubes and in the axillae ; the labia 
majora and the breasts resemble those of full-grown women, and 
the pelvis also has the adult form. Commonly also the sexual im- 
pulse develops early, whilst, in other respects, the intellectual de- 
velopment lags behind the physical. It is most probably a primary 
hyperplasia of the ovaries that gives rise to precocious menstruation, 
the ovarian follicles ripening earlier than usual. Frequently other 
pathological processes are associated with this early sexual develop- 
ment, such as general lipomatosis, rachitis, and new growths of the 
ovaries. In several cases of this nature, early conception has also 
been observed. According to oriental tradition, Khadijah was mar- 
ried at the age of five years to the prophet Mohammed, who co- 
habited with her three years later. 

Even if we except those cases in which in earHest infancy there 
is a sanguineous discharge from the vagina which remains, how- 
ever, an isolated occurrence, or if repeated is repeated a few times 
only and at quite unequal intervals (cases in which the bleeding can- 
not be regarded as menstrual — such, for instance as were reported 
by Eross of six new-born female infants in whom a sanguineous 
discharge from the vagina appeared three or four days after birth 
and lasted two to five days, the infants not remaining subsequently 
under observation), — numerous well-authenticated cases yet remain 
in which menstrual haemorrhage was observed before the end of 
the first year of life. One case, even, is recorded by Bernard in 
which from the time of birth to the twelfth year menstruation with 
molimina occurred every month, lasting two days ; from the twelfth 
to the fourteenth year menstruation ceased, recurring subsequently 
at irregular intervals. 

In the recorded cases of such precocious menstruation the men- 
struation recurred as a rule at regular intervals of four weeks ; only 
in quite exceptional cases were the intervals three to five months. 

Some of the most striking and well-authenticated cases of pre- 
cocious menstruation recorded in the recent literature of the subject 
are appended. 



V 



The Sexual Epoch of the Menarche. 



79 



Observed by Comhys: A girl aged 6 years and 2 months had 
the appearance of a girl aged 14 or 15; she was a brunette, 3' loi" 
in height, with full, firm, rounded breasts, girth of chest 28 J", mons 
Veneris covered with hair, uterus normal on rectal examination, 
hymen intact ; menstruation had occurred regularly since the second 
year of Hfe. Mother and five sisters began to menstruate between 
the ages of twelve and fourteen. General condition good. 

Case recorded by Diamant: A girl aged 6 years, weight 75 
pounds, thighs, buttocks, and breasts developed like those of a sex- 
ually mature woman, axillae and mons Veneris covered with hair. 
Menstruation began at the age of 2 and recurred regularly, the flow 
lasting 4 days. 

Case recorded by Plyette: A girl with precocious physical de- 
velopment began to menstruate in the fourth year of life ; menstrua- 
tion continued regularly with the exception of two monthly periods, 
when vicarious epistaxis occurred. 

From the collection made by Gehhard of the records of fifty-four 
cases of precocious menstruation, giving the first appearance and 
the type of menstruation, the development of the breasts, the other 
signs of premature sexual development, and any complications that 
may have been observed, we extract the age at which the first men- 
struation occurred. This was : 



In a new-born 


At the 


a^e 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


i At the 


age 


of 


At the 


age 


of 


At the 


age 


of 


, At the 


age 


of 



infant in I case. 

2 weeks in i case. 

2 months in i case. 

3 months in i case. 

4 months in I case. 

5 months in i case. 

7 months in i case. 

9 months in 4 cases. 

10 months in 2 cases. 

12 months in 5 cases. 

15 months in i case. 

16 months in I case. 

18 months in 2 cases. 

19 months in i case, 

22 months in i case. 

2 years in 4 cases. 

2^2 years in i case. 

2 years and 9 months in i case. 

3 years in 6 cases. 

3/^ years in i case. 

4 years in 4 cases. 

4 years and 3 months in i case. 

5 years in i case. 

5^ years in i case. 

6 years, in i case. 

614 years in i case. 

7 years in 3 cases. 

9 years in 2 cases. 

iiH years in i case. 



8o The Sexual Liee of Woman. 

From this collection of Gebhard's we learn that in one case men- 
struation already existed at birth, and that in a large number of 
cases it occurred before the expiration of the first year. In many 
cases the development of the breasts preceded the appearance of 
menstruation, and was noticed from the time of birth. The vulva 
also early exhibited the characteristics seen in the sexually mature 
woman. Further, a high body-weight, great development of fat, 
and early dentition, were usually seen in these cases, in which, how- 
ever, the intellectual development was not in correspondence with 
that of the body. 

In several of these cases of premature puberty, moreover, sexual 
intercourse and even parturition occurred at a very early age. A 
girl in whom menstruation began at the age of one year, gave birth 
to a child when she was ten years old (Montgomery). A girl who 
began to menstruate at the age of nine years, became pregnant 
very shortly afterward {d'O litre port). The well-known case re- 
corded by Haller, in which at birth the pubic hair was already 
grown, and in which menstruation began at the age of two years, 
was also one of very early pregnancy, the girl giving birth to a 
child when nine years old. Another girl in whom at birth the pubes 
were already covered with hair began to menstruate when four 
years old, copulated regularly from the age of eight, and at nine 
years became pregnant, and was delivered of a vesicular mole with 
an embryo (Molitor). A girl began to menstruate at the age of two, 
had a growth of hair on the pubes and developed mammae at the 
age of three, and became pregnant at the age of eight (Cariis). 
With these cases must be classed that observed by Martin in America 
of a woman who was a grandmother at the age of twenty-six. 
Lantier, in his Travels in Greece, speaks of a mother of twenty-five 
with a daughter of thirteen. 

Observations made by Knssnianl and by Hofmeier prove that in 
many cases changes in the ovaries form the probable cause of pre- 
cocious menstruation and the other phenomena of premature puberty. 
In one case of Hofmeter's, for instance, of a girl of five with pre- 
cocious menstruation, the removal of a rapidly growing ovarian 
tumor was followed by the cessation of menstruation, and the pubic 
hair, which had been shaved ofT, did not grow again. 

Abnormally early puberty related to the early practice of sexual 
intercourse is seen in many prostitutes. This is shown by the fol- 
lowing figures relating to 150 prostitutes in Russia. Sexual inter- 
course began : . 

In I prostitute at the age of 9 yeafs. 

In I prostitute at the age of 10 years. 

In 4 prostitutes at the age of 12 years. 

In 12 prostitutes at the age of 13 years. 



The Sexual Epoch of the Menarche. 8i 

In 14 prostitutes at the age of 14 years. 

I" 33 prostitutes at the age of 15 years. 

In 36 prostitutes at the age of 16 years. 

Thus, among- the 150 prostitutes, 65 were less than 16 years of age. 

Parent-Duch^elet found among 3,517 prostitutes under official 
observation, 5.6 per cent, under 17 years of age. There were: 

2 prostitutes under 10 years of age. 20 prostitutes under 14 years of age. 

3 prostitutes under 11 years of age. 51 prostitutes under 15 years of age. 
3 prostitutes under 12 years of age. iii prostitutes under 16 years of age. 
6 prostitutes under 13 years of age. 

Martineaii^s observations also showed that in nearly all pros- 
titutes the first coitus took place in very early youth. Of 607 prosti- 
tutes there were 489 in whom defloration had occurred between the 
ages of 5 and 20 years. According to Grimmaldi and Gurrieri de- 
floration usually takes place in prostitutes before they attain the age 
of 10 years. 

Sometimes we find increased sexuality in early life as a pathologi- 
cal manifestation — psychopathia sexualis. Thus, Esquirol records 
the case of a little girl aged four years who undertook improper 
manipulations in association with little boys. A female prisoner, 
Lombroso writes, had at the age of six years practiced mutual mas- 
turbation with her brother aged seven, and at the age of eight years 
underwent defloration; another murderess, while still a schoolgirl, 
had conducted herself after the manner of an experienced prostitute. 
Laurent reports the case of a girl who from the age of ten was 
engaged in sexual malpractices with her brothers and sisters, and 
finally underwent defloration at the age of fifteen. 

In many cases premature sexual development is manifested by 
enlargement of the breasts and growth of the axillary and pubic 
hair, and yet menstruation fails to appear. Thus, Kussmaul has ob- 
served girls who while yet children exhibited all the external char- 
acteristics of sexually mature women, but who had not yet begun 
to menstruate. Ploss has published a photograph showing in a 
girl five years of age the mons Veneris and the labia majora de- 
veloped like those of a full-grown young woman, and covered with 
long thick hair ; in this case, however, not only had menstruation 
not yet begun, but the breasts were still in the infantile condition. 

The opposite state to menarche prsecox is that in which the first 
appearance of menstruation is unduly delayed ; it may be even till 
after the age of twenty. Such a postponement of the menarche 
sometimes occurs in girls who exhibit at this period of life an ex- 
traordinarily great general fatty development of the body, or a nota- 
bly severe chlorotic state of the blood, or in whom during the years of 

6 



82 The Sexual Life of Woman. 

development some sudden and extensive change in the mode of 
Hfe has occurred, as for instance when the girl's place of residence 
has been removed from the country to the town, or when she has had 
to undertake some completely new kind of physical or mental work. 
Raciborski attributes the late appearance of menstruation, at the 
ages of 20, 22, 24, or 26, in otherwise healthy girls, to an " apathy 
of the sexual sense," a phrase which does not convey much meaning. 

According to Alarc d'Espine, puberty occurs early in girls with 
dark hair, grey eyes, a delicate white skin, and of a powerful build ; 
late, on the other hand, in girls with chestnut hair, greenish eyes, 
a coarse darkly-pigmented skin, and of a delicate weakly build. 

The genitals of girls in whom the first appearance of menstrua- 
tion is delayed, frequently exhibit distinct signs of the backwardness 
of the reproductive organs in their development. The external geni- 
tals, in such cases, have little if any covering of hair, and are flabby 
and relaxed ; the body and the fundus of the uterus are shorter and 
more slender than usual, the uterus as a whole is small and flaccid, 
sometimes anteflexed ; the vaginal portion of the cervix is small, 
often almost undeveloped, its anterior lip barely projecting above 
the surface of the vaginal fornix ; the vagina is usually short and 
narrow. The ovaries also are flaccid and inelastic, and occasionally 
are remarkably small. The breasts are small, the nipples and areolae 
undeveloped. 

In other cases, notwithstanding the delay in the appearance of the 
menarche, the genital apparatus is developed to a degree quite in 
correspondence with the age, but some pathological condition is 
present, for instance, the mucous membrane secretes excessively, 
exhibits a catarrhal tendency, there are erosions at the os uteri, etc. 

Pathology of the AI en arc he. 

A series of disturbances of function and pathological changes in 
the organs may occur at the time of the menarche, either directly 
connected with the genital organs, or etiologically dependent upon 
the changes occurring in these organs. 

The commencement of menstruation, as we have already men- 
tioned, may itself be abnormal in character, being either precocious 
(menarche precox), or retarded (menarche tardiva). But even 
where menstruation begins in a normal manner, the period of the 
menarche may be disturbed by a great number of pathological 
phenomena, of which the developmental processes occurring in the 
genital organs of the young girl must be regarded as the cause. 
First of all, the menstrual haemorrhage itself may be abnormal in 
amount and duration. Then, again, functional disturbances of the 
most various character may occur: especially prominent are, dis- 



The Sexual Epoch of the Menarciie. 83 

turbances of haematopoiesis, of the cardiac functions, and of the 
nervous system, and constitutional anomahes, which deserve atten- 
tive consideration; in addition we have to mention disorders of 
digestion and disorders of the sense-organs, among which latter 
certain changes in the skin especially deserve attention. 

The diseases of the female genital organs at the time of the 
menarche are very various in nature. Whereas during infancy and 
early childhood the uterus and its annexa are in a state of com- 
plete quiescence, so that nothing occurs in them to attract attention, 
at the approach of puberty these organs emerge from obscurity, and 
the percentage of diseases of the reproductive organs suddenly 
rises to a great height. In very young girls, among diseases of these 
organs, we observe only malformations, malignant tumors, and 
gonorrhoeal infections, and these pathological states, even, are quite 
rare; but at puberty all this is altered, and we have to do with dis- 
turbances of the menstrual function and their consequences, and 
with various inflammatory processes, and the period of sexual ma- 
turity offers us an overplus of diseases connected with the reproduc- 
tive system, justifying the epigram of the French gynecologist who 
defined a sexually mature woman as " iin uterus servi par dcs or- 
ganes." ^^ 

Anomalies of Menstruation. 

Not infrequently, though the catamenial flow has appeared at the 
usual age and has for a time been regular, pathological disturbances 
of this function ensue. 

Amenorrhoea at the time of the menarche may depend on com- 
plete aplasia of the ovaries, associated with a rudimentary and im- 
perfect development of the uterus. In such girls, the development 
of whose reproductive system is thus imperfect, the continually ex- 
pected menstrual flow fails to appear, in spite of the fact that a 
recurrent menstrual discomfort, evoked by the congestion of the 
genital organs, recurs at intervals of four weeks ; as, for instance, 
colicky pains in the abdomen, irritable, nervous states, and mental 
disturbances. Further, amenorrhoea may be due to one of the 
various forms of atresia of the genital organs, as for instance to 
vaginal or h3^meneal atresia. In such individuals the first period 
passes by without anything to attract attention. But at the second 
period, distress will usually be manifested ; and from this time for- 
ward, painful contractions of the uterus will continue to occur at 
four-weekly intervals, and to become more violent as period succeeds 
period, whilst the menstrual discharge is wanting, or, to speak 
strictly, fails to find an outlet. The blood collects behind the seat 
of atresia, and the accumulation gives rise to pressure symptoms 

20 "A uterus served by organs." 



84 The Sexual Life of Woman. 

affecting the bladder and the rectum, and ultimately also the sacral 
nerves. 

Menstruation, after its first appearance in normal fashion, may 
be suppressed in young girls in consequence of mental impressions, 
such as sudden fright ; such cases are observed after an escape from 
a fire, or after a railway accident. Mental stimuli of less intensity 
but longer duration have a similar effect ; sometimes these take the 
form of auto-suggestion. A well-known instance of the latter 
phenomenon is furnished by the case of a girl who, in consequence 
either of actual intercourse or it may be merely of too intimate an 
embrace with a man, fears she has become pregnant, and actually 
suffers from amenorrhoea though pregnancy does not really exist. 
I saw a case in which amenorrhoea was thus produced in a girl 
seventeen years of age, whose ideas on the process of sexual inter- 
course were still far from clear. She had permitted a young man to 
kiss her repeatedly and fervently, and to clasp her in a close em- 
brace. She was then afraid that she had become pregnant ; the 
catamenial flow, w^hich had been regular since she was fifteen years 
old, ceased to appear ; and it was not until at length I was consulted, 
was able to assure myself that the girl was essentially virgin, and 
was, therefore, in a position to reassure her as to her own condition, 
that menstruation again became regular. 

Functional amenorrhoea may also occur in young girls in conse- 
quence of a sudden change in the conditions of life, a removal from 
town to country, for instance, or the reverse, travel in regions where 
the climatic conditions differ widely from those hitherto experienced, 
or a change from an active to a sedentary kind of occupation. Of 
this nature is the following case observed by Winter: Miss Q., 
aged 20; menstruation began at the age of 13 and was regular there- 
after; on three successive occasions amenorrhoea occurred during a 
visit to Berlin, in one case lasting 3 months, another 2 months, 
and a third 6 weeks, whereas when at home menstruation was regular 
though somewhat scanty. There were no molimina. Examination 
showed the wall of the uterus to be thin, length of this organ 7 
centimetres (2J"), both ovaries distinctly palpable. Such a form 
of amenorrhoea as this, commonly disappears when the girl re- 
moves from the conditions unfavorable to the fulfilment of her 
sexual functions to the conditions favorable to that function. 

Not infrequently a chill is in young girls the cause of suppression 
of the menstrual flow that has hitherto been quite regular, espe- 
cially effective in this respect being, standing in cold water, getting 
the feet wet, the influence of rain and wind at the menstrual period 
on the insufliciently clothed lower extremities, and vaginal injec- 
tions with water at too low a temperature. Such cases are common 



The Sexual Epoch of the Menarche. 85 

among the working classes, especially in washerwomen ; but they are 
also observed among the well-to-do. An example is given by 
Winter: Miss H., aged 19; menstruation began at the age of 13, 
regular, at intervals of 4 weeks, the flow lasting 2 to 3 days, and be- 
ing normal in amount. Several years ago the patient caught a severe 
cold through paddling in cold water during the period. Suppression 
of the menses resulted, amenorrhoea being complete for a year and 
a half. Then menstruation recommenced, but was irregular, some- 
times anticipating, sometimes postponing the proper period, the 
interval being occasionally as long as four months ; when it occurred, 
the flow was represented by a drop or two of blood only, and dys- 
menorrhoea was severe. At each proper period, if the flow failed to 
appear, severe moHmina occurred in the form of abdominal cramps 
and headache. Examination showed the uterus to be normal in 
shape, 4j^ centimetres {iYa') in length, with a very thin wall; both 
ovaries were palpable, but smaller than normal. 

The commonest form of amenorrhoea at this period of life is, 
however, the constitutional amenorrhoea associated with chlorosis. 
In chlorotic subjects we have to do, not with a symptomatic ab- 
sence of the menstrual discharge, but with a failure of the ovarian 
function, the graafian follicles failing to ripen. We generally find, 
according to Gebhard, that chlorotic girls begin to menstruate at 
the usual age, or even earlier. Menstruation recurs once or twice 
at irregular intervals, and then gives place to complete amenorrhoea, 
it may be suddenly, it may be gradually, the flow on each occasion 
being scantier than before. In chlorotic patients, the menstrual 
discharge, when present, is very thin and watery, and often con- 
tains a large admixture of mucus derived from the cervical canal 
and the cavity of the uterus. The amenorrhoea may be of short 
duration ; or it may last for a long time ; so that it is not until after 
the lapse of months or years, and as a rule in consequence of suit- 
able treatment, that menstruation recurs, being henceforward either 
normal in frequency and strength, or on the other hand permanently 
scanty and of the postponing type. The associated disorders from 
which the patients suffer take the form of headache, dizziness, 
syncope, feelings of oppression, disinclination for mental and physi- 
cal exertion, and so on. Since in such cases the ripening of the 
ovarian follicles also fails to occur, when the amenorrhoea is com- 
plete the menstrual molimina are generally wanting (Gebhard). 

Stephenson also states that in girls who have been chlorotic for 
a longer or a shorter time, menstruation frequently begins very 
early, in any case earlier than in healthy girls. 

Usually in these cases various other disorders are associated with 
the amenorrhoea, such as colicky pains in the abdomen, sensitiveness 



85 The Sexual Life of Woman. 

of the abdominal wall to contact or pressure, headaches, attacks of 
hemicrania, general mental depression, and hysterical manifestations. 

In chlorotic girls, at the times when menstruation is due, a watery 
discharge often occurs, sometimes slightly tinged with blood. Dys- 
menorrhoea may also occur at such times. 

Attacks of menorrhagia in young girls are usually dependent on 
disturbances of the nervous system. Sometimes such an attack 
occurs at the very first menstrual period. Occasionally also 
menorrhagia may occur in association with chlorosis, to be dis- 
tinguished according to Virchozv from a rare condition named by 
him " menorrhagic chlorosis," characterized by excessive menstru- 
ation of an anticipating type. The bleeding is in such cases seldom 
very profuse, however, but the periods are very long, and the in- 
tervals exceedingly short. Castan regards such profuse menorrhagia 
and metrorrhagia occurring in young chlorotic girls, especially at 
the commencement of puberty, as of an endoinfective nature de- 
pendent upon auto-intoxication. The toxins lead to inflammatory 
and degenerative changes in the muscular substance of the uterus. 
According to Frccnkcl in these cases the ovaries are usually enlarged, 
seldom smaller than normal. 

Froclich has discussed this subject exhaustively in his monograph 
on Menorrhagia of Young Girls and Hypertrophy of the Cervix 
Uteri?'^ He states that the cases of menorrhagia in young girls 
at the time of the menarche may be arranged in two groups. In 
one of these the patients are chlorotic, and menstruation is normal 
neither in amount nor in duration, but it is the long continuance 
of the flow rather than its profuseness that gives rise to danger; 
in the cases belonging to the other group the patients are in excel- 
lent health at the commencement of puberty, but menstruation soon 
takes the form of long-continued and profuse menorrhagia. Cases 
of the latter kind are due to hypertrophy of the cervix uteri and 
fungous metritis. Such attacks of menorrhagia in young girls are 
seen also in cases of infectious disorders, as in smallpox, measles, 
scarlatina, and above all, influenza. The haemorrhage often begins 
in the first days of the infection, and even during the period of in- 
cubation, one or two days before the appearance of the general 
symptoms. If the patient is attacked by influenza while menstruat- 
ing, the menstrual flow may assume the character of a true men- 
orrhagia. More often, however, in such cases, we have to do with 
an extra-menstrual haemorrhage, such as may indeed be observed in 
girls who have not yet begun to menstruate. 

21 Mcnorrhage dcs Jeunes Filles et Hypertrophie du Col Uterin. 



The Sexual Epoch of the Menarche. 87 

Inilafnmatory Processes. 

Chronic metro-endometritis, both corporal and cervical, occurs 
occasionally in young girls during the years of development. It 
is especially common in chlorotic subjects; and next to these in 
girls who are careless about the observance of hygienic precautionary 
measures during the menstruation. Thus it may result from physical 
exertion among the w^orking classes ; and from dancing, skating, 
riding, or mountaineering, among girls belonging to the well-to-do 
classes, during menstruation. Again, we meet with it in girls who 
work very hard at the sewing-machine ; and, finally, in those who 
have long practiced masturbation. Through uncleanliness at the time 
of menstruation, the blood with which chemise and drawers are 
stained and the pubic hair soiled, undergoes decomposition, and 
this may lead to catarrhal inflammation of the vulva and vagina and 
of the endometrium. The most striking symptoni in persons thus 
affected is the discharge of mucus, which in cervical metro-en- 
dometritis leads to a very moist condition of the external genitals, 
and leaves greenish-yellow spots on the under-linen ; in corporal 
metro-endometritis the discharge is of a thinner consistence, milky 
in appearance, and not very abundant. As a result of the endome- 
tritis, the patient suffers from various pains in the body, a feeling 
of fulness, sacrache, general sense of fatigue, and diverse nervous 
manifestations ; sometimes also from dysmenorrhoea, strangury, or 
obstinate constipation. In consequence of the great thickening of 
the mucous membrane that often occurs, menstruation becomes very 
profuse and long-continued, lasting from one to two weeks. 

A form of chronic vulvitis, sometimes, though indeed quite rarely, 
met with in girls at this tim.e of life, is inflammation of the external 
genitals dependent on masturbation. As characteristic signs of this 
we may observe an elongation of the nymphae, the clitoris, or the 
praeputium clitoridis, and at the same time on the inner surface of 
the greatly stretched labiae we may notice a great increase in the 
sebaceous glands, so that the yellowish spots formed by these struct- 
ures may be seen beneath the mucous membrane with the unassisted 
eye — the mucous surface, indeed, may be slightly uneven in con- 
sequence of their enlargement, so that they resemble small retention- 
cysts. The mucous membrane of the vulva between the margin of 
the hymen and the nymphae is moreover, according to Veifs descrip- 
tion of masturbatory vulvitis, often beset with small pointed ex- 
crescences, the soft furrow between the clitoris and the external 
orifice of the urethra being very commonly marked by swelling of 
the mucous membrane and the presence of these little outgrowths ; 
but sometimes also the parts lying to either side of the urethral 
orifice may exhibit similar changes. These small structures differ 



88 The Sexual Life of Woman. 

entirely from pointed condylomata — they do not branch, they occur 
only upon the vulval surface proper, not upon the parts exhibiting 
the characters of true skin, and they are non-infecting. More par- 
ticularly, it must be remembered, we find these changes principally 
in virgins in whom on account of obscure symptoms an examina- 
tion of the genital organs has been undertaken, and who suffer in 
addition from nervous and hysterical manifestations. The hymen, 
when intact, as it usually is in these cases, furnishes objective evi- 
dence that sexual intercourse is not the cause of the patient's trouble, 
and indeed a distinctly ascertainable cause is hard to find. The 
patient usually exhibits abnormal sensitiveness and excessive 
prudery. Vcit is of opinion that the association of all these symptoms 
justifies the diagnosis of masturbation as the exciting cause of the 
chronic vulvitis; in such cases we may at one time find the mucous 
membrane pale, but at a later examination fiery red, and we often 
see a clear, transparent secretion exuding from the ducts of Bartho- 
lin's glands. 

In consequence of long-continued masturbation, other patholog- 
ical changes may take place in the female genital organs, such as 
hypertrophy of the nymphse, proliferation or glandular hyper- 
trophy of the uterine mucous membrane, ovarian irritation, pains 
in the ovarian region which, in severe attacks, may radiate to the 
thighs. These pains become more severe at the menstrual period, 
especially at the beginning of that period; and are sometimes also 
especially troublesome in the middle of the intermenstrual interval, 
in this case usually as a result of great bodily exertion. 

These morbid processes in the genital organs of young girls 
have long attracted the attention of physicians, and it is more than 
sixty years since Bcnnct described the '' virginal metritis " observed 
by him in twenty-three virgins. Bonton published in 1887 a mono- 
graph on this condition. Gallard assigns masturbation as its 
principal cause. 

Retroflexion of the uterus is also sometimes observed in virgins, 
induced by the bad habits which are so common in young girls of 
retaining the urine for excessively long periods and of neglecting 
constipation. The prolonged distension of the bladder leads to a 
daily, long-continued stretching of the ligamentous apparatus of 
the uterus ; the full bladder presses the uterus backwards, and after 
the viscus has been emptied, the flaccid ligaments are no longer 
able to restore the uterus to its normal position of anteflexion. 
The organ is left wiith its fundus directed backwards, and the intra- 
abdominal pressure keeps it permanently in this position; at the 
same time, an accumulation of faeces in the rectum, by pressing 
the cervix forward, favors this displacement of the uterus. More- 
Over, when the uterine tissues are flaccid through malnutrition in 



The Sexual Epoch of the Menarche. 89 

chlorotic or aiiiemic subjects, the organ yields more readily to 
mechanical influences than it would if its muscular tone was healthy. 

Disorders of Hccmatopoicsis. 

Chlorosis is in general rightly regarded as a disease of the period 
of puberty etiologically dependent on the processes that at this 
time of life occur in the genital organs. Its appearance gen- 
erally coincides with the menarche, occuring at the age of 14 
to 16, or even later, at the age of 19 to 21. As regards the 
composition of the blood in chlorosis, investigations have shown 
that its haemoglobin-richness is always diminished ; its specific 
gravity is proportionately lessened, but the specific gravity of the 
serum is normal. The erythrocytes are normal in number^ or 
only slightly diminished ; their shape is sometimes normal, some- 
times, however, poikilocytosis is present. The leucocytes are gen- 
erally normal both as regards number and form; myelocytes (Mark- 
nellen) are also described as present in the blood of chlorotic 
patients (Neusser, Hammerschlag, Gilbert, Weil) ; the blood-plates 
are normal in number, the alkalinity of the blood also normal, the 
isotonicity of the erythrocytes rather low. 

The relation of chlorosis to the menarche is variously explained. 
Kahane, in his elaborate monograph on chlorosis, regards it as an 
independent disease belonging to the group of '' disorders of vegeta- 
tion " (Kundrat), one which ''according to its essential nature is 
an expression of the disharmony that obtains between the congeni- 
tally inefficient haematopoietic apparatus and the demands made 
upon the feminine organism by the processes of puberty." 

An insufficiency of the haematopoietic organs as regards their 
functional capacity is believed by Kahane to be in the case of women 
so far physiological inasmuch as their blood is inferior to that of 
men in haemoglobin-richness and corpuscular richness to the extent 
of about 10 per cent. In this way the predisposition of the female 
sex to chlorosis may perhaps be explained. A further fact which 
must be taken into consideration is the difiference between the de- 
velopment undergone by the respective sexes at puberty. In the 
female sex, this development is quickly completed, and has the 
characteristics of a revolution ; but in the male, the development is 
a more gradual one, and has the characteristics of an evolution. 

F. A. Hoffmann also regards chlorosis as associated with the 
development of the uterus and the establishment of menstruation. 
It is possible that these processes exercise some reflex influence; 
but we must also remember that the chemical processes involved 
in the growth and maturation of the ovarian follicles are still in- 
sufficiently understood, and that it is quite possible that these too 



go The Sexual Life of Woman. 

may have powerful and unaccustomed effects on the organism such 
as may well disturb metabolic processes of a somewhat unstable 
character. 

Grazmtz, who regards chlorosis as a vasomotor neurosis in which 
disturbances arise in the interchange of fluids between the tissues 
and the vessels, refers the appearance of chlorosis at puberty to the 
general disposition to disorder exhibited at this age by the vasomotor 
system. 

Other authors consider chlorosis to be an ovarian auto-intoxica- 
tion, beheving that under certain conditions the ovaries give off 
into the organism certain poisons ; or, on the other hand, supposing 
that a certain antitoxic function, normally possessed by the ovary, 
fails. Von Noordoi, for instance, regards chlorosis as a disorder 
of blood formation referable to a disturbance of the internal secre- 
tion of the ovary during the developmental period. 

Blondcl, who also regards ovarian auto-intoxication as causal, 
is of opinion that chlorosis is induced by products of decomposi- 
tion formed in the organism during the process of growth. As in 
childhood the thymus gland, so later in life the ovary, renders these 
products innocuous. When this peculiar functional activity of the 
ovary is retarded in its appearance, the intoxication effected by the 
products of decomposition formed during the process of growth 
gives rise to chlorosis. 

Meincrt, in an interesting manner, brings the harmfulness of 
wearing a corset during the years of development into etiological 
relations with chlorosis. In the transitional period between child- 
hood and the age of puberty the wearing of the corset usually begins. 
Now Meincrt discovered that in chlorosis, as a result of wearing 
a corset, a vertical or subvertical position of the stomach ensues 
as a partial manifestation of enteroptosis, leading to tension on the 
abdominal plexus of the sympathetic, which in turn results in changes 
in the blood, and other nervous symptoms. According to this view, 
chlorosis is a peculiar general neurosis dependent upon an artificially 
induced gastroptosis ; this form of enteroptosis being due, not to 
relaxation of the suspensory ligaments of the abdominal viscera, 
but to pressure exercised by adjacent organs in consequence of a 
change in the form of the thorax, which has been permanently 
constricted by tight-lacing {Hxierter Schnurthorax). 

Of importance is the fact that in girls suffering from chlorosis a 
condition of hypoplasia of the genital organs is not infrequently 
met with. It would seem, not only that imperfect development of 
the female genital organs may be a cause of chlorotic changes in 
the blood, as appears possible in view of the relations between the 
ovaries and the haematopoietic organs through the intermediation 



The Sexual Epoch of the Menarche. 91 

of the sympathetic system; but also that genuine chlorosis and the 
anomalies of the genital organs met with in this disease, may per- 
haps be common manifestations of some more general disturbance. 

According. to Virchoiv, two distinct forms of chlorosis are to bo 
recognized, one form in which no great abnormalities of the repro- 
ductive apparatus exist, and another form in which imperfections 
in the development of the central portion of the vascular system 
are associated with similar imperfections in the reproductive ap- 
paratus. In many cases of chlorosis, he found the ovaries small and 
imperfectly developed, in an infantile condition ; in other cases, 
however, they were three times the normal size ; the development 
of the uterus in such cases usually corresponds with that of the 
reproductive glands. With regard to the etiological connection be- 
tween chlorosis and developmental disturbances, Virchow inclines 
to the view, that in chlorosis a predisposition, either congenital or 
else acquired in early youth, must be assumed to exist, but that this 
does not manifest itself by the production of actual disorder until 
the arrival of puberty ; and he considers it Hkely that primary de- 
ficiencies of the blood and the vascular apparatus hinder the develop- 
ment of the reproductive apparatus. 

Stieda found that in chlorotics displacements of the uterus were 
common, with abnormal narrowness of the vagina, absence of the 
pubic hair, imperfect development of the pelvis, and the growth 
of the breasts interfered with to this extent, that the nipples and 
areolse were abnormally small. He classifies these manifestations 
as disturbances of development in the sense that they are among 
the so-called stigmata of degeneration. If in chlorotics the breasts 
in certain cases have a normally full and rounded appearance, this 
appearance is sometimes deceptive, the fulness being due, not to a 
proper growth of the parenchymatous mammary tissue, but to an 
excessive deposit of fat. Genuine chlorosis, therefore, not referable 
to some other primary disorder, is a developmental disorder, in the 
sense in which various other stigmata of degeneration met with 
in the human body are developmental disorders, and is indeed fre- 
quently associated with other stigmata of degeneration, or with mal- 
formations due to arrest of development, as for instance, an in- 
fantile type of pelvis or of genital organs, abnormalities of the 
cranial bones, vaulted palate, the root of the nose broad and de- 
pressed, extreme prognathism. 

Hcgar also maintains the view that chlorosis is in most cases a 
developmental disturbance, the origin of which is not limited to 
the so-called years of puberty; it often arises from noxious influ- 
ences which are either strictly inherited or began to operate when 
the infant was still in her mother's womb. Frcenkel is inclined to 



92 The Sexual Life of Woman. 

regard a primary developmental disorder of the genital organs as 
the cause of many cases of chlorosis. 

Recently, Brcucr and Scilcr have undertaken experiments on 
bitches, which they spayed at the outset of puberty, and from 
the results of these experiments it seems probable that a disordered 
influence exercised by the ovaries on the blood plays a part, at least, 
in the pathological mechanism by which chlorosis is induced. 

The intimate relationship believed to exist between chlorosis and 
the sexual life of woman finds expression in the opinion, which 
dates back to the days of antiquity, and has been widely held even 
by physicians, that the disease (hence designated morbus virgineus 
or fcbris auiatoria) is due to sexual abstinence in individuals with 
powerful sexual impulse, and that for this reason chlorosis is often 
cured by marriage. This result of marriage, which, though ap- 
parent merely, may indeed often be witnessed, is explained by 
Kahane on the ground, that in very many cases, the symptoms of 
chlorosis become less severe after the first five years have elapsed 
since the commencement of puberty, the improvement occurring quite 
independently of the marriage or continued celibacy of the sufferer. 
The influence of marriage in curing chlorosis is thus apparent 
merely to this extent, that a very common age for marriage in 
women is precisely in the twentieth, twenty-first, or twenty-second 
year, when five years have passed since menstruation began. By 
this time the organism will to a large extent have become accom- 
modated to the demands made upon it by the processes of puberty. 
Experience also shows that chlorotic girls sometimes continue to 
suffer from the various symptoms of chlorosis even after they have 
become wives, and that chlorosis is not infrequently rendered more 
severe by the puerperium — but in a wife it is no longer customary 
to describe such symptoms by the name of chlorosis, they are called 
anaemia, hysteria, nervousness, etc. Further, in order to give the 
doctrine of morbus virgineus its death-stroke, Kahane directs at- 
tention to the fact that numerous cases of chlorosis are met with in 
young girls who are far from practicing sexual abstinence, espe- 
cially, for instance, amongst the lower classes, amongst whom it is 
hardly customary to wait for marriage before beginning sexual in- 
tercourse. The connection between masturbation and chlorosis, 
which has also been widely alleged from the etiological standpoint, 
is moreover one that cannot be admitted. On the other hand it is 
easy to understand that the erotic reveries which are so often seen 
in chlorotic girls are very likely to induce the habit of masturbation. 

In young girls at the time of the menarche, especially in those 
who suffer from amenorrhoea or from irregular menstruation, the 
anaemic form of obesity not infrequently develops. Such patients 



The Sexual Epoch of the Menarche. 93 

at the time of puberty exhibit signs of marked anaemia in associa- 
tion with a notable increase in fat. The skin in such cases is always 
strikingly pale and of a whitish-yellow color; in bodies which are 
in other respects beautiful the bust may have the appearance of a 
marble statue. Such girls are strikingly sLout, but the fatty tissue 
is flaccid, soft, and spongy, and dependent parts readily become 
cedematous; the muscular system is generally. feeble. 

What especially characterises this anaemic form of lipomatosis in 
young girls is, that, even in mild forms of the affection, cardiac 
symptoms are apt to become prominent. Frequent and violent pal- 
pitation will occur even in the absence of any severe exertion or 
especial excitement, often also we see shortness of breath, pre- 
cordial pain, anxiety, respiratory distress, and sensations of chilli- 
ness and fatigue. 

The principal cause of the obesity in these cases is to be found in 
the anaemia, inasmuch as the diminution in the number of the eryth- 
rocytes is a diminution in the number of the oxygen-carriers, and this 
entails defective and insufficient oxidation. The deficiency in the 
albuminous constituents of the body also gives rise to a rapid and 
extensive deposit of fat, the power for the combustion of the fats 
absorbed from the food being insufficient. An auxiliary factor in 
producing obesity in such anaemic girls is their disinclination to 
physical exercise, dependent on the speedy onset of sensations of 
fatigue. The long-continued repose of the muscles, and the re- 
maining almost continuously in close rooms insufficiently supplied 
with oxygen, also result in the withdrawal from the blood of the 
circulating fat and its deposit as adipose tissue. 

Albuminuria at the time of the menarche is a disease of develop- 
ment which is not infrequently met Vv^ith in chlorotic girls, as in 
adolescent boys. On examination of the urine in such young girls 
we detect the presence of a variable quantity of albumin, which is 
present especially after severe physical exertion, mental application, 
or emotional excitement, whilst the urine secreted at night is usually 
free from albumin. The skin is pale, the accessible mucous surfaces 
are comparatively colorless, the face is puffy, the eyelids are 
cedematous ; the patients suffer from various nervous troubles, espe- 
cially headache and dizziness, and they are also liable to dyspeptic 
disorders. 

The cause of this albuminuria of puberty is according to von 
Leube in part disordered haematopoiesis, in part a slight degree of 
cardiac insufficiency with a tendency to stasis. At the time when the 
processes of development and the growth of the body in height are 
most active, there is not a corresponding increase in the energy of 
haematopoiesis, and the heart also fails to keep pace with the growth 



1 



94 



The Sexual Life of Woman. 



of the body and to meet the demands thus made upon it by vigorous 
growth and increased energy. In general the capacity of the heart 
in such individuals is indeed sufficient to maintain the circulation 
through the kidneys ; but as soon as the functional activity of the 
heart is more strongly taxed and the energy of the circulation conse- 
quently declines, albuminuria occurs — and occurs all the more 
readily in consequence of the fact that, the hgemoglobin-richness of 
the blood having been lowered by the customary anaemia, the epithe- 
lium of the renal glomeruli is badly nourished and functionally in- 
adequate. 

When the period of the menarche is safely passed, when the 
menses recur w^'th regularity, and the chlorotic manifestations dis- 
appear, when the process of hsematopoiesis has improved in quality, 
and the growth of the body is completed — when, in short, the func- 
tional equilibrium of all the vital processes becomes re-established, 
the albuminuria of puberty ceases. It seems, however, that those 
who have suffered in this way are predisposed to a return of the 
albuminuria at the climacteric period, when the metabolic balance 
is once more disturbed. 

Cardiac Disorders. 

The commonest cardiac disorder at this period of life is nervous 
palpitation, occurring in young girls who are in other respects in 
good health, being free frOm anaemia and from any discoverable 
disease of the heart or vessels. That this disorder is dependent on 
the sexual processes is indicated by the fact that it first manifests 
itself in a stormy manner some time, weeks it may be or months, be- 
fore the first appearance of menstruation ; recurring at irregular 
intervals, the attacks continue till after the first menstruation, and 
cease soon after the regular return of the period. Objectively, the 
palpitation of the heart manifests itself by an increase in the fre- 
quency and strength of the cardiac impulse, and increased frequency 
and tension of the pulse ; in a few cases, however, it is perceived 
subjectively only by the patient, as a distressing sensation of ex- 
cessively frequent and powerful cardiac action. In the former group 
of cases, the enhanced activity of the heart is perceptible, not only by 
auscultation, by which we usually find the heart-sounds quite pure, 
but also by inspection, which shows us the violent agitation of 
the thoracic wall and increased pulsation of the carotids. On per- 
cussion, no change is found in the area of cardiac duhiess. The 
frequency of the pulse is increased, usually reaching 120 to 140 
beats per minute; it is full, and may be intermittent or irregular. 
In those cases in which the palpitation of the heart is a purely 
subjective sensation, we find no increase either in the frequency or 



The Sexual Erocii of the Menarciie. 95 

in the strength of the pulse, which may indeed be less frequent 
than normal. With the palpitation is associated a sensation of 
strong pulsation in the great vessels of the neck, and often there 
is pain on the left side of the lower part of the chest, with a sensa- 
tion of shortness of breath, respiratory distress, precordial pain, and 
a feeling of pressure upon the chest. Respiration is shallow, and 
abnormally frequent. The attacks of palpitation recur daily in some 
patients, in others at intervals of several days ; they may occur 
entirely without exciting cause, or with a cause so trifling that it 
would not in a normal subject have produced any nervous excite- 
ment ; the duration of the attacks varies from a few minutes to sev- 
eral hours, and they may occur either by day or by night ; in the 
intervals between the attacks the functions of the heart and the 
arteries are conducted in a normal manner. The pulse-curves I have 
obtained during the attacks of palpitation, in those cases in which 
the manifestations were objective as well as subjective, exhibit a 
high pulse-wave, the upstroke being rapid and steep, the down- 
stroke also sudden and steep, the predicrotic elevation but little 
marked, the dicrotic elevation often very distinct. 

Less frequent than such attacks of palpitation recurring at ir- 
regular intervals are paroxysmal attacks of tachycardia, in which 
the frequency of the heart and pulse is increased to an enormous 
extent. This disorder manifests itself a little time before the first 
appearance of menstruation, thenceforward recurring regularly 
every three or four weeks, accompanying menstruation, or occurring 
at the proper menstrual period if mensi ruation is in abeyance ; the 
attacks last several days. This trouble also disappears a few months 
after the establishment of menstruation. 

Associated with these cardiac troubles are, not constantly indeed, 
but in the majority of cases, disturbances of the digestive organs. 

From the heart-troubles already described, another group of cases 
must be distinguished, which are also observed at the time of the 
menarche. They occur in girls in whom the first appearance of 
menstruation is strikingly delayed, not having yet begun at the 
ages of 18, 19, or 20 years, or in whom considerable irregularities 
have occurred in connection with the commencement of menstrua- 
tion. In such girls, in whom menstruation has appeared late and 
been irregular, or who are perhaps entirely amenorrhoeic, cardiac 
troubles may be so pronounced that the physician may be led to 
suspect the presence of organic disease of the heart. The most 
prominent symptom is frequent and violent palpitation, with strong 
pulsation in the carotids, respiratory distress, and feeling of anxiety, 
on continued exertion or even on very slight occasion. On percus- 
sion, the heart is not found to be enlarged ; on auscultation, the heart- 



96 The Sexual Life of Woman. 

sounds are found to be very loud, often with a systolic murmur In 
the mitral region, whilst over the lower end of the internal jugular 
vein, the humnrng-top murmur (bruit de diahle) is audible. The 
pulse is increased in frequency, at times arhythmical, and easily com- 
pressible. The sphygmographic tracing usually shows a subdicrotic 
or dicrotic character. The upstroke is not high; the downstroke 
descends low, almost to the lowest level of the curve, before the 
enlarged dicrotic elevation begins. The skin is always strikingly 
pale, pale also are the visible mucous surfaces, the haemoglobin- 
richness and the corpuscular richness of the blood are considerably 
diminished, a feeling of fatigue and various other nervous mani- 
festations are constantly present — in short, in all cases we have to 
do with the well-known chlorotic disposition, sometimes in associa- 
tion with the manifestations of the anaemic form of lipomatosis uni- 
versalis. In several such cases, skin affections were also present. 
Some suffered from acne vulgaris of the face with the usual 
comedones; others perspired profusely from the palms of the hands 
and the soles of the feet ; others exhibited a bluish coloration of the 
nose and the ears. 

There is yet a third form of heart trouble, much rarer indeed 
than the forms already described, from which young girls some- 
times suffer at the time of the menarche. It occurs in girls who 
just before the first appearance of menstruation have grown very 
rapidly, '' shooting up to a great height." They are not anaemic, 
nor do they appear '' nervous ;" but they are extremely thin, and 
they have grown enormously in height during the previous year. 
These individuals also, who in the previous course of their life 
have been free from heart trouble, now complain of cardiac distress. 
As in the cases previously described, they complain of severe pal- 
pitation, a feeling of fulness in the chest, shortness of breath on 
exertion, etc.; but the results of the objective examination are very 
different. The cardiac dulness is increased in area, especially in 
vertical extent, the apex-beat may be normal in position or dis- 
placed outwards, the impulse is always heaving, abnormally power- 
ful and resistant, the heart-sounds, especially those of the left ven- 
tricle, are louder than usual, the aortic second sound accentuated, 
sometimes ringing, the carotids pulsate visibly. The radial pulse, 
the tension of which is abnormally high, can be compressed by the 
finger only with difficulty; sometimes it is jerky in character. The 
sphygmographic tracing show^s a rapid and steep upstroke ; in the 
downstroke, the predicrotic elevation is much larger than normal 
and also nearer the summit of the curve. Thus we see that all the 
signs of cardiac hypertrophy are present, hypertrophy, that is to say, 
of the left venticle. 



The Sexual Epoch of the Menarche. 97 

The cases of this nature that have come under my observation 
have not been in girls of the working classes, but among the well- 
to-do. We cannot therefore regard them as due to overstrain of tho 
heart in consequence of excessive bodily exertions, comparable to 
the cases met with in young recruits after long marches and violent 
exercise. We must rather assume that the development of the fe- 
male genital organs has eVoked a storm in the cardio-vascular sys- 
tem, more especially that in some way an . increased resistance has 
been offered to the work of the heart, and that thus the hypertrophy 
has been brought about ; though we may suppose that other un- 
favorable influences have also been in operation. Such an influence, 
in these cases, is the rapid growth of the body, which makes enhanced 
demands on the work of the heart; another is furnished by the al- 
most universally worn unhygienic article of clothing, the cuirass- 
like corset, which offers a rigid hindrance to the rapid growth of the 
female body, to the development of the breasts, the thorax, and the 
upper abdominal organs, and which fails to accommodate itself to 
the changing conditions of growth, so that much extra work is 
thrown upon the heart. In such young girls we have very frequently 
found tight stays, which were worn unchanged without regard to the 
growth of the body in length, and which, by pressure on the epigas- 
tric region, elevation of the diaphragm, and limitation of the respir- 
atory movements of the thorax, actually offered such considerable 
resistances to the driving power of the heart, as ultimately to lead 
to hypertrophy of the cardiac muscle. 

Summing up our observations, we find that at the time of the 
menarche cardiac disorders occur in young girls which may be 
arranged in three groups of cases : 

1. Nervous palpitation and paroxysmal tachycardia in persons in 
other respects in good health, the affection appearing shortly before 
the commencement of menstruation, and disappearing soon after the 
flow is regularly established, 

2. Cardiac disorders occurring in young girls suffering from 
chlorosis, which itself results from the processes of the menarche. 

3. Cardiac hypertrophy developing at the time of the menarche, 
and dependent on the circulatory disturbances associated with that 
process, its appearance being favored also by rapid growth of the 
girl and by unsuitable clothing (tight lacing). 

With respect to the activity of the heart and the circulation of the 
blood at the time of the menarche, the little-known observations 
made by Beneke, on the growth of the heart and arteries in the 
various stages of development, deserve especial attention. Accord- 
ing to this writer, the growth of the heart is slow until the age of 
fifteen years is attained, but becomes accelerated at the commence- 



98 The Sexual Life of Woman. 

ment of puberty. During this time of puberty, the blood-pressure 
attains its highest level, being comparatively low in childhood and 
later in life. The development at puberty of the female heart is 
less extensive than that of the male heart, and for this reason 
throughout adult life the capacity of a woman's heart is on the 
average 25 to 30 cubic centimeters (1.5 to 1.8 cubic inches) less 
than that of a man. In women, also, the great arteries are on the 
average somewhat smaller than in men. The various arteries do 
not develop with equal rapidity throughout the period of growth ; 
after puberty the common carotid grows very much more slowlv 
than the common iliac artery, the former vessel being the onlv 
large trunk which has already nearly reached its maximum size at 
puberty. 

The comparatively great development which the heart undergoes 
at the time of puberty is a phenomenon so important alike in its 
physiological and its pathological relations that it deserves the special 
designation of the puberal development of the heart ; the com- 
mencement and the completion of puberty appear beyond question 
to be to a large extent dependent upon this development of the 
heart and upon the simultaneous rise in the blood-pressure of the 
systemic circulation due to the comparative diminution in the 
calibre of the arteries. 

In the literature of this subject of cardiac disorders during the 
menarche, v/e find only short annotations on palpitation of the heart 
in young adolescent girls, and on cardiac manifestations in chlorotic 
subjects. Further, the statistical fact that valvular lesions of the 
heart are commoner in women than in men is by many authors ex- 
plained on the ground that the disturbances of the time of puberty, 
which certainly occur more frequently and are more severe in the 
female sex than in the male, play an important part in their causa- 
tion. Changes also in the vessel, such as cirsoid aneurysm 
{angioma arteriale raeemosum) , are supposed to be connected with 
the sexual processes of this period of life. C. Heine maintains that 
in consequence of puberty and of the sexual functions that become 
established at this period, a teleangiectasis will not infrequently un- 
dergo transformation into a cirsoid aneurysm ; especially in cases 
in which menstruation is scanty and irregular, angiectatic tumors 
may exhibit a vicarious periodic increase. 

Krieger describes nervous palpitation and also '' cramps of the 
heart " ^^ as occurring in girls who have not yet begun to menstruate, 
in the form of prodromal manifestations ; similar attacks may occur 
also at every menstrual period in girls in whom menstruation is 

22 7|-,g German v/ord used is Herzkrampf ; in the first line of the paragraph 
it is used in the plural, and in inverted commas. Angina pectoris proper, 
the severe and often fatal disease met with chiefly in elderly men, is some- 



The Sexual Epoch of the Menarche. 99 

fully established. In most of these cases the pulse is increased in 
the patients complain of a sensation of anxiety, and speak of feeling 
the heart roll, tremble, or flutter, to which is sometimes superadded 
a sensation of sudden cessation in its activity. Not infrequently 
there is a blowing adventitious sound, masking or accompanying 
the heart-sounds ; there are also venous murmurs, especially when 
the heart-trouble is associated with anaemia or chlorosis. Of the 
cases of pseudo-angina pectoris^^ observed by Kricgcr^ the attacks 
occurred as prodromal manifestations before the first appearance of 
menstruation in 22 per cent, of the cases, after menstruation was 
fully established in 78 per cent, of the cases ; as regards the relation 
of the attacks, in cases of the latter group, to the menstrual period, 
they occurred before the flow in 33 per cent., during the flow in 67 
per cent.; menstruation was irregular in 10 per cent, of the cases 
under observation, in most of the other cases menstruation had 
been irregular, but was now regular. 

Hennig records a case in which he observed as a prodromal 
symptom before the establishment of menstruation the regular re- 
currence of congestion of the pelvic organs associated with cardiac 
disorder. 

Diseases of the Nervous Syste^m. 

The extensive transformatory processes occurring in the genital 
organs of young girls at the time of the menarche, and the power- 
ful impression which the new thoughts, hopes, and fears excited at 
this period of life cannot fail to exercise on the nervous and emo- 
tional life, will enable us to understand how it is that the appear- 
ance of the first menstruation may give rise, especially in neurasthe- 
nic or psychopathic subjects, to manifold nervous disturbances and 
also to disorders of the mind. 

Amongst the severe neuroses and psychoses hable to occur at the 
menarche in those suffering from congenital nervous weakness, in 
those the conditions of whose life are very unfavorable, and in those 
affected by some sudden disagreeable and powerful influences, we 
may enumerate : Hemicrania, precordial pain, hysteria, and epi- 
lepsy ; impulsive manifestations, such as bulimia, longings for 
various unsuitable things, kleptomania, and pyromania ; severe feel- 
ings of anxiety; various forms of psychoses. 

On the other hand, the first appearance of menstruation has some- 
times a favorable influence in girls suffering from nervous or 
mental disorder. This is seen, for example, in cases of chorea in 

times known in Germany as Herzkrampf, but the established and distinctive 
German name for the affection is Stcnokardia. It is evident, however, that 
Krieger's cases are not cases of true angina, and it is probable that they would 
be classed by English physicians under the heading" of pseudo-angina pectoris. 
— Tr. 



lOO The Sexual Life of Woman. 

fully developed, rapidly growing girls who have not yet begun to 
menstruate; in such subjects the chorea sometimes disappears as 
soon as menstruation is regularly established. 

Quite frequently, the first appearance of hemicrania in young 
girls coincides with the menarche. According to Warner, hemi- 
crania made its first appearance : 

In I girl of 3 to 4 years. In 4 girls of 10 to 11 years. 

In 2 girls of 5 to 6 years. In 2 girls of 11 to 12 years. 

In I girl of 6 to 7 years. In 4 girls of 12 to 13 years. 

In 5 girls of 8 to 9 years. In 15 girls of 13 to 15 years. 

In 5 girls of 9 to 10 years. 

Toothache, according to Hollander, in the early days of puberty 
sometimes exhibits the twenty-eight-day type of menstruation. The 
same periodicity has been recorded in cases of vicarious bleeding 
from the gums in girls suffering from disturbance of the menstrual 
function. 

In the period of the menarche and before this period, chorea minor 
occurs, as a functional disturbance of the motor region of the nervous 
system, and especially in girls is it associated with the processes of 
the period of physical development. The statistical data supplied 
by a number of authors, Hughes, Pye-Sniith, Russ, See, and Steiner^ 
show that the proportion of boys to girls affected with chorea minor 
is I to 2.8, and that of all ages 49 per cent, of the cases occurred 
at the ages of 6 to 11 years, 29.8 per cent, at the ages of 11 to 13 
years. In several cases, in quite young girls suffering from chorea, 
pathological changes were found in the genital organs. Thus, in 
24 out of 2y girls from the age of 9 to 15 years affected with chorea, 
Marie found the symptom-complex designated by Charcot as ovarie. 
Ovarian tenderness was manifested on palpation, and always on 
that side on which the chorea had first manifested itself. Leonard 
found in a girl aged eleven suffering from chorea, adhesion of 
the praeputium clitoridis ; after the separation of the prepuce, the 
chorea disappeared. 

As in respect of various nervous affections, so also in respect of 
various mental abnormalities, we witness at the time of the menarche 
numerous manifestations confirming the statement that, " no spinal 
reflex has such widely-opened and easily accessible paths of conduc- 
tion toward the organ of mind, as the sexual reflex." " The men- 
strual proces," contmviQ^s Friedmann, "is the only bodily process 
in relation to which the organ of mind somewhat readily loses the 
remarkable stabiHty of its equilibrium.'* 

In the experience of all alienists, it is, speaking generally, the 
inherited psychopathic tendency that especially manifests itself at 
the time of puberty; and it appears that this predisposition, the 
manifestations of which the resisting powers of childhood have 



The Sexual Epoch of the Menarche. ioi 

hitherto been competent to suppress, undergoes a sudden and stormy 
development in consequence of the action of the menstrual stimulus, 
leading to the unexpected appearance of mental disorders. The 
commonest of these are mania and melancholia of the ordinary type, 
the prognosis in first attacks being favorable ; next in frequency 
to these are the psychoses characterized by fixed ideas, which usually 
terminate favorably after a short time; finally, we meet with the 
moral psychoses of puberty, and the form of melancholia distin- 
guished by Kahlbaum as Hebephrenie,^^ the prognosis of which 
is very unfavorable, for it speedily terminates in dementia, similarly 
to the dementia of puberty described by Svetlin, dependent upon or 
associated with premature synostosis of the cranial bones. Very 
often we witness at puberty the beginning of the periodic varieties 
of mental disorder, which develop into periodic menstrual psychoses, 
manifesting themselves regularly at the recurrence of every men- 
strual period. 

The fact that hysteria often first manifests itself at the time of 
the first appearance of menstruation was noticed already by Hip- 
pocrates, who indeed believed that the association was sufficiently 
explained by the well-known manifold relations between this nervous 
disease and disturbances in the female genital organs. The first 
hysterical attack often coincides with the first menstruation ; or the 
first menstruation may lead to the recrudescence of hysteria which 
had manifested itself previously, but had passed into abeyance. 
We have to deal chiefly with the minor forms, such as uncontrollable 
and unconditioned attacks of laughing and crying, globus hystericus, 
clavLis hystericus, etc.; hysteria major, on the other hand, is very 
seldom observed at the time of the menarche. As regards the fre- 
quency of hysteria at the time of puberty, we append certain statisti- 
cal data. 

Landouzy found : 

4 cases of hysteria occurring at the ages of I to lo years. 

45 cases of hysteria occurring at the ages of lo to 15 years. 

105 cases of hysteria occurring at the ages of 15 to 20 years. 

80 cases of hysteria occurring at the ages of 20 to 25 years. 

After the age of twenty-five is attained, the frequency of hysteria 
declines very rapidly. 

According to Bernut::, all the statistical data prove that hysteria 
in more than half the cases first manifests itself either just before 
or simultaneously with the commencement of menstruation. It 
seems also that at the time of puberty amenorrhoeic and dysmenorr- 

23 Hehephrenie. — There is no current English equivalent of this word, used 
by Kahlhaum to denote a form of melancholia occurring at puberty, and 
terminating in dementia. — Tr. 



102 The Sexual Life of Woman. 

hoeic manifestations may give rise to the development of hysteria. 
In girls at this time of life, hysteria seldom takes the form of the 
great hystero-epileptic crisis, manifesting itself rather as nervous and 
moody states of mind, moral changes, weakness of will, in associa- 
tion with various forms of anaesthesia, spasm, and paralysis. 

On the threshold of puberty the girl with a hereditarily neuro- 
pathic disposition may exhibit a tendency to epilepsy. In such cases, 
as Kozvalezvski writes, the patient has sudden attacks of loss of con- 
sciousness, commonly ushered in by a wild scream ; during the at- 
tacks, tonic and clonic muscular spasms occur, the patient is com- 
pletely insensible, the pupils are dilated and do not react to light, 
the pulse- frequency is increased — in short, the typical phenomena 
of an epileptic fit are exhibited. The loss of consciousness lasts 
from two to three minutes ; and when the girl recovers, she remem- 
bers nothing of what has occurred durmg the fit. Though con- 
sciousness has returned^ the mind is still at first somewhat dis- 
ordered ; but this disorder soon passes off, the girl becomes calm, and 
forgets what has happened. The physician is summoned, but in 
ninety-nine cases out of a hundred, he assures the relatives that 
" the attack is nothing of any consequence — a simple fainting-fit, 
the result of menstruation — a transient trouble merely." A second 
*' fainting-fit " disturbs the calm of the parents, but the reiterated 
authoritative assurance of the physician that '* the trouble will soon 
pass away" restores their confidence ; and they gradually become 
accustomed to the '' fainting-fits " from w^hich their daughter suf- 
fers at each successive menstrual period. The daughter marries, 
and gives birth to neuropathic and psychopathic children, and every 
one wonders what can be the cause of this misfortune. Hence it is 
necessary to pay careful attention to these " fainting-fits during men- 
struation/' In the great majority of cases they are in fact epileptic 
seizures, and as such they must be treated. Binswanger points out 
that in such cases, in which epilepsy first appears at the commence- 
ment of menstruation, the attacks may continue to accompany men- 
struation for several years thenceforward. Already established 
epilepsy is said by some authors, Lmvsoii Tait, Tissot, and Matottc, 
for instance, to undergo at puberty in young girls an increase both 
in the severity and in the frequency of the attack; Esqnirol, on the 
contrary, attributes to puberty a favorable influence on the course of 
epilepsy, a view held already by Hippocrates. 

Not infrequently, attacks of precordial pain associated with tachy- 
cardia occur during the first menstruation. These attacks are 
usually of short duration. 

Acromegaly, a disease regarded as a trophoneurosis, also requires 
mention here, this disturbance of growth being considered by several 



The Sexual Epoch of the Menarche. 103 

authors, and especially by W. Frciind, to be in some way connected 
with the development of puberty ; the tendency to acromegaly, it is 
suggested, is produced by the remarkable transmigration that occurs 
at puberty of the energy of growth from its accustomed paths into 
new channels. The relations which Neiisser has shown to exist 
between the ovaries on the one hand and the vegetative nervous 
system and the process of hsematopoiesis on the other, give a certain 
amount of support to this hypothesis, even though we have no inti- 
mate knowledge of disturbances occurring in the reproductive sys- 
tem during the period of development, which might have an in- 
fluence in the causation of acromegaly. 

Of old and of recent observations on the psychoses connected 
with the menarche, there is no lack. From the time of Hippocrates 
down to the present day, the authorities have continued to report 
cases in which the commencement of menstruation proved the ex- 
citing cause of the appearance of psychoses. Rousseau writes of a 
girl at the time of the menarche, who before the first appearance of 
menstruation sufifered from attacks of melancholia and a tendency 
to pyromania, and under the influence of the latter tendency she 
twice committed acts of incendiarism. 

According to Kirn, the psychoses that manifest themselves in the 
first period of the commencement of menstruation, sometimes melan- 
cholia, sometimes amentia in the form of slight and transitory 
maniacal derang^ement, more rarely a katatonic^^ condition, may 
precede the menarche, or may accompany or follow it. 

A special form of psychosis is associated with the menarche (von 
Krafft-Ehing, Griesinger, Friedmann, Schonthal). The influence 
exercised by puberty in this direction manifests itself in various 
ways, and is the more powerful for the reason that several factors 
are in operation, each of which exercises an individual influence 
upon the type of the psychical affection ; these factors are, childhood, 
the development of puberty, and the periodicity of the disturb- 
ance exercised by the menstrual reflex. The last named of these 
influences is the most potent. It manifests itself in the following 
manner : Certain psychoses which develop before the commencement 
oi menstruation or during the suppression of the flow, undergo 
modification when menstruation appears ; further, in the typical 
menstrual psychoses of psychopathically predisposed girls, the at- 
tacks recur either at the beginning of each period, or, when the flow 
is in abeyance, at the dates when it should appear — the menstrual 
stimulus thus being the exciting cause of the successive attacks 
in an organ of mind whose resisting powers are deficient ; and, finally 

24 Katatonia (Katatonie) is a term used in Germany to denote insanity 
associated with muscular rigidity. — Tr. 



104 ^^^ Sexual Life of Woman. 

a disturbance in the development of menstruation may be, not 
merely the exciting cause, but the efficient cause of the psychosis. 

In cases of the last kind, which have been observed by Schonthal 
and also by Friedmann, who has described them very fully under 
the name of primordial menstrual psychosis, we have to do with 
young girls in whom the appearance of menstruation is retarded, 
or in whom the flow has been suppressed very soon after its com- 
mencement. The girls were as a rule hereditarily well endowed, 
and the psychosis thus appeared without warning, like a storm from 
a clear sky. Exactly periodical in form and character, the period 
of recurrence being three or four weeks, this phychosis clearly 
showed its dependence upon menstruation ; the individual attacks 
usually lasted a few days only, and were characterized by distinct 
mental disorder, in the form either of maniacal restlessness, or of 
dominant depression ; vasomotor disturbances were very prominent, 
with disordered pulse, as for instance, a rapid rise in the pulse-wave 
just before the onset of the attack, succeeded during the attack by 
a correspondingly rapid decline. 

Friedmann enumerates a number of the peculiarities that char- 
acterize these attacks. The general course of the malady is an 
exceptionally stormy one. The ultimate cure may coincide with 
the definite regularization of menstruation ; or, in cases in which 
menstruation is restored but remains inadequate, the course of the 
disorder may become a gentle undulatory one, the violent stimulus 
of total suppression being replaced by a more moderate stimulus — 
here also, however, a cure ultimately follows when menstruation 
at length becomes free as well as regular. But during the height 
of the malady a proper development of menstruation is always 
wanting. The total duration of the malady may vary from as little 
as two to as long as nine months, or even longer. The cure is, how- 
ever, ultimately a complete one. The combination of a disturbed and 
delayed development of menstruation with a stormy periodic cycle 
of attacks of mental disorder, and the ultimately favorable termina- 
tion, constitute according to Friedmann the peculiar characteristics 
of this form of puberal psychosis. 

Masturbation. 
Masturbation is sometimes practised in very early childhood, 
being then commonly due to local irritation of some kind, as for in- 
stance when threadworms find their way into the vagina. Itching 
results, leading the child to rub the genital organs. This rubbing 
produces a pleasurable sensation, and gives rise to repeated mastur- 
bation. But in adolescent girls at the time of the menarche, a vague 
impulse arises to handle the genital organs, depending upon cerebral 



1, 



The Sexual Epoch of the Menarche. 105 

processes which are themselves the result of sexual sentiments, of 
reading, or of conversations with sexual instructed female friends. 
This vague impulse may lead to masturbation, and will do so earlier 
and more surely if the girl is a neuropsychopath by inheritance. 
The local influence of menstrual congestion, however, also plays a 
part in provoking the impulse toward masturbation, since at every 
period a hyperaesthetic state recurs in the genital organs. 

Girls thus addicted have sometimes a very striking general ap- 
pearance. They are pale, with a weary expression of countenance, 
their eyes are dull-looking and darkly ringed, their movements are 
sluggish, they like to spend a long time in bed — signs, however, 
which I by no means wish to adduce as characteristic of onanists. 

Temperament and mode of life are decisive in determining the 
greater or less frequency of the habit of masturbation in young 
girls. Girls of a passionate temperament, those also who from 
early childhood have been accustomed to mix much with young per- 
sons of the opposite sex, and those, finally, in whom from conversa- 
tion on the subject with female friends or from the perusal of erotic 
literature, sexual enlightenment has occurred at an early age, ex- 
perience the awakening of the sexual impulse earlier and with 
greater force, than phlegmatic girls, than those who have growi^ 
up apart from boys, and than those who have been strictly and care- 
fully brought up. Masturbation may arise either instinctively or 
from instruction. 

In young girls masturbation is usually effected by friction of the 
clitoris ; less often by intra-vaginal manipulation, since this is liable 
to lead to injury to the hymen. For the former purpose the finger 
may be used ; or some other article, such as a knot tied in the night- 
gown, or a rounded projection on some article of furniture ; in 
one case the friction was effected by the naked heel. If two female 
onanists come together, they practice tribadism, presently to be de- 
scribed. Opportunity for this practice occurs especially in institu- 
tions in which young girls occupy a common dormitory, and sleep 
together without adult supervision. 

An experienced physician, Gntccit, is of opinion that in young 
girls of 10 to 16 years of age masturbation is on the whole less com- 
mon than in boys of the same age, but that on the other hand from 
the ages of 18, 19, and 20 onward, " sexual self-gratification is al- 
most universally practiced by women, even if it be not always prac- 
ticed to excess," an opinion which cannot, however, be regarded as 
conclusive. As consequences of masturbation in the female sex, 
this author has observed: Fluor albus, menorrhagia, enlargement 
and prolapse of the uterus, pains in one or other ovary, hysterical 
paroxysms, great pallor. 



io6 The Sexual Life of Woman. 

L. Lozvenfeld remarks that the manifestations of the sexual im- 
pulse are not normally present in the days of childhood. In con- 
sequence of pathological conditions, especially of such as effect the 
genital organs, in consequence of chance impressions, or in conse- 
quence of a bad example, sexual passion may indeed be awakened 
in children in its fullest intensity. Normally, however, the distinct 
manifestation of the sexual impulse is associated with a certain de- 
gree of development, of ripeness, of the reproductive organs. Phys- 
iologically, sexual passion is entirely wanting in young girls before 
the age of puberty. 

As regards the act of sexual self-gratification, this author dis- 
tinguishes two forms of masturbation: (a) Peripheral-mechanical; 
(b) mental (psychical onanism). In the former class of cases, the 
sexual orgasm is produced solely or chiefly by mechanical stimula- 
tion of the skin or mucous membrane of the genital organs. In 
the female sex, in addition to manual stimulation, an extraordinary 
variety of hard and soft articles are introduced into the vagina for 
this purpose. Many females effect sexual self-gratification by 
rubbing and pressing movements of the thighs one against the other, 
in which the clitoris is implicated. In psychical onanism, on the 
contrary, as Lowenfeld points out, the orgasm is produced solely 
by central stimulatory representations, without the assistance of any 
manipulation of the genital organs. The ideas that have this effect 
are for the most part lascivious trains of thought or the recollection 
of previous sexual experiences, on which the attention is concen- 
trated. If we wish to estimate the harmfulness of the different 
forms of masturbation as regards the mind and the nervous system, 
psychical onanism must incontestably be regarded as the most 
deleterious. 

In the female sex onanism is, in Lowenfeld' s opinion, less widely 
practiced than in the male ; none the less, it is in the former sex 
far commoner than is generally believed, a fact on which Eulenhurg 
likewise insists. Frequently, also, in females, a congenital neuro- 
pathic tendency plays a part in the causation of masturbation, in so 
far as this tendency takes the form of premature sexual excitement 
or of excessive intensity of the sexual impulse. In the absence of 
this tendency, masturbation rarely leads to the production of well- 
marked nervous disturbances, and does so only when practiced to 
very great excess. Beard reports that in the powerful and full- 
blooded working-class girls of the Irish race, masturbation, even 
when practiced for many years, did not result in any notable dis- 
order to health. 

As regards the nature of the nervous manifestations met with 
in women as a result of masturbation, there develops, according to 



The Sexual Epoch of the Menarche. 107 

Lozvcnfeld, in one group of the cases, the sexual form of myelas- 
thenia, characterized principally by sacrache and lumbago, hyper- 
sesthesia and paraesthesia in the domain of the genital organs 
(ovarie,^ pruritus vulvae et vaginae, etc.), irritable bladder, coccy- 
godynia, weakness and paraesthesia of the legs (feelings of fatigue 
and chilliness), finally, the onset of erotic dreams. In many cases, 
in the course of time, to these symptoms are superadded the mani- 
festations of cerebral and visceral neurasthenia (headache, insomnia, 
nervous dyspepsia, palpitation), so that the clinical picture comes 
to be one of general neurasthenia. In addition to the neurasthenic 
troubles, manifold hysterical manifestations may occur. 

Disorders of Digestion. 

Disorders of the digestive apparatus are quite common in girls 
during the period of puberty, and usually take the form of nervous 
dyspepsia. Disturbances of sensibility predominate, with a sensa- 
tion of pressure after meals, sometimes increasing to nausea, retch- 
ing, and vomiting, as manifestations of general hypersesthesia of the 
gastric mucous membrane, loss of appetite, a pasty or acid dis- 
agreeable taste, sometimes bulimia, perverse sensations of taste, and 
pyrosis. Especially in chlorotic girls, periodic attacks of pain occur, 
localized in the epigastrium and its neighbourhood, and exhibiting no 
relation to the ingestion of food. The free hydrochloric acid varies 
in amount, being now normal, now diminished, sometimes also in- 
creased. In chlorotic cases, the symptoms of round ulcer of the 
stomach are sometimes observed. Intestinal activity is usually de- 
pressed, peristalsis is diminished, so that more or less obstinate 
constipation is one of the most frequent symptoms. 

Hypertrophy of the tonsils at the time of puberty is in some way 
related to the menstrual processes, whether by the intermediation 
of the nervous system or by that of the blood. Eisenliart quotes 
observations made by Chassaignac, of girls eighteen or nineteen 
years of age with hypertrophy of the tonsils, associated with re- 
tarded puberty, menstruation having begun late and being scanty, and 
the breasts being underdeveloped ; in one young girl with tonsillar 
hypertrophy, one of the breasts had failed to develop properly, but 
after the removal of the tonsils it speedily grew to the normal size. 

Diseases of the Respiratory Organs.^^ 
Not uncommonly at this period of life the growth of a goitre is 
observed. The influence of puberty on the growth of the thyroid 

25 A term introduced by Charcot. See page 97. _ 

^^ The author's classification is adhered to. It is not usual, I believe, in 
Germany, to class the thyroid body among the organs of respiration. But the 
only disease mentioned under the above heading is goitre. — Tr. 



io8 The Sexual Life of Woman. 

body has indeed been asserted by several authors; and Neudorfer 
maintains that precisely during the period of puberty to this body 
must be assigned an important regulatory trophic significance for 
the nourishment and growth of the reproductive organs. Stein- 
berger and Sloan record the observation of cases occurring in young 
girls in whom, menstruation having first been regular, but having 
been suddenly suppressed in consequence of external noxious in- 
fluences a rapidly growing goitre suddenly appeared. 

P. Miiller states that in many regions, as for instance in Canton 
Berne in Switzerland, where the school children exhibit with extraor- 
dinary frequency a hereditary tendency to the formation of goitre, 
during the years of childhood these growths are much less frequent 
in girls than in boys. At the time of puberty, however, this relation 
is entirely changed. Whereas in boys from this time onward no 
further growth of the thyroid body is observed, in girls at puberty 
the hypertrophy greatly increases, so that very large goitres are 
formed. The same author recurs to the earlier observations of 
Heidenreich and Schdnlcin, as well as to those of Friedreich, by 
which this influence of puberty is strikingly manifested, and he be- 
lieves it to be established by experience that sexual excitement can 
produce a transient swelling of the thyroid body. He alludes also to 
the remarkable fact that a swelling of the thyroid body, to which a 
number of animals show a tendency, occurs chiefly at the time of heat 
or rut ; this is especially well known to occur in the case of stags. 
Similarly, during menstruation, a transient swelling of the thyroid 
body can sometimes be detected ; the swelling is greater if the men- 
strual discharge fails to occur. 

Diseases of the Organs of the Senses. 

At the time of the menarche in cases in which there is retarda- 
tion or some other disturbance in the regular appearance of men- 
struation, affections of the eye are observed, which are in part 
functional, dependent on reflex influences proceeding directly from 
the genital organs without organic changes, and in part are due to 
circulatory disturbances. Mooren, S. Cohn, and Pozver have dis- 
cussed the relations between the uterus and the eyes in general, and 
also in this especial connection. Of ocular troubles during the 
menarche, iridochoroiditis, haemorrhages into the vitreous body, 
long-continued blindness, and pannous keratitis, are mentioned, 
which may either disappear with the reestablishment of menstrua- 
tion (spontaneous or artificially effected), or may exhibit in 
such circumstances a notable alleviation. Chronic inflammatory 
states of the conjunctiva, usually of an eczematous nature, which 
frequently occur at the time of puberty, often exhibit a relation to 
the menstrual process, a monthly exacerbation of the ocular trouble 



The Sexual Epoch of the Menarche. 109 

coinciding with disordered menstruation, and cure taking place 
only when menstruation has become perfectly regular. Vicarious 
haemorrhages into the vitreous body also occur, associated with 
disturbances of menstruation, the relapses ceasing as soon as men- 
struation becomes regular ; such a case was observed by Courserants 
in a girl of fourteen years. 

Disturbances of hearing have been observed at the time of puberty 
in young girls addicted to masturbation ; the patients complain of 
subjective noises, rising in intensity till actual hallucinations may 
be experienced. Lichtcnherg reports the case of a strong girl 
eighteen years of age, in whom the congestion associated with 
puberty was followed by atrophy of the auditory nerve. The same 
author, also Ashzvell, Lazv, Piiech, Rossi^ Stepanow, and Gilles de 
la Toiirette, have published cases of vicarious menstrual haemorrhage 
from the external auditory meatus, occurring in girls of ages varying 
from 14 to 16, 17, 20, and 22 years. Amongst these cases, in some 
the auditory organ was in a healthy condition, but in others there 
was associated purulent discharge ; the bleeding took place from 
the ears at the menstrual periods, the proper menstrual discharge 
being absent or scanty ; after the ear trouble was cured, menstrua- 
tion was normal. Of 200 cases of vicarious menstruation, there were, 
according to Puech, six in which the vicarious bleeding was from 
the ears. 

Disturbances of the olfactory sense, taking the form, sometimes 
of diminished acuteness of this sense, sometimes of increased acute- 
ness, and sometimes of perversion, also anomalies in the secretion of 
the nasal mucous membrane, either abnormal dryness, or greatly 
increased secretion of mucus, come under observation at this period 
of life, either as reflex manifestations through the intermediation 
of vasomotor nerves at the time of the first appearance of menstrua- 
tion, or in consequence of chronic nasal catarrh, which may be con- 
nected with masturbation. In cases in which the menarche is re- 
tarded, vicarious epistaxis may also occur, the bleeding sometimes 
being very profuse, in one case, indeed, reported by Fricke, in a 
girl seventeen years of age, having a fatal termination. Accord- 
ing to Mackenzie, sexual excitement leads to swelling of the nasal 
mucous membrane^ and habitual masturbation to chronic nasal 
catarrh ; the same author asserts that during menstruation, swelling 
of the turbinate bodies may always be observed, and that in this 
lies the explanation of the fact that many women complain of a 
monthly cold in the head as an accompaniment of menstruation. 

Diseases of the skin are not uncommon in young girls at the time 
of the menarche, and later as an accompaniment of each successive 
menstruation. It is a well-known fact that at puberty girls some- 
times lose a hitherto beautiful complexion, and suflfer from various 



no The Sexual Life of Womakt. 

disfigurements of the skin of the face. These are produced espe- 
cially by the profuse secretion of sweat, and by the excessive secre- 
tion of the sebaceous glands, which so often results in acne, an in- 
flammation of these glands. Ecchymoses also, effusions of blood 
into the skin, are observed, especially, as a form of vicarious men- 
struation, in cases in which menstruation is irregular. When actual i 
bleeding occurs from the intact skin, the blood finds its way out I 
through the suderiferous ducts — hsematidrosis occurs; in some | 
cases, however, the haemorrhage takes place from areas of skin | 
altered and injured by disease, from wounds or other injuries, from 
ulcers, or from excrescences. Haemorrhage into the skin occurs 
also in the so-called stigmatization, in which condition also an \ 
etiological role has been assigned to menstruation. 

In the skin, remark Spietschka and Grihifcld, a new life begins 
at the time of the development of puberty, and it is this which first 
gives to human beings the external characteristics of sexual maturity. 
In certain regions which have -hitherto been covered only by fine 
downy hairs,^"^ thick, strong hairs develop, and at the same time the 
general growth of hair becomes more active. These regions are, 
the genital region, and the axillae. This increased growth of hair 
is accompanied by a stronger secretion of the sebaceous glands, 
which very often is in excess of actual requirements, and may thus 
lead to cosmetic disturbances and to various diseases of the skin. 
Thus arise the various forms of seborrhoea.^^ The commonest of 
these is the formation of comedones, which, at the time of puberty, 
may make their appearance especially on the nose, the forehead, and 
below the corners of the mouth, but also on other parts of the face 
or on the back and the breast ; in those regions, that is to say, in 
which the sebaceous glands attain a considerable size. The reten- 
tion of the sebum may give rise to inflammation, which the access 
of micro-organisms converts into suppuration. Thus arises acne 
vulgaris. In another form of seborrhoea,-^ the secretion is more 
fluid in consistence, and collects on the surface of the skin, furnish- 
ing this with an oily covering — seborrhoea oleosa.^^ This most 

27 In Germany the term Lanugo, or Wollhaar, is used to denote the rudi- 
mentary hairy covering of the body throughout life, as distinguished from the 
specialized and fully developed hairs of the head, beard, axillae, etc. In Eng- 
land the use of the term lanugo is usually restricted to denote the downy 
crop of hair with which an infant is covered at birth, which is shed in a few 
months thereafter. See the English edition of Toldt's Atlas of Human 
Anatomy, Part VI., Appendix, note 503.— Tr. 

28 It will_ be noticed that the author uses the term seborrhoea as a general 
term for diseases of the sebaceous glands, including acne. In England acne, 
and its prelirninary stage, the formation of comedones, are separately con- 
sidered, the signification of the term seborrhoea being limited to denote cases 
in which the secretion of the glands forms an oily, waxy, or scaly accumula- 
tion on the surface. Seborrhoea oleosa is defined bv Crocker as that form 
of the affection in which the olein is in excess. — Tr.' 



The Sexual Epoch of the Menarche. hi 

commonly occurs on the face; if the fatty layer is removed, the 
skin remains dry for a brief period only, and soon becomes greasy 
and shiny once more. Dust readily adheres to the greasy surface, 
and this gives the face a dirty appearance. Seborrhoea faciei is 
readily converted into eczema. 

With the puberal development of the external genital organs is 
associated an increase in the sebaceous secretion* of these regions. 
On the clitoris and its prepuce, and on the folds and in the furrows 
of the vulva, in consequence of insufficient cleanliness, an accumu- 
lation of sebum and cast-off epidermic scales readily occurs ; such 
an accumulation may become rancid, may irritate the skin, and 
may thus give rise to erosions and to purulent secretion. 

In chlorotic girls at the time of puberty, on account of the anaemic 
condition of the blood, eczema is not uncommon, especially on the 
hands and the face. On the face, or on the forehead, red papules 
appear on circumscribed areas, and become vesicular ; raw, weeping 
spots are thus formed, and have a very disfiguring appearance. 
Such eczema may occur also in connection with disturbances of 
menstruation, when the menses are scanty and pale, or when dys- 
menorrhoea is present. 

At the time when menstruation ought to appear, but fails to do 
so, sometimes also, when menstruation is regular, with each succes- 
sive period, an eruption of urticaria takes place ; it usually disap- 
pears quickly, but in some cases is more persistent ; owing to the 
intense itching it is always an extremely distressing complaint. 
Sometimes it takes the form of urticaria factitia, in which the 
skin reacts to every kind of mechanical stimulation, such as rubbing, 
scratching, or pressure, all of which alike lead to the formation of 
weals, which may be diffused all over the body. Less often in as- 
sociation with disturbances of menstruation, acute oedema or erythe- 
ma are observed. 

Finally, we must mention herpes progenitalis, a rather uncommon 
acute condition in which, with violent itching and burning sensa- 
tion, intense redness and oedematous swelling of the skin, vesicles 
form on the prseputium clitoridis, the nymphae, and the inner sur- 
face of the labia majora. 

Hygiene During the Menarche. 

It is the object of rational hygiene to increase the resisting power 
of the organism, which has been depressed by the processes of the 
menarche, in order that the increased demands made by the awak- 
ened sexual life may be adequately met. 

The principal means for this purpose are, suitable diet, a suitable 
mode of life, and the employment of physical therapeutic measures, 



112 The Sexual Life of Woman. 

among which strengthening and hardening measures are to be pre- 
ferred. 

The diet should be at once as richly albuminous as possible and 
readily digestible, there should be several, four or five, meals every 
day; in chlorotic patients food should be taken at regular intervals 
of two to three hours. Meat should be a predominant article in the 
diet, but fresh vegetables should also be eaten in abundance for the 
sake of the nutritive salts they contain ; the vegetables rich in com- 
pounds of iron, such as spinach, oats, beans, and lentils, are. to be 
recommended ; fruit, raw or cooked, should also be taken in con- 
siderable quantities. The evening meal-^ should not be too succulent 
or too plentiful ; it may best consist of soft-boiled eggs, an omelette, 
•or milk. AlcohoHc beverages should be avoided or taken in minimal 
quantities ; only as a stomachic may a glass of beer or of light wine 
be recommended. 

Chlorotic patients should even at their first breakfast"^ have a 
meal rich in albumin, such as a considerable helping of meat, or a 
beefsteak, with rolls, butter, and tea or coffee. Milk should be 
taken in small quantities only, not more than a pint to a pint and a 
half daily ; only when solid food cannot be tolerated should milk be 
given freely. Beer and wine are often of value in chlorotic girls 
from, their stimulant action on digestion and circulation. Half an 
hour's rest before and after meals is useful. 

For the bill of fare of these patients I recommend especially : 
Roast beef and veal, underdone beefsteak a I'Anglaise, ham ; roasted 
venison, hare, partridge, grouse, fieldfare, hazel-hen, ptarmigan, 
pheasant, chicken, pigeon, turkey, oysters ; asparagus, cauliflower, 
and spinach. For variety, fish or shellfish may occasionally be 
taken.. Sweetbread in soup or with sauce forms a very delicious 
and easily digestible dish. 

Kahane recommends for chlorotic patients the systematic use of 
Bavarian beer, to the amount of about two pints daily ; it should, 
he says, be a beer rather dark in tint, full-brewed, rich in malt, but 
containing a comparatively small proportion of hops, alcohol, and 
carbonic acid. Jaworski has recommended a dietetic iron-beer, con- 
taining 4.7 per cent, of alcohol and from 0.0317 to 0.0644 per cent, 
of iron. 

When girls are at the same time anaemic and very thin, fat-con- 
taining foods must be taken in abundance,- such as milk, butter, and 

2^ It must be remembered that these dietetic directions are for German and 
Austrian middle-class people, the arrangement of whose meals differs from 
ours considerably. The usual meals and hours are : Early breakfast, coffee 
and rolls, at 8 or earlier ; second breakfast, a more substantial meal, at 10; 
mid-day dinner, the principal meal, at i or 2 p. m.; afternoon coffee, at 4; 
supper at 8 p. m.— Tr. 



The Sexual Epoch oe the Menarche. 113 

cream; also large quantities of carbohydrates. Farinaceous foods, 
rice, potatoes, arrowroot, sago, tapioca, oatmeal, barley meal, car- 
rots, turnips, sweet fruits, grapes, dates, pippins, plums, pears, and 
preserved fruits — all these must appear at table more frequently 
than usual; beverages, in addition to milk, that are suitable are 
chocolate and cocoa, Bavarian beer, and sweet, heavy wines. 

The diet-table of such thin chlorotic patients should be as follows : 

First breakfast, 7.30 to 8 a. m. : Coffee or cocoa with milk, or a 
pint of milk, white bread and butter, honey. Second breakfast, 10 
A. M. : Half a pint to a pint of milk, egg and bread and butter, or 
sandwiches of sausage, ham, or roast meat. Mid-day dinner, i a. m. : 
Soup, roast meat with vegetables and potatoes, or fish may take 
the place of the soup, sweets to follow. Afternoon, 4 p. m. : Coffee 
with milk, or a pint of milk, with bread and butter. Supper, 7.30 
p. M, : A plate of meat with accessories. Evening, 9 p. m. : A glass 
of milk. 

In the treatment of the anaemic form of obesity, to which chlorotic 
patients of the better classes are subject, in consequence of sedentary 
habits and overfeeding, the diet must be so arranged that albumins 
predominate, whilst carbohydrates should be given sparingly, and 
as little fat as possible. As the average quantities of the food ele- 
ments required in such cases, I suggest, 200 grammes of albumin, 
12 grammes of fat, and 100 grammes of carbohydrate. 

The quantity of fluid taken must be as small as possible, since 
the deprivation of water may result in a proportionate increase in 
the solid constituents of the blood, and thus increase its haemoglobin- 
richness. 

The amount of physical exercise taken by young girls at this 
period of life must vary according to the circumstances of each 
individual case. In general, we may recommend for them much 
active movement, especially in the open air, in order to counteract 
the effects of sedentary habits and confinement in close rooms. 
Chlorotic patients must, however, be careful to avoid overdoing 
their exercise, and in some cases it will be necessary to limit the 
amount of this very strictly. In severe cases of chlorosis, Noth- 
nagel, Hayem, and other authorities recommend complete rest in bed 
for from four to six weeks. This rest-cure can be carried out as far 
as possible .in the open air, and can be combined with systematic 
massage and the use of passive movements. 

8 



114 



The Sexual Life of Woman. 



I have drawn up the following diet-table for obese chlorotic 
patients : 





Quantity in 
Grammes. 


Contains of 


Albumin. 


Fat. 


Carbohydrates. 


Morning: 
Beefsteak 


100 

150 

30 

100 

200 

50 

50 

150 

120 

25 

200 
25 

150 
30 


38.2 

0.45 
2.9 

I.I 

76.4 
0.8 

4.8 

0.2 
2.4 

46.4 
0.4 

2.9 


1-7 
0.2 

1-5 
3-4 
0.2 
0.4 

0.67 
0.2 

3-4 
0.1 

0.2 






0.9 
18.0 

5-7 

4.2 

30.0 

1.0 

1.7 

15.0 


White bread 


Mid-day: 

Meat soup 

Roast meat 

Vegetables 

White bread 


Light wine 

Afternoon: 
A cup of coffee 


White bread 


Evening: 

Roast meat 

Vegetables 


2.1 

1.0 
18.0 


Wine 


White bread 


Total 


1380 


206.97 


11.92 


97.6 


Contains about 1300 cal 


ories. 



For young girls at this period of life systematic gymnastic exer- 
cises are usually valuable, not only for strengthening the muscular 
system and improving the physique during these years of growth, 
but also for assisting the functions of respiration, circulation, and 
digestion. Beginning with the simplest and easiest exercises of 
chamber gymnastics, the girl gradually proceeds to more difficult 
and elaborate exercises and to the use of medico-mechanical ap- 
paratus. 

The clothing of young girls at the time of the menarche must 
receive attention to this extent, that all articles of clothing should be 
rejected which increase the tendency already existing to hypersemia 
of the genital organs or offer any hindrance to the circulation in 
general. Above all, the physician must take his part in the contest 
so long and so vainly urged against the corset. But further, all 
tight clothing, such as restricts the freedom of movement of the 
thorax and the abdomen, tight collars, and tight garters — all these 
must be forbidden ; moreover excessively warm underclothing, of 
the lower extremities especially, which may stimulate the genital 
organs, must also be prohibited. 



The Sexual Epoch of the Menarche. 115 

As regards the night hours, a thick feather bed is unsuitable. 
The young girl should sleep on a hair mattress, and the bed clothing 
should be light. Eight to nine hours sleep is sufficient ; in the words 
of the English proverb, '' early to bed and early to rise, is the way 
to be healthy, and wealthy, and wise.'' 

To live by rule, with regular hours of work and suitable pauses for 
rest, is of great importance. Among the well-to-do classes also 
care should be taken that 'the adolescent girl takes moderate physical 
exercise for several hours daily ; she should go for a good walk, and 
not spend hour after hour recumbent upon a sofa in idle reverie. 
Sitting for too long a time, whether engaged in sewmg or at the 
piano, is harmful ; working at the sewing-machine is permissible 
for short periods only, and is indeed at this period of life better 
altogether avoided. Bicycling is also an unsuitable exercise at this 
age and readily leads to masturbation. Lawn tennis and croquet, 
on the other hand, are very suitable active open-air games ; in 
winter, skating may be indulged in if proper precautions are taken 
against chill ; in summer, swimming and rowing. The reading of 
light Hterature should be kept under supervision ; equivocal novels, 
such as may give rise to erotic reverie and sensual excitement, must 
be strictly forbidden. A watch should be kept Jor any indications 
of the habit of masturbation ; and if the habit exists, appropriate 
measures should be taken. 

Hydrotherapeutic procedures and baths are of great hygienic and 
therapeutic importance for girls at the menarche. In healthy girls 
at this period of life, a cold sponge-bath lasting one or two minutes, 
the temperature of the water ranging from 10° to 20° C. (50° to 
63° F.), taken either on rising in the morning or immediately before 
going to bed, is a valuable means for hardening the whole body ; 
equally useful are cold shower-baths, lasting from a few seconds up 
to half a minute. If the girl is somewhat anaemic, it will be well 
for her to take a glass of warm milk or a cup of tea half an hour 
before the bath, in order to guard against too great an abstraction 
of heat. Cold bathing in rivers, when available, may also be recom- 
mended. In cases in which a considerable degree of anemia or 
chlorosis is present, cold baths and every form of strong mechanical 
stimulation by the use of water, douches and the Hke, are to be 
avoided, since we have to fear both excessive abstraction of heat and 
overstimulation of the nerves. In such anaemic and chlorotic 
patients, either partial washing with lukewarm water or general 
lukewarm baths, the temperature of which may be gradually and 
cautiously lowered, either on rising or at bedtime, have a refreshing 
and stimulating effect. 

In girls who are in other respects healthy, but in whom the men- 



ii6 The Sexual Life of Woman. 

arche is delayed, and in whom menstruation, when begun, has been 
scanty and irregular, cold sitz-baths of short duration, the abdomen 
being simultaneously douched from a considerable height, or cold 
shower-baths in combination with powerful abdominal douches, are 
often of value. 

Recently, hot air and vapor baths have been especially recom- 
mended for girls suffering from chlorosis, at first, by Scholz and 
Schubert, in association with phlebotomy, but also without this. 
Kiihne, for example, has seen the most satisfactory results follow 
the simple use of sudatory baths in cases of chlorosis ; improvement 
was manifested by an increase in the corpuscular richness of the 
blood, an increase in the hsemaglobin-richness, and an increase in 
the body- weight. In cases of chlorosis, Traugott also has seen 
favorable results follow the use of hot-air baths and the consequent 
diaphoresis. 

Still more recently DcJiio and especially Rosin have recommended 
hot baths for girls suffering from chlorosis. In fifty cases of 
chlorosis, in which other methods of treatment had given negative 
results. Rosin gave three times a week baths at a temperature 
of 40° C. (104° F.), lasting at first a quarter of an hour, but later 
half an hour. After the bath, in those strong enough to bear it, a 
very short cold douche or cold sponging followed ; then the patient 
had to. lie down for an hour. The treatment was carried out for 
from four to six weeks. Each bath by itself had a notable refresh- 
ing effect in these patients, and at the end of the course most of the 
cases exhibited an improvement in all their symptoms, such as other 
methods of treatment had failed to produce. 

The favorable influence exercised by these hot baths, as by steam 
bath-cabinets, light baths, sun baths, wet packing, and similar 
sudorific measures, may in part be explained by the dehydration of 
the system that is thus effected ; whilst those who maintain the auto- 
intoxication theory of chlorosis may regard the diaphoresis as a 
means for the elimination of noxious substances from the body. 

Bathing in water aerated with carbonic acid may be recommended 
for patients suffering from anaemia and chlorosis at this period of 
life, for the reason that such baths can be tolerated at a lower tem- 
perature than baths of ordinary water. The natural mineral waters 
containing free carbonic acid, and chalybeate waters rich in car- 
bonic acid, when used as baths, are effective principally in virtue 
of the carbonic acid they contain, which stimulates the skin ; this 
stimulus being conducted by the nervous system from the periphery 
to the nerve-centres, is reflected thence, and by irradiation exercises 
a quickening effect on all the processes of nutrition. These baths 
are usually taken at a temperature progressively reduced from 32° C. 



The Sexual Epoch of the Menarche. 117 

to 25° C. (90° F. to 'jy° F.), and each bath lasts from ten to twenty 
minutes ; they are in most cases taken every other day only. For 
young girls in whom the menarche is delayed, also for chlorotic 
patients with amenorrhoea and neuralgic manifestations, chalybeate 
peat baths are indicated, which influence the peripheral nerves by the 
exercise of a gentle yet considerable thermic stimulus. These chaly- 
beate peat baths have further been shown to increase the haemo- 
globin-richness, the corpuscular richness, and the specific gravity of 
the blood, transitorily after each bath, but to some extent perma- 
nently also, a certain increase enduring after the course is over. 

Young girls suffering from disturbances of their general health 
dependent upon a scrofulous or rachitic habit of body may with 
advantage be sent to brine baths, especially to such as are situated 
in the Alps or other mountainous regions. These weakly, lymphatic, 
scrofulous girls, suffering from scanty or irregular menstruation, 
may also practice sea-bathing with advantage, especially at watering 
places on the sea coast, where the waves are powerful. In such 
cases, however, it is advisable in the first instance to take artificially 
warmed sea-water baths, before proceeding to actual sea-bathing. 

If the sensibility of a chlorotic patient is so great that she can 
endure neither peat baths nor carbonic acid containing mineral 
water baths, we must add to the latter, in order to make their action 
milder, decoctions of chamomile, wheat bran, malt, and the like. 

In cases in which nervous symptoms predominate, with an 
apathetic, melancholic frame of mind, aromatic herb baths are some- 
times useful. For this purpose such herbs should be employed as 
contain a notable quantity of ethereal oils, such as sage (salvia of- 
ficinalis), wild thyme (thymus serpyllum), hyssop (hyssopus offi- 
cinalis), wild marjoram (origanum vulgare), rue (ruta graveolens), 
archangel (archangelica officinalis), levisticum (levisticum offici- 
nale). Equally useful are the balsamic pine needle baths, for 
which the fluid obtained by the distillation of pine needles (pinus 
sylvestris), freshly collected day by day, is employed. 

As regards the climatic conditions suitable for adolescent girls 
suffering from the disorders of the menarche, from the nervous 
conditions associated therewith, and from chlorosis, residence either 
in the mountains or at the seaside is especially to be recommended. 
An altitude of about 1,200 metres (4,000 feet) is the most suitable, 
being that at which the peculiar characteristics of mountain climates 
are most fully developed. The influence of such a climate on 
hsematopoiesis has to be taken into consideration, as well as its 
special influence on the menstrual function. 

Even though it cannot yet be regarded as fully determined 
whether the increase observed by Viault, Egger, and Mercier^ in the 



ii8 - The Sexual Life of Woman. 

corpuscular richness and haemoglobin-richness of the blood in conse- 
quence of residence in a mountain climate, is lastin,^ or merely 
transitory, yet it is certain that the haematopoietic organs are favor- 
ably influenced by such residence, and that the good results are 
augmented by the stimulating effect mountain air exercises on the 
appetite and the digestion. Lombard has moreover observed, that 
at a high altitude the menstrual flow is more abundant and dysmen- 
orrhcea is less common. For young girls, therefore, suffering from 
irritable conditions of the heart, increased frequency of the pulse, or 
increased arterial tension, and for those also in whom the resisting 
power of the organism appears deficient, a visit to a mountain health 
resort situated amid forests may be recommended. For scrofulous 
girls a visit to the coast of the North Sea is especially suitable. For 
the slighter forms of anaemia, a sea voyage, in which the benefits of 
sea air can be obtained more fully, and for a longer period, may be 
advised ; but such a voyage is quite unsuitable for those suffering 
from severe anaemia or chlorosis. 

Such very weakly, intensely anaemic and chlorotic patients should 
spend the winter in some southern health resort. 

The skin, in which disturbances so readily occur at the time of 
the menarche, requires careful attention, all the more because it is 
precisely at this age that young girls have the greatest need of their 
personal charms. The skin of the face, which is often disfigured by 
comedones and acne, must be carefully guarded against the accumu- 
lation of sebum in the sebaceous glands by sedulous washing with 
warm water and a good soap. If the seborrhoeic^^ process in these 
glands becomes at all severe, ordinary soaps are unsuitable, and a 
potash soap must be used, such as sapo viridis, or spiritus saponatus 
kalinus, which have great power of dissolving fats. 

The best way of dealing with seborrhoea is according to Spietschka 
and Grunfeld the following: The washing is best effected in 
the evenings, when the skin will not again for many hours be ex- 
posed to the fresh air, to wind, or to dust. Pour into a basin about 
a pint of warm water and add from one to two teaspoonfuls of 
spirit of soap (equivalent to the linimentum saponis of the 
British Pharmacopoeia) or as much soft soap as can be taken up on 
the end of a table-knife. The water is then stirred vigorously till a 
good lather is formed, and with the water and the lather the face is 
thoroughly w^ashed. The skin must then be carefully dried, and 
thereafter it is well to smear it with some greasy material., such as 
boric vaseline, in order to prevent the plugging of the pores with 

30 Regarding the significance attached by the author to the words seborrhoea 
and schorrhoeis, see note to page 107. 



The Sexual Epoch of the Menarche. 119 

dust, and to protect the sebum subsequently exuded from dessication. 
On the next day the Washing should be repeated only if the face 
has become covered with sebum within an hour or two after the 
first washinp;. If the exudation is less free, the eyes only should be 
washed with fresh water, whilst the rest of the face should not be 
wetted, but merely be wiped with a dry face towel lii^^htly dusted 
with toilet powder, in order to remove any accumulation of sebum. 

The skin of the genital regions must be carefully cleansed, espe- 
cially in cases in which there is a tendency to hypersecretion of the 
sebaceous glands, to eczema, or to herpes progenitalis ; subsequently 
it should be powdered, and pads of absorbent cotton-wool dusted 
with toilet powder should be placed in the labial furrows. 

It is of great importance that in girls at this time of life gyneco- 
logical examination should be undertaken only in cases of the utmost 
need, and this restriction should be especially inflexible in the case 
of girls with a neuropathic predisposition. Instances have been 
observed in whxh a vaginal examination, the introduction of a 
vaginal speculum, or the use of the uterine sound, has deLcrmined 
the onset of a psychosis. Still more does what has been said hold 
true of local treatment in gynecological cases. Repeated passage of 
the uterine sound, cauterization of the cervix, and the manipulations 
of gynecological massage, make a very deep impression upon the 
mind of a girl, and give rise to morbid ideas and erotic storms, so 
that even in those with a powerful constitution, various neuroses, 
neurasthenic states, and even mental disorders may result. If in 
such cases, especially i;i girls of a neuropathic temperament, gyne- 
cological treatment is quite indispensable, a single, though energetic, 
operative procedure is to be preferred to a number of successive, 
though taken singly less extensive, manipulations of and in the 
female genital organs. The importance of this proposition has 
been repeatedly established. Scenger, for instance, points out as a 
fact to be regretted that uterine cauterization with mild caustics is 
far too frequently undertaken ; and Odehrecht from the same stand- 
point proclaims the advantage of a single curetting as compared with 
milder intra-uterine impressions repeated during a course of treat- 
ment lasting many months. On the other hand, the physician must 
bear in mind the fact, established by the record of a very large num- 
ber of cases, that in women predisposed to psychoses severe gyneco- 
logical operations are apt to lead to the actual appearance of mental, 
disorders, or to the exacerbation of mental disorders which have 
previously been very mild or have merely threatened to appear. 
Careful consideration is needed, on the one hand as regards the 
severity of the disease of the genital organs, and on the other as 
regards the resisting power, temperament, and constitution of the 



I20 The Sexual Life of Woman. 

giri concerned, and in many cases a consultation between the gyne- 
cologist and the neurologist is expedient. 

A very powerful influence on the physical and moral well-being 
of the girl at puberty is exercised by her domestic upbringing. 
The general truth of Goethe's saying, that the circumstances into 
which we are born exercise a determining influence on the whole 
life, being admitted, we have to remember that this applies with 
especial force in the case of girls. 

The educational- views which obtain at the present day among 
the upper ten thousand, are by no means calculated for the produc- 
tion of a woman healthy in body and sound in mind. From the 
time when the young girf becomes sexually developed, the claims 
which society makes upon her become pressing. Every day, by a 
number of stimuli, her curiosity and her desires are directed toward 
sexual matters. Visits to museums, picture galleries, and theatres, 
the perusal of modern romances, the free mingling of the sexes in 
all places of am.usement — all these combine to awaken prematurely 
an instinct to which the '' old fashioned " methods of education 
allowed a much more prolonged slumber. In other cases, the 
mother's supervision of the developing girl is hindered and rendered 
insufficient because the mother herself is claimed by her society 
duties and taken much away from her home. In addition, the 
young brain is overburdened with mental work, the modern idea of 
the equality of the sexes in matters of love is instilled, and a desire 
is artificially evoked, and is matured by a certain idle vanity, to 
indulge the "natural" instincts — to manifest sexual passion and 
to indulge it to excess — and thus the modesty so natural and so 
becoming to young girls is completely lost. Nourished in such a 
soil, neurasthenic and hysterical states, disorders of menstruation, 
and masturbation, cannot fail to flourish. 

In these respects also a change is requisite, and a mode of up- 
bringing must be inculcated from which everything likely to inflame 
the sexual impulse is removed. For the adolescent girl a systematic 
alternation of work and recreation must be arranged. From great 
entertainments where she will mix with young men, from theatres, 
evening parties, and balls, the young girl at the time of the menarche, 
at the period when menstruation commences, must as far as possible 
be kept away, and such pleasures must be reserved for a more 
advanced stage of this period of development. Intellectual over- 
strain, the overtaxing of the young head, must be avoided; the 
acquirement of knowledge must take place gradually and slowly, 
and in a manner adapted to individual peculiarities. Intercourse 
with female friends also requires supervision in respect of the 
moral characteristics of these latter. Religious reverie must be 



The Sexual Epoch of the Menarche. 121 

avoided, but also to be avoided is the modern nihilism in respect 
of religion and good morals. Books must be carefully chosen in 
order that the imagination may remain pure and in order that girlish 
illusions may not be prematurely destroyed. Domestic recreations 
in the way of games, music, singing, painting, and other forms of 
artistic culture, are of importance for the development of a strenu- 
ous faculty for learning. Travel in regions where the scenery is 
beautiful, forms a most valuable means for the ennoblement of the 
intellect and the emotions. 

Additional matters demanding attention are, as already men- 
tioned, the suitability of the diet, and proper physical exercise. All 
stimulating articles of food are to be avoided, the excessive use of 
meat is to be forbidden, and a sufficient mixed diet, containing both 
animal and vegetable substances, is to be prescribed. Tea and 
cof¥ee should be taken as sparingly as possible, and alcoholic bever- 
ages must be absolutely prohibited. The regulation of the bowels 
is of great importance. Young girls should accustom themselves 
to evacuate the bowels every day at a fixed hour, the best time to 
adopt being either immediately on rising or just after breakfast. 
Constipation is very apt to lead to the production of irritable con- 
ditions of the genital organs. 

We can point out as a happy instance of modern progress that 
the practice of certain physical exercises has actually become the 
fashion for young girls. Gymnastics, with or without apparatus, 
swimming, skating, and lawn tennis, involve a number of bodily 
movements advantageous for the health ; and in connection with 
most of these the enjoyment of fresh air offers an additional favor- 
able influence. BicycHng, however, at this period of life is open to 
many objections, not only on account of the likelihood of direct 
injury to the genital organs now in course of development, but also 
on account of the impulse it produces toward onanistic manipu- 
lations. 

Especial attention must be paid to the clothing, regarding which 
the requirements of fashion so often conflict with those of hygiene, 
the victory, unfortunately, in most cases falling to the former. The 
period of the menarche is indeed usually regarded as the proper 
time for the young girl to begin wearing a corset, if it has not been 
worn before. In this connection M. Rtinge makes the significant 
remark : ''As long as bodice and skirt form the two principal articles 
of woman's clothing, the corset or some similar article cannot be 
dispensed with. The vicious features in the corset are its con- 
striction of the thorax, with the object of giving the woman a 
* figure,' and the introduction into its substance of strips of whalebone 
or steel in order to give firmness to the figure. The harm done by the 



122 The Sexual Life of Woman. 

former feature, the compression of the abdominal viscera, the corset 
Hver (lacing liver, constricted liver, Ger. Schnilrleher) , the movable 
kidney, etc. — all are so well known that they need not be particu- 
larly described. But the strong pressure from above has a dele- 
terious effect upon the internal genital organs also, leading to 
passive hypersemia and to displacements. The ' bones ' of the corset 
take part in the compression, and they replace the functions of the 
muscles of the back. If a woman who has long worn a corset lays 
it aside later in life, she complains that she is no longer able to hold 
herself upright. In consequence of insufficient work the muscles 
of the back have become incapable of keeping the back straight. 
The corset, then, must neither constrict the body, nor must it con- 
tain ' bones.' An article of clothing analogous to the corset is, 
however, required for the support of the skirt and the petticoats that 
clothe the lower limbs. These latter are usually fastened by means 
of bands which encircle the body above the crest of the ilium. 
In order to give these bands a sufficient hold, this region of the body 
is compressed by the corset. The burden of skirt and petticoats is 
thus borne by a furrow, above the pelvis and below or in the region 
of the asternal or false ribs, which is in great part artificially pro- 
duced. All this is bad. In order to avoid the necessity for any 
constriction, the petticoats should be fastened to the corset, and this 
latter should be supported from the shoulders by means of shoulder- 
straps or braces crossing one another behind. No constriction of 
the thorax then occurs, and if the corset has suitable supporting 
pouches for the breasts, and the wearer is accustomed to hold herself 
erect, the figure of a well-formed woman thus attired is far from 
unpleasing, and is, above all, natural. If the weight of skirt and 
petticoats is too great to be borne by the shoulders, the burden 
can be divided, some being fastened to the corset, others tied round 
the waist. This method is less to be commended, but may be re- 
garded as a permissible middle course. If chemise and drawers are 
woven in one piece, as in the ' combination ' under garment, there 
is one article the less to be attached to the corset. Recently a 
number of corsets and articles of clothing have been made in accord- 
ance with these principles. 

" The growing girl, then, may wear a soft corset with shoulder- 
straps, made to measure, to which all the garments clothing the 
parts below the waist should be made to fasten. It must unfor- 
tunately be .admitted that this rational mode of arranging the cloth- 
ing cannot be adapted to the ' low dress ' which etiquette demands 
on so many occasions for evening wear, since with the latter the 
shoulder-straps cannot be worn. 

'' It is most unhygienic for women to wear, as they so often do, 



The Sexual Epoch of the Menarche 123 

drawers that are widely open. Both cleanliness and the need for an 
equable warmth demand that these garments should be closed be- 
tween the thighs, not to speak of other reasons." 

In order to diminish the sexual impulse in girls at the menarche, 
where this impulse has developed prematurely or is abnormally in- 
tense, and even in later years with the same end in view, it is neces- 
sary, not merely that the diet should be suitable and non-stimulating 
and that the educational environment should be satisfactory, but 
above all that there should be regular occupation and regular physical 
activity. Ribbing rightly calls attention to his experience in dealing 
with animals, that equally in the case of the stallion and of the 
mare, the whole of life may without difficulty be passed in complete 
abstinence from sexual gratification, provided that the diet is suit- 
able, being neither too rich nor too meagre, and that the animal has 
regular occupation of a nature and degree adapted to its powers. 
In these animals a certain amount of disquiet, of restlessness, of 
sulky irritability, etc., may indeed be noticed at times, but these 
manifestations are to be overcome by mingled gentleness and firm- 
ness, aided now and again also by mild chastisement, but altogether 
without any severity. '' Chastity," says Oestcrlcn, '' is possible only 
when the mode of life is simple and regular, and is characterized by 
appropriate self-command and frugality. For this reason it is rarely 
encountered in palaces and similar places, in which from youth 
onwards every one can do what he pleases ; but just as little is it 
really practicable amid conditions of lack of culture, rudeness, and 
poverty." 

From the point of view of education, what More an wrote a hun- 
dred years ago is of importance : '' In the ordinary course of nature 
the young woman at the time of the first appearance of menstruation 
is still in full possession of those amiable qualities of blamelessness 
and chastity which we are accustomed to denote by the term moral 
virginity. To an honorable and pure-minded man this beautiful 
attribute of budding womanhood is much dearer and more estimable 
than physical virginity. By libertines only is the latter regarded 
as a most valuable possession, since it furnishes a powerful stimulus 
to their jaded imaginations. But moral virginity and physical 
virginity are not always and necessarily associated, for either can 
be present in the absence of the other. Physical virginity may be 
destroyed by diverse forms of violence, and yet moral virginity may 
remain pure and uninjured amidst its ruins. Thus the two are 
widely different one from the other, widely different also are they in 
value and significance." 

What Eulenburg says regarding the prophylaxis of sexual neuras- 
thenia in general is true regarding the sexual life of the girl at this 



124 The Sexual Life of Woman. 

period of life. '' What is needed," he writes, '* is the control of 
educational influences with these ends in view, that, on the one hand, 
the sexual excitability, of developing youth shall be diminished and 
kept within bounds, and that nevertheless, on the other, the urgently 
needed enlightenment shall be afforded to the young people at the 
proper time and in a suitable form. How these aims are to be 
effected cannot be explained in generally applicable propositions. 
It is a matter which must be left to the tact of the parents and of 
other members of the family, who will be guided by the insight they 
have acquired into the mental life of those concerned. ''' * *. 
Children inclined to onanism must be carefully supervised by day 
and by night ; they must be protected from all stimulating things 
and from bad company ; in boarding-schools it is the common dor- 
mitories that require the most strict, most careful, and most con- 
tinuous control. In the case of auto-onanists, female as well as 
male, we must enquire into the possible existence of local stimulating 
influences, among which, in both sexes, oxyuris must be men- 
tioned — but in truth it is rare for such local conditions to be the 
exciting cause of masturbation. A healthy mode of life in respect 
of clothing, sleep, and diet, and the systematic practice of bodily 
exercises to the point of considerable fatigue, are the most effectual 
means of counteracting the noxious propensity to onanism." 

A high degree of freedom permitted to girls from a very early age 
is, as Rousseau already maintained, by no means favorable to the 
preservation of virginity. 

A wise mother or a wise instructress can do much towards the 
preservation of physical and moral virginity, by enlightening her 
daughter or pupil at the right time and in a proper manner as to 
the nature of the sexual processes, and their significance for the 
whole life of woman. Ignorance in this respect, equally with pseudo- 
knowledge, entails many dangers. I regard it as indispensable that 
the adolescent girl should in good time learn from her mother the 
nature of menstruation, lest she should first receive enlightenment in 
an unfitting manner from some more experienced female friend. The 
mother should explain that the impending flow of blood is a natural 
process, unattended by danger, but indispensable to the sexual life, 
and a characteristic part of the process of " growing up." 

The knotty and important topic of how the young girl may best 
receive sexual enlightenment from her mother, is discussed by E. 
Stiehl in her notable work ''A Maternal Duty." ^^ The authoress 
points out that this enlightenment must not take place suddenly 
and without apparent motive, but that the mother must in a gentle 

3^ Eine MutterpHichi. 



The Sexual Epoch of the Menarche. 125 

and gradual manner introduce to her child the secrets of nature. A 
beginning may be made by teaching the child to observe the nature 
and growth of plants; then she may be led to interest herself in 
the family life of animals ; and thus an easy way is found to answer 
the questions connected with reproduction — to answer them in a 
manner at once true and befitting. 

Let the mother indicate to her child the methods employed by 
nature for the preservation of the Hfe of the young plant ; let her 
demonstrate in a flower the stamens and the pistil as male and 
female organs respectively ; and let her explain how when the 
pollen-grain reaches and fertilizes the tiny ovule in the ovary, this 
ovule becomes capable of development into a large seed containing 
an active rudimentary plant, which latter itself enlarges to become 
a new full-grown specimen of its kind. The opportunity may then 
be seized to draw attention to the resemblance between the little 
ovules in the ovary of the flower and the minute ova by means of 
which all animal life reproduces its kind. Proceeding further, an 
earnest and thorough introduction to the sanctity and responsibility, 
the perils and duties, of the sexual life, is urgently required by the 
young girl before she proceeds either to marriage or to an econom- 
ically independent mode of life. 

Not only in America and England, but now also in Germany, 
there exist excellent books which may actually be put i;ito the 
growing girl's own hands, by means of which she will be intro- 
duced in an intelligent manner to a knowledge of the method of 
reproduction in the human species. 

Often enough, when the mother is lacking in intelligence or 
sympathy, it will be the duty of the physician to give this enlighten- 
ment to the young girl. The interpreter of such tidings at the time 
of love's dawning will be the family doctor, to whom the girl and 
her family have been confidently accustomed to turn for informa- 
tion regarding the bodily state and well-being. He is accustomed 
to remove many a veil without any offense to maidenly modesty. 
Many sexual disorders and much sexual aberration may thus be 
prevented. 

Certarn definite hygienic rules must now be prescribed. First of 
all, the strictest cleanliness must be observed, not only in the inter- 
vals, but also during menstruation. The prejudice against chang- 
ing the under linen during the flow must be overcome, and care 
must be taken that at this time the external genitals are washed twice 
daily with water at a temperature of 26° C. to 28° C. (about 80° F.), 
and a wad of absorbent cotton-wool or a piece of clean linen (sponges 
are not to be used for this purpose) ; any article of underclothing 



126 The Sexual Life of Woman. 

that becomes soiled VN'ith blood must be changed. ]\Iost useful are 
the so-called " sanitary towels," made of sterilized absorbent cotton- 
wool, fastened to a linen band which surrounds the waist, or simple 
pads of absorbent material may be used, kept in place by means of 
a bandage. During menstruation, full baths, warm or cold, are to 
be avoided, likewise long walks, riding, long journeys by rail, 
gymnastics, with or without apparatus, skating, lawn tennis, and 
bicycling; dancing, above all, must be prohibited, since it involves 
a combination of several noxious influences — the very active move- 
ment, which produces hyperaemia of the genital organs, sexual 
excitement, loss of sleep, long hours spent in close rooms, prolonged 
voluntary retention of urine, and the risk of a chill. Singing, also, 
must be discontinued during menstruation, since otlierwise an injury 
to the voice is very likely to result. A certain limitation in respect 
of physical and mental activity is indicated as a general precautionary 
measure during menstruation, but this measure must not be pushed 
to excess, so that the habit is acquired of resting completely during 
the period, passing the days on a sofa. The favorite practice, in 
cases of scanty menstruation, of taking hot foot-baths is to be re- 
jected. At the conclusion of each menstrual period, however, a tepid 
bath should be taken. The knowledge we have now acquired of 
the rhythmical '* menstrual wave " process (see p. 19 ct scq.) points 
to the practical conclusion that the physician should not direct his 
attention to the actual menstrual period only, but also, and more 
than has hitherto been customary, to the premenstrual period, in 
which temperature, blood-pressure, and excretion of urea attain 
their acme ; especially should this be done, with the aim of pre- 
scribing suitable hygienic precautions, in cases in which the men- 
strual discharge is very profuse or in which nervous manifestations 
accompany menstruation. 

Important is it also for the physician to take precautions against 
the practice by young girls of unduly prolonged voluntary retention 
of the urine, resulting in over-distension of the bladder ; also against 
the performance of very active movements and against powerful 
muscular efforts when the bladder is in a distended state. All of 
these are liable to result in displacements of the uterus. 

During menstruation the diet shotild be sufficient, but free from 
stimulating elements. When the menstrual flow is greatly in excess, 
strong tea and coffee, wine, and beer should be forbidden ; conver- 
sely, when menstruation is scanty, an invigorating diet is especially 
indicated, and the use of strong wines. According to the investi- 
gations of T. Schroder, in order to maintain the nitrogenous balance 



The Sexual Epoch of the Menarche. 127 

(luring menstruation, it is necessary to give the following daily diet, 
representing a heat value of 2,013 to 2,076 (Calories: 

125-150 grammes of fowl. 

100 grammes of butter. 
125—140 grammes of white bread. 
150 grammes of brown bread. 
70—80 grammes of eggs. 
600 grammes of coffee. 
600 grammes of soup. 
560 grammes of Seltzer water. 
20 grammes of salt. 

For chlorotic girls the following diet may be recommended during 
menstruation. Before rising a pint of milk should be taken slowly, 
in sips, during a period not exceeding half an hour; for the first 
breakfast (see note to p. 112), tea or coffee with an abundance of 
milk, a considerable portion of meat (roast beef, cold fowl, cutlets, 
or beefsteak) ; for the second breakfast, a tumbler of milk, bread, 
butter, and a couple of eggs ; for midday dinner, a good helping of 
fresh meat so cooked as to be easily digested, green vegetables, 
potatoes, farinaceous pudding, stewed fruit, and a glass of bur- 
gundy or claret; at 4 p. m., coffee and bread and butter, or a 
tumbler of milk; at 7 p. m.^ a similar meal to the midday dinner, but 
lighter ; no supper. In this diet-table, which represents a heat-value 
of about 2,200 calories, albumin and fat are present in abundance 
(182.8 grammes albumin and ^(y^ grammes fat), but carbohydrates 
in small quantity only (176.9 grammes). 

For those chlorotic patients who find it difficult to digest much 
butcher's meat, the necessary quantum of albumin must be supplied 
by increasing the amount of milk, soup, and the white varieties of 
flesh (chicken and the like), giving also a considerable amount of 
the more easily digested vegetables, with fruit, beer, and a little 
claret. For such cases Dcsqitc has drawn up the following diet- 
table, representing 3,290 calories and containing 150 grammes of 
albumin, 110.7 grammes of fat, and 449.6 grammes of carbo- 
hydrate ; meat is given once a day only : 

7.30 A. M. — Half a pint of milk, 50 grammes roll, 10 grammes butter. 

10 A. M. — 300 grammes apples, strawberries, or cranberries, 50 grammes roll, 
10 grammes butter. 
12.30 P. M. — 200 grammes of beefsteak, 100 grammes of macaroni, 300 
grammes of bread, 400 grammes of spinach, 200 grammes 
of stewed apples or gooseberries. 
4 P.M. — 200 grammes vegetable-peptone-cocoa, 50 grammes roll, 10 
grammes butter. 
7.30 P.M. — 200 grammes rice-broth, 500 grammes buttermilk, 100 grammes 
bread, 10 grammes butter, 200 grammes salad, 300 grammes 
uncooked pears, 40 grammes curds. 



128 The Sexual Life of Woman. 

In cases of profuse metrorrhagia in girls, von Winckel recom- 
mends in addition to rest in the recumbent posture, a diet containing 
large quantities of fluid, and much easily assimilable albuminous 
nutrient material, all stimulating articles and those likely to cause 
nausea and vomiting being avoided. He gives the following diet- 
table : 

7 A. M. — 250 grammes of milk. 

9 A.M. — 250 gram^mes of bouillon, i egg, 20 grammes of brandy. 
II A. M. — 250 grammes of milk. 
I p. M. — 100 grammes of roast meat, 250 grammes of rice-broth with 5 

grammes of somatose, and 150 grammes of claret. 
3 p. M. — 250 grammes of milk. 
5 p. M. — I egg, 20 grammes of brandy. 
7 p. M, — 250 grammes of bouillon or white soup with 5 grammes of somatose. 

As a beverage in the intervals, weak cold tea is allowed. When 
the haemorrhage has ceased, the following beverages are suitable : 
oatmeal, cocoa, Pilsener beer (one pint daily), milk (2 to 3 pints 
daily), claret (a half bottle daily). For food, the lighter varieties 
of meat, 200 to 300 grammes daily, sweet-bread, pigeon, ham, nutri- 
ent and easily digestible vegetables, spinach, carrots, and pea-soup, 
may be recommended. 

In cases of amenorrhoea of scanty menstruation, especially when 
due to anaemia or to underfeeding, mental excitement, or over- 
exertion, warm baths at a temperature of 28° to 29° R. (90° to 
92° F.), rubbing the body with wet towels, and warm sitz-baths, 
are of good service. 

[Note: Although in this translation the English equivalent? of the measures 
used on the Continent have as a rule been appended in parenthesis, this has 
not been thought necessary in the rase of the diet-tables, since even in English 
works these are commonly stated in terms of the metric system. It may here 
be mentioned that, as regards fluid measures, 250 grammes (a quarter of a 
litre) is roughly equivalent to half a pint, an ordinary tumblerful or breakfast- 
cupful; and that, as regards solid measures, 30 grammes are equivalent to a 
very little more than an avoirdupois ounce-] 

Menstruation. 

Menstruation is the name given to the process which manifests 
itself in the human female after the age of puberty by the discharge 
from the genital organs at regular four-weekly intervals of a muco- 
sanguineous secretion. This discharge is not merely the result of 
a local hypersemic condition, but is the expression of a periodic 
excitation of the entire nervous system and blood vascular system, 
intimately related with the whole sexual life of woman; this excita- 
tion is itself dependent upon the process of ovulation, an incident in 
the series of manifestations that arise from the periodic undulatory 
movement in the vital processes of woman. 






The Sexual Epoch of the Menarche. 129 

The Mosaic law regarded the process of menstruation as unclean 
in nature ; the menstruating woman was unclean, and must be puri- 
fied in a prescribed manner. In the fifteenth chapter of Leviticus, 
vv. 19-29, we read: ''And if a woman have an issue, and her 
issue in her flesh be blood, she shall be put apart seven days : and 
whosoever toucheth her shall be unclean until the even. * * * 
Every bed whereon she lieth all the days of her issue shall be unto 
her as the bed of her separation. * * * 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 turtles, or two young pigeons, and bring them vmto the 
priest, to the door of the tabernacle of the congregation." 

In a similar manner the adherents of the faith of Islam regard 
a menstruating woman as unclean. 

This view is found also in the earliest medical writings, alike 
in the early Indian book of Susruta and in the later writings of 
Hippocrates, and it persists to the present day in the use of the 
expression " monthly purification." Susruta teaches that in India 
menstruation begins at the age of twelve, and recurs monthly, the 
flow lasting three days. In the Jewish Talmud it is asserted (see 
'* La Medeciiie du Talmud," by Dr. Rabhinozma:) that menstruation 
begins as soon as the girl has two hairs on the pubic region, or at 
the age of twelve, even in the absence of any growth of the pubic 
hair. The menstrual blood is quite peculiar in its characters. Thus, 
Raschi relates, the mother of the King of Persia exhibited sixty 
varieties of blood, and among them Rahba was able to detect which 
was the menstrual blood. According to a ra^bbimcal authority, a 
woman can become pregnant as soon as she has completed her 
twelfth year. As signs of puberty, Rabbi Josse mentions the ap- 
pearance of a fold beneath the nipple. Rabbi Akiba, the erection of 
the nipples. Rabbi d'Azai, the appearance of a dlark areola around 
the nipples, Rabbi Josse, the recession of the nipple under pressure 
followed by its gradual protrusion when the pressure is removed, 
also the softening of the mons Veneris (in consequence of the deposit 
of fat in its substance). As prodromal signs of the first appearance 
of menstruation, the Talmud mentions, pain in the region of the 
umbilicus and in the uterus, flatulence, shivering, white flux, heavi- 
ness in the head and the limbs, and nausea. 

The blood discharged during menstruation has certain peculiar 
properties. It is always fluid, and rarely contains fibrinous clots, 
it is always mixed with a larger or smaller quantity of mucus, which 
gives it a sticky character; the reaction is alkaline, the smell char- 
acteristic. Only when the bleeding is very profuse are coagulated 
masses evacuated. On microscopical examination of menstrual 

9 



130 The Sexual Life of Woman. 

blood, we detect erythrocytes and leucocytes, the proportional num- 
ber of the latter being greater than in pure blood; there is an ad- 
mixture also of epithelium from the genital mucous membranes, 
cylindrical cells from the uterus, flattened cells from the superficial 
layers of the stratified scaly epithelium of the vagina, also various 
micro-organisms and granular detritus. At the beginning of each 
menstruation, the admixture of mucus is greatest, so that the dis- 
charge sometim.es has the appearance of blood-stained mucus ; but 
during the height of the discharge the consistency is almost that of 
pure blood. The quantity of blood lost at each period is said to vary 
from 90 to 240 grammes (about 3 to 8 fluid ounces) ; but in tropical 
climates the average is said to be 600 grammes (20 ounces). Ac- 
cording to the accurate analysis of Denis, menstrual fluid contains 
in a thousand parts : 

Total solid constituents 175 . 00 

Comprising 

Fat 3.90 

Blood-corpuscles 64 . 40 

Albumin 48 . 30 

Extractives . . i . 10 

Salts 12 . 00 

Mucus 45 . 30 

Water 825 . 00 



Both the quality and the quantity of the blood are subject to 
great variations. Thus, for instance, Bouchardat estimates the soliil 
constituents at 99.20 per mille, Vogel at 161 per mille, and Simon 
at 215 per mille. The amount of blood discharged during menstrua- 
tion depends upon the temperament, the constitution, and the oc- 
cupation, of the woman concerned. It is greater in vivacious 
brunettes than in phlegmatic blondes, greater in southern women 
than in those dwelling in the north, greater in town dv/ellers than in 
women living in the open plains, greater in those whose mode of 
life is sedentary than in those engaged in some active occupation. 

Similar considerations apply with regard to the duration of each 
period. The mean duration is in the great majority of cases from 
four to five days, being generally the same in successive periods 
in the same individual ; in exceptional cases the flow may last a 
week or more. Menstruation lasting more than eight days must be 
regarded as abnormal. 

Kricgcr has collected data relating to the duration of the individ- 
ual periods. He found the duration constant in the great majority 
of cases, i. e., 93.285 per cent. ; but variable in a small minority, 
i. e,, 6.715 per cent. 



The Sexual Epoch of the Menarche. 131 

The periods in which the duration was regular did not always last 
precisely the same number of days, the duration in many cases 
being 3 to 4 days, 5 to 6 days, etc. ; but the same duration recurred 
regularly at each successive period, so that all these instances must 
be reckoned among the periods of regular duration. The duration 
must be regarded as irregular or variable in those cases in which 
the variation was from 2 to 4 days, 3 to 8 days, etc. Sometimes 
a regular three-day or five-day period becomes transformed into an 
eight-day period ; or conversely an eight-day period into a four-day 
period. 

Among the cases in which the duration was regular, it amounted 

Most frequentl}' to 8 days, in 26.695 per cent. 

Next in frequency was a duration of 3 days, in 20.762 per cent. 

Next, a duration of 4 days, in 16.949 per cent. 

Next, a duration of 5 days, in 11 .864 per cent. 

L. Mayer has also drawn a distinction between constant and 
variable duration of the menstrual periods. Among 4,927 women, 
he found 4,542 (92.185^) in whom the duration was constant, and 
385 (7.815^) in whom it was variable. Of the constant periods, 
the duration was : 

8 days in 1182 women, that is in. 26.024 per cent. 

4 days in 829 women, that is in 18.252 per cent. 

3 days in 731 women, that is in 16.094 per cent. 

5 days in 730 women, that is in , 16.072 per cent. 

An extremely short duration, less than 24 hours, was found in 
70 women, an extremely long duration, 7 to 14 days, was found in 
175 women, and finally a duration exceeding 14 days was found in 
19 women. 

The mean duration in these cases was 5.387 days. 

The results obtained by Szitkits, who investigated the duration of 
the periods in 1,013 women, are somewhat divergent from the above. 
He found : 



A duration of a few hours only in 95 women, that 
A duration of i to 2 days in 66 women, that 



A duration of 3 days in 407 women, that is in. . 40. 17 per cent 

in. . 16.88 per cent, 
in. . 11.35 per cent. 



A duration of 4 days in 171 women, that 

A duration of 5 to 6 days in 115 women, that 

A duration of 7 to 8 days in it8 women, that is in. . 11.63 per cent. 

A duration of 9 days and upwards in 41 women, that is in.. 4.05 per cent. 



s in. . 9.38 per cent, 
s in. . 6.51 per cent. 



The mean duration in these cases was- 3.87 days. 

The mean duration of the menstrual flow is : 

In Paris 5 days. 

In London 4.6 days. 

In Berhn 4.5 days. 

In Copenhagen 4.3 days (according to Ma3Tr, 5.3 days). 

In Austria 3.8 days. 



132 The Sexual Life of Woman. 

The interval between one menstruation and the next (the period 
that elapses, that is to say, between the commencement of one period 
and the commencement of the next) is in the great majority of 
cases twenty-eight days. The recurrence in many women is extraor- 
dinarily exact, not merely as regards the day, but even as regards 
the hour of the day. The twenty-eight-day type of menstruation is 
found in about 70 per cent, of the cases ; in the remainder, the thirty- 
day type is most frequent, and next to that the twenty-one-day type. 
The periodicity of menstruation in any individual may however be 
very irregular. 

The quantity of blood lost during menstruation varies within wide 
limits ; according to approximate estimates the usual loss at a single 
period.is from 90 to 240 grammes (about 3 to 8 fluid ounces). The 
following summary statement is made by Krieger regarding the 
quantity lost in different social circumstances and in various na- 
tionalities : 

The amount of blood lost and the duration of the flow are less in 
strong, healthy women, leading an occupied, active, and regular life, 
especially in countrywomen and in women who are poor and chaste, 
than it is in delicate, weakly women, leading a sedentary life, whose 
diet is abundant and stimulating, and who are accustomed to an 
ultra-luxurious and enervating existence. In nuns, for example, the 
quantity of the menstrual discharge gradually declines ; shortly after 
their entrance into the cloister, various irregularities are apt to 
occur, but ultimately the flow becomes exceedingly scanty and lasts 
for a single day only. Climate also has a great influence, for in hot 
countries women usually menstruate very abundantly, whilst in 
cold countries the flow is scanty, and often appears only in the 
warmer months of the year. Of the Lapp and Samoyede women 
this was already reported by l^innccns and Virey. Tilt further re- 
lates that Eskimo women menstruate only during the summer 
months, and even then scantily. In southern France, according to 
Conrty, the quantity varies from 120 to 240 grammes (about 4 to 
8 ounces) ; but it may rise to 300, 350, and even to 500 grammes 
(about 10, 12, and 16^ fluid ounces). In the tropics, severe menor- 
rhagia is said to be common ; and the fact was already known to 
Blumhenhach, that women of European descent born in the tropics 
not infrequently succumb to haemorrhage during childbirth. 

L. Mayer has endeavored to determine the relations between the 
quantity and the quality of the discharge, and distinguishes the 
regular composition, when a considerable quantity of dark-tinted, 
fluid blood is passed, from the Irregular composition, when a small 
quantity of blood, usually pale in color, is passed, or an excessive 
quantity of dark blood, often coagulated, or a discharge of varying 
composition. 



The Sexual Epoch of the Menarche. 133 

Of 4.542 women questioned by Mayer In regard to this matter, 

there were : 

2,998. that is 66.006 per cent., in whom the composition was regular. 
1,544, that is 33.994 per cent., in whom the composition was irregular, 

and among the latter the discharge was 

Scanty and for the most part pale in 511 ; that is 12.250 per cent. 

Profuse or profuse and coagulated in 838; that is 18.428 per cent. 

Variable in 196; t]iat is 4.315 per cent. 

Investigation regarding the individual variations that occur in 
this respect among women, showed that blondes usually menstruate 
more profusely than brunettes, and that in the former also the 
duration of the individual periods is longer. 

The loss of blood must be considered less in respect of its absolute 
quantity than in respect of the effect which continued observation 
shows its loss to have upon the organism. If tlie loss of blood con- 
tinues to have an effect after the flow has ceased, if a woman re- 
covers but slowly, or even fails to recover fully from one loss before 
another begins, if symptoms of increasing ansemia become ap- 
parent, the bleeding must be regarded as a pathological perversion 
of normal menstruation. Pathological is it also if the menstrual 
flow does not exhibit the normal slowly rising and slowly declining 
curve, but sets in profusely, ceases or almost ceases for a time, and 
then again suddenly recurs. In some cases the flow is not profuse, 
but lasts for a long time, and owing to this long duration it has a 
debilitating effect, especially in anaemic and chlorotic individuals. 

As a rule, in normal menstruation, the admixture of the alkaline 
cervical mucus suffices to keep the menstrual discharge fluid and to 
prevent the formation of fibrin. On the other hand, the discharge 
of coagulated masses of blood will alone suffice to indicate an abnor- 
mally free and rapid flow of blood. 

The commonest type of menstruation is the more or less regular 
recurrence of the flow at intervals of twenty-eight days. Variations 
in this respect are, however, very frequent, and are dependent upon 
constitution, position in Hfe, and race. In general it may be said 
that in persons of strong constitution, the type of menstruation is 
much more regular, than in persons of a weakly, delicate constitu- 
tion ; that in vivacious, ardent natures the menses more readily 
anticipate the expected period of their return, whereas in those of 
a flaccid, lymphatic temperament a retardation is more likely to 
occur ; and that amongst women of the upper classes of society the 
type of menstruation is far more frequently irregular than amongst 
women of the working classes and amongst countrywomen. 
Whereas In many women the regularity of the menstrual rhythm 



134 The Sexual Life of Woman. 

is so precise that the flow recurs, not merely at regular intervals of 

twenty-eight days, but even time after time at exactly the same 

hour of the day — in other cases the interval between two periods 

may vary from twenty-one to thirty days. 

L. Mayer, w^io made observations on the type of menstruation 

in 5,671 women, and tabulated his results, distinguishes between 

constant and inconstant intervals. Among the constant intervals he 

enumerates those forms, both regular and irregular, which do not 

during the whole life of the individual undergo transformation into 

another form, but remain always of the same type. If, for instance, 

in any individual the interval is always either two or eight weeks, in 

that woman menstruation is indeed irregular, but constant in type. 

If, however, for some years she menstruates at intervals either of two 

or of eight weeks, and then proceeds to menstruate at intervals of 

four weeks, her menstruation is of the inconstant type. Mayer 

found among his 5,671 cases 

The constant type in 4,981 v/omen, that is in S7.83 per cent. 

The inconstant type in 690 women, that is in 12. 16 per cent. 



Of the cases in which the type w^as constant there were 69.68 
per cent, in which the regular period of four weeks obtained, and 
20.31 per cent, in which it was irregular in the sense above defined. 
Among these latter, the commonest periods were 15 to 21 days and 
22 to 2y days. The same author observed the irregular type of 
menstruation in nearly one-fourth of the women belonging to the 
well-to-do classes. 

According to the observations of Krieger on 481 cases in which 

the periods were regular, that is, in which the intervals in each case 

were equal in duration, the time from the commencement of one 

period to the commencement of the next was: 

28 days in , . . 70 . 80 per cent. 

30 days in 13.74 per cent. 

21 days in i .66 per cent. 

27 days in -. I.45 per cent. 

As regards the season in which menstruation first appears, Krieger 
states that in one-half of the women examined by him menstrua- 
tion had begun in the autumn season, in the month of September, 
October, or November. 

^ Szukits, as a result of an investigation into the menstrual func- 
tions of Austrian women, determined that among 1,013 women men- 
struation occurred : 

Every 28 to 30 days in 642 women. 

Kvery 8 to 21 days in 169 women. 

Every 35 to 56 days in 128 women. 

And was quite irregular in 74 women. 



The Sexual Epoch of the Menarche. 135 

In 500 Jewish women, Hirsch found that menstruation occurred : 

23 days after the beginning of the last menstruation in 19 

24 da^s after the beginning of the List menstruation in . 29 

25 days after the beginning of the last menstruation in 36 

26 days after the beginning of the last menstruation in 56 

27 days after the beginning of the last menstruation in 62 

28 days after the beginning of the last menstruation in Jz 

27s 



and in the remaining cases at other intervals than those stated. He 
is, therefore, of opinion that in the majority of Jewish women the 
type of menstruation is shorter then twenty-nine days. 

According to Bricrre de Boismont, among 100 women menstrua- 
tion recurred : 

Every 4 weeks in 61 women. 

Every 3 weeks in 28 women. 

Every 2 weeks in i woman. 

And at various irregular periods in 10 women. 

Tilt found among 100 women that menstruation recurred : 

Every 4 weeks in 77 women. 

Every 3 weeks in 17 women. 

Every 2 weeks in i woman. 

Every 6 weeks in 5 women. 

Foster instituted inquiries regarding this matter in 56 heaUhy 
women. In 380 periods, 45 recurred after an interval of 28 days, 
225 after a shorter interval than this, no after a longer interval. 
The duration of the flow varied from i to 14 days; most commonly 
it lasted from 3 to 5 days. 

A peculiar change in the type of menstruation sometimes mani- 
fests itself in this way, that in women in whom the regular four- 
weekly type of menstruation has prevailed, exactly in the middle 
of this four-weekly period the menstrual molimina, with or without 
menstrual discharge, make their appearance ;■ the patient suffers 
from pain in the low^er belly, sacrache, sensation of weight, and 
bearing-down pains. Coiirty, Dubois, and Pajot Ncgrier have de- 
scribed such cases of molimen vitcrin intermenstruel, which Tilt 
denotes by the term remittent menstruation. 

From the earliest tim.es the process of menstruation has attracted 
the attention of natural philosophers, and has led them to formulate 
hypotheses and to institute investigations, especially in order to 
ascertain whether the connection between ovulation and menstrua- 
tion is one of temporal succession merely, or whether the relation 
is a causal one. 

From Hippocrates and Galen downwards until well beyond the 
middle ages, the view of the father of medicine was generally ac- 



136 The Sexual Life of Woman. 

cepted, that menstruation is a purificatory process by means of which 
materials harmful to the organism are eliminated from the body — 
a view which finds expression also in the religious and legal ordi- 
nances of all times. 

A new epoch of scientific research into the nature of menstruation 
began with de Graaf's discovery of the ovarian follicles (1672). 
This discovery did not, indeed, bring ovulation and menstruation 
into immediate relationship, but it certainly paved the way for the 
opinion expressed by Sintcmma, a countryman of de Graaf, that the 
ova, even in virgins, leave the ovary spontaneously, and by their 
contact with the capillary terminations of the blood-vessels give 
rise to the menstrual bleeding (1728). 

As a result of anatomical investigations, Ncgricr, in 1840, was 
the first to establish the thesis that in women suffering from con- 
genital absence of the ovaries, menstruation never occurs ; that after 
the loss of the ovaries, menstruation always ceases ; that during 
pregnancy and lactation and during the climacteric period, ovulation 
ceases; and that a relation of temporal succession obtains between 
ovulation and menstruation. This close relation between the two 
processes was maintained also by Gendrm at about the same date. 
Later, Gird':vood, by post-mortem research, proved that the number 
of scars in the ovary coincides with the number of previous men- 
struations. 

Brierre de Boismont, in his exhaustive work on Menstruation, 
lays stress on the view that the periodically recurring ovulation 
furnishes the impulse for the menstrual f^ow. First among German 
mvestigators, Bischoff upheld the opinion that maturation and dis- 
charge of ova are spontaneous processes occurring independently 
of sexual intercourse, and compared heat or rut in other animals 
to menstruation in women — a view shared by Ponchet and Coste. 
Ovulation occurs simultaneously with the menstrual flow, and the 
follicles burst toward the end of menstruation. 

PHiiger, in his important work on the significance and cause of 
menstruation, has demonstrated the causal connection between men- 
struation and ovulation. The bleeding and the discharge of the 
ova are according to him joint effects of a common cause. It is 
not the bursting of the follicle, but the ripening of the follicle, that 
gives rise to the menstrual congestion. The pressure of the growing 
follicle on the surrounding ovarian tissue gives rise to a continued 
stimulation of the ovarian nerves; the summation of these stimuli, 
which after the lapse of a certain time attain always a certain de- 
gree of intensity, results in a reflex from the spinal cord taking the 
form of great congestion of the genital organs ; this congestion leads, 
on the one hand, to haemorrhage from the uterine mucous membrane, 



I 



Tpie Sexual Epoch of the Menarciie. 137 

and, on the other hand, and as a rule simultaneously, to the burst- 
ing- of the ovarian follicle. The swelling];- and ^-ranulation of the 
titerine mucous membrane at every menstrual period signifies noth- 
ing else than the commencement of the formation of the decidua. 

Nligele already mentioned the view, that inasmuch as immediately 
after the first appearance of menstruation a woman has become 
capable of reproducing the species, each process of menstruation 
must be regarded as a renewal of the exhausted faculty for con- 
ception. 

Pfliigers teaching has been opposed by Sigismimd, who, whilst 
admitting the periodicity of ovulation and menstruation, yet re- 
gards the two processes, in the uterus the formation of the men- 
strual decidua, in the ovary the rupture of the graafian follicle, as 
independent of one another, even though they occur simultaneously. 
Should fertilization occur, the ovum implants itself in the prepared 
soil ; should fertilization fail to occur, the menstrual hcemorrhage 
ensues. Thus, the occurrence of menstruation indicates that fertili- 
zation of the ovum has failed to occur. On this theory, then, the 
ovum that is fertilized belongs to the first period missed, whereas 
Pfluger assumes that when pregnancy occurs, it is always the ovum 
belonging to the time of the previous menstruation — the last 
actual menstrual discharge — that is fertilized. 

Lbwenhardt, in his work on the Diagnosis and Duration of Preg- 
nancy, advances the same views as Sigismnnd. The fertilized ovum, 
in his opinion also, is that of the first period missed ; and since at 
the time at which he believes fertilization to occur the ovum is 
certainly still in the ovary, fertilization, on this theory, must always 
take place in the ovary itself, and the fertilized ovum cannot begin 
its intra-uterine life till a month has elapsed after fertilization. 
Reichert, Kiindrat, Engehnann, and Williams, basing their views 
on anatomical data, are of opinion that ovulation recurs periodically, 
and that the extrusion of the ovum occurs not before but- after the 
commencement of menstruation. 

According to Hcnsen, the observed facts support the view that 
the follicles burst as a rule toward the end of menstruation ; antici- 
pation or postponement of the opening of the follicle (conception 
before or after menstruation) would, however, appear not to be 
impossible. 

Leopold, who assumes that menstruation may occur without ovu- 
lation and ovulation without menstruation, maintains on anatomical 
grounds that the rupture of the graafian follicle occurs chiefly dur- 
ing menstruation, under the influence of the swelling due to 
menstrual congestion. Menstruation with ovulation he believes to 
be a common occurrence, menstruation without ovulation, an un- 



138 The Sexual Life of Woman. 

usual occurence. Further, it is certain that, at the time when the 
periodic bleeding is due, ovulation may occur, even though the 
mens-trual discharge fails to make its appearance (ovulation without 
menstruation). 

Chazan and Glavcke also adhere to the generally accepted view \ 

that ovulation is a periodic process, usually but not necessarily 
synchronous with menstruation. 

Strassman bases on clinical facts and on experiments the follow- 
ine view of the connection between ovulation and menstruation. 
The principal processes in the organism of the sexually mature 
woman run their course in a periodic rhythm resembling an undula- 
tory movement, the acme of which occurs in the antemenstrual - 

period with the aim of preparing for the development of an in- | 

fantile organism. Whilst an ovum is maturing in the ovary, in the 5 

uterus, in dependence upon this maturation, the antemenstrual 
mucous membrane, fitted for the reception and nutrition of the 
fertilized ovum, is also undergoing development. At the acme of 
the undulatory movement, the graafian follicle ruptures and the 
ovum is liberated, to undergo fertilization in the infundibulum of 
the Fallopian tube. If fertilization fails to occur, or if for any 
reason the graafian follicle fails to rupture, then, in consecjuence of 
and at the time of the highest intra-ovarian tension, at the time, when 
the rupture of the follicle usually occurs, the extrusion of blood from 
the capillaries of the uterine mucous membrane begins. The inter- 
mediation between the ovary and the uterus is probably effected by 
means of the sympathetic ganglion in the ovary discovered by 
Elizabeth Wintcrhaltcr, and effected in this manner, that the stimu- 
lus proceeding from the ripening follicle passes along the nerve- 
fibrils surrounding the follicle to the processes of the nerve cells 
of this sympathetic ganglion, accumulating in these cells till a cer- 
tain degree of intensity has been reached, and then, by means of 
other processes and of the- vasomotor nerves, influencing the vessels 
of the uterus. 

Gcbhard likewise believes menstruation to be dependent on the 
ovarian function, and thinks that it is probably brought about in a 
reflex manner by the gradual growth of the ovarian follicles. It 
appears that most commonly at the time of menstruation a graafian 
follicle ripe to bursting is to be found in the ovary, but to this rule 
there are many exceptions. We cannot exclude the possibility, that 
the ovum from a follicle that burst after the commencement of the 
menstrual flow may be fertilized ; but more commonly the ovum 
that is fertilizecl is that of the first period missed. The sudden 
decline in vital energy that occurs just before menstruation is ex- 
plained by Gehhard as a kind of atavism, dependent on the fact 



The Sexual Epoch of the Menarche. 139 

that many of the lower animals, butterflies, for instance, succumb 
as soon as they have fulfilled their duty of reproducing the species. 

A number of modern investigators, however, deny that any re- 
lation, tem])oral or causal, exists between ovulation and menstrua- 
tion, and affirm that the latter process is quite independent of the 
former. 

Thus, CJiristophcr Martin maintains that a special menstrual 
centre exists in the lumbar portion of the spinal cord, the impulses 
from which proceed to the uterus by way of the splanchnic plexus, 
the ovarian plexus, or perhaps by both. Similar views are held by 
Lazi'son Taif, Collins, and Johnstone, who severally maintain that 
the ovaries are no more concerned in the production of menstrua- 
tion than any other organ of the body — the liver, for instance. 
They direct attention to the periodicity that occurs in the functional 
activity of various other organs, in respiratory and cardiac activity, 
for instance, both of which undergo rhythmical changes as a re- 
sult of nervous influences. The cessation of menstruation after 
oophorectomy they attribute, not to the cessation of ovulation, but 
to the division of the nerves which run across the broad ligaments 
of the uterus and_ upon which menstruation depends. Heat and 
rut in animals have a different significance from menstruation. The 
latter process is induced by civilization and by the adoption of the 
upright posture. 

But, taking all this into consideration, we must hold fast to the 
fundamental principles, that ovulation occurs at that period of life, 
and only at that period, during which menstruation proceeds regu- 
larly; that ovulation begins when externally and in the whole de- 
velopment of the girl the signs of sexual maturity manifest them- 
selves ; and that ovulation ceases at the climacteric, when menstrua- 
tion also ceases. We must regard as rare exceptions to this rule 
cases in which ovulation begins before the menarche and persists 
after the menopause. 

A physiological interruption of menstruation occurs during preg- 
nancy and lactation ; it seems improbable, however, that during this 
interval ovulation also is in abeyance. It is established by anatomi- 
cal investigations that ovulation and menstruation commonly occur 
in association ; but that menstruation sometimes, though rarely, oc- 
curs in the absence of ovulation ; and, finally, that intermenstrual 
ovulation is also a rare occurrence. In the majority of cases, either 
just before or just after the commencement of the menstrual flow, 
rupture of a graafian follicle occurs. After complete oophorectomy, 
menstruation ceases ; it is only when functionally active portions 
of ovarian tissue have been left behind, that menstruation continues 
to occur. In the absence of the ovaries, the menstrual function is 



I40 • The Sexual Life of Woman. 

in abeyance; hence, for the performance of that function, the 
presence of ripening ovarian follicles and of other follicles capable 
of ripening later, is an indispensable requisite. 

A certain analogy between heat and rut in animals and menstrua- 
tion in women may, according to the investigations of Bischoff, 
Hcgar, Strassniann, and others, certainly be maintained. Heat 
or rut is a process occurring in mammals, dependent on the repro- 
ductive glands, characterized by an increase in sexual and general 
excitability, wnth congestion of the pudendum and the vagina, 
swelling of the sebaceous glands of the external genitals, and in- 
creased secretion ; from the vulval cleft there flows a peculiar, strong- 
smelling mucus, often tinted red from admixture with blood ; there 
is frequent micturition, the uterine glands are swollen, the Fallopian 
tubes are also swollen, and are soft and erected. A well-developed 
menstrual bleeding, analogous to that which occurs in the human 
species, occurs, among the lower animals, only in apes. Matura- 
tion of ova precedes the period of heat, and rupture of the graafian 
follicle occurs during that period. 

Heat or rut occurs in animals at certain seasons of the year, 
which may, according to the species and the mode of life of the 
animal concerned, be in spring, summer, autumn, or winter. The 
season of heat or rut hac further several periods of heat, each 
lasting several days, and among domesticated animals, mares, cows, 
and bitches, succeeding one another at intervals of three or four 
weeks ; in wild animals, rut occurs once only in the year. In ani- 
mals, sexual intercourse takes place during the time of the menstrual 
discharge, and during this time also the capacity for conception is 
increased ; in the absence of heat, the genital organs are in a more 
quiescent condition. In this connection, the experiments on ani- 
mals made by Strassmann, with a view to determining the influ- 
ence upon the uterus of rise of pressure in the ovary, are of great 
interest; these experiments showed that a rise of intra-ovarian 
pressure, produced by the injection of fluid into the parenchyma 
of the ovary, led to changes in the endometrium and the external 
genital organs corresponding to (those occurring in an animal on 
heat. 

In the human species, however, in contradistinction to what oc- 
curs in the lower animals, there is a certain disinclination, on the 
part of the male at any rate, to sexual intercourse during menstrua- 
tion. The human female moreover, notwithstanding the periodicity 
of her sexual life, is at all times capable of conception ; this capabil- 
ity is not confined to any particular part of the intermenstrual period, 
for conception may occur at any time during that period, and has 
even been known to result from intercourse during menstruation. 



J 



The Sexual Epoch of the Menarciie. 141 

This peculiar characteristic of the human reproductive capacity has 
been regarded as compensatory, furnished by nature in her continual 
endeavour for the perpetuation of the species, to counteract the re- 
stricting influences imposed by civilization on the normal process 
of reproduction. 

Credible observations even exist, indicating that among many 
primitive peoples, in whom at the time of puberty no social laws 
hinder the limitless exercise of the reproductive functions, this 
capacity on the part of woman to conceive at any time has no 
existence, and that the reproductive capacity of such human beings 
is, like that of the lower animals, confined to a certain season of 
the year. Thus, G. Schlesingcr reports of the Ainus of the island 
of Yezo, "A friend of mine in Sapporo believes himself to have 
observed that the Ainus have a certain definite rutting period, and 
that in them, as in many of the lower animals, the process of re- 
producing the species occurs only at a certain season of the year." 
An identical statement is current concerning the Indians of West- 
ern America. 

The mucous membrane of the uterus undergoes during menstrua- 
tion important changes, and a question much disputed is, whether 
in the course of menstruation the whole of the uterine mucous 
membrane is removed, or a part only, whether it is shed in its entire 
thickness, or is at least deprived of its epithelium. According to 
the observations made by Leopold on dead bodies, the mucous mem- 
brane of the uterus becomes swollen shortly before the commence- 
ment of the menstrual discharge, until, partly in consequence of 
cellular proliferation, partly in" consequence of oedematous infiltra- 
tion, and partly in consequence of enlargement of the lymph-spaces, 
it attains a thickness of 6 to 7 millimetres (J of an inch). The 
superficial capillaries are notably enlarged, and an efifusion of blood- 
elements continues for several days, without the occurrence of any 
fatty degeneration in the tissues. The epithelium and the most 
superficial cell-layers of the mucous membrane are, however, under- 
mined and shed. No complete destruction of the mucous membrane 
occurs, however, and fatty degeneration forms no part of the men- 
strual process as such. 

Mbricke, who examined portions of the uterine mucous mem- 
brane removed with the curette during menstruation from living 
women, found the superficial layers of the mucous membrane to 
be intact, and he regards the shedding of the epithelium described 
by other authorities as cadaveric phenomenon. Sinety, who also 
found the uterine mucous membrane intact during menstruation, 
adheres to the same view. 

Von Kahlden concludes, as a result of investigations made post- 



142 The Sexual Life of Woman. 

mortem, that during menstruation the greater part of the mucous 
membrane, not the superficial epitheUum only, but the stroma itself 
down to its deepest layers, is shed. According to von Tassenbroek 
and Mendes le Leon, however, the most superficial layers only are 
shed during menstruation. 

According to Wcstphalen, whose investigations were made, partly 
on masses removed by the curette, and partly on freshly extirpated 
uteri, a sanguineo-serous infiltration of the mucous membrane begins 
about ten days before menstruation. Great vascular dilatation oc- 
curs only just before menstruation. The uterine glands undergo 
enlargement, and during and immediately after the flow, numerous 
shed epithelium cells occupy the lumen of the glands. For the rest, 
however, in the interior of the uterus shortly after menstruation, 
we find an almost continuous epithelial covering. Some days after 
menstruation, the proper regeneration of the mucous membrane 
occurs. 

Mandl, who examined totally extirpated uteri, asserts that during 
menstruation the epithelial covering of the mucous membrane is 
never completely lost, but that just as little does it remain com- 
pletely intact. The regeneration of the lost areas of epithelium pro- 
ceeds even during menstruation. 

The researches of Kimdrat and Engclmann on uteri obtained post- 
mortem led these authors to describe as follows the anatomical 
changes that occur in the uterine mucous membrane at the time 
of the catamenial haemorrhage. In the premenstrual epoch a round- 
cell infiltration occurs in the interglandular tissue, the lumina of 
the uterine glands become enlarged, and the blood-vessels dilated ; 
subsequently, fatty degeneration of the superficial epithelium and 
the epithelium of the glands occurs, leading to laceration of the 
vessels and destruction of the affected area of tissue; after the 
cessation of the bleeding, regeneration of the mucous membrane 
occurs. 

According to Gehhard, three stages may be distinguished. The 
first stage is that of premenstrual congestion, or stage of engorge- 
ment : the capillary vessels of the mucous membrane become dis- 
tended with blood, the membrane itself becomes softened, the meshes 
of the stroma become enlarged and are filled w^ith the morphological 
constituents of the blood, subepithelial haematomata are formed. 
The second stage is that in which the blood finds its way to the ex- 
terior : owing to the turgescence of the mucous membrane the blood 
is able to exude between the cells of the intact epithelium ; further, 
tne epithelium becomes lacerated in various places where haemato- 
mata have formed beneath it, allowing the blood to exude through 
the apertures thus formed; shreds of epithelium may be washed 



The Sexual Erucii of the Menarche. 143 

away by the blood-stream. The third stage is that of post-menstrual 
regeneration : the swelhng of the mucous membrane disappears, the 
detached areas of epitheUum readhere, the blood effused into the 
interstices of the tissue is reabsorbed, or is in part transformed 
into yellowish-brown flakes of pigment. According to Gchhard's 
view, during menstruation destruction of the uterine mucous mem- 
brane does not occur. At no time is the membrane denuded of 
large areas of epithelium ; a very active process of regeneration oc- 
curs, however, in the superficial epithelium and the epithelium of 
the glands, which fits the uterine mucosa for the reception of the 
fertilized ovum by keeping it in an ever-young and renovated con- 
dition. The mucous membrane of the cervix takes part in men- 
struation at most by an increased secretion of mucus. 

According to Landau and Rhcinstein, the mucous membrane of 
the Fallopian tubes contributes to the menstrual haemorrhage ; Fritsch 
and Strassma)in, however, are opposed to the view that there is a 
regular tubal menstruation. 

Pathology of Menstruation. 

Only a small proportion of girls and women are entirely free, 
at the time of menstruation, from all change both in their bodily 
and in their mental state. A very great majority complain of feel- 
ing more or less unwell, of sensations of weight and pressure in 
the hypogastric region, of a general feeling of languor, loss of 
appetite, headache, irritability, sometimes of an inclination to weep ; 
in women, a change in the intensity of the sexual impulse mani- 
fests itself, an increase in some, a decrease in others. 

Not infrequently during menstruation, the cardiac activity is 
notably afifected, so that, regularly at the commencement of each 
period, disagreeable sensations occur in the cardiac region, with 
increased frequency of the heart's action ; or complaint is made 
of coldness and dampness of the hands, of icy coldness of the feet, 
which feel as if " dead " to half way up the calves, and cannot be 
warmed — phenomena which, in the cases under consideration, 
occur only at the time of menstruation, and are to be regarded as 
manifestations of the menstrual reflex. 

I examined 140 women in whom the heart and the vascular sys- 
tem were normal, during a number of successive menstrual periods, 
and in 12 of these women, either at the commencement or during 
the course of the flow, I observed an increase in the frequency of 
the heart to the extent of from 12 to 28 beats per minute ; in young 
girls, a systolic murmur was sometimes audible during menstrua- 
tion, but was inaudible in the intermenstrual intervals. In all these 
persons, menstruation was regular ; there was no abnormality in re- 



144 ^^^ Sexual Life of Woman. 

spect either of the duration or of the quantity of the flow. The 
heart in these cases was, therefore, affected by the normal menstrual 
process. 

A remarkable illustration of the alleged influence of menstrual dis- 
turbances on the pulse is reported by de Villenciive, who states 
that Chinese physicians, being accustomed to feel the pulse in 
many different arteries, are able, by a comparison of the characters 
of the pulse in the two arms, to determine whether a woman men- 
struates regularly or irregularly. 

Many women and girls show well-marked menstrual molimina, 
uneasy or actually painful local sensations in the genital organs, 
sacrache, painful uterine contractions, and disturbances of the 
general constitutional state, which are dependent upon menstrual 
congestion of the pelvic organs, upon local engorgement ; sometimes 
such symptoms are the result of uterine contractions caused by 
hyperaemia of the uterus, and these cases often take a paroxysmal 
form. 

Important disturbances of the general constitutional state result 
from sudden suppression of the normal menstrual flow, such as 
may be the effect of a severe chill, of sudden mental impressions, 
even of errors in diet or the use of certain drugs, and may some- 
times follow artificial withdrawal of blood. 

In many women, a few days or it may be a few hours only be- 
fore every menstruation, changing manifestations of manifold dis- 
orders may recur. Among these may be mentioned, general ex- 
citement of the nervous system, notable alteration in the voice, 
strong inclination to sadness, tearfulness, erotic longings, great ir- 
ritability and sensitiveness of the sensory system, drowsiness, flush- 
ings of the face, giddiness, swooning. The appetite is impaired, 
the breath has a disagreeable smell, the digestion is disturbed, there 
is a tendency to diarrhoea ; the facial aspect may be altered, there 
are blue rings round the eyes, eruptions on the skin, tendency to 
sweating, palpitation and feeling of anxiety, and a sensation in the 
extremities as if they had been beaten. Local symptoms also occur : 
disturbances of the function of micturition, swelling of the breasts, 
pains and colics in the renal region, feeling of warmth in the genital 
organs, pruritus vulvae, sensation of weight in the uterus, and a 
strong impulse toward coition. The secretions may be pathological, 
sometimes there are profuse sweats, sometimes profuse mucous or 
bilious diarrhoea, whilst the urine may either be very abundant, 
almost colorless, and nearly free from saline matter, or thick and 
overladen with phosphates and urates. 

Schauta writes regarding the complex of menstrual phenomena 
which occur in normal menstruation : " In the process of men- 



The Sexual Epoch of the Menakche. ,145 

struation, blood and sanguineous mucus find their way through a 
mucous canal, the normal calibre of which is merely a capillary 
fissure. If the flow is slow, without the formation of coagula, and 
if the passage through the cervix is free, very gentle contractions 
of the uterine muscle sufifice on the whole, as the blood exudes into 
the cavity of the uterus, to expel it into the vagina. Without such 
contractions, menstruation is hardly conceivable. Physiologically, 
they are characterized by a bearing-down sensation, passing down 
toward the thighs, and by pains in the back. It is rarely, that no 
pain at all is experienced; there are some women, however, who 
afiirm that in their case menstruation begins quite unexpectedly, 
and without the slightest warning; but it does not follow that con- 
tractions of the uterus do not occur in these women also during 
menstruation. ^ * * The local disturbances which occur as an 
accompaniment even of physiological menstruation are, a sensa- 
tion of fulness and weight in the pelvis, and pains in the lower part 
of the back, and these probably all result from the uterine con- 
tractions. The general disturbances of a reflex nature consist of 
tenderness on pressure in the epigastrium, headaches, general sense 
of languor, irritability, and an inclination to shed tears. Among 
changes in the functions of remote organs may be mentioned, swell- 
ing of the breasts, of the vocal cords, and of the thyroid body, in- 
creased respiratory capacity shortly before menstruation followed 
by rapid decrease during the flow, tendency to diarrhoea, nausea, 
vomiting, flatulence, salivation, profuse secretion of the sebaceous 
glands of the vulva, increased secretion of sweat, tendency to the 
formation of acne pustules. The mental condition also exhibits 
as a rule a considerable change during menstruation, even in cases 
which cannot in any sense be regarded as pathological. In many 
instances, an apparently normal woman may during menstruation 
exhibit a mental state so abnormal that we are led to speak of it 
as a menstrual psychosis. Apart from this, however, it appears that 
during menstruation the mental life of woman never remains en- 
tirely unaffected. Finally, we must mention certain changes in the 
sense-organs which not infrequently accompany menstruation, such 
as herpes conjunctivae, exophthalmos, limitation of the visual field, 
and swelling of the nasal turbinate bodies." 

In the digestive organs, during the menstrual process, changes in 
the secretions of the glands, nausea, vomiting, and flatulence are not 
infrequently observed. In one-half of the women concerning whose 
state during menstruation Krieger made inquiries, he found, espe- 
cially just before and during the discharge, a tendency to diarrhoea, 
or at least to more copious and more frequent evacuations of the 
bowels than occurred at other times. On the surface of the tongue, 

10 



146 The Sexual Life of Woman. 

at the premenstrual epoch, a pronounced exfoliation of the epi- 
thelium may occur, so that in some instances the papillae are entirely 
exposed. 

Not infrequently hypersemia of the liver appears to be connected 
with the menstrual process; and by many observers, among whom 
Senator and Fleischniann may be mentioned, jaundice, slight or in- 
tense, has been seen to occur during menstruation. In a case of 
long-standing amenorrhoea, Duncan noted the appearance of a 
transient vicarious jaundice, apparently reflex in its origin. In some 
cases, jaundice precedes menstruation, and disappears as the flow 
becomes established. 

In the respiratory organs also, menstrual changes frequently oc- 
cur. According to von Ott, respiratory capacity attains a maximum 
shortly before menstruation, and diminishes rather rapidly during the 
flow ; the expiratory power is similarly affected. In the larynx, ac- 
cording to Bottermund, great swelling of the posterior wall occurs 
during menstruation, whereby the closure of the glottis is hindered, 
and a rapid onset of fatigue ensues in the muscles that perform this 
action when the woman sings or speaks ; the fulness of the voice 
is also diminished. More or less extensive swelling of the thyroid 
body^^ occurs during the menstrual period. According to Fliess, 
in most women, the inferior, sometimes the middle and the inferior 
nasal turbinate bodies are greatly swollen ; sometimes also the tuber- 
cula septi are swollen. It is said that the right half of the nose is 
more frequently and more intensely swollen than the left half. 
Epistaxis is sometimes observed at the menstrual periods. 

In the urinary organs, the influence of the menstrual period is 
manifested by a change in the urine. According to Schradcr, the 
elimination of urea is diminished shortly before menstruation ; ac- 
cording to Laval, the elimination of uric acid undergoes a sudden 
diminution on the second day of the flow, followed by an increase 
on the third day, subsequently rising above the normal level. This 
change is to be attributed, not to any excitation of the genital 
organs, but to the loss of blood. 

Hehra already drew attention to the connection between diseases 
of the skin and the physiological and pathological processes occur- 
ring in the female genital organs ; and emphasized the fact that for 
the cure of certain eruptions, local treatment of the disorder of the 
reproductive organs was requisite. He gave four examples of such 
eruptions: i, an acute attack of eczema, which disappeared only 
after the removal of a badly fitting pessary; 2, in a chlorotic girl, 
two large red spots on the cheeks disappeared when menstruation 
was established; 3, improvement of a skin-affection when a co- 

32 See note 26 to p. 107. 



Till': Sexual Epoch of the Menarciie. 147 

existing disorder of the genital organs received appropriate treat- 
ment, followed by recrudescence of the skin trouble when the genital 
disorder became more severe; 4, a case of obstinate seborrhoea, last- 
ing for many years, which disappeared only when the patient became 
pregnant, for the first time, seven years after her marriage. 

Similar cases have been recorded by subsequent observers, and 
numerous monographs have been published, on menstrual skin-erup- 
tions. Schrannn, for instance, reports the case of a woman in 
whom at each menstrual period tubercles and papules appeared on 
the backs of the hands and on the neck ; and the same author men- 
tions another case in which during menstruation red papules ar- 
ranged in rows appeared on the back. Wilhehn observed dark blue 
macules, the size of hazelnuts, which appeared on the thighs shortly 
before menstruation and disappeared when the flow was over. Of 
two cases of menstrual disorder of the skin reported by Stiller^ in 
one, an itching eruption appeared on the upper and the lower ex- 
tremities ; in the other, small red papules appeared on the dorsum of 
the hands and feet. Other cases of menstrual skin-eruptions were 
published by Joseph, PaiiU, Janovsky, and Schwing. Sometimes at 
the menstrual periods severe pruritus vulvae occurs, due, no doubt, 
to the temporary increase in the secretion of the menstrual passages, 
and to the more active influence exercised by this secretion on the 
vulva. 

In two cases in which the menstrual flow was in abeyance, Heitz- 
mann observed affections of the skin. In one of these, a young 
woman aged twenty who had not yet begun to menstruate, there 
appeared every four weeks isolated papules surrounded by a bright 
red areola, itching so violently that scratching resulted. In the 
other, macules the size of a lentil, of a light red or dark red color, 
appeared, and lasted two or three days ; when menstruation became 
regular, fresh crops no longer formed. 

Schauta, in a case of chronic oophoritis, observed the regular re- 
currence of urticaria at each successive menstrual period. The 
suffering being very great, the rest at night being greatly disturbed 
during the periods of eruption, and the patient's general health de- 
clining more and more in consequence, extirpation of the ovaries 
was undertaken, and the operation resulted in a complete cure. 
Schauta further observed that in cases of obstinate skin-affections 
of unknown causation occurring in persons of the female sex, some 
disorder of the genital organs was nearly always present ; more- 
over, in many of these cases, as soon as the genital disorder was 
cured by appropriate measures, the skin-affection disappeared spon- 
taneously and without any further treatment. He had been able to 
collect twenty-six cases of this nature, in which an indubitable 



148 The Sexual Life of Woman. 

connection obtained between disease of the skin and disease of 
the reproductive system. The forms of affection of the genital 
organs chiefly noticed in this association were, retroflexion and 
retroversion of the uterus, erosion and ectropium or eversion of 
the cervix (chronic cervical catarrh), chronic endometritis, 
oophoritis, and salpingitis, and finally with especial frequency 
uterine myomata; the skin-diseases observed were, acne, eczema, 
disorders of pigmentation, psoriasis, lichen, and urticaria. 

During menstruation we observe not infrequently a number of 
changes in the skin, such as hyperidrosis, acne, seborrhoea, erythema, 
and the form of dermatitis known as erysipelas of menstruation; 
sometimes also effusion of blood into the skin as a form of vicarious 
menstruation, and peculiar forms of cutaneous oedema. In many 
women during menstruation the secretion of sweat is markedly in- 
creased every month ; in exceptional cases, menstruation is vicari- 
ously replaced by profuse sweating. In association with menstrua- 
tion we frequently observe excessive secretion of the sebaceous 
glands, especially of those of the hairy scalp. Often urticaria mani- 
fests itself as a recurrent menstrual eruption. In cases of scanty 
menstruation and of amenorrhoea, discoloration and excessive pig- 
mentation of the skin may occur, sometimes taking the form (as 
also in pregnancy) of chloasmia uterinum. Sometimes also in these 
cases the formation of dark rings round the eyes, already seen in 
slighter degree as an accompaniment of normal menstruation, is 
excessive. 

In the organ of vision, changes associated with menstruation have 
been recorded by various observers. Hordeolum menstruale (men- 
strual stye) may recur month after month at the menstrual periods 
as an exacerbation of a chronic conjunctivitis. Herpes of the ocular 
or palpebral conjunctive and eczematous affections may be con- 
nected with menstruation ; also exophthalmos may occur during 
menstruation in association with swelling of the thyroid body and 
palpitation of the heart (H. Cohn) ; again, as an accompaniment of 
normal menstruation, severe papillitis with retinal haemorrhages 
may occur (Heber). According to the investigations of Finkelstein, 
a limitation of the field of vision may be noticed during menstrua- 
tion, beginning on the first, second, or third day of the flow, at- 
taining its greatest intensity on the third or fourth day of the flow, 
and gradually disappearing during the three or four days next 
ensuing. 

The organ of hearing is stated by Hang to be affected during 
menstruation, inasmuch as congestive redness and swelling of the 
external ear, of the external auditory meatas, and of the skin over the 
mastoid process, sometimes occurs; occasionally also, periodic neu- 
ralgia manifests itself at the menstrual* periods. 



The Sexual Epoch of the Menarche. 149 

In the circulatory organs, as already mentioned, normal menstrua- 
tion quite frequently manifests its influence by the production of 
disorders of greater or less severity, referable to the stimulus of 
ovulation. In 8.5 per cent, of the women of whom I have made 
inquiries with regard to this matter, palpitation of the heart of 
variable severity occurred during menstruation, and was most fre- 
quent and most severe on the first and second days of the flow. 
Associated with the palpitation in some cases were, vasomotor dis- 
turbances, transient feelings of heat, a sense of congestion in the 
head, and profuse perspiration without apparent cause. The day 
before the commencement of the flow, the blood-pressure rises con- 
siderably, but falls rapidly during the flow. This menstrual rise 
in blood-pressure is accompanied /by a rise in temperature and an 
increase in metabolic activity. The influence of menstruation on 
the heart is most powerfully displayed in cases in which for some 
reason a disturbance occurs of the normal appearance or normal 
course of menstruation. 

Disorders of menstruation likely to give rise to cardiac disorders 
are, amenorrhoea, menorrhagia, and dysmenorrhoea. 

Amenorrhoea is especially apt to induce cardiac disorder in cases 
in which, in consequence of some sudden impression, such as a 
fright or a severe chill, menstruation, which began at puberty in 
normal fashion and subsequently recurred with perfect regularity, 
has. undergone sudden and complete suppression ; also in cases in 
which severe anaemia or obesity has rapidly led to the onset of 
amenorrhoea. In such cases, attacks of tachycardia sometimes oc- 
cur, it may be at irregular intervals, or it may be exhibiting a 
menstrual rhythm, the cardiac affection manifesting itself always 
a few days before the date at which menstruation ought to begin. 
In these cases, also, systolic murmurs are not infrequently audible. 

In cases in which menstruation is very painful, the dysmenorrhoea 
may give rise to attacks of colic or to convulsive seizures, whether 
the dysmenorrhoea is itself due to inadequacy or to complete sup- 
pression of the flow, to metritis, to anteflexion, to new growths in 
the uterus, or, finally, to diseases of the ovaries or to pathological 
disorders of ovulation. Among the various disorders associated 
with dysmenorrhoea, heart troubles are not infrequent, most often 
taking the form of reflex neuroses, evoked by the stimulus of the 
pain in the genital organs ; but it has also been asserted that an 
acute dilatation of the heart occurs in these attacks. 

Very threatening cardiac symptoms as an accompaniment of 
severe dysmenorrhoea have been seen by me especially in the case 
of two women, one of whom was in the thirties and the other in 
the forties. The attacks took the form of increased frequency of 



150 The Sexual Life of Woman. 

the heart's action, with severe cardiac dyspnoea on trifling exertion, 
sense of suffocation, and intense anxiety. This severe cardiac and 
respiratory distress was a sequel to the appearance of severe dys- 
menorrhciea, and was relieved as soon as the course of menstrua- 
tion became regular and painless; but the cardiac trouble recurred 
in association with each successive attack of dysmenorrhcea. In 
one of these two women, the dysmenorrhcea was the result of ex- 
treme anteflexion of the uterus; in the other woman, the cause of 
the dysmenorrhcea was not apparent. I was unable to decide with 
certainty whether in these cases an acute dilatation of the heart 
occurred. French authorities, who describe similar cardiac trouble 
resulting from diseases of the liver and the stomach by the name 
of asystolic gastrohcpatique (Potain), give the following explana- 
tion of its mode of occurrence. The intra-abdominal plexus of the 
sympathetic is stimulated, this stimulus is reflected to the lungs, in 
which organs it gives rise to vaso-constriction, resulting in increased 
tension in the lesser circulation ; in consequence of this the right 
heart has difficulty in emptying itself, when weak it undergoes dilata- 
tion, and a moderate or extreme tricuspid insufficiency ensues. We 
have to do, then, in these cases, with reflex symptoms, with a reflex 
arc, the starting point of which is the sensory nerve-terminals in the 
abdomen, the afferent tract of which is formed by the sympathetic 
and pneumogastric nerves, and the efferent tract of which passes 
along the pulmonary sympathetic nerves. 

In other cases of dysmenorrhcea we observed signs of cardiac 
weakness ; the pulse was small, very frequent, and barely perceptible, 
the face became suddenly pale, the hands and feet were cold ; com- 
plete syncope sometimes occurred. 

Menorrhagia sometimes leads to cardiac symptoms, owing to the 
severity of the anaemia which follows extensive and long-continued 
loss of blood ; sometimes, however, the heart troubles associated 
with menorrhagia are reflex manifestations, dependent on the dis- 
ease which has also caused the menorrhagia, endometritis, it may 
be, new growths, luksemia, or scurvy. Sometimes here also we 
observe transient attacks of acute dilatation of the heart. 

Nervous disturbances during menstruation, which are so fre- 
quent that Emmet regards it as abnormal for a menstruating 
woman to be entirely free from pain and from uneasy sensations, 
are divided by Windscheid into two classes, general nervous dis- 
orders, and local nervous manifestations. Among general disorders, 
the commonest is a general bodily incapacity; in women, who in 
other respects are quite healthy, during menstruation everything 
will be too great an exertion, and fatigue speedily ensues' on 
the performance of occupations which at other times are under- 



The Sexual Epoch of the Menarciie. 151 

taken without the shghtcst difficuhy. Another comnion nervous 
disorder is an uneasy sensation in the head, it may be a feehng- of 
weight or pressure, sometimes described as a feehng as if an iron 
band were compressing the forehead. Shght mental irritation is 
commonly present also, the woman is capricious, her mental equilib- 
rium is disturbed. Very common also are vasomotor disturbances, 
transient feelings of heat, a sense of congestion in the head, or an 
outbreak of perspiration. Among local nervous disturbances, Wind- 
schcid enumerates, pains in the back (occasionally and erroneously 
described as spinal irritation), sacrache, pains in the lower extremi- 
ties, which by preference generally take the course of the great 
sciatic nerves. Pains ki the abdomen also frequently accompany 
menstruation ; these may be diffused over the whole abdomen, or 
may predominate in the two hypochondriac regions. Disorders of 
the sense-organs sometimes occurring during menstruation are, the 
flickering of objects before the eyes, photophobia, and tinnitus 
aurium. The heart may also be afTected with palpitation in as- 
sociation with these nervous disturbances ; the stomach may exhibit 
associated disorder in the form of cardialgia, or more frequently in 
the form of vomiting, this latter being very frequent at the outset of 
the flow. Less common is profuse diarrhoea, pain in the anus, or 
spasm of the sphincter ani. 

The intensity of such nervous manifestations during menstrua- 
tion is dependent upon the woman's general state of nutrition, upon 
the degree of instability of her nervous system, and upon her occu- 
pation. Robust and powerful women, regularly employed in the 
open air, such as the wives and daughters of farmers and agricul- 
tural laborers, are much less affected by the nerve-weakening in- 
fluences of menstruation than the sedentary and anaemic town-dwell- 
ing women, whether these latter belong to the higher classes of 
society and are addicted to nerve-straining enjoyments, or to the 
class of shop-girls, seamstresses, and factory-women, whose employ- 
ment is apt to lead to nervous exhaustion. 

As regards the forms of neuralgia most apt to accompany men- 
struation, Windscheid mentions trigeminal neuralgia as the com- 
monest, especially aiTecting the first division of the nerve, and pro- 
ducing localized pains which are to be distinguished from the head- 
aches already mentioned. They are characterized by their intensity 
and their persistence in spite of anti-neuralgic treatment, and by their 
spontaneous disappearance as soon as menstruation is over. Ac- 
cording to the same author, the relations between hemicrania and 
the process of menstruation are indisputable ; at the very least it 
must be admitted that menstruation predisposes to an attack of 
hemicrania. I 



1^2 The Sexual Life of Woman. 

Cases also occur in which convulsions almost invariably accom- 
pany menstruation, convulsions which are to be regarded as symp- 
toms of hysteria. 

The extraordinarily powerful influence which the menstrual 
stimulus exercises on the mind is shown by the frequency with 
which the slighter psychopathic states occur as an accompaniment 
even of normal menstruation, these manifestations being sometimes 
melancholic in type, sometimes maniacal or erotic, and, when of 
long duration, leading ultimately to pronounced mental disorder. 
This influence of the menstrual stimulus is yet more potent in cases 
in which important changes in the course of menstruation have 
occurred, in cases, for instance, of suppressed, painful, or irregular 
menstruation. In this connection, however, in order to avoid a 
confusion of cause and effect, we must carefully bear in mind, that 
it is a much commoner causal sequence for psychical disorders to 
disturb the normal course of menstruation, than for disorders of 
menstruation to evoke psychical disorders. This view has only quite 
recently become established, and for this reason it is necessary to 
regard such data when obtained from the writings of the older 
gynecologists in a somewhat critical spirit. 

By the modern alienist, the influence of the menstrual reflex on 
mental affections is recognized only in cases in which a proper valua- 
tion of the predisposing causes has been made, in such cases as the 
following: First, we have to recognize the modifying influence 
exercised by the menstrual stimulus on established psychoses, inas- 
much as these latter not un frequently undergo cure when previously 
irregular menstruation has become regular, and, moreover, the re- 
currence or the first appearance of menstruation has often a power- 
ful influence on the course of some established mental disorder. 
In some cases this influence is a strikingly favorable one on psy- 
choses that have developed before the commencement of menstrua- 
tion, or during the suppression of that function ; it may be, however, 
and, indeed, more frequently is, an unfavorable influence, inasmuch 
as such a psychosis, on the first appearance or on the reappearance of 
menstruation, may assume a menstrual type, the attacks becoming 
more frequent or more violent with the successive recurrence of 
each menstrual or premenstrual period. This is the history of the 
typical menstrual psychosis. 

Again, certain processes of the sexual life, disorders of menstrua- 
tion, diseases of the genital organs, operations on these organs, and 
the processes of the climacteric, influence the origin and the character 
of mental disorder, generally giving rise to chronic affective in- 
sanity (insanity of the emotions and feelings) or to paranoia 
(chronic delusional ins^ity, insanity of the intellect). The men- 



The Sexual Epoch of the Menarche. 153 

strual stimulus must in these cases be regarded as a psychopathically 
exciting physical cause. 

Further, physical disturbances may equally affect the menstrual 
function and the functions of the mind, rendering the exact causal 
sequence in such cases a difficult one to determine ; and, conversely, 
the circumstances that restore the normal working of the mind may 
also regulate the menstrual function. 

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, an espe- 
cial temporal predisposition must exist, connected with the great 
developmental epoch of the sexual life. 

There is, for instance, a group of transitory states occurring dur- 
ing menstruation, and taking the form of disorders of the intelli- 
gence or of explosive emotional states ; such may be witnessed, not 
in tho'Se suffering from psychopathic predisposition, but in quite 
healthy individuals. 

The successive menstruations as they recur regularly throughout 
the course of the sexual Hfe may, just like the first menstruation, 
though with diminished intensity, give rise to manifestations of 
nervous and mental disorders. In many women who are in other 
respects healthy, we see during menstruation, hemicrania, nervous 
irritability, ill-temper, low-spiritedness, and even hysterical and 
epileptic attacks ; these occur chiefly on the first and second days of 
the flow, and disappear altogether toward the end of the period. 
These manifestations are more severe in individuals weakened by 
profuse losses of blood or by chronic disorder in various organs, 
more severe also in those predisposed to such disturbances in con- 
sequence of neuropathic inheritance, more severe in women suffer- 
ing from menorrhagia and dysmenorrhoea, and from any kind of 
mental stress. 

In his work on the influence of the so-called menstrual wave on 
the course of mental disorders, Schiile remarks 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 equilib- 
rium. Even in those whose nervous system is a healthy one, men- 
struation 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 pre- 
disposed women, the influence of regularly established menstrua- 
tion, even when the circumstances are favorable, is pretty much the 
same as the influence of menstruation when it first makes its ap- 



1^4 The Sexual Life of Woman. 

pearancc ; the influence is merely somewhat weaker in so far 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, 
swimming in the head, epileptic paroxysms, toothache, and neu- 
rasthenia." 

Especially frequent during menstruation is hemicrania. Some- 
times hemicrania may begin a day or two before menstruation, as a 
prodromal sign, and may accompany its whole course, becoming, 
however, less severe toward the end of the flow. Hysteria most 
commonly manifests itself in association with menstruation by a 
depressed emotional state, by tearfulness, by complaints made with- 
out sufficient grounds, by globus hystericus or clavus hystericus; 
sometimes also by paroxysms of muscular spasm ; very rarely by 
hystero-epileptic seizures. Epilepsy may occur either by day or by 
night. Nocturnal seizures usually occur without any apparent ex- 
ternal cause, as a result of the central stimulus ; diurnal attacks, 
on the other hand, have usually some external exciting cause. 
Often, however, years may elapse without any attack of major 
epilepsy occurring, the disease manifesting itself in one or more of 
the many varieties of the minor form {petit Dial) , as transient 
absences of mind, attacks of vertigo, etc. 

The nervous disturbance in a menstruating woman may be so 
great as to lead to the production of psychoses. The question of 
the existence of a menstrual insanity sui generis has been answered 
by many alienists in the affirmative ; by others, however, who see 
in the alleged cases nothing specific, it has been answered in the 
negative. The relation of menstruation to the mental disorder may 
be a double one: i, menstruation may occur repeatedly in the 
course of an already established mental disorder ; 2, menstruation 
and its morbid variations may favor the occurrence of psychoses 
that exist already in a latent form, and may lead to the origination 
of psychoses to which the organism in predisposed. 

. In the former connection, Brierre de Boisniont undertook an in- 
vestigation which showed that in women sufifering from mental 
disorder, an exacerbation of that disorder was to be observed dur- 
ing menstruation. Schlager^ who regards the menstrual process as 
possessing when anomalous a high significance for the develop- 
ment and course of mental disturbances, observed that in 33 per 
cent, of wx»men suffering from mental disorder, the menstrual state 
had an unfavorable influence upon the course of that disorder, in- 
asmuch as it led to an increased irritability; in the rest of the 
cases, however, menstruation was without influence upon the course 



The Sexual Epoch of the Menarche. 155 

of the ordinary chronic psychoses. In the cases that were unfavor- 
ably influenced, epileptic attacks usually became more frequent, 
and chronic melancholia became much more profound. Schroder 
observed in chronic forms of melancholia that during menstrua- 
tion the sadness became intolerable and was associated with a 
suicidal tendency ; in chronic maniacal forms of mental disorder, 
the excitement underwent an increase during menstruation. Von 
Krafft-Ehing, as a result of his investigations into insanity during 
menstruation, came to similar conclusions with regard to the un- 
favorable influence of the menstrual process. Algeri likewise states 
that menstruation notably aggravates the cerebral symptoms in the 
course of mental disorders. 

Other authors, Marce and Kowalezvski for instance, whilst em- 
phasizing the powerful influence exerted by menstruation on any 
existing psychosis, point out that in some instances, as in states of 
mental and physical depression, this influence is for the worse ; but 
in other instances, especially in states of maniacal excitement, the 
condition of the patient undergoes notable amelioration during men- 
struation. Schafcr also, in his researches into the relations between 
the processes of menstruation and psychoses, discovered that 
anomalies in the course of menstruation ran almost parallel with 
anomalies in the course of mental activity. 

In psychopathically predisposed women, disorders of menstrua- 
tion, such as amenorrhoea, delayed menstruation, and dysmenorrhoea, 
are more effective than the normal process of menstruation in evok- 
ing manifestations of psychical abnormalities previously latent, and 
in leading to attacks of precordial anxiety, pathological emotional 
states, melancholic seizures, epilepsy in all its varieties, and impul- 
sive manifestations, such as pyromania, kleptomania, infanticide, 
homicide, etc. As results of a special predisposition may appear 
in this connection, congenital imbecility, idiocy, melancholia, and 
chronic weak-mindedness. 

A rich literature exists of cases in which mental abnormalities 
occurred in psychopathically predisposed individuals as a result of 
menstruation. Thus, von Krafft-Ehing reports a case in which, 
during menstruation, a mentally undeveloped woman murdered her 
husband ; and another case in which to chronic weak-mindedness 
and chronic delusional insanity were superadded during menstrua- 
tion peculiar attacks having the character of psychical storms. Tuke 
reports a case in which a mother, in a state of alcoholic excess dur- 
ing menstruation, murdered her daughter. Pel maun records acts 
of pyromania committed during menstruation by a girl seventeen 
years of age. Mahillc records a case in which a woman suffering 
from severe mental disorder was affected during menstruation by 



1^6 The Sexual Life of Woman. 

impulsive kleptomania, whilst after the periods the memory of what 
had happened passed away. Philo-lndicus records the case of a 
woman suffering from severe neuropathy who at the menstrual 
periods exhibited great irritability, experienced marked sexual ex- 
citement, and had suicidal impulses, and who on one occasion at- 
tempted to murder a female friend who had refused to assist her 
in the practice of sexual aberrations. Giraud describes a woman 
suffering from passive melancholia, in whom during menstruation 
horrible fantastic ideas occurred. Ball records the case of a woman 
who suffered always from acute mental disorder during menstrua- 
tion, and who, in one of these attacks, murdered her son. Kowdew- 
ski reports a case of chronic imbecility, in which during menstrua- 
tion attacks of precordial anxiety developed, and in the course of 
one of these attacks the patient set fire to her own house. " In 
such cases," remarks Kozvdewski, " menstruation represents the 
last drop that makes the full goblet overflow." 

In addition, we meet with cases in which the influence of men- 
struation is so powerful that it must be regarded as the principal 
cause of the psycliosis. We must then speak of a true menstrual 
psychosis, the mipulse to which is supplied by the normal or ab- 
normal changes occurring in the process of menstruation, and 
characterized by the menstrual periodicity and the brief duration 
of the attacks. These are the characteristics of the menstrual psy- 
choses of the menarche and of the climacteric period ; and such 
cases occur also during the period of full menstrual activity. 

The menstrual psychosis most commonly makes its appearance 
shortly before the flow, becomes less severe with the establishment 
of the flow, and disappears when the flow ceases ; in other cases, 
the psychosis appears toward the end of menstruation, and speedily 
passes away; or, again, in amenorrhoeic cases, the attacks of mental 
disorder replace the proper menstrual flow, and become less severe 
or disappear entirely as soon as the flow is regularly re-established. 
The commonest forms of these menstrual psychoses are, melancholia, 
mania, irresistible impulses, acute amentia, in rare cases alternating 
insanity {folie circiilaire) in which the periods of alternation as- 
sume the menstrual rhythm. The duration of these psychoses is 
usually short, from a few days up to a fortnight ; there may be only 
a single attack, or there may be a number of attacks presenting 
precisely similar characters. 

The consciousness may be more or less disturbed. Vofi Kraift- 
Ebing points out, as a very dangerous peculiarity of the menstrual 
psychoses, that the fact that the morbid process has once occurred 
in connection with menstruation furnishes in itself a sufficient rea- 
son for the recurrence of such attacks, which are dependent on 



The Sexual Epoch of the Menarche. 157 

constantly repeated functional changes in the hrain closely 
analogous to tliose that occur in epilepsy. When the menstrual 
insanity recurs frequently, it gradually becomes less acute in its 
characters and more protracted in its course ; the lucid intervals are 
less clearly indicated and shorter in duration ; and thus in course of 
time the mental disorder may be transformed into chronic imbecility 
— a transformation liable to occur in all forms of periodic psychosis. 
In such cases we must always assume the existence of a certain lack 
of resisting power on the part of the organism, especially of the 
nervous system, which amounts to a congenital predisposition. Dur- 
ing the period of full menstrual activity, the favorable soil for the 
cultivation of such disorders is usually furnished by anomalies of 
menstruation, by difficult labor and its consequences, severe losses 
of blood, prolonged lactation, physical overexertion, and mental 
shock and stress. 

In the development under the influence of menstruation of such 
periodic acute mental disorders, we may observe various gradations, 
as for instance short, syncope-Hke cataleptic seizures, states of 
hallucinatory confusion lasting several hours or several days, dis- 
ordered consciousness, and even severe mania. 

Such a case was observed by Wille. Under the influence of men- 
struation and of a trifling source of mental disturbance (having 
soldiers billeted on them in a quiet country village), a young woman 
aged twenty-one, whose mental health had previously been good, 
had a sudden attack of anxiety, succeeded by a violent but transitory 
mania, lasting five or six hours ; after a short free interval came 
another attack, this time lasting several days. Similar cases were 
recorded by Friedmann. A blooming and healthy maid-servant 
eighteen years of age (some mental unsoundness was recorded in 
both grandfather and aunt on the maternal side) fell asleep in a 
chair a few days before menstruation, awakened with a start, was 
subsequently disordered in mind, though tranquil, with many 
hallucinations, listening to voices which repeated monotonously 
" they come," was drowsy, and slow to answer when spoken to. On 
the third day she was recovered, her mind being clear and normal ; 
she was not fully aware of what had happened. Since this attack, 
her mind has been free from disorder, during menstruation as well 
as at other times. She is said to have had a similar attack about 
four years ago, that is, at the commencement of puberty. — A girl 
aged thirteen, quite healthy, not nervous, physically rather power- 
ful, with quite healthy family history. Complaints of having 
suffered for two days from general sense of depression with pains 
in the abdomen ; during the afternoon was lying on a sofa, but 
suddenly sprang up, looked extremely anxious and confused, ran 



1^8 The Sexual Life of Woman. 

about the room, begged to be protected from the black man, etc., 
her speech was disconnected, gabbhng, and difficult to understand. 
After two hours she became quiet, and fell into a sound sleep, from 
which she awoke calm and quite forgetful of what had passed. On 
the following day menstruation appeared for the first time, with 
abdominal pains, but without any mental abnormality. During the 
subsequent six years she has remained quite well. 

Since the davs of antiquity an extremely important part has been 
assigned to suppression of the menses in the production of mental 
disorders; but in the opinion of modern alienists, who are opposed 
to the old humoral pathology, no more is to be recognized in this 
connection than the ordinary menstrual stimulus, wdiich, indeed, 
when the soil is already prepared, may furnish a causal determinant 
for an increase in the intensity of an already existing anomalous 
mental condition. Quite recently numerous cases have been pub- 
lished in which such an influence has been recognized as powerful. 
Voii Krafft-Ebing writes : ''' In isolated cases, as a sequel of sudden 
cessation of the menstrual flow, generally, due to a fright or to a 
chill, the development of insanity (usually acute mania) has been 
observed, and the suppression of menstruation has been regarded as 
the causal determinant. It is indeed conceivable that the connection 
between the two events is supplied by a collateral vicarious conges- 
tion of the brain. As a rule, however, the psychosis and the sup- 
pression of menstruation are the coeffects of the same cause, and 
are both of vasomotor origin." 

Maivet reports a case of violent mental disorder of a maniacal 
type, associated with chorea, occurring at puberty, the exciting cause 
of which, in a constitution hereditarily predisposed to insanity, he 
believed to be suppression of the menses. Diamant had under obser- 
vation a girl in whom, at the age of six years, menstruation ceased, 
having previously been regular since the age of two years ; after the 
suppression of menstruation, violent epileptiform seizures s6t in, 
occurring at what should have been the menstrual periods. JVest- 
phal described a case of infanticide committed in a state of melan- 
cholia at the proper menstrual period, the menses being suppressed. 

Menstrual psychoses are observed for the most part in compara- 
tively young women ; after the age of thirty-five they are uncommon. 
Among von Krafft-Ebing's cases there were : 

4 patients between the ages of 15 and 20 years, 

6 patients between the ages of 20 and 25 years. 

2 patients between the ages of 25 and 30 years. 

6 patients between the ages of 30 and 35 years. 

2 patients above the age of 35 years. 

The same author insists that for the development of a menstrual 
psychosis a predisposition on the part of the brain must exist, either 



The Sexual Epoch of the Menarche. 159 

in the form of an inherited predisposition, or in the form of a primary 
mental disorder, or, finally, as the result of some special exciting 
cause, such as emotional disturbance, the abuse of alcohol, or bodily 
illness. Among 19 cases observed by ion Krafft-Ehing 

12 were hereditarily predisposed. 

4 had previously exhibited great nervousness during menstruation, 
7 suffered from primary mental weakness. 

Very remarkable is the influence, demonstrated especially by 
Lombroso, exercised by menstruation on the commission of certain 
crimes. Of eighty women taken into custody for resisting the police, 
there were nine only who were not menstruating at the time. Four 
notorious murderesses and one woman convicted of arson were all 
menstruating at the times when their crimes were committed. 
Krugenstcin found evidence of menstruation in the bodies of 107 
women who committed suicide. Thefts committed by ladies in the 
great shops of Paris are most commonly effected during menstru- 
ation, as was found by Legrand dii Saullc to be the case in thirty 
five instances out of fifty-six investigated by him in respect to this 
matter. According to the same author, hysterical girls who steal 
articles of clothing, bottles of scent, and the like, from the counters 
of shops, are almost always menstruating at the time. 

Von Krafft-Ebing puts forward the following propositions with 
regard to the forensic significance of offences committed by women 
during menstruation: i. The mental integrity of- a menstruating 
woman is questionable from the forensic standpoint. 2. In the case 
of women on trial for any offence, the point should be determined 
whether that offence was committed at a menstrual period. 3. An 
inquiry into the mental condition is expedient in cases in which 
such a coincidence is established ; light is thrown on the matter when 
investigation shows the existence of hereditary predisposition, when 
we learn that psychopathic manifestations have occurred at previous 
menstrual periods, or when the very nature of the offence is one 
suggesting the presence of mental disorder. 4. A recognition of 
the powerful influence which the menstrual process exercises upon 
the mental life should lead, even in cases in which no menstrual 
psychosis has been proved to exist, to the admission of extenuating 
circumstances in apportioning the punishment for the offence. 5. In 
the case of the commission of a punishable act during menstruation 
by a weak-minded individual, we must as a rule admit the plea of 
irresponsibility — at any rate in the case of an offence committed un- 
der the influence of strong emotion. 6. Persons who have been dis- 
charged without punishment on the plea of mental disorder accom- 
panying menstruation must be regarded as dangerous to the com- 
munity, and should always be under careful supervision during the 
menstrual periods. 



i6o The Sexual Life of Woman. 

Amcnorrhcca, Menorrhagia, and Dysnienorrhoea. 

Amenorrhoea, permanent or transient abnormal lack of the men- 
strual flow, may depend upon anatomical changes in the genital 
organs, upon incomplete development or absence of the uterus and 
the ovaries, upon enduring or transient defective nutrition or 
upon atrophy of these organs, or upon parenchymatous disease 
of the ovaries ; or it may be due to functional disturbances of ovarian 
activity, itself dependent upon changes in the nervous system, upon 
constitutional diseases, or upon general nutritive disturbances in 
the body. Among the latter conditions must be especially mentioned 
chlorosis, obesity, diabetes, chronic alcoholism, and morphinism, 
myxoedema, exophthalmic goitre, etc. 

The amenorrhoea that occurs at the time of the menarche has 
already been described in connection with the symptomatology of 
that period. 

If in cases of amenorrhoea the ovaries continue to perform their 
functions, we frequently witness severe and painful menstrual 
molimina, occurring periodically at the times when the flow might 
be expected, but fails to appear. In cases of atrophy of the uterus 
and the ovaries, we see complete and permanent amenorrhoea with- 
out any discomfort. As a kind of vicarious menstruation, in certain 
cases of amenorrhoea, we see haemorrhages into the vitreous body 
or conjunctival haemorrhages ; also, as more extensive disturbances 
of the visual organs, interstitial keratitis, disseminated choroiditis, 
intermittent am.aurosis, acute retrobulbar neuritis, amblyopia, and 
limitation of the field of vision. 

Mooren publishes the following cases, showing the influence of 
amaurosis on the eye. A girl aged fourteen, with severe bilateral 
pannous keratitis, was amenorrhoeic notwithstanding the existence 
of well-marked menstrual molimina. Every four wrecks, at the times 
when the menstrual flow should have appeared, the corneal inflam- 
mation became more severe ; it became amenable to treatment for 
the first time a year later, when the menstrual flow had become 
established. A peasant woman, twenty-eight years of age, had never 
menstruated; the uterus was badly developed; every month an in- 
tolerable heat and swelling of the face recurred. Since the age of 
fifteen she had suffered from bilateral interstitial keratitis, which 
had resisted all treatment, and had been subject every four weeks 
to a recurrent exacerbation of this trouble, lasting several days. The 
exhibition of powerful emmenagogues and the use of Friedrichshall 
water brought about on a few occasions a scanty discharge of blood. 
The comfort to the patient, relieved as if by miracle from her pain 
and photophobia, was most remarkable. Unfortunately, however, 
this state of comparative happiness lasted from twelve to fourteen 



The Sexual Epoch of the Menarche. 161 

weeks only, after which, in spite of everything that was tried, there 
was no further recurrence of menstruation, and the condition of the 
eyes relapsed to what had existed for thirteen years. In other cases 
described by Mo oven the amenorrhoea was complicated with dis- 
seminated choroiditis and with posterior sclero-choroiditis. 

Beer reports a case of retrobulbar neuritis occurring with amenor- 
rhoea, consequent on infantile aplasia of the uterus. An interesting- 
case was recorded by Dunn of a girl fifteen years of age, who had 
not yet begun to menstruate, and who suffered from interstitial 
keratitis, with severe photophobia. The ocular symptoms vanished 
with extreme rapidity as soon as menstruation first appeared. 
Napier observed complete blindness, without discernible anatomical 
cause, associated with amenorrhcea of sudden onset ; the amaurosis 
disappeared as soon as menstruation was re-established. . 

Striking and manifold are the disturbances of the nervous system 
which may be caused by amenorrhcea, ranging from increased irri- 
tability, hypersesthesia of various nerve tracts, neuralgia, and the 
like, to severe psychoses. 

Barnes reports a case of mental disturbance consequent upon 
amenorrhoea in a woman twenty-seven years of age, who had begun 
to menstruate when sixteen years old, and in whom the menses 
had been suppressed a year earlier when she was informed of the 
sudden death of her father. From that time a progressively increas- 
ing weakness of the mind was observed. In a case recorded by 
Macnaughton Jones the mental depression consequent on amenor- 
rhoea was so great that it led to an attempt at suicide. 

Lawrence observed in young girls who from any cause suffered 
from amenorrhoea, that an increased pigmentation of the skin some- 
times occurred, analogous to that met with in Addison's disease. 
This amenorrhoeic pigmentation he compares to the chloasma that 
is seen in pregnant women. 

By menorrhagia we understand the occurrence of typical dis- 
charges of blood from the uterus, occurring at more or less regular 
intervals and differing from normal menstruation in respect either 
of the greater intensity or of the longer duration of the haemorrhage ; 
whereas by metrorrhagia we understand the occurrence of atypical 
discharge of blood from the uterus, which is related to menstruation 
neither in respect to its causation nor in respect to the time of its 
appearance. 

Menorrhagia may be due to local changes in the genital organs, 
to organic diseases of other organs, and to general diseases. 

Local changes which may give rise to menorrhagia are, active 
hypersemia and passive hyperaemia (hypersemia from engorgement) 
of the genital organs, such hypersemia being itself due to sexual ex- 

II 



i62 The Sexual Life of Woman. 

citement, especially when ungratified, to violent physical exercise, or 
to chill during menstruation; menorrhagia is also liable to occur 
when the abdominal circulation is disturbed by extreme obesity or by 
the presence of tumors, also in connection with endometritis, uterine 
myomata, erosions of the cervix, etc. Diseases of organs other 
than those belonging to the reproductive system which are espe- 
cially likely to give rise to severe bleeding are, disease of the heart, 
such as valvular incompetence, lung disease, and nephritis. General 
diseases in which menorrhagia may occur are, anaemia, chlorosis, 
haemophilia, scurvy, scarlatina, cholera, smallpox, influenza, and 
obesity. 

Through severe loss of blood in menorrhagia, whether the bleed- 
ing be sudden and profuse or more moderate but long continued, a 
condition of chronic anaemia results, with all its threatening conse- 
quences to the health and the life of the woman affected. She be- 
comes pale and weak, unfitted for any great physical or mental 
exertion, and is liable to attacks of cardiac enfeeblement and to 
fainting fits ; in some cases degenerative changes ensue in the cardiac 
muscle. 

Dysmenorrhcea is characterized by severe pain occurring before, 
during, and after menstruation. The pain is caused either by abnor- 
mally powerful contractions of the uterus or else by abnormal sen- 
sitiveness of that organ. Abnormally powerful contractions are 
caused by various mechanical hindrances to the normal processes of 
menstruation ; abnormal sensitiveness is due to inflammatory and con- 
gestive states of the uterus and its annexa or to a general increase 
of nervous sensibility. 

Schauta, therefore, distinguishes a mechanical, an inflammatory, 
and a nervous form of dysmenorrhcea. jMechanical dysmenorrhcea 
is most frequently due to stenosis or flexion of the canal of the 
cervix in some part of its course from the internal to the external 
OS, dependent upon malformation or flexion of the uterus, hyper- 
plasia of the mucous membrane, chronic metritis, scarring resulting 
from operative procedures, uterine polypi, etc. In inflammatory 
dysmenorrhcea we have to do " either with an inflammatory pro- 
cess or with excessive tension of the intrapelvic organs, dependent 
upon abnormal distension of their blood vessels." To the same 
category belong ovarian dysmenorrhcea, and dysmenorrhcea due 
to inflammatory changes in the Fallopian tubes and to pelvic peri- 
tonitis. In nervous dysmenorrhcea, no anatomical cause is apparent, 
but the uterine contractions normally occurring during menstrua- 
tion, and the normal congestive distension of the intrapelvic organs 
at that period, become extremely painful, in consequence of a 
morbid increase in the sensibility of the nervous system. 



Tiii-: Sexual Epoch of the Menarciie. 163 

The influence of dysmenorrhoea on the general condition of the 
woman suffering from it is often a very potent one. 

The normal undulatory course of the bodily temperature — which 
as Reinl has shown, undergoes a gradual rise until shortly before 
the appearance of the menstrual flow, gradually falls during men- 
struation, and continues to fall for a time after menstruation is over 
■ — undergoes a change in cases of dysmenorrhoea due to anteflexion 
of the uterus, parametritis, or salpingitis, inasmuch as in these cases 
the acme of the temperature curve is reached actually during men- 
struation and the decline of temperature comes, not at the commence- 
ment of the menstrual flow, but often only after the flow has ceased. 
The curve of blood pressure and the curve indicating the excretion 
of urea are similarly affected in these cases. 

As symptoms in other organs occurring in cases of dysmenorrhoea 
Schauta mentions " sensations of heat, coldness of the feet, retching 
and vomiting, cramps of the stomach and of the voluntary muscles, 
general disorders of nutrition, loss of appetite, strangury, con- 
stipation, dyspepsia, headache, and finally hysteria. As symptoms 
of the latter affection we may notice, anaesthesia, hyperaethesia of 
certain parts of the abdomen, attacks of cramp, paralysis, uterine 
cough, hiccough, spasm of the glottis, epileptiform seizures. The 
repeated severe attacks of pain may seriously disturb the nervous 
system, leading to the appearance of general neuroses and psychoses. 
Frequently we observe, as a peculiar accompaniment of dysmenor- 
rhoea, changes in the fulness of the blood vessels of the face and 
also in other regions of the skin, in consequence of vascular para- 
lysis. In other cases, actual effusion of blood occurs, and, as a sequel 
of this, deposits of pigment ; and the semicircles beneath the eyes 
may become so dark as to look as if they had been artificially tinted 
(Macnaughton Jones). In one case, during menstruation periodic 
swelling of the gums was observed (Rcgnicr). Finally, in associa- 
tion with dysmenorrhoea, various forms of neuralgia, changes in 
refraction, and slight attacks of neuritis and retinitis may occur." 

One of the commonest symptoms and sequelse is headache, some- 
times in the form of hemicrania, which may be associated with 
dyspeptic manifestations, sometimes diffused over the whole surface 
of the skull. 

Dyspepsia is a very frequent associate of dysmenorrhoea. Thus 
we meet with pain and tenderness in the gastric region, nausea, 
vomiting, and also cardialgia. Sometimes the liver becomes en- 
larged and tender on pressure ; in many cases also jaundice is 
witnessed. 

Gchhard refers to another phenomenon which may be classed 
under the head of dysmenorrhoea, from the character of the pain 



164 The Sexual Life of Woman. 

that is experienced, even though this pain is not felt at the men- 
strual periods, but in the intermenstrual epoch. This is the so- 
called intermediate dysmenorrhoea (intermenstrual pain, Ger. 
Mittelschmerz). In the character of the localized pain, interme- 
diate dysmenorrhoea closely resembles ordinary dysmenorrhoea; it 
recurs often with precise regularity on certain days during the inter- 
menstrual interval. Croom distinguishes three forms of intermediate 
dysmenorrhoea ; that in which there is no discharge at all from the 
uterus, that in which there is a sanguineous discharge, and that in 
which there is a clear watery discharge. The first form he attributes 
to asynchronism in the processes of ovulation and menstruation ; 
the second form, to endometritis with disintegration of the mucous 
membrane ; the third, to a kind of hydrops tubse profluens (profluent 
dropsy of the Fallopian tubes — hydrosalpinx in which the fluid 
accumulates in the tube, and at a certain stage of its accumulation 
flows into the uterus). Cases of intermediate dysmenorrhoea are 
somewhat rare, if we eliminate the cases in which pains occur in 
the intermenstrual epoch in consequence of disease of the uterine 
annexa. Inflammatory manifestations may be discovered in nearly 
all typical cases of intermediate dysmenorrhoea. 

Long-continued dysmenorrhoea may give rise to numergus hys- 
terical troubles, general convulsive seizures, local muscular spasm 
and paralysis, hiccough, spasm of the glottis, uterine cough, twitch- 
ing and spasm of various groups of voluntary muscles. In some 
cases we see fully developed epileptic convulsions, with complete 
loss of consciousness and immobility of the pupils. Finally, psy- 
choses may arise in association with dysmenorrhoea. 

In cases of pathological changes in menstruation, a carefully ar- 
ranged hygiene at the menstrual periods is of importance both for 
prophylactic and for therapeutic purposes, and in this connection 
I may refer to what I have written in the section on Hygiene during 
the Menarche. In cases of dysmenorrhoea a certain amount of 
repose and precaution are needed during the flow, with avoidance of 
chill, scrupulous cleanliness, and regulation of the bowels. In cases 
of amenorrhoea we must prescribe attention to the general nutritiort 
by means of an easily digested roborant diet, as much fresh air as 
possible, and systematic bodily exercise. In these cases, bicycling, 
lawn tennis, and suitable gymnastics are often of value ; also baths, 
in the form of warm general baths, hot sitz baths, and hot foot baths. 

Vicarious Menstruation. 
In cases in which, in consequence of morbid conditions of the 
uterus, the ovaries, or the organism as a whole, the menstrual flow 
has at the time of the menarche either failed entirely to appear or 



The Sexual Erucii ue the Menarche. 165 

been exceedingly scanty, haemorrhages from other organs have since 
ancient times been witnessed, and these haemorrhages have been 
regarded as vicarious menstruation. The congestion that occurs 
during menstruation is not limited to the genital organs, and 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, and vicarious haemorrhages take place from the mouth, 
the nose, the intestines, the anus, the gums, the mammae, the ears, 
and the lungs ; or haemorrhages occur in the brain, the nerves, or 
the eyes. 

Although it must be admitted that confusion has often occurred 
between vicarious menstruation and haemorrhages dependent on 
pre-existing genuine organic disease, such as haemoptysis due to 
pulmonary tuberculosis, or haematemesis due to gastric ulcer, still the 
existence of a true vicarious menstruation must be regarded as fully 
established. 

Thus, F richer, Fleischmann, Ohermeier, Beige!, Withrow, Plyette, 
and Parsons observed vicarious epistaxis ; Watson, Decaisne, Ede- 
holds, Fischel, and Seeligmann, vicarious haematemesis; Franchi, 
Hotte, Rat gen, Voigt, and Windmiiller, vicarious haemoptysis; 
Diinlap, vicarious gingival haemorrhage ; Lazv and Petiteau, vicarious 
otorrhagia ; Heusinger and le Fort, vicarious haemorrhages, occur- 
ring variously from the anus, bladder, hand, ear, nipple, stomach, 
and nose ; Baumgarten, vicarious haemorrhage from the vocal cords 
and trachea ; Hahn, from the bladder ; Kerley, in the thyroid body ; 
Gallemairts, in the eyes. Piiech found, in the cases he collected, that 
vicarious menstrual haemorrhage 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 membrane 
eighteen times. In all the cases menstruation, had long been in 
abeyance. 

Regarding vicarious epistaxis, especially exact observations have 
been published, showing the mutual relationship between the genital 
and the nasal mucous membrane. A series of cases has been re- 
corded by Fliess. In one of these a remarkably well-developed girl 
of fourteen, who complained at three-weekly intervals of molimina, 
in the form of languor, headache, and sacrache, after an interval of 
four weeks epistaxis occurred instead of the expected menstruation ; 
three weeks later came another attack of epistaxis ; and finally, after 
an interval of seven weeks, came the first menstruation, which hence- 
forward recurred every three weeks. In another case, that of a 
girl aged fifteen, menstruation appeared once ; four weeks later came 
an attack of epistaxis instead of menstruation, and these attacks of 
epistaxis were continually repeated, at intervals of twenty-nine days. 



1 66 The Sexual Life of Woman. 

in place of menstruation, until finally pregnancy occurred. During 
pregnancy the epistaxis ceased, to recur however six weeks after 
i:>arturition; the attacks continued for eight monthly periods, when 
they ceased finally at the commencement of the second pregnancy. 

Other similar cases are known in which epistaxis recurred with 
all the regularity of the menstruation it replaced during pregnancy 
and ceased at parturition. Analogous cases occur in which epistaxis 
has persisted during pregnancy, during the puerperium, and at the 
climacteric period, replacing the physiologically suppressed men- 
strual flow. Similarly Licgois has observed vicarious haemoptysis 
during pregnancy. According to Baumgarten, in vicarious epistaxis 
the bleeding almost always proceeds from the region of the carti- 
laginous septum, and may become very violent ; vicarious hoemorrhage 
from the larnyx proceeds from the true and false vocal cords. 
Tracheal haemorrhage is a much rarer occurrence. 

Analogous to these cases are those in which the vicarious haemor- 
rhages occur after removal of the ovaries. Thus Taiiffcr in one case 
saw epistaxis replace menstruation after this operation. Schmalfuss 
reports a case in which a woman suffering from valvular disease 
of the heart, w^as said after oophorectomy to have had almost 
daily attacks of haemoptysis and epistaxis. Glacvccke found in the 
post-operative history of forty- four cases of oophorectomy that two 
patients suffered from vicarious haemorrhages. The last-quoted 
author is of opinion that the suppression of menstruation resulting 
from oophorectomy rarely leads to vicarious haemorrhages, and that 
even when these do occur they are so inconsiderable in amount as 
to have no practical significance. 

Qiiain records the case of a woman aged thirty-three, in whom 
uterus and ovaries were absent, and in whom for two years epistaxis 
recurred every month with considerable regularity. 

In cases in which menstruation is in abeyance, we sometimes wit- 
ness, instead of vicarious haemorrhages, the occurrence of non-san- 
guineous vicarious discharges from various mucous membranes. 
Thus, vicarious leucorrhoea is seen, especially in chlorotic patients, 
in whom, from the time of the menarche onward, such a discharge 
may occur every month, instead of the delayed menstruation. Simi- 
larly, vicarious diarrhoea and vicarious salivation have been observed. 

The Sexual Impulse. 
By the term sexual impulse, we understand the impulse shared by 
women and by men towards intimate physical contact and sexual in- 
tercourse with individuals of the opposite sex. In the child this 
impulse slumbers, to awaken at the menarche with the onset of pu- 



The Sexual Epoch of the Menarche. 167 

berty, to increase slowly at first, and then more rapidly, after the 
manner of an avalanche, until it becomes a powerful passion, domi- 
nant throughout the active sexual life of the woman, and it may 
even continue far beyond this period. The proper aim for whose 
attainment the sexual impulse in woman strives is by no means 
(as is asserted in some quarters) the fulfilment of '' the impulse 
toward motherhood," but is merely the complete satisfaction of 
sensual passion by intercourse with the male. Still, the sexual im- 
pulse is often satisfied by the minor degrees of sexual gratification in 
the form of the mutual contact, so agreeable to the sense of touch, 
of portions of the body, and even by the play of imagination and 
illusion under the dominion of love. Finally, also, love amounts 
to what Buff on, the celebrated naturalist, expressed with coarse 
incisiveness in the phrase, " L'amour c'est le frolement de deux 
intestins." 

In the sexually mattire woman, the sexual impulse always exists, 
though its strength varies in accordance with individual inheritance, 
with physical and mental condition, and with external circumstances, 
and though its manifestation may be repressed by force of will. 
The sensation of the sexual impulse in a maiden during the years 
of development is described by Goethe in a masterly manner in the 
verses. ^^ 

" Meiiie Ruh ist hin 
Mein Herz ist schwer, 
Ich finde sie nimmer 
Und nimmermehr. 
Mein Busen drangt 
Sich nach ihm hin, 
Ach, diirft ich ihn fassen 
Und halten ihn 
Und kiissen ihn, 
So wie ich wollt, 
An seinen Kiissen 
Vergehen solU. 

A resemblance to heat or rut in animals, wdio exhibit the sexual 
impulse only at definite periods, those at which the ovules ripen, 
is manifested in females of the human species only in so far as there 

33 My peace is lost, 
My heart is heavy, 
I find it never 
And nevermore. 
My bosom presses 
Towards him, 
Ah, could I seize him 
And embrace him, 
And kiss him, 
As I long to do. 
In his kisses 
I should pass away. 



i58 The Sexual Life of Woman. 

is during menstruation a more intense sexual sensibility; but the 
limitation of the sexual impulse to definite periods, and its close 
association with reproduction, are not found in women. Educa- 
tion and morality impose artificial limitations on the sexual im- 
pulse in women, whilst nature endows this impulse with a coercive 
power, a fact recognized by thinkers of all times and all peoples. 
Thus, Buddha wrote : " The sexual impulse is stronger than the 
ankus with which the wild elephant is controlled, it is hotter than 
fiame, it is like unto an arrow driven into the spirit of man." In 
a similar sense Luther writes : '' He who wishes to restrain the 
impulse of nature and not to allow it free play, as nature will and 
must, what does he do but this, to insist that nature shall not be 
nature, that fire shall not burn, that water shall not wet, that man 
shall neither eat, drink, nor sleep." Schopenhaur describes the 
sexual impulse as " the completest outward manifestation of the 
will to live, the concentration, that is to say, of all wills. * -s^ * 
The aflfirmation of the will to live concentrates itself in the act of 
generation, and this act is its most determined expression." Main- 
Hinder in his Philosophy of Deliverance makes the following state- 
ment : " In the sexual impulse lies the centre of gravity of human 
life. To nothing does man devote a more earnest attention than to 
the business of generation, and in the pursuit of no other aim does 
he concentrate the intensity of his will in so striking a manner as 
in the performance of the act of generation." Debay similarly 
insists on the strength of the sexual impulse, saying : '' The union 
of the sexes is one of the great laws of nature ; to that law men 
and women are subordinated as completely as all other creatures, 
they cannot escape its operation." 

According to the general opinion, the sexual impulse is not so 
strongly developed in women as it is in men. Hcgar, Litzmann, 
Lombroso, P. Miiller, and many others, assume that the sexual sen- 
sibility of women is less than that of men ; Fiirbringer is inclined 
to attribute the characteristic of sexual frigidity to the great ma- 
jority of German wives. I do not believe that this view, of the 
slight intensity of the sexual impulse in women in general, is well 
grounded, and can admit only this much, that in adolescent girls 
who are inexperienced in sexual matters, the sexual impulse is less 
powerful than in youths of the same age who have undergone 
sexual enlightenment. From the moment when the woman also has 
been fully enlightened as to sexual affairs, and has actually ex- 
perienced sexual excitement; her impulse toward intimate physical 
contact and toward copulation is just as powerful as that of men. 
According, however, to the dominant artificial conditions, man as- 
sumes it as his right to give free rein to his sexual desires and 



The Sexual Epoch of the Menarche. 169 

to gratify them without regard to consequences, whereas woman, 
narrowly confined within the boundaries imposed by law and con- 
vention, cannot so readily yield to her inclination in the direction 
of physical love, and must forcibly control that inclination. More- 
over, a powerful check on the free indulgence of the sexual im- 
pulse is imposed on woman by the consequences of such indulgence, 
consequences which exist for woman only. 

I may further indicate as differential characteristics, that in woman 
the sexual impulse is more accessible to voluntary control than it 
is in man, the ardor of female sexual passion is more readily dimin- 
ished than that of the male ; and again that in the female the grati- 
fication of the sexual impulse is less narrowly restricted than in the 
: male. Excessive sexual gratification on the one hand and suppres- 
sion of sexual desire on the other are, generally speaking, less harm- 
ful to the female organism than to the male. In these differentiae is 
to be found, in my opinion, the influence which determines the type 
of sexuality in the respective sexes. 

The following account is given by Havelock Ellis of the differential 
characters of the sexual impulse in the female : " In courtship, woman 
plays a more passive part than man ; in woman the physiological 
mechanism of the sexual processes is more complicated, and the or- 
gasm develops more deliberately ; the sexual impulse in woman needs 
more frequently to be actively stimulated ; the culmination of sexual 
activity is attained later in the life of woman than in the life of man, 
the strength of sexual desire in woman becomes greater after she has 
entered upon regular sexual intercourse, women bear sexual excesses 
better than men ; the sexual sphere is larger and more widely dif- 
fused in women than it is in men ; finally, in woman the sexual im- 
pulse exhibits a distinct tendency to periodic exacerbations, and it 
is in any case much more variable than in man." The same author, 
who has published several notable biological studies on subjects 
connected wnth sex, maintains that the source of erotic pleasure in 
the case of the male lies in activity, but in the female in the passive 
state, in the experience of compulsion, and he holds that sexual 
subordination is a necessary element in the sexual enjoyment of 
women. 

Hegar maintains that under the term sexual impulse two distinct 
conceptions are confounded : First, the impulse toward copulation, 
the desire of carnal union with a member of the opposite sex ; 
secondly, the impulse toward reproduction, the desire for children. 
At the same time, this author admits that it is questionable if we 
can properly speak of an impulse toward reproduction, when repro- 
duction is merely a consequence of copulation ; in the case of civilized 
man, at any rate, so much reflection is connected with the idea of 



i^o The Sexual Life of Woman. 

reproduction that it can hardly be proper to speak of anything of 
the nature of an impulse. In the case of woman, the expression is 
less unsuitable, since in woman special organs exist for the main- 
tenance of the ovum after fertilization, and these organs may perhaps 
lead to the production of this peculiar form of mental activity. 

According to Darwin, a comparatively less intensity of sexual desire 
is common to the females of all species of the animal kingdom. 
The female demands a prolonged courtship, and often endeavors 
for a considerable time to elude the male. In the lowest classes of 
the animal kingdom the female leads a separate existence as soon as 
she has been fertilized by the male, the sexual functions being thus 
subordinated to the maternal. Among birds at the pairing season 
the male is always the more passionate and active of the two, whilst 
the female commonly remains passive and occupies herself in build- 
ing the nest. Among mammals, it is difficult to determine whether 
sexual feeling is stronger in the female or in the male; but it is 
certain that sexual relations are seldom long lasting, they continue 
in most cases only during the period of heat or rut, and at most 
only till the birth of the young. 

From these phenomena witnessed in the animal kingdom, many 
naturalists have concluded that in females of the human species also, 
sexual sensibility and the intensity of the sexual impulse are less 
than in the males, and even that the sexual sense in general is but 
little developed in the female sex, or sometimes entirely wanting. 
The complicated apparatus which the primary and secondary sexual 
characters of the female combine to make up, exists, according to 
this view, not for the gratification of the sexual impulse, but for the 
fulfilment of the function of motherhood. "Love in women," says 
Lomhroso, " is in its fundamental nature no more than a secondary 
character of motherhood, and all the feelings of affection that bind 
woman to man arise, not from sexual impulses, but from the instincts, 
acquired by adaptation, of subordination and self-surrender." 

Mantegazza lays stress on the fact that in the female, sexual de- 
sire is very rarely accompanied by pains analogous to those which 
occur in man, in whom sexual excitement manifests itself in painful 
tension of the testicle and the seminal vesicles, or in spasmodic, 
long-continued priapism. 

Sergi writes to Lombroso: " The normal woman loves to be flat- 
tered and wooed by man, but yields herself to his sexual desires only 
like an animal at the sacrifice. It is well known how much pains 
must be taken, how many caresses must be expended, before a woman 
will yield with pleasure to a man's desires, and will share his sexual 
passion. Without the employment of these means, a woman remains 
cold and gives as little satisfaction as she feels. There are girls 



The Sexual Epoch of the Menarche. 171 

who are quite obtuse tO' the joys of love, and either resist energetically 
a man's approaches, or yield to him passively, without ardor and 
without enthusiasm. It is well known, also, that among the lower 
races of mankind, means are employed to stimulate the sexual sen- 
sibility in women, means that seem to us to amount to torture ; and 
that the male, with the same end in view, undergoes the most pain- 
ful operations, from which it is apparent that the slight sexual 
sensibility of women in these lower grades of civilization is fully 
recognized." And again: '' If a normal woman marries for love, 
she hides that love deep in her heart, and even on the wedding-day 
exhibits no great sexual excitement ; she often complains later that 
in her husband the love-fervor of the first days still continues ; the 
very moderate sexual needs of the wife form a natural and most 
valuable check to the much more powerful passion of the male." 

Saint Prospcre expresses himself to a similar effect: ''Women 
do not fall in consequence of the excessive power of the senses — 
in this domain they are overlords, in striking contrast to men, whose 
weakest side is here. It is not by means of the senses that a woman 
is to be overcome; her weakness lies elsewhere — in her heart, in 
her vanity." And de Lambert wrote the epigram, '' Women play 
with love, and yield themselves to love, but they do not abandon 
themselves to love." 

Well known also is the saying of Dante: 

" We know how speedily in women the fire of love Is consumed 
Unless eye and hand continually supply it with fresh fuel." 

On the other hand, it is asserted in the laws of the Hindus that 
sexual desire in women can as little be satisfied or fed full as a de- 
vouring fire can be fed full of combustible materials, or as the ocean 
can be overfilled by the rivers that pour their waters into it. 

Lomhroso finds a proof of the sexual indifference of women and 
of the greater sexual needs of man, in the existence of prostitution, 
with which can be contrasted the existence only among the degener- 
ate classes (both rich and poor) of a small group of male prosti- 
tutes (alfons, souteneurs). This author also refers to the rarity and 
uniformity in women of the sexual psychoses so frequent in men, 
as indications of the minor intensity of sexual desire in the former ; 
and he refers also to a series of facts, as for instance, to the occur- 
rence of platomc love, which, though indeed often hypocritical, has 
a real existence more often in the female sex than in the male ; to 
the long-enduring chastity of girls, and to vows of chastity, 
which are rarely made except by females ; moreover, the ready adap- 
tation of women to polygamy, as well as their scrupulous observance 
of monogamy, which latter for the male is nominal rather than 



\y2 



The Sexual Life of Woman. 



actual. If in general the opposite view concerning women prevails, 
this is ascribed by Lomhroso to the fact, that love is the most im- 
portant circumstance in a woman's life. The reason therefore, how- 
ever, is to be found, not in the erotic sphere, but in the desire for the 
satisfaction of the maternal instinct, and in a woman's need for pro- 
tection. A celebrated accoucheur, Giordano, has remarked : '' Man 
loves woman for the sake of the vulva ; what woman loves in man is 
the husband and the father. Comprehensively we may express the 
matter by saying that woman has less eroticism and more sexuality." 

As a rule, remarks Erh, it is believed that the sexual impulse is 
less intense in women than in men. This is true enough, he writes, 
as regards youthful and virgin individuals, who have not yet come 
into intimate contact with men, and in whom sexual desire and 
sensibility have not yet been directly excited ; later, however, when 
sexual intercourse has been begun, a change usually takes place, and 
the sexual needs become active in women also, and demand satisfac- 
tion. It is well known that not a few women experience powerful 
and uncontrolled sensual inclinations, just like those of men. On 
the other hand, we must insist that quite a large number of women 
possess the so-called naturae frigidae, and have no sensual inclination 
to sexual intercourse, to which they are either indifferent, or in 
some cases strongly averse, even regarding it with horror. This lack 
of the sexual sense in women, is especially common in hysterical sub- 
jects, and Erh reports that he has encountered quite a large number 
of cases of this character. Whether in quite healthy women with 
normal sexual impulse, complete abstinence from sexual intercourse, 
too often compulsory but sometimes voluntarily undertaken, is harm- 
ful in its consequences — this, says Erh, is a question very difficult 
to answer. Many such unfortunate women have assured him that 
they suffered severely in consequence of their enforced continence ; 
the majority of these became neurasthenic or hysterical. The com- 
plication of purely physical influences with mental influences, in- 
creases the difficulty of the problem. Neurologists have observed 
women on whom continence was forced either during marriage or 
after its dissolution, who thereupon fell into a state of severe ner- 
vous exhaustion or nervous excitement, or suffered from threatening 
or even actually developed psychoses. That sexual abstinence is 
" absolutely harmless," as moralists and many physicians would so 
gladly believe, appears to Erh a quite unwarrantable assumption. 

"In the processes of reproduction," continues Erb in his discus- 
sion of this subject, '' woman is the principal sufferer. With inhuman 
cruelty, nature has condemned woman to a fat more difficult role 
than man in the intercourse of the sexes and in the preservation of 
the species; she is overpowered and forced by man, she is com- 



The Sexual Epoch of the Menarche. 173 

pelled to make the most severe sacrifices for the sake of the new 
generation, first when it is germinating within her womb, and later 
when it is entrusted to her care ; and only too frequently she fails to 
find the respect and protection due to her for the performance of 
these functions ! Compared with the sacrifices made by woman, the 
temporary continence which is all that is demanded from man will 
be admitted to be a small matter ! It is fortunate that as a rule the 
young woman who has never come into intimate contact with the 
male, appears to be endowed by nature with a relatively weak sexual 
impulse! This unequal and unjust distribution of the male and 
female roles on the part of nature may be regretted, but it cannot 
be altered." 

The modern advocates of the rights of women, who demand that 
in the sexual sphere also, woman should receive emancipation, op- 
pose the view that in the male the sexual impulse is stronger than in 
the female, and also the view that whilst in the male the impulse is 
simply one toward sexual congress, in the female the determining 
motive to intercourse is furnished by the desire for motherhood. 
They complain of '' the perverse repression in woman of the sexual 
impulse and its physiological gratification," since sexual energy and 
sexual sensibility are equal in intensity and identical in quality in the 
female and in the male. Thus, Johanna Elberskirchcn writes 
{Die Scxualempfindiing bci IVeib und Mann — Sexual Sensation 
in Woman and Man) : " Body and soul, the whole being is subor- 
dinated to a single powerful feeling and impulse, a single will flows 
through nerves and blood, forcing and driving the female toward 
the male with irresistible power ; the yearning, the longing for the 
relief of sexual tension, the craving for the euphoria and fleshly 
delight that dominate the whole personality. And this elementary 
sexual longing it is that clouds the woman's brain, that drives her 
into the man's arms, that leads her to forget all the shame threaten- 
ing her and her child, that brings her to sexual union — not the 
longing for a child, not the so-called impulse to motherhood." And 
again : '' Woman yearns for love, all her love-organs cry out for 
love, soul and body * * *. "We do not long only for the rude 
sexual act. We spiritualise it — at least some of us do so ; at any 
rate we individualize it. It is one particular man whom we desire, 
he alone can still our longing, our bodily and mental hunger for 
love. He satisfies us with all his love-afifinities." Naturally, also, the 
consequence is deduced, " a free course must be given to sexual 
sensation in women, and to the satisfaction of sexual desire, within 
physiological limits, within the bounds of physiological necessity." 

Lowcnfcld asserts that in the life of woman the sexual functions 
play a comparatively much greater part than in the life of man, 



174 



The Sexual Life of Woman. 



woman's thoughts and feelings are, that is to say, much more power- 
fully influenced by sexual matters than those of men ; but none the 
less he is of opinion that in the normal woman the desire for sexual 
satisfaction is on the average less keen than in the normal man. Dis- 
tinctly greater in woman is the erotic element only, the need to love 
and to be loved after an ideal manner, which is excited by the repro- 
ductive glands just as much as is the simple sensual desire. Very 
frequently, manifestations of this ideal need are erroneously at- 
tributed to the sensual impulse, yet this latter may be entirely absent 
in cases in which the erotic element is strongly developed. Accord- 
ing to Lowenfeld, the sexual impulse is altogether wanting in young 
girls before the time of puberty, and in elderly women (in the case 
of the latter we consider this assertion most questionable) ; this lack 
of the sexual impulse persists in girls for an indeterminate time even 
after puberty, as long as they remain free from all experience of 
sexual stimulation. In this respect they offer a notable contrast to 
males of the same age. In normal girls, according to the same au- 
thor, erotic dreams and similar occurrences are entirely wanting, and 
specific sexual sensations therefore remain absolutely unknown to 
them ; hence it follows that the sexual impulse cannot, properly speak- 
ing, arise in such individuals, and in so far as they experience any 
desire for sexual intercourse it can only take the form of a craving 
for some enjoyment, the nature of which is entirely unknown. The 
absolute lack of the sexual impulse (complete frigidity) persists, 
according to Lozvcnfcld, in a not inconsiderable proportion of women 
even after their introduction to sexual intercourse — Efforts esti- 
mates that such complete frigidity is permanent in lo per cent, of all 
women — and in a still greater proportion of women the sensual 
impulse never exceeds a certain minimal intensity (partial frigidity). 
It is probable that in the higher classes of society, inherited predis- 
position, education, and perhaps also higher intelligence, combine 
to diminish the intensity of the sexual impulse. In contrast with 
these women of frigid temperament, however, we meet with women, 
certainly in very limited numbers, whose sexual passions are ex- 
tremely powerful, and whose needs no man can satisfy. 

Hcgar, who considers that the sexual impulse in women is seldom 
very powerful, draws the following conclusions in respect of the 
influence of sexual gratification, on the one hand, or of continence, 
on the other, on the duration of life and on physical and mental 
health : ''As far as comparisons between married women and women 
vowed to celibacy (nuns and members of other celibate religious 
orders) justify any conclusion, sexual activity and inactivity, respec- 
tively, would appear to have little influence on the duration of 
life. Comparisons between married and single women show, 



The Sexual Epoch of the Menarche. 175 

indeed, that the gratification of the sexual impulse and the processes 
of reproduction are distinctly injurious when experienced before the 
attainment of complete sexual maturity. In married women up to 
the age of thirty, in some countries even up to the age of forty, the 
mortality is greater than in unmarried women. The notably smaller 
mortality of married women, as compared with unmarried, after the 
age of forty, is usually explained as the result of the complete ful- 
filment of the genital functions. It may, however, find a truer 
explanation in the selection effected by marriage, especially when 
we take into consideration that from the women thus selected the 
weaker individuals have been previously weeded out by the processes 
of reproduction: 

" The lesser mortality of married men from the age of twenty 
upwards is to be explained by the selection of the fit which occurs 
in marriage, by the smaller proportion of marriages among men 
engaged in hazardous occupations, and by the deterioration in the 
quality of the unmarried which results from emigration. Still the 
directly favorable influence of marriage is undeniable, and, no doubt, 
the ethical factors of this institution have a beneficial effect, whereas 
the gratification of the sexual impulse hardly enters into the account. 

'' Suicide is certainly very little dependent upon repression of the 
sexual impulse, since all the motives arising out of the affairs of 
love play together but a small part among the causes of suicide." 

''The beneficial influence of marriage in the prevention of insanity 
is in part apparent merely, since, in the selection exercised by mar- 
riage, those predisposed to mental disorder, and those in whom such 
disorder has already manifested itself, are, for the most part, already 
excluded. Still, as regards the male sex at any rate, the beneficial 
influence of marriage is undeniable, and consists principally in the 
favorable ethical factors of this state. In women, on the other 
hand, the advantage of marriage is doubtful, since the nerve centres 
and the nervous system as a whole are strongly affected by the proc- 
esses of reproduction. 

" Satyriasis, nymphomania, and hysteria are in no way dependent 
upon the repression of the sexual impulse. 

" Criminality in the married is comparatively less common than 
in the unmarried. In criminal assaults on young persons, repressed 
sexual impulse plays a part. 

" Chlorosis is not in any way dependent on repression of the 
sexual impulse. A disease apparently analogous to chlorosis, occur- 
ring in unmarried women from twenty to thirty years of age, is 
dependent rather on mental causes, and is relieved by other 
means than marriage, especially by suitable occupation. Marriage 
and gestation are distinctly injurious in cases of true chlorosis. 



j;76 The Sexual Life of Woman. 

" The satisfaction of the sexual impulse, and still more gesta- 
tion, favor in women the origin and growth of tumors, give rise 
often to mechanical disturbances, and open the way for the invasion 
of toxic pathogenic germs. 

" Osteomalacia occurs only in parous women." 

Moll divides the sexual impulse into two components : The impulse 
toward intimate contact (in a sense both physical and mental) with 
a person of the opposite sex, which he calls the contrectation-impulse 
[Kontrektationstrieb) ; and the impulse to bring about a change in 
the 'genital organs, which he calls the detumescence-impulse 
{Detiuneszcnztrieh) . The former impulse induces intimate physical 
and mental contact between the' two persons concerned, the latter 
impulse induces the local processes of copulation. In women, detu- 
mescence results from the passing off of local swelling and the release 
of nervous tension in the genital organs, with the discharge of in- 
different glandular secretions, notably the secretion of Bartholin's 
glands, and perhaps also the secretion of the uterine glands. The 
intensity of the detumescence-impulse in women varies greatly in 
different individuals, these " variations being more extensive than 
those occurring in the male. In some women the impulse toward 
intimate contact, the contrectation-impulse, is normal, though the 
detumescence-impulse is wholly wanting {vide Dyspareunia). 

Riinge defines the sexual impulse as the impulse which brings the 
sexes together. This impulse is subservient to an instinct, namely 
the instinct of reproduction ; that is to say, the sexual impulse in- 
duces the individual to perform actions which subserve the purpose 
of reproduction without the agent's being directly or chiefly con- 
cerned with this purpose. 

The sexual impulse, as sensation, perception, and impulse, is, 
according to von Krafft-Ehing, a function of the cerebral cortex ; 
a centre for the sexual sense has not as yet, however, been localized. 
The close relations which obtain between the sexual Hfe and the 
sense of smell lead to the supposition that, the sexual and the olfac- 
tory spheres of the cerebral cortex are in close proximity one with 
the other. The development of the sexual life has its beginnings 
in the organic sensations of the developing reproductive glands. 
A mutual dependence now arises between the cerebral cortex as 
place of origin of sensations and perceptions, and the organs of 
generation. By anatomico-physiological processes these now give 
rise to sexual perceptions, representations, and impulses. The cere- 
bral cortex, by apperceived or reproduced sensuous perceptions, 
influences the organs of generation. This influence is effected by 
the intermediation of the centres of vascular innervation and ejacu- 
lation, which are situated in the lumbar enlargement of the spinal 



The Sexual Erocii of the Menarche. 177 

cord, and are certainly in close proximity one with the other. Both 
are reflex centres. 

The psycho-physiological process embraced in the conception of 
the sexual impulse is according to von Krafft-Ehing constituted in 
the following manner : 

I. Of the central or peripherally aroused perceptions. 

II. Of the pleasurable sensations associated with these. 

Hence arises the impulse to sexual satisfaction (libido sexualis). 
This impulse becomes stronger in proportion as cerebral excitement, 
consequent on appropriate perceptions and the working of the imagi- 
nation, strengthens the intensity of these pleasurable sensations. If 
the conditions are favorable to the performance of the sexual act by 
means of which satisfaction is attained, the continually increasing 
impulse finds expression in action ; in other circumstances, inhibitory 
perceptions intervene, sexual excitement diminishes, the activity of 
the centre for erection is inhibited, and the sexual act itself is pre- 
vented. In the case of civilized humanity the ready action of such 
perceptions for the inhibition of the sexual impulse is necessary 
and decisive. On the strength of the impulsive perceptions the con- 
stitution and various organic processes have an important influence ; 
on the strength of the inhibitory perceptions, education and the 
cultivation of self-control are powerfully operative. 

Ti addition to mental influences, all forms of local irritation of 
the sensory nerves of the female genital organs and adjacent parts, 
by internal processes or external friction, serve to increase the 
strength of the sexual impulse. Among internal processes which 
stimulate the erectile centre by centripetal impulses must be in- 
cluded, the stimulus of the enlarged graafian follicle, stasis in various 
vascular areas of the genital organs in consequence of a sedentary 
mode of life, abdominal plethora from excessive consumption of 
food and stimulating drinks, and habitual constipation. External 
friction may be in the form of intentional manipulation, but it may 
be due to certain bodily attitudes or to the arrangement of the 
clothing. 

In normally constituted individuals, the sexual impulse is by no 
means constant in its intensity. Apart from the temporary indif- 
ference resulting from sexual gratification, and apart from the de- 
cline in the impulse that occurs after prolonged continence, ensuing 
after a certain reactionary intensity of desire has been happily over- 
come, the mode of life has a very great influence. The town-dweller, 
who is continually reminded of sexual matters, and continually 
solicited to sexual intercourse, is in any case more subject than the 
countryman to sexual excitement. A sedentary and sheltered mode 
of life, a chiefly animal diet, the free use of alcohol and of spices, 

12 



1^8 The Sexual Life of Woman. 

and the like, have a stimulating action on the sexual life. In the 
female, the sexual impulse is stronger just after menstruation. In 
neuropathic women this increase of excitement may occur to a 
pathological degree. Not infrequently also in the climacteric period, 
women are subject to sexual excitement due to pruritus, especially in 
those neuropathically predisposed. Magnan reports the case of a 
lady who was subject to matutinal accesses of intense erethismus 
genitalis. The same author writes of a young lady who since pu- 
berty had been subject to continually increasing sexual impulse, 
which she gratified by masturbation. Gradually it came to pass 
that the sight of a good-looking man produced violent sexual ex- 
citement, and on these occasions, since she felt herself unable to 
answer for her own conduct, she used to lock herself up in her bed- 
room till the storm had passed away. Ultimately she surrendered 
herself to any available man in order to obtain rest from her tortur- 
ing desires, but neither intercourse nor onanism gave her relief, 
so that she was finally sent to an asylum. 

As regards pathological increase of the sexual impulse, hyper- 
aesthesia sexualis, the constitution of the individual is, according to 
von .Krafft-Ehing (Psychopathia Sexualis), of great importance. He 
writes : " With a neuropathic constitution, a pathological increase 
of sexual desire is often associated, and such individuals bear for 
the greater part of their Hfe the heavy burden of this Constitu- 
tionally anomalous sexual impulse. The intensity of the sexual 
impulse may be such as to amount to an organic compulsion, and 
the freedom of the will may thus be seriously imperilled. Non- 
satisfaction of this desire may induce a true sexual heat (like that 
of lower animals), or a mental state characterized by sensations 
of anxiety, in which the individual yields to the impulse, and his 
responsibilty for his action is most questionable. Should the person 
so affected not give way to his desire, he runs the .danger, by this 
enforced abstinence, of injuring his nervous system by the induction 
of neurasthenia, or of seriously aggravating neurasthenia that al- 
ready exists, 

" Excessive sexual desire may arise either from peripheral or from 
central causes. The former variety is less common. Such cases as 
do occur, may arise from pruritus of the genitals, from eczema, or 
from substances which by their remote local action stimulate sexual 
desire, such for instance as cantharides. 

*' Sexual excitement of central origin is common in those suffer- 
ing from congenital neuropathic predisposition, in hysterical subjects, 
and in states of mental exaltation. In such cases, when the cerebral 
cortex, including the psychosexual centre, is in a state of hyper- 
sesthesia (abnormal excitability of the imagination, facilitated asso- 



Tiiii Sexual Epoch of the Menarciie. 179 

elation of ideas), not only optical and taetile sensations, but also 
auditory and olfactory impressions, will arouse lascivious per- 
ceptions. 

" Sexual hypersesthesia may be continuous, with exacerbations, 
or intermittent, and even periodic. In the last case, according to 
von Krafft-Ehing, it is either an independent cerebral neurosis, or 
else a partial manifestation of a general condition of mental excite- 
ment (mania, dementia paralytica, dementia senilis, etc.). 

Erotogenic zones, the stimulation of which leads to an increase 
in the intensity of the sexual impulse and of sexual sensibility, are 
in woman first of all and principally the clitoris, which indeed is 
said to be the only zone of this nature in the virgin state (an 
opinion held by von Krafft-Ehing and others, but certainly most 
improbable) ; next to this comes the whole of the external genitals, 
and especially the parts covered with hair ; also the vagina by friction 
and inter coitum ; finally the nipple and its areola when stimulated 
by titillation — an increase of the excitability of this region appears 
to result from suckling. 

According to Hensen, the direct stimulation of the sexual impulse 
proceeds by way of the dorsal nerve of the (penis or) clitoris; he 
assumes, however, that certain states of the reproductive glands are 
able to induce an increase in the irritability of the centres con- 
nected with the aforesaid nerves. In women it certainly appears 
that particular states of the ovary have a stimulating or inhibiting 
influence respectively on sexual excitement, so that we might ascribe 
to the ovaries the role of a regulator of the sexual impulse. The 
processes that occur in the ovary at the time of the ripening and 
rupture of the graafian follicle, and the resulting tension of the folli- 
cular wall, induce by stimulation of the ovarian nerves an increased 
sensibility of the central zones, and produce in a menstruating female 
a condition of increased sexual excitability, so that slight stimuli will 
give rise to a powerful orgasm more readily than would otherwise 
be the case, when the reflex irritability of the centre is less pro- 
nounced and the sexual impulse is consequently less intense. Still 
more than during these ordinary menstrual processes may this 
stimulation be effective at the time of the menarche, when the 
changes in the ovary occur for the first time and with the greatest 
intensity, so that at this time the individual may be especially sus- 
ceptible to sexual stimulation. 

At such times of sexual excitement, very slight external peripheral 
stimuli, in the form either of tactile stimulation of the sensory 
nerves of the skin and the external genital organs, or of stimula- 
tion of the imaginative and perceptive faculties of the brain, suffice 
to induce a powerful increase of the sexual impulse ; whereas at 



l8o The Sexual Life of Woman. 

other times, at which no particular sexual excitement exists, much 
stronger stimuli are needed to produce such an effect. Thus the 
sexual impulse in women is more readily and more powerfully in- 
creased in proportion as the central organ is in a condition of tem- 
porarily enhanced excitability in consequence of the condition of 
the ovaries. 

The gratification of this impulse, the act of copulation, produces 
the specific sensation of sexual pleasure; in the female this is 
effected chiefly by friction of the glans clitoridis, the organ when 
erect projecting downwards at a right angle, and pressing upon 
the intromitted penis — the friction of the glans produces powerful 
mechanical stimulation of the numerous plexuses of sensory nerve 
fibres, which terminate in the genital corpuscles of Krause. In 
woman, then, we find in the ovary the place of origin and the means 
of regulation of the sexual impulse, and in the clitoris we find the 
seat of the specific sensation of sexual pleasure. 

In the poorer classes of society, an increase of the sexual impulse 
occurs in women chiefly in consequence of bad example and of un- 
favorable domestic conditions, such as lead to persons of opposite 
sexes sleeping in the same bed, and also in consequence of the 
abuse of alcohol. In the well-to-do classes, it is the perusal of 
modern equivocal romances, visits to theatres, balls, and evening 
parties, and, speaking generally, idleness combined with luxurious 
living, that serve to stimulate the sexual impulse in woman. 

A certain dependence of the sexual impulse upon seasonal varia- 
tions appears to exist also in the human species. At any rate in 
certain months of the year, a definite increase in the number of 
conceptions continues to recur, which indicates that during these 
months a larger number of sexually mature individuals is engaged 
in the discharge of sexual functions. Rosenstadt regards this as the 
manifestation of a '* physiological custom," immanent in the physical 
constitution of civilized man, and inherited by him from his animal 
ancestors. He explains it in the following terms : '' Primitive man 
inherited from his mammalian forefathers the peculiarity of re- 
producing his kind only during a certain definite period, the period 
of heat or rut. After humanity had entered upon this period, copu- 
lation was effected en masse, as was easy in view of the primitive 
community of sexual intercourse before the origin of marriage. In 
the course of his progress toward civiHzation; however, man began 
to reproduce his kind indifferently throughout the entire year; but 
the original " physiological custom," in accordance with which 
reproduction occurred at definite seasons only, did not disappear, 
and persists, indeed, to a certain extent even to the present day as a 
survival of earlier mammalian life, and manifests itself in the annual 
recurrence in certain months of an increase in the number of con- 



The Sexual Epoch of the Menarche. i8i 

ceptions. The analogy in structure and function between the genital 
organs of the human species and those of other mammals (the 
female anthropoid apes do not merely exhibit from time to time a 
period of heat, but are subject to a more or less regular menstru- 
ation), which for the most part reproduce their kind only at certain 
definite periods, leads to the conclusion that in the human species 
also the sexual impulse may originally have awakened only at a 
particular season of the year, and that the persistence of this physio- 
logical custom in man, in spite of the fact that sexual intercourse 
occurs all through the year, and notwithstanding that the conditions 
necessary to awaken the sexual impulse are actually perennial, must 
be ascribed to inheritance." 

This view, which is maintained also by other gynecologists, finds 
support in Kulischer's assumption, based upon ethnological investi- 
gations, according to which coupling in primitive man took place 
only at certain seasons, namely, at spring and at harvest-time. In 
support of this view, which was held also by von Hellwdd, Kulischer 
refers to a number of actual and symbolical practices among dif¥erent 
races, which make the assumption extremely probable. 

Sexual desire in women, the sexual impulse, outlasts the proper 
sexual life, and manifests itself even after the cessation of menstrua- 
tion, when the possibility of conception has passed away ; it appears, 
therefore, to have no necessary connection with the function of 
ovulation. 

This is indicated by the always respectable number of women who 
enter upon marriage even after the climacteric age. Thus the per- 
centage of brides who were more than 45 years of age was : In 
Prussia, 2.58 per cent.; in England, 1.38 per cent.; in Sweden, 1.53 
per cent.; in Ireland, 0.31 per cent. Of quite peculiar interest are 
the figures relating to elderly women who marry men considerably 
younger than themselves. Thus we learn from the tables of Routh 
that in the space of 10 years in Ireland : 

Women between the ages of 46 and 55 years married 

Men below the age of 17 in i instance. 

Men between the ages of 17 and 25 in 35 instances. 

Men between the ages of 26 and 35 in 145 instances. 

Men between the ages of 36 and 45 in 227 instances. 

And women of ages greater than 55 years married 

Men below the age of 17 in i instance. 

Men between the ages of 17 and 25 in 3 instances. 

Men between the ages of 26 and 35 in 12 instances. 

Men between the ages of 36 and 45 in 15 instances. 

Men between the ages of 46 and 55 in 52 instances. 

In England during the year 1855 the age of the bride exceeded the 
climacteric age in 778 instances. The brides were : 

From 46 to 50 years of age in 135 instances. 

From 51 to 55 years of age in 219 instances. 



i82 The Sexual Life of Woman. 

From 56 to 60 years of age in 89 instances. 

From 61 to 65 years of age in 22 instances. 

From 66 to 70 years of age in 7 instances. 

From 71 to JS years of age in . . 3 instances. 

From 76 to 80 years of age in • 3 instances. 

In Bohemia in the year 1872 the oldest bride numbered no less 
than — 86 years. 

Bonier reports cases in which the sexual impulse remained in full 
activity after the change of life, and in some cases was rjreatly in- 
creased in intensity — these latter individuals being in a condition 
of real torment, which induced them to masturbate to obtain relief. 

The sexual impulse may be present in cases in which the ovaries 
are entirely wanting. Thus, Hauff reports the case of a young girl 
who had no ovaries, but was nevertheless excessively addicted to 
masturbation. Glih'ckc speaks of a puella publica in whom the 
uterus and the ovaries were entirely absent, but who asserted that 
she experienced during coitus active sexual sensation. Both 
Kussniaul and Piicch report similar experiences in cases of absence 
or arrested development of the uterus. 

As regards the effect on the sexual impulse of the operation of 
oophorectomy, m.ost authors state that no change occurs ; still, there 
remain many who express the opposite opinion. From the col- 
lective summary of cases bearing on this question made by Gl'dveke, 
it appears that after extirpation of the ovaries the sexual impulse 
remains unchanged in the great majority of cases, or at most is but 
slightly diminished in intensity. He gar states that he has often 
witnessed a diminution of the sexual impulse after oophorectomy, 
but that this decline is by no means constant, indeed he states that 
one of his patients assured him that in her case no decline in the 
intensity of the sexual impulse had followed the operation. Similarly 
variable reports were the experience of Sehmalfiiss. In one case 
he found there was but little sexual inclination ; in one case, dis- 
inclination ; in one case disinclination at first, followed by a return 
of inclination. Bruntzel reports that in four patients subjected to 
oophorectomy, in two cases the sexual impulse persisted, but in the 
remaining two it was extinguished. Koherle is of opinion that 
sexual inclination diminishes as a result of this operation. Peaslee, 
on the contrary, asserts that the patients remain striking examples 
of womanhood, in whom all the qualities peculiar to their sex are 
preserved. Pcan observed as a rule no difference in the sexual 
impulse to result from this operation, but he considers that the 
patients are apt to describe in exaggerated terms the amount of 
sexual feeling that remains to them. In one case, Spencer Wells 
observed after oophorectomy an increase in sexual excitability; 



The Sexual Epoch of the "Menarche. 183 

Tissier had the same experience, and this author believes that in 
these cases the sexual impulse is generally preserved. ( )n the other 
hand, Bailly observed a case, in which both ovaries were removed 
on account of new growths, where the sexual impulse at first be- 
came excessive, and then completely disappeared. Anger and 
Goodcll speak in the same sense. 

I am myself acquainted with a woman twenty-six years of age 
who in girlhood underwent oophorectomy on account of extremely 
severe nervous troubles associated with menstruation; she had not 
experienced in consequence any loss of the sexual impulse; she 
married a man belonging to the upper strata of society, and con- 
sulted me four years later to learn if she could by any means be 
rendered capable of bearing a child. Two other cases have come 
within my personal experience in which young women married after 
extirpation of the ovaries, and in whom sexual desire and sexual 
sensation were all that could be wished. 

In twenty-seven women who had undergone the operation of 
oophorectomy, Glavckc made inquiries regarding the three following 
points : First, whether the sexual impulse had been affected by the 
operation ; secondly, whether during intercourse sexual pleasure was 
experienced to the same degree as formerly ; and thirdly, whether 
during intercourse any kind of difference was observed as compared 
with pre-operative experience. He obtained the following results : 

Sexual inclination was 

Unaffected in 6 cases 22 per cent. 

Diminished in lo cases Z7 per cent. 

Extinguished in ii cases 41 per cent. 

Sexual pleasure during coitus was 

Unaffected in 8 cases 31 per cent. 

Diminished in 10 cases 38 per cent. 

Extinguished in 8 cases 31 per cent. 

In a considerable number of cases the sexual impulse was thus 
foimd by GVdvcke, not indeed to be entirely extinguished, but still 
notably diminished. In another set of cases, the sexual impulse- 
was entirely extinguished, but only in one case was there actual 
aversion to coitus. The women readily permitted intercourse when 
their husbands desired it, but remained themselves quite indifferent. 
The greater number of these women stated that the specific sensation 
of pleasure during coitus was markedly weakened, but not entirely 
lost ; in a small proportion, this sensation was completely extin- 
guished. In the case of seven women who complained that coitus 
was very painful, Gldvcke found that the calibre of the vagina was 
much diminished. In these cases, the sensation of pleasure during 
coitus was' either greatly diminished or completely extinguished. 
The women permitted intercourse very unwillingly, their unwilling- 



i84 The Sexual Life of Woman. 

ness arising, not from any actual aversion, but because they dreaded 
the pain which coitus produced. An extremely hysterical woman, 
affected with severe prolapse of the uterus, stated that every at- 
tempt at intercourse was frustrated by violent hysterical convulsions. 
The sexual impulse appears always to suffer first and most severely, 
and only after this is the sensation of pleasure during coitus af- 
fected. In a few women only, according to the experience of this 
author, was the sexual impulse quite unaffected by the removal of 
the ovaries. 

Amputation of the clitoris appears notably to diminish both the 
sexual impulse and the sensation of sexual pleasure, but the results 
of clitoridectomy for the cure of masturbation are by no means al- 
ways favorable. In the women of the Russian sect of the Skopstki, 
the clitoris, the nymphce, and a part of the labia majora are removed, 
in order to destroy sexual desire. According to Z'on Krafft-Ehing it 
is probable that in the virgin the clitoris is the only erotogenic zone, 
that is to say, that only by the stimulation of the clitoris can erec- 
tion, the orgasm, and the sensation of ejaculation be induced. It 
is probable that the vagina becomes erotogenic only as a result of 
coitus; thenceforward, however, the erotogenic significance of the 
clitoris is notably lessened, and in multiparae may entirely disappear. 

Nymphomania, An.^^sthesia and Psychopathia Sexualis. 

The sexual impulse in women is subject to morbid changes, both 
in the way of increase and of diminution, exhibiting abnormal vio- 
lent increase (nymphomania), or declining to the state of com- 
plete frigidity and sexual indifference, or, finally, manifesting itself 
in some perverse manner (psychopathia sexualis). 

Psychopathically increased sexual impulse in woman is known 
as nymphomania or uteromania. In such women there is a dominant 
state of psychical hyperaethesia, principally in the genital sphere. 
Tlie most indift'erent perceptions give rise to erotic sensations and 
to lascivious impulses. All sensory perceptions obtain a sexual con- 
tent, and induce stimulation of the cerebral cortex. All sensation and 
all activity in such unhappy beings ultimately concentrates itself in 
the act of copulation, or in some other form of sexual gratifica- 
tion, the greatest perversities of sexual practice frequently arising, 
masturbation, tribadism, and, for the most part, prostitution, even 
in the case of married women. 

The nymphomaniacal woman, says von Kraift-Ehing, endeavors 
to allure men by means of exposure of the genital organs or indecent 
gestures ; the sight of man produces intense sexual excitement, which 
is gratified by masturbation or by stimulatory movements of the 
pelvis. According to this author, nymphomania is not very infre- 



The Sexual Epoch of the Menarciie. 185 

quent at the climacteric period ; it may even occur in old age. Ab- 
stinence in association with simultaneous excitement of the sexual 
sphere by mental or by peripheral stimuli (pruritus pudendi, oxyuris, 
etc.), niay induce these states, probably, however, only in those 
hereditarily predisposed. 

The history of antiquity contains records of the corrupt practices 
of nymphomaniacal empresses. Tlius, Messalina furnishes a well- 
known historical example of the abnormal violence of a pathologi- 
cally intensified sexual impulse in woman. She was given the agno- 
men of invicta, having received the embraces of fourteen athletes. 
Pliny says of her, die ac nocte superavit quinto ct vicessimo con- 
ciibitu; and Juvenal writes of her the verses, 

tameii ultima cellam 

Clausit, adhiic ardens rigidae tintigine vulvae 
Et resupina jacens multorum absorbuit ictus 
Et lassata viris, necdum satiata, recessit. 

In corrupt Rome, Messalina was not the only woman necdum 
satiata, ever insatiable ; we need only refer to the orgies of an Ag- 
gripina, a Livia, a Mallonia, or a Poppsea ; and Seneca hurls against 
the women of his day the reproach, adeo perversiim coninientcB genus 
impudicitice viros ineunt. And of Cleopatra, the beautiful Egyptian 
queen, Marcus Antonius writes in a letter to his physician, Soranus, 
that she had such violent sexual desire as to lead to her having 
connection in a brothel with 106 men. 

Through the report of Herodotus it is well known that the pyramid 
of Cheops was built by the numerous lovers of the daughter of 
this king, who raised this enormous monument in recognition of 
the innumerable times she had yielded herself to their desires. On 
record also are the sexual excesses of the Roman ladies at the festival 
of Saturn, the festival of the Bona Dea, and the festival of Priapus ; 
indeed, many of these women allowed themselves to be debauched 
in the temples (Ploss and Bartels). 

But returning to the present day, both gynecologists and alienists 
record numerous cases of great pathological increase in the in- 
tensity of the sexual impulse in women. According to Lonihroso, 
such continued ardency of sexual desire occurs chiefly in women 
with an inherited tendency to crime and to prostitution, whose 
natures exhibit a commingling of lasciviousness with barbarism. 
He gives examples of such women, one of w^hom surrendered her- 
self to her husband's laborers ; another had as her lovers all the 
desperadoes of Texas ; a third had intercourse with all the herdsmen 
of her village ; a fourth, though her husband occupied a good 
social position, led the life of a prostitute; a fifth, a cultured and 



i86 The Sexual Life of Woman. 

intelligent woman, entertained a common bricklayer, and wrote 
to him letters full of shameless declarations of her sexual passion ; 
further he writes of a series of criminals, in whom, indeed, increased 
sexual desire is a common phenomenon; one of these, a thief, ex- 
perienced sexual excitement at a mere glance at a good-looking man ; 
a murderess, in whom lascivious feeling induced masturbation when- 
ever she saw a man, and who made experiments in sexual inter- 
course with dogs ; another, who often took to bed with her, in ad- 
dition to her son, three or four men selected at random from the 
streets; and many others. Jolly reports the case of a widow, a 
celebrated lionnc of the dcmi-v.ionde, who kept in her desk, side by 
side with devotional literature, a number of lascivious books and 
preparations of cantharides, and entertained quite a number of 
powerfully-built lovers drawn from the lowest canaille. 

In hysterical women the sexual impulse is frequently excessive, 
and may increase to such a degree as to produce hallucinations of 
coitus ; sometimes, on the other hand, the impulse is extinguished, 
or ps3xhopathically metamorphosed, passing in a most paradoxical 
manner from sexual frigidity to lascivious reflections and continuous 
occupation with sexual afifairs ; not uncommon in such women are 
false accusations of indecent assaults of which they assert them- 
selves the victims. 

Lombroso gives several examples of the increase of the sexual 
impulse in hysterical women : *'A hysterical girl visited a physician, 
and said to him : * I am still a virgin, take me ;' she submitted him 
to the utmost extremity of provocation, and asserted afterward that 
she had been violated/ Another hysterical subject, a rich young 
lady, met a workman in the street, ofifered herself to him, was ac- 
cepted, and when she returned home related the affair with laughter. 
A third sought men from the street in order to find one suffering 
from syphilis, her object being to infect her own husband with the 
disease." 

According to the observations of Schillc, young married, hysteri- 
cal women not infrequently run away with a waiter during the 
honeymoon journey. This author also points out that in women 
moral insanity is especially apt to manifest itself during the first 
years of married life. Many advocate a far-reaching libertinism, 
and threaten to enter a brothel. In these forms we observe, in 
addition to ill-temper and malignity, especially obscenity and 
tribadism. 

Such a case, observed by Giraud and quoted by von Krafft-Ehing, 
is the following: Marianne L., of Bordeaux, during the night, 
while her master was sleeping soundly urfder the influence of nar- 
cotics she had administered, was in the habit of giving up her 



The Sexual Erocii of the Menarche. 187 

master's children to her lover for his sexual gratification, and made 
them witnesses of the most immoral scenes. It appeared that L. 
was hysterical, suffering- from hemianaesthesia and convulsive 
seizures, and that before her illness she had been a sensible and 
trustworthy individual. After the illness, however, she prostituted 
herself in the most shameless manner and completely lost her moral 
sense. 

Galoi relates of his own mother that she suffered from nympho- 
mania, and that in the attacks she bit her female slaves like a wild 
animal. 

As a negative aspect of the sexual impulse in woman we must 
regard the absence of the impulse, or anaesthesia sexuaHs, and also 
the deficiency of the sensation of pleasure during the act of copula- 
tion, or dyspareunia. 

Of dyspareunia we shall speak more at length later, in connec- 
tion with the pathology of copulation. As regards the entire lack of 
the sexual impulse, however, in women whose genital organs are 
normally developed and normal in the performance of their functions, 
and whose cerebral condition is also normal, we must consider such 
lack an extremely rare condition, if indeed it ever occurs. It is 
only in cases in which the fenlale genital organs are wanting, 
wholly or to a considerable extent, or in which there are important 
cerebral disturbances or states of mental degeneration, that the 
sexual impulse is wanting. 

Normally, in the young, sexually unspoiled girl, the sexual in- 
stinct^^ slumbers in the cerebral cortex, but becomes active, as sen- 
sation, perception, and impulse, as soon as the cerebral centre has 
been aroused by mental impressions or by physical peripheral stimu- 
lation of the genital organs and their environment. Among stimuli 
of the latter class must be reckoned the menstrual stimulus, set 
on foot by the developmental processes of puberty. These stimuli 
arouse in the cerebral cortex sensations and perceptions which, ris- 
ing to specific sexual feelings, produce an impulse to increase the in- 
tensity of these feelings by purposive action ; thus is awakened the 
sexual impulse, the strength of which is extremely variable. 

Only when the cerebral cortex, as the place of origin of sensa- 

^^ It seems expedient to point out that whilst in this work the German word 
Gcschlechtstrieh has in the great majority of cases been rendered in English 
by the term sexual impulse, on two or three occasions, as here, the author 
speaks of the Geschlechtstrieb as composed of sensation, perception, and im- 
pulse (Drang) , when for obvious reasons the rendering sexual instinct be- 
comes necessary. Though the term sexual irdpulse is, T think, in more gen- 
eral use than the term sexual instinct, it must not be forgotten that the 
inclination towards sexual congress is composite in nature, and that an 
impulse in the strict sense of the term is only one element in its com- 
position. — Tr. 



i88 The Sexual Life of Woman. 

tions and perceptions, fails to perform its functions in the manner 
just described, or when the anatomico-physiological processes in 
the genital organs which normally act as peripheral stimuli fail to 
occur, or when there is a failure in the conducting tracts, are sexual 
perceptions and impulses lacking. Such anomalies may be con- 
genital. A milder form is that, likewise congenital, in which a 
woman has a sexually "cold nature;" in these cases the sexual im- 
pulse is not completely wanting, but it is so slight in intensity that 
it can be awakened only by very powerful stimuli, and in her normal 
state the woman so affected is quite free from any wish for sexual 
gratification. 

Such congenital subnormal intensity or entire lack of the sexual 
impulse may be due to very various causes. According to von 
Krafft-Ehing, these causes may be organic or functional, mental or 
physical, and central or peripheral. The decHning intensity of the 
sexual impulse with the advance of years, and the temporary dis- 
appearance of that impulse after the sexual act, are both physiological 
occurrences. Education and mode of life have a marked influence 
on the intensity of the vita sexualis. Strenuous mental activity, 
earnest study, severe physical exertion, mental depression, and sexual 
continence, notably diminish the excitability of the sexual impulse. 
At first, indeed, abstinence leads to an increase in the intensity of 
the impulse, but sooner or later the functional activity of the organs 
of generation declines, and therewith also the intensity of the sexual 
impulse. As peripheral causes of diminution or disappearance of the 
sexual impulse, von Krafft-Ehing mentions oophorectomy, degenera- 
tion of the reproductive glands, marasmus, sexual excess, whether in 
the form of coitus or of masturbation, and alcoholism. In like man- 
ner is to be interpreted the disappearance of the sexual impulse in 
general disorders of nutrition (diabetes, morphinism, etc.). 

A decline ni the intensity of the sexual impulse in consequence of 
degeneration of the conducting tracts, is found, according to von 
Krafft-Ebing, in diseases of the brain and the spinal cord. Central 
affection of the sexual impulse may be due to organic disease of the 
cerebral cortex (dementia paralytica, general paralysis of the insane, 
in the later stages), or it may be due to functional disorder, such 
as hysteria, or to mental diseases (melancholia or hypochondriasis). 

Finally, in some instances, the sexual mipulse in women manifests 
itself, not in the normal manner with copulation with the male as its 
goal, but in a form demanding some abnormal kind of gratification 
(psychopathia sexualis), whether it be because sexual intercourse 
with the male afifords the woman no enjoyment, or simply because 
no opportunity exists for such intercourse. 

Masturbation is very frequent; the habit having been acquired 



The Sexual Epoch of the Menarche. i8g 

from bad example by the ^irl during the menarche, it is sometimes 
contiiuied by the wife during married hfe. In these cases we often 
find (hslinct changes in the genital organs, such as hypertrophy of 
the clitoris, enlargement and bluish discoloration of the nymphse, 
retroversion of the uterus, tenderness and displacement of the ovaries, 
considerable vaginal discharge, and sometimes menorrhagia. 

Kiissjiiaul draws attention to the connection between masturbation 
and nymphomania, on the one hand, and imperfect development of 
the uterus and the other genital organs, on the other. Campbell 
records the case of a woman addicted to masturbation, who had 
never menstruated, and who, in addition to imperfectly developed 
genital organs, had a dermoid cyst of the ovary. In a young woman 
who indulged in masturbation, Aran found that the uterus and its 
annexa were imperfectly developed. Vaddingfon also describes a 
case of abnormal sexual impulse which was associated with absence 
of the uterus. 

Troggler reports the case of a woman twenty years of age, who 
had been six months married to a healthy, potent man, was herself 
healthy and blooming, with a good family history, and had never 
suffered from any severe illness. At the age of thirteen she had 
learned to masturbate, effecting this by stimulation of the clitoris. 
Now she found no gratification in coitus, so that she continued to 
masturbate, and during coitus obtained satisfaction by manual fric- 
tion of the clitoris. Examination showed that the clitoris was strik- 
ingly large, the vagina flaccid, and that there was some vaginal dis- 
charge ; in other respects the genital organs were normal. 

Not infrequent, it may be in those whose mental condition is in 
other respects fairly normal or it may be in psychopathic subjects, 
is the existence of contrary sexual sensation, or sexual inversion, a 
condition which has been described by Casper, Westphal, von 
Krafft-Ehing, and Moll, and has indeed been well known since the 
days of antiquity. In the case of a considerable number of notable 
women, homosexual practices have been recorded. According to 
the observations of CofUgnon, in Paris the homosexual instinct, 
when occurring in other women than prostitutes, is found chiefly 
among the ladies of the aristocracy. 

Of homosexually inclined women, some engage in the practice of 
tribadism, familiar to the ancient world, and recorded by Martial in 
a satire, in which sexual gratification is obtained by mutual friction 
of the genital organs, or by penetration of one woman's clitoris into 
the vagina of the other; whilst some indulge in the amor leshicus, 
in which gratification is obtained lambendo lingua genitalia, a very 
ancient practice indeed, transported from Phoenicia to Greece (where 
in especial it was indulged in by the women of Lesbos), and later 



190 The Sexual Life of Woman. 

from Syria to Italy, where it was widely diffused among the Romans 
of the imperial age. Sappho, celebrated as the tenth muse, is sup- 
posed to have been addicted to the practice of Lesbian love. 

All such homosexual (female) individuals are, then, endowed with 
the perverse instinct toward sexual connection with women instead of 
with men. In such cases, the genitals are usually quite normal ; 
sometimes, however, the woman thus affected is markedly of a male 
type, being called by z'on Krafft-Ebing a gynandrist, the affection 
itself being termed gynandry ; when the woman concerned not only 
possesses a homosexual impulse, but also in other respects exhibits 
tendencies properly characteristic of the male sex, she is called virago, 
and the affection is termed viraginity. 

I had under my care such a woman, belonging to the upper cir- 
cles of society, who had been married sixteen years before, had 
lived a married life for six years (during which she remained bar- 
ren), and had then separated from her husband. She was of a 
very masculine disposition, smoked, gamed, drank like a student, 
and preferred to wear men's clothing, and she bestowed her affec- 
tions on a female companion. Examination of the genital organs 
disclosed no abnormality beyond a slight vaginal catarrh. Menstru- 
ation was regular, and the general appearance showed no departure, 
with the exception of a slight moustache that shaded the upper lip, 
from that of a normal feminine beauty. 

Mantegazza is of opinion that in the case of many unhappy mar- 
riages, in which the source of the unhappiness is obscure, the trouble 
is to be found in the homosexual inclination of the wife. Martineau 
and Moll report that married women who are homosexually inclined, 
indulge in sexual intercourse with other women behind their 
husbands' back. Diihoussct, at a meeting of the Anthropological 
Society at Paris in 1877, related the almost incredible case of a 
married homosexual woman who, in intercourse with another 
woman, transferred to the latter her husband's semen, so as to 
induce pregnancy. 

Many writers on forensic medicine, Tardieii, Pfaff, Schauenstein, 
Wald, and Mantegazza, for instance, have recorded that in numer- 
ous circles of European society women practice masturbation and 
tribadism (sodomy, so called) with dogs and monkeys; and Phi- 
tarch's statement is well known regarding Egyptian women and the 
sacred goat, Mendes, that the women who were locked in with this 
animal practiced sodomy therewith ; and again it is asserted that 
the serpents in the temple of ^sculapius and also in private houses 
were employed in the practice of sodomy. 

Von Maschka records a case which came before the courts a few 
years ago in Prague, in which a woman forty-four years old con- 



The Sexual Epoch of the Menarche. 191 

fessed that '' in consequence of the very ardent temperament she 
possessed, she had, perhaps, as often as six times indulged herself 
with her house dog, which jumped between her legs and licked her; 
that she took the animal between her bare legs, stroked its belly 
until its penis became erect; then, supporting herself on the back 
of a chair, she pressed the animal against herself, introduced its 
penis between her labia majora, and let it continue its movements 
until its semen had been ejaculated." Examination of the genital 
organs of this woman disclosed no abnormality. 

Schauenstein reports the case of a girl who carried out unchaste 
practices with a little dog to an utterly immoderate extent, so that 
after the lapse of some years she died in an asylum. In a case re- 
corded by Wald, a maid servant was observed in lewd practices with 
a poodle ; she supported herself on elbows and knees, while the dog 
copulated with her from behind. 

A woman about thirty years of age, who had lived with her hus- 
band in sterile marriage for nine years, complained to me that she 
had not for a long time had sexual intercourse, since during copula- 
tion she not only experienced no sexual pleasure, but actually felt 
a loathing to the act; on the other hand, she was subject to an un- 
controllable impulse to handle the genital organs of children, both 
of the male and of the female sex, and this performance gave her 
sexual gratification ; during the menstrual period, this impulse over- 
powered her will. Local examination in this patient showed that the 
uterus was enlarged and retroflexed, and that there was anaesthesia 
of the vagina. 

Anjel reports the following case of periodic psychopathia sexualis, 
associated with menstruation. A lady of quiet disposition, near the 
climacteric. Serious congenital predisposition. During youth suf- 
fered from attacks of minor epilepsy. Married, but childless. Sev- 
eral years ago, after violent emotional disturbance, she had a 
hystero-epileptic seizure, followed by post-epileptic mania lasting 
several weeks. Thereafter, insomnia for several months. As a 
sequel, continually recurrent menstrual insomnia, accompanied by an 
impulse to embrace boys under ten years of age, to kiss them, and to 
handle their genital organs. Impulse toward coitus, to close sexual 
contact with a grown man, non-existent at this time. The patient 
often speaks openly of her morbid impulse, and begs that she may 
be supervised, as she feels unable to answer for her own conduct. 
In the intervals, however, she carefully avoids all reference to the 
matter, is strictly decent in her conduct, and in no way sexually 
ardent. 

Tribadism is frequently mentioned by the writers of classical 
antiquity, especially by those of Greece, where the cult of naked 



192 The Sexual Life of Woman. 

beauty encouraged sexual excitement of this character. This form 
of unchastity was common among the flute-playing girls of Greece, 
and at the secret festivals of such associates Aphrodite Peribasia was 
invoked. Liician, in his dialogues of hetairai, depicts the intensely 
passionate nature of these homosexual unions between girls. Lom- 
broso reproduces Juvenal's description of such a love-feast. " When 
the flute calls to the dance, the maenads, inflamed "with wine and 
beer, loosen their long tresses, they sigh languishingly and eagerly, 
and an ardent desire draws them one to another, the desire and the 
passion of the dance gives their voices an alluring sound; nothing 
now can serve to bridle their unrestrained desires. Lacasella swings 
her wreath, which she has w^on in the contest of lascivious gestures 
and movements, but even she must give way before Aledullina with 
her ardent postures. About these games there is no trace of un- 
reality, and the most rigid Spartan, hardened from the very cradle, 
even old Nestor himself, notwithstanding his hernia, could not fail 
to be stimulated by such an inflammatory spectacle." 

In the present day, also, the practice of tribadism is more widely 
diffused than people in general imagine. I have often encountered 
instances of it in ladies of good position, who were past their first 
youth, who would not or could not marry, and who undertook 
extensive and long-enduring journeys with a female '' companion," 
of similar age, or perhaps a little younger. Their erotic needs, which 
could not be gratified in normal fashion, led to this sexual per- 
version — a tendency observable especially in persons with neuro- 
pathic predisposition, or with a liability to hysteria or to epilepsy. 
Sometimes such girls, even before puberty, show an inclination to 
wear boys' clothes, to avoid all feminine manual occupations, and 
to examine and to handle the genital organs of their playmates. 
Even_ after puberty, such tribadists like to make a parade of mascu- 
line attitudes, they have their hair cut short, wear clothes of a 
masculine cut, smoke a great deal, and show in their conversation, 
and still more in their letters, great exaltation of the passions. It 
not infrequently happens that an elderly lady who has lived well in 
her day, and from youth upward has had much intercourse with 
men, comes at last to lament her worthlessness to men, and from 
this proceeds to the idea of obtaining sexual enjoyment by means 
of tribadism. The tribadistic union sometimes lasts for several 
years, but in most cases the alliances are quickly and frequently 
changed. 

According to Taxi!, tribadism is fairly common among the mar- 
ried women of Paris, and in upper-class women is extremely preva- 
lent. This author describes with what industry and perseverance 
many elderly tribadists endeavor to win for themselves and to seduce 



The Sexual Epoch of the Menarche. 193 

young girls, just as old women often work hard to gain money 
for the enjoyment of the favored person. 

In these unions, according to the descriptions of Lomhroso, very 
remarkable phenomena occur. A particular jargon arises with ten- 
der designations for this or that bodily beauty; a violent jealousy 
develops, and a newly united pair keep together as much as possible 
for fear of losing one another's affection ; the " friends " tread 
always in one another's footsteps. This author rightly points out 
that the very numerous romances describing relations of this kind 
prove the diffusion of this vice in '' high life." Novels of this class 
are referred to by Mantegazza in his book, '' Woman as Criminal and 
Prostitute." He mentions : Diderot, '' La Religieuse ;" Balzac, '' La 
Fille aux Yeux d'Or;" Gautier, "Mademoiselle de Maupin ;" 
Fcydcau, " Le Comtesse de Cholis ;" Flaubert, "Salammbo;" Belot, 
" Mademoiselle Giraud ma Femme ;" Willhraud, '' Fridolins Heim- 
liche Ehe;" Graf Stadion, ''Brick and Brack;" Sacher-Masoch, 
" Venus im Pelz." Zola, also, in " Nana " and " La Curee," and 
Butti in " L'Antona," make some reference to this matter. 

Sauval relates of the dissolute life at the court of the French 
king, Francis I, that the women learned also to play the part of 
men ; a princess had a hermaphrodite maid-of-honor, and the court 
and all Paris gossiped about the Lesbian-loving ladies, whose hus- 
bands were delighted, since they were thus quite freed from jealousy, 
and prized their wives above all on this account. Such a mode of 
life was so pleasing to many ladies that they refused to marry, and 
refused also to allow their " friends " to marry. 

Tribadism is very common among prostitutes. According to 
Parent-Duchatelet, tribadism begins only after prostitution has long 
been practised, between the twenty-fifth and the thirtieth year of 
life; generally there is a notable difference in age and also in beauty 
between the two women forming a tribadistic alliance, and as a rule 
the younger and prettier of the pair is the more passionately sensi- 
tive and the more constant. Parent-Duchatclct endeavours to ex- 
plain the origin of tribadism by referring to the manner in which in 
brothels and reformatories the women are closely packed together, 
to the enforced abstinence from normal sexual intercourse (in 
prisons and reformatories), to the loathing for men sometimes felt 
by prostitutes, and to the opportunities for mutual observation of 
the most intimate nudities. Even women who at first object to it 
most vehemently, commonly give way to this vice after eighteen or 
twenty months. 

Among 103 prostitutes examined by Lomhroso, he found tribadism 
to be practiced by five. He considers the principal cause of tribadism 
to be in the lascivious search for new and unnatural pleasures, and 

13 



194 



The Sexual Life of Woman. 



quotes in illustration the characteristic remark of Catharine II, her- 
self a tribadist, " Why did not nature endow us with a sixth sense? " 
Female criminals who seduce others to the practice of tribadism 
have usually themselves acquired the vice during a long term of 
imprisonment — it is, in fact, the long-sentence criminals, women 
with a congenital inclination toward crime, that incline also to un- 
natural vice. The influence of environment is, according to Lorn- 
hr.oso, indicated by the fact that the most confirmed criminals, in 
prisons for women, corrupt in this manner so many of the inmates 
who are merely '' criminaloids," and corrupt even the wardresses. 
Further, he is led to conclude, the confinement in close association 
of so many extremely sensual and prostituted women, leads to the 
origin of a kind of ferment of new lascivious desires, and causes an 
increase of one form of degeneracy by means of another. Prosti- 
tutes often see one another naked, sleep two or three together in 
the same bed; similar things occur in boarding-schools. In asylums 
also we m.2iy observe that the admission of a tribadist will result in 
the infection of all the inmates with this vice. 

According to Moll's estimate, 25 per cent, of the prostitutes of 
Berlin practice tribadism. According to the experience of this 
author, in cases in which tribadists live in concubinage, one of them 
is always a prostitute; the active and the passive role are always 
played by the same respective members of the alliance; the active 
member is called '* papa " or " uncle," is usually a prostitute, and, 
like the man in the married state, possesses great comparative free- 
dom in sexual matters, whilst the passive member, the *' mother," 
is not allowed to form any sexual relations outside the concubinage. 

According to Riccardi, many frigid prostitutes practice with pleas- 
ure clitoris-masturbation, cunnilictio, and, especially, sapphism, pre- 
ferring these perversions to the normal sexual act. Moreover, 
among prostitutes and female criminals there is no lack of lovers 
of martyrization, of flagellation, even to the drawing of blood, of 
tyrannical treatment, and of the initiation of children into the 
mysteries of sex. 

[For a detailed account of Sadism and Masochism, see voii 
Krafft-Ebiiif/s " Psychopatbia Sexualis. 'These particular perver- 
sions, common in men, are rare in women ; hence but passing allu- 
sion is made to them in the present work.] 

Lonihroso records on account of its rarity a case of masochism 
observed by him in a woman thirty-five years of age, who liked being 
whipped. 

Moraglia reports a remarkable instance of sexual perversion in a 
girl of eighteen, who preferred to coitus, masturbation associated 
with the stimulating influence of the odor of male urine ; this peculiar 
form of irritability was so powerful as to drive the girl to mastur- 



The Sexual Epoch oe the Menarche. 195 

bation in public urinals, notwithstanding the risk of arrest, which 
indeed often occurred. 

According- to Carlier, there are four or five brothels in Paris 
which are not infrequently visited by rich ladies in search of triba- 
distic enjoyments, and ladies of '* high life " assemble there for 
communal orgies ; it is noteworthy that prostitutes surrender them- 
selves for such purposes to these women who are outside their own 
circle with great reluctance, and only for a very high fee. 

Speaking generally, however, sexual perversion is rarer and 
less intense in women than in men. This fact is explained b}- 
Lonihroso on the ground that the erotic element in women's nature 
is less active, and that women are less often affected by epilepsy, 
the principal source of these anomalies. In cases in which the 
genital organs are healthy we must, with IVestphal, conclude, with 
reference to contrary sexual sensation, that the abnormal sexual 
feelings have a cortical origin. 

From von Maschka's elaborate account of unnaitural offences, in 
his Handbook of Forensic Medicine, we abstract the following pas- 
sage relating to the female sex : '' Lascivious procedures liable 
under certain circumstances to legal punishment may consist : 
I. In handling or other rhanipulation of the genitals, without actual 
intercourse. If the genital organs of a female have merely been 
gently handled, without any more violent manipulations, we shall 
not, as a rule, either in the case of children or of adults, find any 
local changes as a result ; contrariwise, if the handling has been 
rough and brutal, if the fingers have been forcibly thrust within 
the vulval cleft, or if the pudendum has been pulled and rent, we 
may expect to find excoriations, redness, swelling, laceration of the 
hymen, or even of the vagina and the perineum. 2. In licking the 
female genitals (cunnilingere). An analogous process also effected 
by members of the female sex, whether children or adults, is 
irriimare, id est, penem in os arrigere; fellare, id est, vel lahiis vel 
lingua perfricandi atqiie exsiigendi ofUciuni penis prccstare. 3. In 
introduction of the membrum virile into the rectum, either of chil- 
dren or of adults, paederasty. That this form of sexual gratification 
is not infrequently practiced upon women has been pointed out 
especially by Parent-Duchatclet, and is asserted by von Maschka 
from personal knowledge of cases in which it has occurred. 

Tribadism and Lesbian love, unnatural vice practiced by two 
individuals of the female sex, occur, according to von Maschka' s 
description in the following manner: a.) By masturbation, either 
one person gratifying the other by manipulation, or mutual mastur- 
bation. In a case of this kind recorded by Tardicu, a wife still 
young repeatedly, and by day as well as by night, introduced her 



196 The Sexual Life of Woman. 

finger deeply into the vagina or the rectum of her Httle girl, moving 
it about there sometimes for as long as an hour. According to the 
child's account, the mother herself at these times was in a con- 
dition of excitement, no doubt sexual, which she gratified in this 
manner. In another case, several older girls engaged with their 
own fingers and tongues in lascivious practices with the genital 
organs of a little girl of seven. According to Krausold, among 
female prisoners such " forbidden friendships " are extremely com- 
mon, formed for the purpose of mutual masturbation, and in con- 
nection with which the bitterest jealousy and the most ardent love 
are exhibited, h.) With the assistance of an enlarged clitoris, 
with which one woman performs the sexual act by introducing the 
organ within the vagina of another. In France in the nineteenth 
century a woman is said to have lived whose genital organs were 
so formed that, on the one hand, as a woman she played the passive 
part in intercourse with men, and, on the other hand, was able to 
give sexual gratification to women by assuming the active part of 
the male, r.) By the employment of an artificial memhrum virile. 
This mode of obtaining satisfaction of sexual desire was known 
already to the ancients, and such a priapus was by the Greeks termed 
oXtado^, The fact that such articles are manufactured and sold, 
affords sufficient proof that their use is not imknown in our own 
day. Von Maschka describes such priapi as being made of india 
rubber, of the size and shape of an erect penis, perforated longi- 
tudinally and fitted at the lower end with a testicle-like attachment, 
to be filled with warm water or milk, so that by squeezing it an 
ejaculation can be counterfeited. This priapus is also so constructed 
that it can be attached to the body by means of a girdle and can 
thus be employed for the gratification of another individual. 

We have already referred to sodomy, unnatural intercourse with 
the lower animals. Von Maschka gives several instances of this, 
which we have previously, mentioned, and states also that some 
years before, during his stay in Paris, a female was accustomed to 
hold a secret exhibition, the entry to which cost ten francs, and at 
which she had sexual intercourse with a bulldog trained for the 
purpose. 

According to Lornhroso, even at the present day, the inmates of 
licensed brothels frequently hold exhibitions, for admission to which 
a fee is charged, of tribadistic couples in poses plastiqiies, and of 
another prostitute in coitus caninus. 

In his widely-celebrated work on Psycho pathta Sexualis, von 
Krafft-Ebing discusses these morbid sexual processes in women. 
We select certain data from his exposition. Regarding the con- 
genital morbid phenomenon of the lack of sexual feeUng in women, 



The Sexual Epoch of the Menarche. 197 

as contrasted with perversion of sexual feeling, and the sexual 
impulse toward an individual of the same sex (antipathic sexual 
feeling-), ron Krafft-Ebing writes: "The woman-loving woman 
feels herself sexually to be a man, she rejoices in the exhibition of 
courage, of masculine sentiments, since these characteristics make 
the man desirable to the woman. Ihe female iirning,^^ therefore, 
hkes to have her hair cut short and her clothes of a masculine cut; 
and one of her greatest pleasures is when opportunity offers to 
appear in male attire. Her ideals are notable feminine personalities, 
distinguished by spirituality and energy; in the theatre and in the 
circus, it is only the female performers that attract her interest; 
and in the same way, in collections of pictures and statues, it is 
only the representations of women that awaken her aesthetic sense 
and her sensibility." Von Krafft-Ebing insists that in nearly all 
cases of antipathic sexual feeling in which a family history was at- 
tainable, that history was found to exhibit instances of neuroses, psy- 
choses, stigmata of degeneration, etc. In hysteria, according to 
this author, the sexual life is especially often abnormal ; in cases 
with neuropathic inheritance, one may say always : ''AH possible 
anomalies of the sexual functions occur in such cases, with the 
utmost variety and the strangest commingling, based upon heredi- 
tary degenerative processes, and accompanied by moral imbecility 
in its most perverse manifestations. * * *. Frequently, in hys- 
terical subjects, the sexual life is morbidly excitable. This excite- 
ment may be intermittent (? menstrual). Shameless prostitution 
may result, even in married women. In cases of a milder type, the 
sexual impulse is exhibited in the form of onanism, nude perambu- 
lations about the room, wearing of male attire, etc. In cases of 
hysterical mental disorder, the morbidly excited sexual life may 
manifest itself in the form of maniacal jealousy, baseless complaints 
against men of indecent assault, hallucinations of coitus, etc. Some- 
times there may be frigidity, with lack of sexual pleasure, commonly 
due to genital anaesthesia." 

Incest in women, dependent upon psychopathic causes, is also 
alluded to by von Krafft-Ebing; it occurs in those in whom a partial 
imbecility that leaves the sense of modesty undeveloped is combined 
with eroticism. Thus, a case reported by Schilrinayer is mentioned, 
in which a mother had, or attempted, intercourse with her son, 
aged five and one-half years ; and again a case reported by Lafarque, 
in which a girl of seventeen laid her thirteen-year-old brother on 
herself for the gratification conjunctionis membroruni, while simul- 

35 This word urning, used to denote individuals exhibiting this particular 
type of homosexuality, belongs to the terminology now generally adopted by 
writers on sexual pathology, and has been used by English writers on the 
subject — Havelock Ellis, for instance. 



1^8 The Sexual Life of Woman. 

taneously masturbating her brother; Magnan's case, an unmarried 
woman twenty-nine years of age, who could hardly resist the impulse 
toward copulation with her nephews as long as they were quite 
young; Lc grand's cases, in one of which a girl fifteen years of 
age seduced her brother to the performance of all possible sexual 
excesses on her body; another, a married woman aged thirty-five, 
who committed incest with her eighteen-year-old brother; and a 
third, a mother aged thirty-nine, who committed incest with her son. 

According to Moll, women who suffer from antipathic sexual sen- 
sation are, in many cases, married ; it appears, however, that for 
the most part they have no inclination to marry. In isolated cases 
there may exist a psychical hermaphroditism, the woman thus 
affected having sexual inclination both towards men and towards 
women. In the case of homosexual women, normal intercourse 
appears not to furnish complete satisfaction. As regards fetichistic, 
masochistic, and sadistic inclinations on the part of women with an- 
tipathic sexual sensation, JMoll was unable to obtain any trustworthy 
information. Sometimes in women the perverse sexual impulse 
appears periodically, being then often associated with the appearance 
of other psychical abnormalities. In some women the perverse 
impulse is especially active at the menstrual periods ; whilst at other 
times these subjects, even though not quite sexually normal, are 
still very much quieter. Antipathic sexual sensation in women may 
depend upon inherited predisposition, and may often be traced back 
to a very early age. In many cases an exciting cause may be 
demonstrated. 

Mantcgazza, who relates that homosexual practices are common 
among the inmates of harems, believes that antipathic sexual feeling 
is readily curable in women soon after marriage, but that later a 
cure is rare. 

A perverse form of sexual gratification sometimes met with in 
women is flagellation. By chastisement with birches, straps, or whips 
on the bare buttocks, the nerves of the sexual apparatus are stimu- 
lated, and these organs become congested, with an effect resembling 
that of onanism. Such flagellation was practiced by the wanton 
ladies of ancient Rome. In the Middle Ages, hysterical women 
derived great pleasure from the stimulatory effect of whippings. 
It is reported of Catharine de Medici, that she had herself whipped, 
and that she delighted in seeing the ladies of her court undergoing 
similar treatment. In the present day many women derive intense 
sexual pleasure from being birched by their lovers on bared portions 
of their bodies. In Paris and other large towns there are special 
places of resort for those who pursue this form of perverse sexual 
gratification. Sometimes such women are only the active fouet- 
teuses for worn-out, perversely-feeling men. 



The Sexual Epoch of the Menarche. 199 

Among the Greeks, a woman who had remained barren during 
the early years of marriage would visit the temple of Juno, in order 
to receive from a priest of Pan the gift of fertility. She stripped 
naked, and, while thus exposed to the flagellant priests, she received 
all over the back of her body numerous blows inflicted with thongs 
of a he-goat's hide — this process being supposed to induce fertility. 
The object of this form of flagellation would appear to be to induce 
an increase of sexual desire. 

Sexual neurasthenia is defined by Eiilcnburg as a neuropsychosis 
of chronic course, manifesting itself chiefly in the form of excessive 
irritability of the sensory and psychosensory neuron-systems, in 
association with excessive tendency to exhaustion of the motor and 
psychomotor neuron-systems. This exhaustion occurs especially In 
relation to the genital system, in which we see exhibited the phe- 
nomena of irritable weakness, of increased excitability combined 
with increased tendency to fatigue of the genital nerve apparatus — 
such chronic morbid disturbances are, according to this author, com- 
paratively rare in women, that is to say, the developed typical picture 
of the disease does not occur in women, or occurs very rarely. 
Among 168 patients suffering from sexual neurasthenia, only six 
were women. Two of these latter were addicted to masturbation, 
and in the anatomical sense both were still virgins ; the rest were 
married women, not receiving suflicient sexual gratification in their 
married life, two of these were probably also addicted to mastur- 
bation, two indulged in homosexual practices. 

Onanism, according to Eidenhurg, is the cause of sexual neuras- 
thenia in women as well as in men. If, however, among the relatively 
very large number of women addicted to masturbation, there appears 
to be such a very small proportion of instances of sexual neuras- 
thenia, this depends on the fact that from the nature of onanism in 
women the physical and also as a rule the psychical consequences are 
as a whole apt to be much less severe than those arising from similar 
practices in men ; but it depends also on the circumstances that 
neuromental abnormalities of other kinds and denoted by other 
names, such as dyspareunia, vaginismus, sexual hysteria, nympho- 
mania, feminine sadism, and tribadism, are apt to arise in conse- 
quence of onanism. As regards onanism, so also may it be in regard 
to sexual excesses and aberrations in general ; they may be on the 
one hand causes, but on the other symptoms and sequelse, of sexual 
neurasthenia. Early-acquired or inherited homosexual tendencies 
and habits may, as Eidenburg further points out, lead to sexual 
neurasthenia only, but then very easily, when such individuals have 
allowed themselves, against their nature but in obedience to conven- 
tional points of view and to the advice of the relatives, to be per- 
suaded into marriage. That sexual abstinence alone is competent to 
induce sexual neurasthenia must be dismissed as a fal)le. 



n. THE SEXUAL EPOCH OF THE MENACME, 



By the term menacme I designate the culmination of the sexual 
development of woman, during which the processes of reproduction, 
copulation, conception, pregnancy, parturition, and lactation occur. 

The processes of puberty in woman are fully completed at the age 
of from eighteen to twenty years, so that from this time forward 
she is fully equipped for the performance of her sexual duties. The 
first act in the fulfilment of these duties is copulation, which in 
civilized countries is in the great majority of women first undertaken 
at the commencement of married life. The average age at marriage 
in the women of this part of the world is 22; but marriages at 
an earlier age are very common, and in many circles of society the 
average age is as low as 20. The fullest maturity of sexual ac- 
tivity in women occurs, however, in the thirty-second year of life, this 
being the year in which on the average the maximum fertility is 
attained. 

At the menacme, the beauty and energy of women attain their 
fullest evolution, her sexual characteristics their strongest develop- 
ment. It is this period of life, however, that entails the greatest 
dangers to beauty and health in connection with the functions of 
the genital organs. Copulation, the first act of sexual intercourse 
with the male, often produces in the female injuries from which she 
never completely recovers. Gonorrhoeal infection has been a source 
of unspeakable miseries to women. Motherhood itself entails the 
risk of a great number and variety of illnesses, which, as puerperal 
sequelae, affect this phase of woman's life. The struggle for exist- 
ence, in which woman at her prime is also involved, and the fulfil- 
ment of duties to husband and children, further lead to the produc- 
tion of a series of changes, both physical and mental, in the feminine 
organism, which influence all the functions. 

The great characteristic of this epoch is maternity. In maternity 
the fully developed woman lives and has her being, but to maternity 
also she often succumbs as a sacrifice to the fulfilment of her natural 
functions. Inasmuch as in this sexual phase the functions of the 
genital organs are of greater importance, to the same degree is 
enhanced the importance of the mutual relations between these 
organs and the other organs of the female body. 

[200] 



The Sexual Epoch of the Menacme. 201 

Another influence of fundamental importance in the sexually 
mature woman is that of the sexual impulse, the force of which is 
at times overwhelming, so that its gratification is sometimes sought 
without regard for the consequences to married and family life. 

The physiology and pathology of the menacme coincides with the 
normal processes and pathological changes respectively of the female 
genital organs consequent on their functional activity as organs 
of sexual sensation and of reproduction. Woman as w^ife and 
mother stands at the climax of her existence. 

In a quite astonishing manner, however, many of the advocates of 
the modern movement for the emancipation of w^omen contest the 
significance of maternity to women. 

A modern authoress and supporter of women's rights, Ellen Key, 
avows that she was in error when at an earlier date she " regarded 
maternity as the central point in woman's existence." She asserts 
that it lies within the sphere of a woman's individual rights, as of 
a man's, to reject marriage, or to accept marriage while rejecting 
maternity. " The grounds for the rejection of maternity may as 
well be deeply altruistic as deeply egoistic. It lies within the sphere 
of individual rights to dispense with love or with maternity when 
either is regarded or both are regarded from this point of view. 
It is entirely within a woman's rights to transform herself into a 
member of the * third sex,' the sex of the worker bee, of the neuter 
ant, if she finds therein her greatest pleasure. ^ ^ ^ Women 
exist in w^hom erotic feeling is totally atrophied ; there are yet others 
who fail to find in intercourse with the modern man that soulful 
and deep erotic harmony which they rightly desire ; and there are 
others still more numerous who desire love, but not maternity, 
which indeed they dread." 

A celebrated German authoress of the present day, Gahriele 
Renter, refers in similar terms to the justifiable fear with which 
so many aspiring and hard-working women regard maternity, '' the 
perpetual, watchful, emotional dread of motherhood, a dread which 
causes them to turn at bay. A dread, a hatred, it is, which has 
grown so strong, so active, that one might almost regard it as an 
obscure perverse instinct, awakened and developed and strengthened 
by bitter necessity. It is as if in the innermost recesses of their 
nature such women had a belief that should they pay their tribute 
to sex they would loose all the energy, clearness, and brightness of 
mind, by means of which they have raised themselves above the level 
of their sex. And perhaps women of a certain type are justified 
in this fear." 

Fortunately, however, the woman who does not prize maternity 
still remains an exception. The great instinct for the preservation 



202 The Sexual Life of Woman. 

of the species, which nature has planted deeply in every human 
being, still as a rule in women remains much more powerful than 
the instinct of self-preservation at every one else's expense — more 
powerful than such self-sufficient egoism. And now as ever it is 
the duty of humanity to educate women for maternity from her youth 
upward, so that she is in every way fitted for the supreme duty of 
her sexual nature, the renewal of life from generation to generation. 

Against the significance and importance of maternity to woman, 
the mountainous waves of the movement for the emancipation of 
women dash themselves as vainly as against the solid rock. Much 
justification may be found for the efforts of women in modern 
civilized communities to engage in departments of activity to which 
hitherto men only have been admitted ; and as regards the intellectual 
capacity of women we may acknowledge their competence for 
the higher scientific professions ; but while admitting this we must 
hold firmly to the physiological standpoint and must more espe- 
cially bear in mind the sexual life of woman. Such professions only 
are suitable for a woman as do not entail a restriction of the sphere 
of her reproductive activity, a hindrance to her principal duty, that 
of maternity, an interference with the discharge of her obligations 
to husband and children, or a diminution of her domestic value and 
an evasion of her responsibilities in family life. As L. von Stein 
so justly remarks, the woman who spends the whole day at a desk, 
in the law courts, or in a house of assembly, may be a most honorable 
and most useful individual, but she is no longer a woman, she can- 
not be a wife, she cannot be a mother. In the condition of our 
society, the emancipation of woman is in its very nature the negation 
of marriage. 

We may not agree with the great misogynist, Sclwpenhanr, in his 
depreciation of the female sex, or in his assertion that woman exists 
simply and solely for the propagation of the species, and that '' her 
life should therefore flow more quietly, more inconspicuously, and 
more gently than that of man toward its goal ;" nor need we regard 
as justified the severe sentence of the philosopher, E. von Hartuiann, 
that from the moral standpoint, '' the greater number of women pass 
the whole of their lives, in a state of minority, and, therefore, to 
the end stand in need of supervision and guidance;" but the state- 
ment made by Fricdr. Nictsche in his book Also sprach Zarathustra 
deserves acceptation, " Everything in woman is a riddle, and every- 
thing in woman has its answer: it is called pregnancy," and again, 
" For woman, man is only the means ; the end is always the child." 

Unsearchable in its judgments, nature has imposed on woman alone 
the consequences of the act of generation ; man has the pleasure, 
but not the labor and the pain. We might indeed regard as highly 



The Sexual Epoch of the Menacme. 203 

unjust the distribution of the roles in the process of reproduction, 
were it not that in a mother's love and a mother's joys, woman finds 
a compensatory solace. The man's part is a much easier one and 
costs far less than that of woman ; with the gratification of his sexual 
desire, man shakes off any further responsibility, whereas the 
woman's body becomes the workshop in the wonderful act of crea- 
tion of a new human life. 

Maternity, says Lomhroso, is the characteristic function of the 
female sex, upon which rests her whole organic and physical varia- 
bility, and this function is indeed throughout of an altruistic nature. 
Although there is a certain antagonism between the sexual impulse 
and maternity — according to I card, the sexual impulse is extin- 
guished in women during pregnancy, — still, maternity appears to 
depend upon sexual perceptions. For instance, the act of suckling 
the infant often arouses voluptuous sensations, and I card mentions 
a case in which a woman permitted fertilization to occur solely on 
account of the pleasure obtained by suckling. The anatomical 
cause of this fact is to be found in the connections between the nipple 
and the uterus by way of the sympathetic nervous system. * * * 
It is likew^ise probable that in the happy feeling of maternity there 
intermingle very gentle voluptuous sensations derived from the 
genital organs. According to Bain also, very delicate sensations of 
contact form an element in maternal love. 

The epoch of the menacme is that in which, independently of 
maternity, the sexual impulse often becomes so powerful in woman 
as to be entirely dominant. The problems relating to marriage and 
to the sexual position of woman, so widely discussed at the present 
day, are, therefore, of especial importance in regard to women at 
this period of life. The forcible repression and control of the sexual 
impulse inculcated by moral and religious ordinances are now, ac- 
cording to the modern leaders, both male and female, of the woman's 
movement, to be abandoned ; and it is loudly asserted that every 
woman has the same right as man to physical love and the happiness 
it produces. Hence, free love is demanded. " Freedom in love, 
freedom for love — this is what the dignity of the human race de- 
mands," asserts the authoress of a book recently published (Elisa- 
heia von Steinhorn, The Sexual Position of Woman). With laws 
for the regulation of marriage, this section of the women's rights 
party will have nothing to do. A truly good and honorable man, 
they contend, has as little need of laws to regulate his amorous 
relations as he has of laws against murder and theft. In the* first 
place, love, the sexual relation between man and woman, must be 
free, and humanity, freed from vexations and needless control, will 
then seek and find the proper path, even if at the expense of a few 



204 



The Sexual Life of Woman. 



errors by the way. Only after this unrestrained sexual intercourse 
has lasted for a long time, will free marriage become the rule. 
'' Out of this phase will develop the monogamic system willed by 
God, for which, in its most ideal form, we are not yet sufficiently 
ripe." It is hardly necessary to discuss in detail the general dele- 
terious influence of such unlimited, unregulated free love upon the 
community, upon human society as a whole, to describe the results 
of free love, to attempt to realize the chaos which it would bring 
about in the social relations of civilized humanitv. We must rather 



Prepuce of the 

clitoris ^' 



Posterior com- 

nii-,sure of 
Vulva 




Mons veneris 



Anterior commis- 
sure of the vulva 



Labium majus 



Rima urogenitalis, 
or vulval cleft 



Perineum 



Post anal furrow 



Fig. 48. — The female pudendum , or vulva, with the labia majora. The 
vulval clett. Female perineum,. Mons veneris, with the pubic hair. 
(From Toldt : Atlas of Human Anatomy.— Rebman Company, New York.) 

indicate it as desirable from the medical standpoint also, that such a 
change in general domestic economy shall be aimed at as will enable 
the great majority of women to share in married life and family 
happiness, and thus making allowance both for human nature and 
the demands of social life, to effect a true harmony between sexual 
morality and sexual practice. 



The Sexual Epoch of the Menacme. 



205 



We must point out that in so far as the modern woman's move- 
ment aims at dispensing with man and at basing the entire hfe of 
woman upon the independent ego, that movement is in opposition 
to nature and its eternal laws. A woman who thus seeks the solu- 
tion of the woman's question in the direction of freedom and in- 
dependence is one who endeavors to avoid the burthen of woman- 
hood. She desires to escape, always from guardianship, often from 
maternity, and usually from the restrictions, the unselfishness of 
womanhood. But none the less does she remain unable to escape 
from her femininity. 

" The true significance of woman," insists Laura Marholm in 
opposition to the modern tendency, *' has at all times consisted rather 
in what she is than in what she performs, and it is precisely in 



Prepuce of th 
clitoris 

Glans clitoridis 



Fraenun of the 
clitoris 

Labium minus, 
or nympha 



Vestibule of the 
vagina 



Caruncul 
myrtiformes 

Orifice of the duct 
of Bartholin 
gland 



Fossa navicularis 
(of the vulva) 

Fourchette, or fraenu 
lum pudendi 




Anterior commissure 
of the vulva 



xH^ Labium majus 



Orifice of 
Skene's tubule 
or para-ure- 
thral duct 
External ori- 
fice of the ure- 
thra 
Urethral ridge 



Anterior vagi- 
nal column 

Vaginal orifice 



Posterior vaginal 
column 



Posterior commissure 
of the vulva 



Fig. 49. — Vestibule of the vagina, with the labia minora or nymphae, the 
vaginal and urethral orifices, and the glans ditoridis. (From Toldt: Atlas 
of Human Anatomy. — Rebman Company, New Yori<:.) 



the former point that the women of the present day seem so un- 
usually wanting. Their performances are indeed many and various, 
they study and they write innumerable books, they are the directors 
or principals of all possible concerns and collect funds for every 
possible object, they wear doctors' gowns, conduct agitations, and 
found clubs, and they come continually more and more into publicity. 
And yet their public significance is after all diminished. The 
greater the influence of woman in the mass and as a numerical 



2o6 The Sexual Life of Woman. 

majority, the less is her influence as an individual, the smaller is the 
triumph of her sex. She herself has induced man to sound the 
trumpet note of the abhorrence of women. Tolstoi in The Kreiizer 
Sonata, Strindhcrg in numerous dramas, Huysmans in En Menage, 
write in this strain ; and in the works of many lesser luminaries we 
encounter this mistrust of love. * * * The modern system of 
education for girls, with its polyglossia and polymathy, favors a 
superficial development of the understanding, and produces women 
who are pretentious without being profound." 

Feminine beauty suffers during the menacme from the stress 
of the demands made on the sexual activity as well as on the func- 
tional capacity of the individual. Repeated, rapidly succeeding preg- 
nancies and confinements impair the beauty of the breasts and the 
abdomen, the figure and the carriage. In consequence of suckling, 
the breasts, hitherto firm and elastic, usually become more or less 
pendent and wrinkled, sometimes also flabby and inelastic, some- 
times nodular. Diseases of the genital organs and the disorders of 
the general health dependent thereon, leave disfiguring wrinkles in 
the face and other traces in the whole structure of the body. Toil, 
anxiety, and grief also write their horrible marks deeply on the ap- 
pearance. The mature working-class woman, through sharing in 
masculine labors, through long-continued muscular exertion, and 
through neglect of bodily care, frequently assumes in her features, 
her carriage, her figure, and her whole appearance, a rather mascu- 
line type. 

The beauty and the youthful freshness of girls belonging to the 
labouring classes seldom endure for long after the menarche, and 
in cases in which the environment is one of poverty, they last through 
a very short part only of the epoch of the menacme. The early ap- 
pearance of wrinkles in the face, the stifif, angular character of the 
movements, the ungraceful carriage of the body, all these combine 
to make a woman of five-and-twenty who groans under the burthen 
of toil appear at the first glance an elderly woman, and a closer 
investigation shows what damage has been wrought to the attributes 
of beauty, how the breasts are flabby and flattened, the belly prom- 
inent, the buttocks pendulous, the arms muscular. 

In the well-to-do classes, again, at this period of life, when gen- 
erous diet combines with insufficient exercise, an abundant deposit 
of adipose tissue may already have occurred, resulting in a great 
impairment of beauty, the body and hmbs being enlarged, the gait 
and the carriage correspondingly altered for the worse — changes 
which seem desirable only to those orientals to whom such obesity, 
such exaggeration of femininity, is sexually stimulating. If, how- 
ever, this deposit of fat is not excessive, this it is which endows 



The Sexual Epoch of the Men acme. 



207 



women during these years of fullest development with an imposing 
appearance and buxom form. In favourable circumstances, beauty 
of this type may persist to the fortieth year of hfe and even be- 
yond, and it is of such a character as to justify the proverb that 
woman's first sexual epoch is dedicated to love, her second to volup- 
tuousness. 

Anterior, straight, or attached border of the ovary 

Isthmus of the Fallopian Fundus of 

I tube the uterus 

I Ligament of the • 

ovary 

i 



Mesovarium 


Mesosalpinx j 




Ampulla of the Fallo- ; • 
pian tube \ ' 




Abdominal on- "^^.i! jw.i ' '^;\||Iau»,. 
fice of the ^^^^r^/Mlii;,,; y %* 

Fallo- . y^ JmWIImkJ!! 


^ 


pian \f oidiS> V*r^ 1 PHI 


'wWfA 




Fallopian tube 
Ligament of the 
vary 



Round liga- 
ment of the 
uterus 

Body of the uterus 



Fimbriae 
of the Fal- 
lopian tube 
Ovarian ar- 
tery and vein /"" 
Superior or tubal 
extremity of the 
ovary 

Ovary (external ' /' 
surface) / 

Posterior, convex or free 
border of the ovary 
Inferior or uterine extremity 
of the ovary 



Neck of the uterus 



cervix 
Os externum - 
Anterior lip of the cervix. 



Fornix of 
vagina 



the 



Vaginal portion of 
the cervix 



Fig 50. — The uterus, the left Fallopian tube and the left overy, in their connection with the 
broad ligament of the uterus, which has been fully unfolded. Seen from behind. From a virgin, 
aged nineteen years. (From Toldt: Atlas of Human Anatomy. — Rebman Company, New 
York.) 



" Bountiful nature," writes Mantegazza, regarding woman at this 
sexual epoch, *' sends to woman an ingenious engineer, who en- 
larges the hills to mountains and fills up the valleys with a soft 
alluvium of fat. The commencing wrinkles disappear, being 
smoothed out under the beneficial influence of this plastic material ; 
the slender, elastic palm-tree stems are converted into majestic col- 
umns of Parian marble ; quality is replaced by quantity, and if the eye 
has lost a few provinces, the hand has gained just as many. * * * 
A certain number of chosen women understand how to preserve for 
as long as ten years the unstable equilibrium of the period which 
separates these two ages of life. There are divine beings who with 
every oscillation of their tresses or rocking of their hips, with 
every undulation of their bosom, every serpentine movement of their 
limbs, instil desire. * * * They constitute our most intense 



2o8 



The Sexual Life of Woman. 



delight, and our intensest torment, they make our life a blessing or 
a curse, they are the uttermost goal of human passion, of human 
voluptuous desire." 



Ampulla of the Fallopian tube 



Infundibulum of the "-—. 
Fallopian tube 



Fimbriae of the Fallo- 
pian tube 

Posterior, convex, or 
free border of the 
ovary 

Internal surface or 
the ovary 

Anterior, straight, or 
attached border 

Ligament of the - 
ovary 

Inferior or uterme 
extremity of the 
ovary 

Posterior or in- 
testinal surface 
of the uterus 

Utero-sacral liga- 
ment 

Os uteri internum 

Cavity of the 
cervix 
Uterovesical - 
pouch 

Posterior vag 

inal fornix 
Posterior lip of 

the cervix 

Pouch of Douglas 
Os uteri externum 
Anterior lip of the cervix 



Suspensory ligament of the 

ovary 
Superior or tubal extremity of 

the ovary 

Bursa ovarica 



Mesosalpinx 
Mesovanum 



- Isthmus of the Fallopian 
tube 



Fundus of the uterus 



Anterior or vesical sur- 
face of the uterus 



Vagina I 




Uterine cavity 



Visceral peri- 
toneum 



Internal orifice of 
the urethra 



Urethra 



Anterior wall 
Posterior wall 



Fig. 51. — Female internal genital organs in the fully developed state. 
(From Toldt: Atlas of Human Anatomy.— Rebman Company, New York ) 



Among the injuries to beauty effected by pregnancy, one above all 
evident to the eye is the almost invariably ensuing change in the 
skin, principally taking the form of a change in pigmentation, with 
the appearance of spots varying in size and tint, on the face and 
especially on the lips and the forehead, there is greatly increased 
pigmentation also of the areola mammae and the linea alba, and in 
addition of the labia majora and minora and of the anal region. It 
is not certain whether this chloasma uterinum is dependent, as Jea- 
min assumes, on the discontinuance of menstruation, or, as Virchow 
believes, on changes in the blood and the blood-pressure. Some- 
times also, in pregnant women, we observe on the face, chiefly on 



The Sexual Epoch of the Menacme. 209 

the nose and the cheeks, dilatations of the small cutaneous vessels, 
often associated with acne nodules. 

A permanent disfigurement is caused by the linecu (vel strice) at- 
hicanteSj White lines or streaks of varying length and resembling 
scar tissue in appearance on the skin of the abdomen, the adjoin- 
ing parts of the buttocks and thighs, the lower part of the front 
of the thorax, and the mammae. They are not true scars, not 
being new formations of connective tissue, being on the contrary 
dependent on solutions of continuity, on relative diminution, that is 
to say, of the connective tissue layer of the skin. They are formed 
in consequence of the fact that the connective tissue bundles are not 
able to keep pace in their superficial enlargement with the neces- 
sarily rapid extension of the cutis, hence great meshes appear in 
the former, situate in the direction of the greatest tension of the 
skin. (Spietshka and Grunfeld). 

Transiently during pregnancy, but in some cases permanently 
also, the beauty of the lower extremities is apt to be impaired by 
enlargements of the veins, the formation of varices, and sometimes 
also by oedema ; these conditions depend upon the hindrance to the 
venous return caused by the pressure of the pregnant uterus. Thick, 
vermicular, bluish strings or nodular enlargements appear in the 
course of the great veins, with consequent eczema and ulceration. 
In pregnant woman, eczema is common in other regions, on the 
face, the hands, the forearms, and the genitals ; also erythema, 
urticaria, and the pustular eruption known as impetigo herpetiformis. 

Parturition and lactation entail further disfigurement of the skin 
through the production of various lesions, such as cracks and fissures 
of the skin of the breast, dermatitis due to venous thrombosis in the 
lower extremities, scarring of the breast after mastitis, etc. 

In the description of the sexual life of woman in the epoch of the 
menacme, we shall consider at some length copulation and concep- 
tion, the relations of fertility and sterility, the important topic of 
the use of measures for the prevention of pregnancy, and the in- 
teresting subject of the determination of sex; on the other hand, 
pregnancy, parturition, and the puerperal state, since these subjects 
are specially treated in the ordinary text-books on midwifery, we 
shall discuss only in so far as certain relations between these repro- 
ductive processes and the organism as a whole and its functions, 
appear to us especially worthy of note. 

Anatomical Changes in the Female Genital Organs in the 
Period of the Menacme. 

In the fully-developed woman during the period of the menacme, 
the mons Veneris forms a rounded elevation which consists of very 
14 



2IO The Sexual Life of Woman. 

dense connective tissue containing large quantities of fat, while the 
integument that covers it is usually coated with a thick growth of 
hairT The form of this hairy covering, which by the Roman poets 
was designated Hebe, by the Greeks ziinaikomitstax (translated by 
Alhrccht Di'ircr as Weyhsbart — woman's beard), by Galen termed 
ornamcntum loci, is various, and, as an external sexual character, it 
deserves more accurate observation than it has hitherto received from 
anatomists. 

The hairy covering of the female genital organs is in adults, and 
especially in brunettes, very abundant; above, it is usually sharply 
limited by a transverse line across the top of the mons Veneris, and 
it extends outwards only a little beyond the labia majora, whilst be- 
low it extends only to about the middle of the sides of the perineum. 
According to Bergh, however, who made an exact study of this 
matter in 2,200 women of ages for the most part between fourteen 
and thirty years, in some cases the shape of the patch of hair (which 
is in such instances always very thick) resembles that so common in 
the male, there being a pointed process, usually rather narrow, 
extending upward toward the navel. This masculine form of the 
pubic hair is by no means common in women ; according to Lorn- 
broso it is met with more frequently in Italian women than in those 
belonging to other European nations. In most women, the thick 
hairy covering of the mons Veneris is sharply limited above by the 
curved line that indicates the upper margin of the eminence, whereas 
in men a strip of hair usually passes up from the mons pubis to the 
umbilicus. Still, exceptions are met with. Thus, in 100 women, 
Schultzc found five in whom the hairy covering extended up to the 
navel. Sometimes other variations occur, for instance, the hair may 
extend laterally into the groin, occasionally as far as the anterior 
superior spine of the ilium, and across the upper part of the front 
of the thigh, not infrequently in association with a thick growth of 
hair along the sides of the perineum as far as the anus. Of women 
with the hair growing in this fashion, not a few appeared to Bergh 
to have unusually strong sexual passion. 

In contradistinction to these cases in which the development of 
the pubic hair is thick and even excessive, we meet with others in 
which it is very scanty, and this not only in quite young individuals 
(at an age from 15 to 18 years), with but slight development of the 
labia, but also in older and fully developed women — for the most 
part blondes. 

The growth of the pubic hair is thickest and strongest near the 
median line, whilst laterally the hairy covering is thinner and 
weaker. The thickness is extremely variable. " In some women we 
find a flattened, occasionally frizzled, turf-like covering; in others. 



The Skxual Epoch of the Menacme. 211 

a dense, elevated, luxuriant bush of hair " (Bergh). The length of 
the pubic hair is variable, but as a rule it is somewhat shorter in 
the female than in the male. Still, cases have been known in women 
in which it reached to the knees. 

The colour of the pubic hair commonly resembles that of the hair 
of the head, bat the pubic hair is usually the darker of the two. 
Blondes with dark or black eyebrows have, according to Bergh, 
usually dark or black pubic hair. The pubic hair turns grey late in 
life, later as a rule than the hair of any other part, a fact known al- 
ready to Aristotle; it is rather late in life also that the pubic hair 
becomes thin, and in this state it remains almost invariably up to 
an advanced age, even when the scalp has become almost or quite 
bald. 

The pubic hair, according to the same author, is seldom straight, 
being almost always curly, frizzled, or more or less rolled up into 
rings or spirals, generally forming smaller or larger locks. Fairly 
often, we meet with curled locks, either one pair or two, symmetri- 
cally disposed on either side of the depression adjoining the prsepu- 
tium clitoridis ; these usually have an outward direction. Much 
more rarely we find similar locks symmetrically attached further back 
on the labia. 

In the case of 1,000 adult women examined by Eggel with regard 
to the colour of the pubic hair, the colour of the eyes, and the colour 
of the hair of the head, there were 239 with dark eyes, 333 with dark 
hair on the head, and 329 with dark pubic hair; contrariwise, 761 
had light eyes, 667 light hair on the head, and 679 light pubic hair. 
Obviously, then, a considerable number of women with light-coloured 
eyes must have had dark pubic hair. Rothe, in 1,000 North German 
women examined by him, found the pubic hair blonde, but a rather 
dark blonde, in a large majority of the cases; in fed-haired women, 
the pubic hair was in all cases bright red, in black-haired women 
the pubic hair was black in two-thirds only of the cases, in nearly 
a third it was brown, in two cases dark blonde ; in Jewesses, in a 
large majority of instances, the pubic hair is brown. The arrange- 
ment of the pubic hair is described by Rothc as very variable. 
" Sometimes it is short and frizzly, sometimes a luxuriant bushy 
growth ; sometimes the hairs are scanty and thinly set ; sometimes 
they are irregularly distributed ; sometimes we see only a narrow 
strip of long hairs down the middle of the mons Veneris, which 
is bare at the sides. In some the lateral boundaries of the pubic 
hair are sharply defined, in others the hairy covering spreads beyond 
the usual limits." 

Among the ancient Greeks and Romans, it was customary for 
women to remove the pubic hair, a custom even now observed by all 
oriental races; for this reason in ancient art the nude female body 



212 The Sexual Life of W omax. 

is depicted without pubic hair. According to Sfrat::, in the Chansons 
dc Bilitis it is said of the priestesses of Astarte : " They never 
draw their hairs out, in order that the dark triangle of the goddess 
shall represent on their bodies the form of a temple." 

The physiological purpose of the pubic hair is to prevent irritation 
of the genital organs by the sweat that would otherwise run down 
upon them, and to protect the skin from direct friction during the 
act of copulation. 

The labia majora in women during the menacme are usually 
strongly developed, their outer surface is hairy ; in parous women 
we almost invariably observe small or even large lacerations of 
the frjenulum pudendi or fourchette, in front of the posterior 
commissure of the vulva. On the inner surface also of the labia 
majora, the general characters of which are those of mucous mem- 
brane rather than of skin, fine hairs are also to be found. In multi- 
parae, and even in women who have frequently had sexual inter- 
course, these inner surfaces of the labia majora are not usually any 
longer in mutual contact, so that the rima urogenitalis or vulval 
cleft gapes more or less. In well-nourished women who have led the 
" sheltered life," the dense and fat-containing connective tissue of 
the labia majora (continuous with and similar to that of the mons 
Veneris) gives these structures a certain firmness and elasticity, and 
the labia minora or nymphs do not project beyond them. But when 
the genital organs are not well preserved, projection of the nymphse 
occurs. In women whose genital organs are beautifully formed, 
the nymphae are of a soft, delicate consistency, and their mucous 
membrane is of a pink color ; but when the reproductive organs 
have been subjected to excessive stimulation, the nymphse are dry, 
hard, brown in color, and they project from the vulval cleft. In 
women of the Hottentot and Bosjesman races, the nymphae attain, 
as is well known, an excessive length, forming the so-called " Hot- 
tentot-apron ;" and in certain other indigenous races of Africa, the 
enormous size of these organs renders resection necessary. 

During this sexual epoch, in women with strong sexual passion 
and having frequent sexual intercourse, the clitoris is largely de- 
veloped, and sometimes the dorsum of the organ protrudes from 
between the anterior extremities of the labia maiora. 

The vaginal orifice gapes a little, so that the irregular carunculse 
myrtiformes are visible. In parous women, the vaginal orifice is 
enlarged in such a manner that the wall of the vagina passes directly 
and without limitation into the wall of the vestibule, and the ex- 
ternal orifice (meatus) of the uretha is situate immediately in 
front of the anterior vaginal column, and thus lies within the vagi- 
nal orifice. 



TiiE Sexual Epoch of the Menacme. 213 

The breasts of a strong, healthy woman who has attained com- 
plete sexual maturity are more or less firm in consistency, and 
considerable in size, exceeding now Ovid's demand concerning these 
organs, ut sit quod capiat nostra tegatque manus. The normal 
hemispherical form and the somewhat soft texture are subject to 
many variations, these being dependent upon race, climate, and sexual 
activity and also upon the kind of clothing worn. The nipple and 
its encircling areola are usually of a brownish colour ; but in beautiful 
women they sometimes retain the pink colour characteristic of these 
structures in the virgin. In parous women who have suckled' their 
children, the breasts are usually pendent, and often the left breast 
will be found to be somewhat larger than the other ; generally also 
in such women the nipples are longer and thicker than normal. Not 
infrequently the nipples a*-e withdra,wn into a furrow of the skin, 
and become prominent only on local stimulation or as a result of 
sexual excitement. Sometimes in the region of the areola, especially 
in brunettes, we see a circle of small glands, which produce eminences 
beneath the skin. 

It is easy to understand that the breasts of such women in gen- 
eral no longer have the virginal form of small hemispheres, but 
have matured to a greater fulness and size. This, however, does 
not diminish their beauty, for the ideal of beauty must take into 
account the natural development of the body. Whereas at the present 
time, under the influence of the modern negation or at any rate 
undervaluation of maternity as the goal of woman's life, it is the 
tendency of a certain school of art to misprize the influence of that 
state on the form of the breast, and to esteem the " flat bosom," at 
an earlier day under the influence of Rousseau's Emile, a book in 
which mothers are strongly urged to suckle their own children, the 
full bosom as a beauty was the fashion in art. 

Only a perverted taste can find a woman beautiful without bosom 
— without '' that golden chalice, from which men quaff love, and 
children life" {Mantegazza) , — an angular, flat being, without a 
rounded form. Nothing but a morbid desire for equality with man 
can induce woman herself to endeavor to conceal also the external 
manifestation of her sexual characteristics, and by her clothing to 
disguise, like a nun, the sexual curves of her figure. 

Great 'deposit of fat, such as occurs from liberal feeding in con- 
junction with a sedentary mode of life, or as a result of several 
pregnancies, destroys the beautiful form of the breasts, which attain 
an immoderate size, thus disturbing the grace and symmetry of the 
feminine figure, a fact recognized already by the Romans. Hyrtl 
condemns, from the point of view of anatomical beauty, the nude 
female figures in the pictures of Rubens, remarking that '' the god- 



214 The Sexual Life of Woman. 

desses and angels of this painter are as luxuriant in their develop- 
ment as a Flemish dairy-maid;" and the buxom '' goat's-udder 
breast " prized by the Arabs does not represent any nobler ideal of 
beauty. Sometimes these excessively large and fat breasts hang 
down in a conical form, or, as more or less flattened hemispheres, 
reach right down over the gastric region; moreover, the interspace 
between the two breasts seems to disappear, and they touch or rub 
against one another. 

According to PIoss and Bartels, the various forms of breast oc- 
curring in different races may be classified as follows : A. Accord- 
ing to size : i, very large ; 2, large ; 3, medium ; 4, small. B. Accord- 
ing to consistency and firmness : i, high ; 2, semi-pendent ; 3, pendent. 
C. According to shape: i, shell-shaped (disc-shaped) ; 2, hemispheri- 
cal; 3, conical. The nipples also, according to these authors,- ex- 
hibit variations dependent upon race, being in some cases small and 
flat, like a little knob, in some cases large and conical in shape, with 
a broad base and a rounded extremity, and in some cases large and 
cylindrical, having almost the shape of a finger-joint. The areola, 
finally, is in some women quite pale in color, in some dark pink, in 
some brown and even almost black from excess of pigment. 

The uterus of a woman who has attained complete sexual maturity, 
has undergone such alterations in its proportions that the cervix 
and the body are of almost the same length. The constriction, visible 
externally, indicating the separation between these two segments 
of the organ, is depressed somewdiat toward the external os. In 
sexually active women, a widening and an increased curvature of 
the region of the fundus occur, the uterine extremities of the Fallo- 
pian tubes becoming more widely separated ; at the same time the 
posterior wall becomes more and more convex. The more fre- 
quently the uterus has functioned as a reproductive organ, the more 
strongly marked is the convexity of the body of that organ. The 
relative lengths of the corporal and cervical portions of the uterine 
cavity are now the reverse of those that obtain in the uterus of the 
child; the transverse and antero-posterior diameters have greatly 
increased. Transverse diameter at the fundus ; virgin, 4 centimetres 
(1-575"). multipara, 5.5-6.5 centimetres (2.165-2.559"): sagittal 
(antero-posterior) diameter; virgin, 2 centimetres (0.787") ; multi- 
para, 3-3.5 centimetres (1.181-1.378"). (Chrobak and von Rost- 
horn. ) 

During the menacme, in consequence of the act of reproduction, 
the uterus undergoes important changes in form. In a nulliparous 
married woman, the uterus differs little from that of a virgin; the 
cavity is somewhat more extensive, the convexity of the outer sur- 
face a little greater, there is some increase in width in the neighbor- 



The Sexual Epoch of the Menacme. 215 

hood of the fundus, the pHcae palmatse {arbor vitcc uterinum) are 
confined to the cervical canal ; further, under the influence of copula- 
tion the appearance of the vagina changes, it becomes larger, and 
its walls become smoother, sometimes quite smooth, from the dis- 
appearance of the rugae of the mucous membrane and especially of 
those attached to the posterior vaginal column. Much more ex- 
tensive are the alterations in the uterus of a multipara. According to 
Toldt, '' the parts of the cavity representing the cornua, which are 
pointed on either side as they pass toward the Fallopian tubes, be- 
come completely included in the lower undivided portion of the 
cavity^ this change being effected chiefly by means of the increasing 
Outward curvature of the walls, so that the cavity comes to assume an 
amygdaloid form ; the cervical canal is also enlarged, especially the 
lower part, where also the plicae palmatas {arbor vitcc uterinum) be- 
comes less distinct ; the vaginal portion of the cervix is shortened, 
the OS uteri externum gapes, the lips of the cervix are tumid, nearly 
equal in length, and usually beset with scarred depressions." In 
nulliparae, the vaginal portion of the cervix is, as in a virgin, of a 
rather tough consistency, smooth on the surface, while the external 
OS is small, like a dimple, or transversely oval ; the color of the 
vaginal portion of the cervix is identical with that of the vaginal 
mucous membrane in general. Through frequent copulation, how- 
ever, the form of the vaginal portion of the cervix is so far altered 
inasmuch as it is more freely supplied with blood, and, therefore, 
changes slightly, in consistency. In multiparae, in consequence of 
lacerations of the cervix, the os uteri externum changes to a wide 
transverse fissure with tumid margins, justifying the old designa- 
tion of this orifice as os tincce, carp's mouth. A large size of the 
external and internal os, moderate enlargement of the cavity, round- 
ing of the upper angles adjacent to the uterine orifices of the Fallo- 
pian tubes, increased convexity of the walls, and partial or complete 
efifacement of the plicae palmatae (arbor vitcc uterinum) , are the 
characteristics of the uterus of a multipara {Chrobak and von Rost- 
horn). According* to Hennig, the vaginal portion of the cervix is 
longest in women who have undergone defloration, and in nulliparae ; 
widest in prostitutes ; narrowest in childless wives ; thickest in young 
widows. This author gives the following measurements of the ex- 
ternal OS, showing its variations in accordance with age and sexual 
activity : 

In childhood, transversely oval 0.46 — 0.56 cm. (o.iS — 0.22") 

In the virgin, rounded 0.20 — 0.50 cm. (0.08^ — 0.20'') 

In prostitutes, transversely, oval 0.60 — 2.50 cm. (0.24 — o.qS'') 

In sterile married women, round o. 16 cm. (0.06'') 

In parous married women, transverse fis- 
sure 1. 10 cm. (0.43'') 

After the menopause 0.81 cm. (0.32") 



2i6 The Sexual Life of Woman. 

In the fully-developed woman, the ovaries undergo changes in size, 
shape, and consistency, these changes being dependent upon the 
age, the sexual functional activity, and the constitutional predisposi- 
tions of the individual. The average length of the ovary is 3-4 centi- 
metres (1.18-1.58") ; the average width, 2-3 centimetres (0.79- 
1.18"); and the average thickness i centimetre (0.39"). The sur- 
face of this organ gradually assumes a ragged appearance, from the 
scarred depressions caused by the great number of successive men- 
struations (ovulations) — sometimes the appearance produced re- 
sembles that of a mulberry. 

In the vagina at this sexual epoch, the surface of the anterior and 
posterior vaginal walls is rendered uneven and rugose by well-devel- 
oped vaginal columns {columncc r n gam m) , which feel almost as hard 
as cartilage, and project considerably above the general level of the 
wall ; the transverse ridges (riii^cr) run horizontally outward from the 
columns. By frequent copulation, the rugae are partially effaced, and 
the columns themselves become flatter and softer; still, except in 
cases in which the genital functions are exercised to great excess, 
the vagina remains tense and rugose until after several children have 
been born, when it becomes soft, flaccid, and smooth. Even in women 
who have been accustomed to frequent intercourse, the narrowest 
portion of the vagina is still the orifice and the part of the passage 
lying immediately within the orifice, which can be constricted by the 
levator ani muscle ; childbirth, however, brings about great and 
permanent distension of these parts also. The widest and most dis- 
tensible portion of the vagina is the uppermost segment, the region 
of the fornices. 

A special significance must be attached to the glands of the cervix 
uteri, which, according to my own observations, have the function 
of providing a secretion that increases the mobility of the spermato- 
zoa, and this enables them more readily to find their way into the 
uterus. I have endeavored, by a series of histological observations, to 
determine the properties of these glands and the changes they un- 
dergo in the different phases of sexual life. The most important 
results of these researches may be stated as follow^s. These glands, 
which are lined with columnar ciliated epithelium, are but slightly 
developed before puberty, being then simple excavations; at the 
time of the menarche, they become tubular ; later, during the me- 
nacme, they become long, dendriform, blind-ending glands, which 
during menstruation and under the influence of sexual excitement, 
furnish a secretion, variable in quantity, and in quality distinguished 
especially by its alkaline reaction ; further, in connection with a 
number of pathological disorders of the female genital organs, these 
glands undergo various changes both in their anatomical structure 
and in their secretory activity. At the time of the menopause and 



The Sexual Epoch of the Menacme. 



217 



after the climacteric age, these glands, which have hitherto con- 
sisted of branched tubules, tend to undergo cystic degeneration, 




Fig. 52. — Sagittal section through the 
cervix uteri of a woman 26 years of age. 
dendriform branched glands. 




Fig. 53. — Cervix of a woman 
72 years of age, with glands 
that have undergone cystic 
degeneration. 



leading to the formation of the vesicles know^n as oviila Nabothi. 
After the climacteric, the existence of these cysts may be regarded 
as a normal occurrence ; and, sometimes arranged in grape-like 
clusters, they often project so as to occupy the greater part of the 
lumen of the cervical canal. 




Fig. 54. — Sagittal section through the cervix uteri of a woman 65 years 
of age. The glands have undergone cystic degeneration. 

Diseases of the uterine mucous membrane during the period of 
sexual maturity often induce various pathological changes in these 
cervical glands. In consequence of obstruction of their excretory 



2i8 The Sexual Life of Woman. 

ducts, they may undergo cystic degeneration, forming follicles filled 
with muciis and epithelium, or cavities containing blood, which pass 
through the substance of the cervix in every direction; or they 
may give rise to the formation of slowly-growing glandular polypi 
and other glandular new formations — changes the general result 
of all of which is to interfere with the secretory function of the 

glands. 

Pathology of the Menacme. 

The full evolution of the sexual life brings in its train many 
dangers to a woman's life. This appears at first sight from a com- 
parison of the mortality of married women during the period of 
greatest sexual activity with that of single women of similar age. 
Between the ages of 20 and 25 years, the mortality of married 
women is in all races higher than that of unmarried women ; and 
the same is true between the ages of 25 and 30 years, except in 
France, in which country from artificial causes maternity ceases 
at a very early age. In Prussia, in the year 1880, of every 10,000 
married women, between the ages named, 21 died, of every 10,000 
unmarried women, only 2. In Holland, Belgium, and Bavaria, this 
excess in the mortality of married women continues up to the age 
of 40 years; whilst in Prussia, from the age of 30 upward, the 
mortality of married women and unmarried is practically the same. 
In many countries, the mortality of married women at many ages 
exceeds even that of unmarried men. 

This greater comparative mortality of married women is ascribed 
by Hegar to the satisfaction of the sexual impulse, and this authority 
believes that the dangers attendant on this function would be mani- 
fested yet more clearly if the contrast were made, not between married 
women and single, but between those habituated to sexual indulgence 
and those who are continent. We, however, are of opinion, that 
the satisfaction of the sexual impulse is only harmful to this extent, 
that it exposes women to the consequences of venereal infection, 
and also to the risk of numerous puerperal and other diseases of 
the genital organs. This is proved also by the statistical results of 
the investigations concerning mortality during pregnancy, parturi- 
tion, and the puerperium. According to Hcgar, adding deaths re- 
sulting from premature delivery to deaths resulting from delivery 
at full term, we find the mortality of childbirth in Germany to be 
about 0.6 per cent. 

Whilst DertUlon and Simpson believe that the lower mortality 
of married women above forty years of age as compared with un- 
married women at the same period of life is dependent upon the 
advantage to the former of the fulfilment of sexual functions, Hegar, 
on the contrary, gives another explanation. He writes: *'At the 



The Sexual Epoch of the Menacme. 219 

age of 40, the less powerful married women have already been 
weeded out. At first, owing- to the selection exercised by marriage, 
the quality of the unmarried women was inferior to that of tjie 
married' women ; the former, however, have not been exposed to 
the dangers attendant on the reproductive process, and so have 
passed through the time during which the body possesses the greatest 
elasticity ; but in the years in which a decline in the vital powers 
naturally sets in, the originally inferior quality of the unmarried 
women is manifested by a comparatively higher mortality. Also we 
have to take into account among the unmarried, the consequences of 
extra-marital sexual intercourse and of prostitution, and further the 
lack of a family, of the support furnished by husband and children." 

In addition to the far-reaching disturbances of health dependent 
on sexual activity at this period of life, there are the minor domestic 
troubles by which woman is depressed and by which her powers are 
exhausted. The influence of these latter is admirably described by 
G. von Amyntor: '' How many millions of brave house- wives boil 
and scrub away their vital energy, their rosy cheeks, their merry 
dimples, in the performance of their household duties, until they 
become wrinkled, worn-out, dried-up mummies. The ever-renewed 
question, .' what must be cooked for dinner to-day,' the perpetually 
recurring necessity for scouring and sweeping and dusting and 
washing-up — ■ these are the continual dropping which slowly but 
surely wears away soul and body. * * * Qn the flaming altar 
on which the sauce-pan simmers, youth and simplicity, beauty and 
good temper, are offered up ; and who can recognize in the old, 
hollow-eyed cook whose back is bent with toil and trouble, the once 
blooming, energetic, chastely coquettish bride adorned with her 
myrtle crown ? " 

A great number of the diseases of the female genital organs oc- 
curring at the epoch of the menacme need only a passing mention. 
Even coitus, in cases in which there is great disproportion in size 
between the penis and the vaginal orifice, or when the organ is very 
rapidly introduced or the act is very roughly performed, may lead 
to injury to the vulva or the vagina, a fact to which a very large 
number of recorded cases bears witness. 

During the acme of the sexual life of woman, disturbances of the 
menstrual function are also frequent. Menstruation may cease in 
consequence of intercurrent diseases or constitutional anomalies ; 
amenorrhoea may occur during the convalescence from acute dis- 
eases, in obese women, in those suffering from tuberculosis, diabetes, 
alcoholism, or psychoses. On the other hand, severe menorrhagia 
or atypical metrorrhagia may occur, the bleeding either being due 
to diseases of the uterus, such as endometritis, retroflexion of the 



220 



The Sexual Life of Woman. 



uterus, or uterine myomata, or resulting- from infectious diseases, 
disease of the heart or kidney, or from general disturbance of the 
health by cliill or over-exertion. Or, again, dysmenorrhoea may arise, 
either as a symptom of some local uterine disease or in consequence 
of external noxious influences or weakness of the nervous system. 

During the life-epoch of the menacme, moreover, disturbances of 
the nutrition of the uterus are of common occurrence, as, for ex- 
ample, hyperplastic processes in the mucous membrane of the cervical 
canal and of the cavity of the body of the uterus. Common also 
during the menacme is chronic oophoritis, which may be due to mal- 
regulation of marital intercourse (especially to coitus too soon after 
childbirth), to carelessness during menstruation (dancing, skating, or 
mountaineering), to incomplete coitus {congrcssus intcrniptiis) , and 
not infrequently, to gonococcal infection ; or, finally, the oophoritis 
may occur soon after the puerperium in association with subinvolu- 
tion of the uterus. 

Next we may mention inflammatory diseases of the Fallopian 
tubes. In the etiology of these diseases in latter-day marriage, a 
dominant role must be assigned to the gonococcus ; but they also 
arise in many cases from nutritive disturbances, infection (other 
than gonorrhceal), and indiscretions during menstruation. Pelvic 
peritonitis owns similar causation. 

In this phase of women's life, the commonest new grow'dis of the 
uterus, myomata, also develop, most commonly between the ages 
of thirty-six and forty-five, and they occur in strikingly larger pro- 
portion in unmarried women ; it is between the same ages also that 
cysto-adenomata of the ovaries are of commonest occurrence. 

Sexual intercourse gives frequent opportunities for the introduc- 
tion of infective germs into the vagina, and for the origination of 
inflammatory affections of the mucous membrane (colpitis), the 
intensity of which depends upon the species, the quantity, and the 
virulence of the germs in question, on the one hand, and upon the 
local and constitutional predisposition of the infected person, upon 
the other. Especially grave "in its consequences is gonorrhoeal in- 
fection transmitted by the male, for this virus gives rise to a great 
variety of pathological processes in the female g-enital organs. In 
the act of defloration, considerable injuries are sometimes produced, 
and these readily supply a breach for the invasion of infective organ- 
ims. The condition of passive hypersemia that occurs in the genital 
organs during pregnancy also provides a favorable soil for their 
growth. 

Gonorrhoeal infection of young married women is so frequent and 
so serious an occurrence in the sexual life of woman, that it requires 
sjxr^'nl ronsideration. The cases in which the man entering upon 



The Sexual Epoch of the Menacme. 221 

marriage is so tinscrupiiloiis and so brutal as to deflower his young 
wife and to continue copulating- with her, while suffering himself 
from a quite re,cent and active gonorrhoea, are on the whole rare. 
More common is it for the bridegroom to believe himself completely 
cured of his previous claps, and he is declared cured by his phy- 
sician. The disease is, however, latent merely, the gonorrhoea has 
become chronic, the discharge is so slight tliat it is overlooked; but 
by the stimulation of the frequent acts of coition usual in the early 
days of marriage, the disease is lighted up afresh, the gonococci 
multiply quickly and intensely, the young wife is infected, and 
suffers from an acute gonorrhoea, which may often escape observa- 
tion for a co'nsiderable period. 

In a gonorrhoeal marriage, one in which both husband and wife 
have gonococci in their genital organs, very diverse phenomena may 
be observed and very various conditions may result. On this sub- 
ject M. Rimge writes : ''If the husband's gonorrhoea is not cured, 
fresh, virulent cocci are repeatedly transmitted to the wife, in whom, 
therefore, the disease often gets worse by distinct stages. If the 
wife undergoes treatment, the effect in these circumstances will 
naturally be nil, since the husband is always supplying fresh infec- 
tion. On the other hand, the wife on her side returns the gonococci 
to her husband, and in this way his gonorrhoea may undergo aggrava- 
tion. If the husband is compelled, by illness, for instance, or by 
absence, to abstain for a long period from intercourse with his wife, 
the latter's gonorrhoea may, in favorable circumstances, undergo 
alleviation and cure. It may happen, however, that in the husband, 
in consequence of sexual rest, the gonorrhoea becomes latent, and 
even entirely disappears, whilst the wife still suffers from infection. 
If now, after long abstinence, the husband has renewed intercourse 
with his wife, he may be reinfected, and suffer from an acute attack 
of gonorrhoea, though this is due to the descendants of the very 
gonococci that he himself sometime before conveyed to the genital 
organs of his wife — he reinfects himself, as people say. Such 
cases have given rise to suspicions of unchastity on the part of the 
wife, when the husband is in actual fact enjoying his own work in 
a new edition. A further possibility is that both husband and wife 
have become habituated to their own gonococcal interchange ; that 
is to say, the organisms produce no notable effect in either. But if 
the wife in such a condition receives the embraces of a lover, the 
latter may be infected with an acute gonorrhoea — a fact that has 
long been known." 

The principal role in the etiology of the diseases of the female 
genital organs must be assigned to pregnancy and childbirth. Anae- 
mic women readily suffer during pregnancy from a further decrease 



222 The Sexual Life of Woman. 

in the corpuscular richness of the blood ; those affected with valvular 
incompetence find their troubles much aggravated by pregnancy ; 
where the kidneys are in an irritable condition, pregnancy not infre- 
quently results in the onset of nephritis , those with disordered di- 
gestion often suffer from increased disturbance of the functions 
of the stomach and the intestinal tract; those with gall-stones are 
apt to suffer from exceptionally severe attacks of biliary coHc, and 
acute yellow atrophy of the liver is especially apt to occur during 
pregnancy. In women in whom dilatations of the veins already exist, 
very great increase of the enlargement is apt to occur during preg- 
nancy; and in the same circumstances, trifling teleangiectases in- 
crease to extensive angiomata. Enlargements of the thyroid body 
undergo rapid increase during pregnancy, so that they may attain 
threatening proportions. In women in whom the abdominal walls 
are flaccid, the viscera may protrude during pregnancy through the 
enlarged lacunae, giving rise to herni?e. The great relaxation of the 
peritoneal and other ligamentous attachments of the great abdominal 
glands, occurring during pregnancy and the puerperium results in 
displacements of these organs; hepatoptosis (migrating or movable 
liver), lienoptosis (splenoptosis or wandering spleen), nephroptosis 
(ren mobile, floating or movable kidney), and other varieties of entero- 
ptosis (splanchoptosis, visceroptosis, or Glenard's disease). During 
pregnancy, previously sound teeth are apt to become carious, and al- 
ready existing caries rapidly advances. New growths of various kinds 
originate at this period, those previously present exhibit rapid increase ; 
and relapse after operations for the extirpation of malignant tumors is 
especially apt to occur. Even the bones are unfavorably influenced. 
A weakened nervous system is subject to a storm of changing 
nervous troubles, in some cases so severe as to lead to the outbreak 
of actual psychoses; while mental disorder already present tends, 
as a rule, to be seriously aggravated during pregnancy. In the eyes, 
serious disorders may occur, such as retinitis, and atrophy of the 
choroid with complete amaurosis. As regards the hearing, tinnitus 
aurium is not uncommon, and sometimes complete deafness occurs. 
-Numerous diseases of the skin are apt to occur during pregnancy ; 
in addition to the well-known pigmentation of the face, the areola 
mammae, and other parts, we may have herpes, eczema, or pruritus. 
The serious aggravation which pregnancy is liable to induce in 
many disorders previously existent, is well known, and this exacer- 
bation provides in some cases an indication for the induction of ar- 
tificial abortion. This necessity may arise in severe cases of renal, 
cardiac, pulmonary, or hepatic disease, in progressive anaemia, severe 
osteomalacia haemophilia, and many other acute and chronic patho- 
logical states, since, in exceptional cases, as pregnancy advances, the 



The Sexual Epocii of the Menacme. 223 

symptoms of any one of these diseases may become so threatening, 
that the patient's hfe is either in immediate danger or is ahiiost 
certain to be in danger within a very short space of time — this may 
occur, for instance, in diabetes, struma (goitre), or certain nervous 
diseases, such as chorea, polyneuritis (muhiplc neuritis), or mental 
disorders. Undoubtedly, in this connection, as W. A. Frciind in- 
sists, it is not the actual nature of the disease that is of decisive 
importance, but rather its intensity, and its influence on the health of 
the pregnant women ; these circumstances, considered in relation to 
the resisting powers of the patient, must be determinative in the adop- 
tion of measures for terminating the pregnancy. An indication for 
the induction of artificial abortion is generally furnished also by un- 
controllable vomiting dependent on pregnancy and endangering the 
hfe of the patient ; irreducible incarceration of a retroflexed gravid 
uterus in the pouch of Douglas, or of a gravid uterus in a hernia, or 
irreducible prolapse of a gravid uterus will also necessitate abortion. 

W. A. Freiind gives an example of a common pathological state, 
usually quite free from danger, but now and again, when as- 
sociated with pregnancy, seriously endangering life and rendering the 
induction of artificial abortion absolutely necessary — this is acute 
struma vasculosa — (vascular enlargement of the thyroid body), 
which may during the first three months of pregnancy exhibit such 
rapid growth as to lead to severe orthopncea and cyanosis and so to 
imperil the patient's hfe. 

In cases in which laryngeal tuberculosis exists as a complication of 
pulmonary tuberculosis, the former disease sometimes progresses 
so rapidly in^the course of pregnancy that sudden death from oedema 
of the glottis is by no means rare. Freiind, therefore, sees in this 
complication an absolute indication for the artificial termination of 
the pregnancy. 

In cases of previously well-compensated vulvular lesions of the 
heart, disturbances of compensation not infrequently occur as a re- 
sult of pregnancy ; whilst in cases in which cyanosis, dyspnoea, al- 
buminuria, and dropsy existed even before pregnancy, the latter 
condition is likely to result in an aggravation of these symptoms to 
a degree that imperils life. 

Parturition, to an even greater extent than pregnancy, may in- 
duce serious injuries to the female organism. Thus, during parturi- 
tion, lacerations of the vagina are frequent, with consequent scar- 
formation and stenosis ; lacerations of the perineum are also com- 
mon, causing great inconvenience, and when complete, leading to 
incontinence of faeces with all its unpleasant consequences. Great 
is the danger arising from septic puerperal inflammations, such as 
pelvic peritonitis (perimetritis) ; serious are the results of puerperal 
vesico-vaginal and recto-vaginal fistulse. 



224 The Sexual Life of Woman. 

A large part in the local pathology of the female genital organs is 
played by the various displacements of the uterus, either arising in 
consequence of inflammatory processes in their hgaments, or de- 
pendent upon relaxation of these ligaments from subinvolution of 
the internal generative organs, either following delivery at full 
term or following abortion. 

The injury which women alike of the well-to-do and of the labor- 
ing classes suffer in consequence of numerous and frequently re- 
peated pregnancies, is minutely described by Hcgar. '* We can," he 
writes, '' calculate the danger to life to which such an unfortunate 
woman is exposed by the act of reproduction. If we assume the 
ordinary mortality of women in childbed to be 6 per mille, then, 
in a woman who within 15 years has been delivered 16 times 
(whether prematurely or at full term, the danger will be 16 times 
as great as that of a single delivery, and the mortality will be 
6X16 = 96 per mille; that is to say, of 1,000 women who have all 
been pregnant that number of times, 96 will die — nearly I in 10. 
Moreover, in this calculation the increased danger consequent upon 
the unusually rapid sequence of the deliveries has not been taken 
into consideration. And, again, only the immediate results of the 
deliveries have been taken into the account. Not infrequently women 
succumb at a later date to illnesses acquired in childbed ; whilst 
others, in consequence of repeated pregnancies, have their powers of 
resistance so greatly diminished, that they are unequal to the contest 
with incidental diseases. In any case, a woman who has experienced 
numerous and rapidly successive pregnancies, has sustained dam- 
ages which will endure for the rest of her life. Her tissues have 
lost their elasticity, the abdominal walls are flaccid, the abdomen is 
prominent, the abdominal viscera are displaced, the vessels dilated, 
the reproductive organs in a state of subinvolution, and are the seat 
of structural alterations. The greatest dangers arise in cases in 
which the pregnancies are consequences that have to be paid for 
illicit love, since in such cases syphilitic and gonorrhoeal infection are 
exceptionally common. These complications, indeed, are not ex- 
cluded in the case of married women^ since marital infidelities occur, 
and, again, a premarital but not completely cured venereal illness may 
bear fruit in marriage, the latter occurrence being almost always at- 
tributable to the husband. Syphilitic or gonorrhoeal infection may 
also arise in some other way than by copulation, and to this women 
are more exposed than men, owing to the greater size of the genital 
passage in the former." 

Very numerous are the disorders of the nervous system referable 
to the sexual functional activity of woman during this epoch of her 
sexual life. 



The Sexual Epoch of the Menacme. 225 

Frciiiid, in his description of a neurasthenic symptom-complex 
to which he gives the name of angst-neurosis,^^, maintains that the 
cause of these attacks of anxiety^^' is very frequently to be found in 
a number of injurious influences in the sphere of the sexual life. 
In women, these anxiety-neuroses occur : 

a) As virginal anxiety, or anxiety of adolescents. Frciind has 
observed a number of unequivocal instances showing that a first 
encounter with the sexual problem, a rather sudden unveiling of 
what has hitherto been concealed, as, for instance, the sight of some 
sexual act, or something read or heard in conversation, may, in a 
girl at the time of puberty, give rise to an anxiety-neurosis, which 
is in a very typical manner combined with hysteria. 

h) As anxiety of the newly married. Young wives who have 
been without sexual feeling in their first experience of intercourse 
are not infrequently attacked by an anxiety-neurosis, which, how- 
ever, disappears as soon as the sexual feeling becomes normal. 
Since, indeed, the majority of young women who lack sexual feel- 
ing in their first experience of sexual intercourse remain neverthe- 
less quite healthy, it is evident that some other cause must cooperate 
in arousing the anxiety-neurosis. 

c) As anxiety in married women whose husbands suffer from 
ejacnlatio prcecox or from great diminution of sexual potency, or 

d) Whose husbands practice coitus interruptus or coitus reser- 
vatiis. Cases in these tw^o classes are closely associated, since it is 
easy to ascertain, from the analysis of a sufficiently large number 
of cases, that the really important question is, whether during coitus 
the wife obtains or fails to obtain sexual satisfaction. In the latter 
event, the condition requisite to arouse the anxiety-neurosis is sup- 
plied. 

e) As anxiety in widows and in voluntary abstinents, not infre- 
quently in typical combination with impulsive ideas. 

/) As anxiety in the climacteric period, during the final flare-up 
of sexual passion. 

Numerous anomalies of the genital organs which gave rise in the 
virgin to no trouble whatever display their influence during the 
menacme by unfavorably affecting the nervous system. Thus, in 
cases of malformations of the external organs of generation, slight 
atresia of the vagina, a rudimentary condition of the vagina, a rigid 
hymen, or local changes in the vagina, it is only when sexual inter- 
course begins that neuroses or hysteroneurasthenic troubles ensue. 

^♦''The German word Angst, here translated anxiety, is used in various 
senses, ranging from anxiety to anguish, according as the mental element or 
the element of pure feeling predominates in the conception. In the case of 
the angst-neurosis, however, a condition of mental uneasiness would appear 
to be connoted, and therefore anxiety is the best rendering. — Tr. 

IS 



226 The Sexual Life of Woman. 

So also at times nervous diseases which, though the disposition to 
them was present, were latent in the girl, such as epilepsy and various 
mental disorders, first become apparent in consequence of sexual 
intercourse. 

The mechanical irritation of the nerves of the pelvis that occurs 
in sexual intercourse may, even in women whose reproductive organs 
are healthy, arouse sensations of weight, pressure, and bearing-down, 
various painful sensations in the sacral region, over the coccyx, in 
the buttocks, or in the upper part of the thighs, and also " lumbar 
enlargement symptoms," ^' viz., weakness of the lower extremities, 
abnormal sensations of fatigue in the lower extremities and the 
back, sometimes also disorders of micturition and defsecation. 

Throughout the manifold diseases of women in or connected with 
the reproductive system during the age of sexual maturity, associated 
mental processes take place, which powerfully affect the nervous 
system. Such processes are, melancholy and anxious thoughts con- 
cerning the possible influence of the illness on the happiness of mar- 
ried life, concerning childlessness, or concerning loss of a husband's 
sexual esteem, or again, fear that the affection will become can- 
cerous, fear of some necessary operative procedure, or vexation in 
consequence of the limitation of her usefulness as housewife, wife, 
and mother. Ihus in women suffering from sexual affections, a 
state of general neurasthenia, or some neurasthenic functional dis- 
turbance of other organs, very commonly arises. 

The knowledge that she is suffering from an affection of the 
genital organs, makes a deep and lasting impression on the mind 
of a woman who takes a serious view of her duties as a wife, and 
whose thoughts and feelings are concentrated in the sexual sphere. 
The result is, that minor troubles are regarded through the magnify- 
ing lens of anxiety, and the general sensibility is increased. This 
hypersesthesia is not confined to the affected region, but manifests 
itself in various other parts of the body by numerous phenomena of 
a reflex character. In the first place must be mentioned severe 
headaches, sacrache, sensations of pressure in the abdomen, car- 
diac troubles, palpitation, stomach-ache, nausea and retching and 
disorders of appetite and digestion. Capacity for work and the 
enjoyment of life are destroyed by these disorders. 

We have further to take into account the numerous conditions 
liable to disturb the mind at this period of life. In childless women, 
we have the subject of their sterility, the continued yearning to be 
blessed with children, the eager search for a remedy, and not rarely 
in these cases the conflict between the reproductive impulse and the 
ethical principle of conjugal fidelity. In fruitful mothers, on the 

"'''''' German, Lcndcnniarksymptome. 



The Sexual Epoch of the Menacme. 227 

other hand, we have the anxiety lest, by too fre(jucnt chlldbearing 
their beauty should be impaired and the Hvehhood of the family en- 
dangered ; these considerations leading in many cases to the practice 
of coitus rcscrvatus, with its deleterious physical and moral conse- 
quences. In the middle and working classes, we have the strain 
of the endeavor to be a helpful companion to the husband and at 
the same time to assist in the support and the education of the 
children. Last but not least, we have the potent influence of local 
therapeutic measures, and the fear of operative procedures, both 
of which have a most agitating effect on a woman's mind. In truth, 
the menacme is a period full of stormy excitations and powerful 
revolutions. 

In addition to its influence on the genital organs themselves, the 
sexual life of woman during the period of the menacme manifests 
its powers for evil especially in relation to the digestive functions, 
and to the functions of the heart and the nervous system. 

When we compare the various consequences which may be in- 
duced in the principal organic systems as a result of functional 
disturbances and organic diseases of the female genital organs, we 
find that in respect of the frequency of their occurrence the diseases 
of the nervous system occupy the first rank ; next in frequency come 
the disorders of the digestive organs that arise in sympathetic as- 
sociation with diseases of the female reproductive organs ; whilst the 
third rank in respect of frequency and importance is occupied by the 
cardiac disorders that arise in connection with changes in the female 
organs of generation, and take the form either of disturbances of 
the heart's functions or structural changes in the heart's muscle. 

Dyspepsia Uterina. 
Although it has long been a familiar observation that pregnant 
women and women suffering from diseases of the reproductive or- 
gans suffered from various dyspeptic troubles, I was myself the 
first (in the Berliner Klinische Wochen^chrift, 1883) to bring to- 
gether, and to describe under the name of dyspepsia uterina, a, pe- 
culiar group of dyspeptic conditions which are dependent upon dis- 
eases of the female reproductive organs. I dismissed from considera- 
tion organic diseases of the stomach and intestine dependent upon 
anatomical changes in these organs, even though these also might owe 
a similar etiology, and described only the more frequent dyspepsias 
occurring without organic change in the digestive apparatus, the ori- 
gin of which is to be explained by the fact that certain structural 
changes and displacements of the uterus (to be discussed later) 
arouse centripetal impulses, and that these exercise a reflex influence 
on digestive activity. 



228 The Sexual Life of Woman. 

This influence, according to my observations, affects the secretory 
and muscular apparatus and also the nervous elements of the di- 
gestive tract, and I regard the following conditions as characteristic 
of uterine dyspepsia, though they do not necessarily all occur simul- 
taneously : changes in the gastric secretion, excitement of the vomit- 
ing centre, an inhibitory influence on intestinal peristalsis, and 
hyperiesthesia of the stomach. 

The symptoms of uterine dyspepsia may vary greatly in intensity, 
but not infrequently become so severe as to disturb very seriously 
the general health of the woman so affected. They may be enu- 
merated as follows : The appetite in uterine dyspepsia is variable, 
but is generally good; the tongue is not usually coated to any 
great extent, nor does the mucous membrane of the mouth com- 
monly exhibit any notable change; pain in the epigastrium is com- 
mon after meals, with acid eructations and heartburn (pyrosis) f^ 
sometimes there is violent vomiting, occurring after every meal, or 
in the morning on an empty stomach ; in addition, constipation is 
an almost constant symptom, associated with excessive development 
of gases in the intestinal canal. The pain is usually dull in char- 
acter, and somewhat relieved by pressure, but it may be severe 
and lancinating, and may shoot along the intercostal spaces. The 
accumulation of flatus within the abdomen gives rise to various 
painful sensations, distension, a sense of fulness ; .and its expulsion 
is attended with notable relief. 

As regards the composition of the gastric secretion, an increase 
of acidity is sometimes noticed. Gastric digestion is retarded ; ex- 
perimental evacuation of the stomach, after a simple test meal (beef- 
steak and roll) showed that small quantities of undigested remnants 
were to be found in the stomach as long as seven or eight hours 
afterwards. The frequent eructations evacuate flatus, or else a 
watery fluid with an acid reaction (pyrosis or zvater-brash — see 
note 38). By the act of vomiting, larger or smaller masses of 
the food that has been taken are evacuated; in the vomit, sarcinse 
in large numbers may frequently be detected by the microscope. 
Constipation is present in nearly all cases of uterine dyspepsia ; and 
even in cases in which attacks of diarrhoea occur from time to time, 
careful examination will show that these are generally transient, 
being sequelae of constipation due to the irritation caused by the 
accumulated masses. In one case of long-standing uterine dyspepsia, 
I observed, in the absence of any gastric dilatation, the well-known 

3^ German, saures Aufstossen und Sodbrennen; for the latter noun heart- 
burn would appear to be the most precise EngHsh equivalent, since the term 
pyrosis IS sometimes employed to denote the acid eructation (or water-brash) 
and sometimes the accompanying sensation at the pit of the stomach — heart- 
burn or cardialgia. Etymologically, of course, the latter sense of pyrosis is 
correct (Greek, 7rD/>, fire).— Tr. 



The Sexual Epoch of the Menacme. 229 

phenomenon of ''peristaltic restlessness of the stomach" (tormina 
vcntriculi nervosa), in which the peristaltic activity of the stomach 
is greatly exalted, and becomes visible to the naked eye in the form 
of large and powerful undulations in the gastric region, moving from 
left to right. 

With these symptoms affecting the digestive organs are associated 
variable nervous manifestations in different organs, such as neuralgia 
of various nerves, palpitation of the heart, vertigo, headache, and 
nervous asthma. The general nutrition of the body often suffers 
considerably in cases of long-enduring uterine dyspepsia ; excessive 
emaciation and general marasmus may ensue ; we see also mental 
depression, melancholia, an irritable disposition, and disinclination 
for every kind of work. 

Very important, but very difficult, is the differential diagnosis 
between uterine dyspepsia, on the one hand, and, on the other, 
chronic gastric catarrh, chronic ulcer of the stomach, nervous dys- 
pepsia, and sometimes even carcinoma of the stomach. 

As regards the distinction from chronic gastric catarrh, in this 
latter disease loss of appetite and changes in the oral mucous mem- 
brane are prominent symptoms ; the vomit also usually contains much 
mucus. More difficult is the differential diagnosis of chronic ulcer 
of the stomach, in cases in which anaemic subjects complain of 
anomalies of menstruation, associated with dyspeptic troubles and 
cardialgia. In severe cases of uterine dyspepsia, the distinction from 
carcinoma of the stomach may be very difficult — at any rate in 
cases in which no examination of the genital organs has been made. 
Obstinate dyspeptic troubles, resisting all curative measures (unless 
indeed these are directed to the relief of the local disorder of the 
reproductive organs), progressive anaemia, great emaciation, and 
pains localized in the stomach, are all conditions common to both 
of these maladies. The absence of a tumor of the stomach, care- 
ful examination of the vomit, and examination of the genital organs, 
will lead to a correct diagnosis if the case is one of uterine dyspepsia. 
A superficial investigation is exceedingly likely to result in a case 
of uterine dyspepsia being regarded as one of nervous dyspepsia 
{von Leiibe) ; none the less, even though a very close resemblance 
exists between the symptoms of the two diseases, to differentiate 
them is a matter of importance. In nervous dyspepsia, the act of 
digestion influences the nervous system in such a manner that, even 
when the chemical processes are normal, the organism as a whole 
is sympathetically affected by a reflex from the stimulation of the 
nerves of the stomach, and in return reacts on the mechanical process 
of digestion in a more or less violent manner. In uterine dyspepsia, 
however, the relationship that obtains is exactly the reverse of this. 



230 The Sexual Life of Woman. 

inasmuch as the gastric activity is influenced by the nervous system, 
by reflex impulses originating in the morbid processes in the repro- 
ductive organs; moreover, in this form of dyspepsia, in direct con- 
trast with nervous dyspepsia, the chemistry of digestion is often 
disordered, and, in addition, the process is not completed within the 
normal period. 

Oftentimes, the diagnosis of uterine dyspepsia can be made with 
certainty only ex juvantihus.^^ For this disorder cannot be cured 
unless the disease of the reproductive organs on which it depends is 
first relieved ; and, conversely, local measures for the relief of uterine 
disease, will often at once remove all the dyspeptic troubles from 
which the patient suffers. 

My own experience has led me to conclude that it is certain dis- 
tinct local mechanical stimuli affecting the female genital organs 
which, acting for a long period on the sensory nerves of the uterus 
or its annexa, induce by reflex action the before-mentioned digestive 
disturbances. Diseases of the vulva and the vagina, catarrhal in- 
flammation, colpitis and leucorrhcea, and prolapse of the vagina, 
do not by themselves lead to the occurrence of uterine dyspepsia; 
nor do inflammations of the uterine mucous membrane, such as en- 
dometritis (unless associated with parenchymatous changes of the 
whole uterus), chronic catarrh of the mucous membrane, erosion 
and ulceration of the cervix to an inconsiderable extent, or moderate ^ 

perimetritic and parametritic exudations. On the other hand, uterine i 

dyspepsia frequently ensues in cases of uterine displacements, | 

flexions, or versions, or in cases of structural changes of the uterus 
accompanied by enlargement of the organ, chronic metritis, myo- 
ma'ta, especially when intramural (interstitial), displacement of the ,; 

Fallopian tubes and the ovaries, chronic oophoritis, extensive in- | 

flammatory exudations, resulting from pelvic peritonitis, and lead- | 

ing to dislocation, '' compression *' or distortion of the uterus and its ^' 

annexa, deep follicular or carcinomatous ulceration of the cervix, or, f- 

finally, ovarian tumors. As the commontest condition giving rise to S 

dyspeptic disturbances of the kind under consideration, retroflexion § 

of an enlarged uterus must be mentioned. p 

Under the head of uterine dyspepsia, we may also classify dyspep- $ 

tic disturbances occurring at the time of puberty or of the meno- 
pause, and in association with certain amenorrhoeic and dysmenor- 
rhceic conditions, and, in addition, the vomiting of pregnant women. 

The vomiting of pregnant women, which must be regarded as a 
reflex disturbance of the stomach, occurs, with especial severity in 
first pregnancies, in the early months of pregnancy, with such regu- 
larity that it is regarded as one of the most typical signs of preg- 

3^ By consideration of the results of treatment. 



The Sexual Epoch of the Menacme. 231 

nancy. Thus, in 177 pregnant women, Horiintz observed vomiting 
in 147 (83 of whom were primiparse, and 64 multiparse), and in 
29 only was this symptom wanting. In this series of cases, it most 
commonly made its appearance between the tenth and eleventh week 
of the pregnancy. The vomiting of pregnant women occurs most 
commonly early in the morning, immediately after rising (morning 
sickness), but also at other times of the day; it usually takes place 
easily, without any great distress, and after it is over the patient 
feels quite comfortable. It rarely continues later than the fourth 
month of pregnancy. 

Very serious in its effect on the general state of nutrition is the 
uncontrollable vomiting that sometimes occurs in pregnant women 
(hypcremesis gravidarum), lasting throughout the whole term of 
pregnancy. It must be regarded as an exaggeration of the physio- 
logical vomiting of pregnant women, in patients whose nervous 
equilibrium is profoundly disturbed ; but equally with the ordinary 
" morning sickness " is it dependent on the reflex stimulation 
of the nerves of the stomach exercised by the growing uterus. One 
source of such stimulation may be found in the stretching of the 
peritoneal investment of the uterus which results from the enlarge- 
ment of that organ ; another, in certain displacements of the uterus ; 
but in addition to these local anomalies, we must assume the exist- 
ence of a peculiar predisposition on the part of the nervous system, 
in virtue of which reflex irritabihty is increased, while the power of 
reflex inhibition is diminished. 

The prognosis and treatment of uterine dyspepsia depend chiefly 
upon the nature of the diseases of the female genital organs that 
have given rise to the disturbances of digestion, and this pathological 
relationship demands above all a careful investigation. The follow- 
ing instance from my own case-book may be regarded as typical 
of cases of this class. Mrs. N., aged 25, married 6 years, barren, 
complains of severe dyspeptic trouble. Appetite fairly good, but 
after every meal severe gastralgia occurred, with heartburn and acid 
eructations, and very often the food was rejected; there was also 
obstinate constipation, and great distress from the accumulation of 
flatus in the intestinal canal. No blood was ever seen in the vomit. 
The patient was much emaciated, and was greatly depressed in 
spirits. Neither in the lungs nor in the digestive organs had any 
of the physicians under whose care the lady had been for the last 
four years found any abnormal change to account for the stormy 
manifestations. Now, at length, the gynecological examination, 
which had hitherto been neglected, was undertaken. The uterus 
was found to be strongly retroflexed and enlarged. Rectification of 
the position of this organ was immediately followed by the disappear- 
ance of all the stomach troubles ; the vomiting ceased, some months 



232 The Sexual Life of Woman. 

later the woman became pregnant, and pregnancy and parturition 
were quite normal; since then there has been no return of the 
dyspepsia. 

Since the appearance of my work on dyspepsia uterina, numerous 
observations have in recent years been published, proving even more 
clearly the causal dependence of disturbances of the gastric function 
upon diseases of the female genital apparatus. 

Lainy, for example, has made an elaborate study of one of the 
above-mentioned symptoms of uterine dyspepsia, namely, excite- 
ment of the vomiting centre. His conclusions are as follows : 
Among the general symptoms of diseases of the uterus, dyspepsia, 
in all its forms and in all degrees of intensity, occupies the first rank 
in respect of frequency of occurrence. Among the accompaniments 
of these reflex processes, uterine vomiting must be mentioned. It 
seldom occurs as the sole symptom of disorder of the digestive 
organs ; but when it does occur alone, it is of great importance that 
the cause of the affection should not be misunderstood. Diseases 
of the uterus and periuterine affections are the conditions that most 
commonly give rise to this trouble, but in a certain number of 
cases it is due to physiological changes in the female genital organs. 
Such changes are those associated with the functional activity of 
the reproductive apparatus at the time of puberty, during menstrua- 
tion, in connection with coitus, during pregnancy, and at the change 
of life, the menopause. The vomiting of pregnant women is of 
the same nature, and confirms our belief in the uterine origin and 
pathogenesis of vomiting at other times than during pregnancy. The 
diagnosis of the true cause of uterine vomiting cannot be made 
from the nature of the latter, but only from a knowledge of the con- 
ditions in which it occurs, just as with other uterine reflexes, such 
as neuralgia or cough. The vomit may consist merely of the food 
last taken, or it may contain bile, without the presence of this latter 
constituent indicating the existence of any disease of the liver. The 
treatment of this disorder, which indeed does not threaten life, but 
does seriously impair the general state of nutrition, must be local, 
directed against the disease of the genital organs : Thus, in one 
case of this nature, a cure was effected by oophorectomy. 

The majority of the women in whom Lamy observed this symptom 
of uterine dyspepsia were chloro-anaemic individuals with an ir- 
ritable nervous system, town-dwellers, young girls in whom fre- 
quent evening parties and dances, ill-chosen diet, and a gen- 
erally unsuitable mode of life, had led to the development of a 
"virginal metritis." The signs of the disturbance of the gastric 
functions were in the first place a retardation of gastric digestion 
while the appetite remained good. Moreover, the stomach was 



I 



The Sexual Epoch of the Menacme. 233 

often distended ^vith flatus, and this caused frequent gaseous eructa- 
tions ; there was also epigastric pain, which made it (Hfiicult for 
the patient to bear the pressure of the clothing, and sometimes 
great pain was aroused by the slightest contact. The attacks ot 
vomiting, which occurred in a characteristic manner -with periodical 
intervals of freedom, were usually preceded for a longer or shorter 
period by dyspeptic symptoms. The vomiting itself, if it occurred 
immediately after a meal, was not accompanied by nausea, a feeling 
of faintness, or cold sweats, but rather resembled a kind of pain- 
less regurgitation ; but when the vomiting did not occur till some 
hours after food had been taken, it was painful, and the vomit was 
then green-tinted owing to the admixture of bile. 

The gastric troubles that occur during menstruation are regarded 
by P. Milllcr as a further indication of the intimate connection be- 
tween the genital organs and the digestive tract. In women Vv^ho 
suffer from hysterical manifestations, gastric disturbances, cardialgia, 
and nervous dyspepsia, are very frequently associated with men- 
struation. These gastric symptoms generally make their appearance 
a few days before menstruation is due, and disappear as soon as the 
flow is established. In other forms, again, the digestive troubles 
set in with the appearance of the flow, to disappear during the later 
course of menstruation; and in yet other cases the gastric disturb- 
ance begins even later, and ceases only when the flow, comes to an 
end. These symptoms may occur in women in whom the genital 
organs are perfectly healthy and in whom menstruation runs a 
regular course. More severe symptoms may, however, appear if 
menstruation is disturbed for any reason, or if it is suppressed. 
Not rarely such women, when they become pregnant, suffer, espe- 
cially during the early months, from dyspeptic symptoms ; but 
similar dyspepsia may occur in pregnant women who have previously 
been quite healthy. 

To the same category belong the cases formerly described by von 
Leyden under the designation of neuralgia and hypersesthesia of 
the stomach, which he observed in young girls as a sequel of men- 
strual disturbances, and more particularly of suppressio mensiuin. 
In these circumstances, the sensibility of the stomach may become 
so extreme that every time food is taken the patient suffers from 
such severe pains, or from so distressing a sense of anxiety and 
oppression, that she comes to eat less and less, and an extreme de- 
gree of emaciation and marasmus results. In one such case, con- 
genital atrophy of the uterus was discovered on gynecological ex- 
amination. 

According to R. Arndt, it is especially in chloro-neurotic individ- 
uals that the stimuli proceeding from morbid conditions of the 
reproductive organs frequently induce, by reflex action, all kinds 



234 The Sexual Life of Woman. 

of disturbances of the alimentary tract, such as constipation and 
flatulence, gastric uneasiness and loss of appetite, weakness of di- 
gestion, cardialgia, and stricture of the oesophagus. Even simple 
menstruation suffices to give numerous proofs of this fact, but still 
more do such consequences arise from serious diseases of the re- 
productive organs, such as changes in form, displacements, and in- 
flammatory states, and also, on the other hand, more or less pro- 
nounced hypoplasia. 

G. Braiin has published three cases illustrating the connection 
between neurosis of the stomach and uterine disorders. In the first 
of these cases, severe digestive disturbances occurred after every 
meal, with occasionally violent vomiting, in a woman, aged twenty- 
five years. No changes were found in the stomach or other digestive 
organs, and the symptoms obstinately resisted all direct treatment. 
Gynecological examination showed extreme mobility of the uterus, 
and for the relief of this a suitable pessary was introduced. The 
vomiting thereupon immediately ceased, all the other digestive 
troubles passed completely away, and the general state of nutrition, 
which had before been so much impaired as to necessitate the use 
of nutrient enemata of meat-solution, now became normal. The 
second case was that of a woman aged thirty, who, since her last 
confinement two years before, had continually suffered from dis- 
agreeable gastric sensations and from vomiting, which latter had 
proved quite uncontrolable. Gynecological examination disclosed 
extensive laceration of the cervix with ectropium of the mucous 
membrane. An operation was performed for the relief of this con- 
dition, and the vomiting of two years standing was also thereby 
cured. In the third case, that of a woman twenty-eight years old, 
vomiting began three months after her confinement, and recurred 
whenever the patient left the recumbent posture, in which latter 
she felt quite well. On local examination, the uterus was found 
to be prolapsed, the vaginal portion of the cervix moderately en- 
larged and just within the vaginal orifice. Amputation of th^ vag- 
inal portion of the cervix cured the vomiting and completely re- 
stored the patient's health. 

The frequency of gastric affections in cases of retroflexion of the 
uterus is insisted on by Panccki. In eight instances he found neu- 
roses of the stomach consequent upon such retroflexion, and in all 
cases a cure immediately followed rectification of the position of 
the uterus. He urges that if after the reposition of the retroflexed 
uterus the gastric troubles should still persist, a careful local exa- 
amination of the stomach is indispensable. 

Eisenhart, in a woman forty-two years of age, corrected a mobile 
retroflexion of the uterus, and thereupon very severe gastric symp- 
toms of several months' duration soon disappeared. Graily-Hewitt, 



The Sexual Epoch of the IvIenacme. 235 

in an unmarried woman twenty-seven years of age, cured by reposi- 
tion of a retroflexed uterus a gastric disorder which had subsisted 
for nine years ; Elder and Henrik report identical results in gastric 
troubles consequent on retroflexion or retroversion of the uterus. 
Jaffc, in a virgin, aged twenty-three, who had been brought near 
to death by gastric disorder with vomiting, found on local exam- 
ination that there was a profuse, thick, purulent discharge from the 
interior of the uterus ; curetting, and irrigation of the uterine cavity 
with' antiseptic solutions, gave immediate relief to the stomach 
trouble. Similar experiences are recorded by C. van Tussenheck and 
Mendes de Leon in cases of gastric disorder consequent on en- 
dometritis fungosa and endometritis inter stitialis parenchymatosa; 
and by Gottschalk, in cases consequent on sarcoma of the chorionic 
villi. Lezuy and Butler-Smythe have observed the relief of per- 
nicious vomiting by Emmet's operation (trachelorraphy). 

As regards the relations of gastro-intestinal affections to the 
diseases of the reproductive organs, Theilhaber, in the cases ob- 
served by himself, distinguishes three groups. In the first group 
of cases, the gynecological abnormality was a chance accessory, 
and was not the cause of the gastric trouble. In the second group, 
he regards the gynecological trouble as dependent upon the affec- 
tion of the gastro-intestinal tract, believing that, in consequence of 
atony of the intestine and an accumulation therein of faeces and 
flatus, a retardation of the circulation occurs in the region of the 
inferior vena cava, resulting in venous stasis in the uterus, and so 
giving rise to metrorrhagia, dysmenorrhoea, and fluor albus. In 
the third group of cases, Theilhaber believes that the uterine trouble 
is the cause of the disturbances in the stomach and intestine. He, 
like myself, has found in all these patients an inhibition of the in- 
testinal movements; but he found, on the other hand, that the gastric 
secretions were more commonly normal, and that only in a small 
proportion of the cases was the vomiting centre excited. Further, 
in the majority of these women, the course of the digestive processes 
was quite normal ; and, finally, in his series of cases, endometritis 
was one of the commonest causes of consecutive gastric disorders. 
His observations led him to conclude that " in consequence of af- 
fections of the uterus a large number of different symptom-com- 
plexes of gastric trouble occur :" the pure nervous dyspepsia of 
Lcuhe, dependent on atony of the large intestine and atony of the 
stomach, hyperchlorhydria and anacidity, periodic gastralgia without 
anatomical cause, etc. 

Cardiopathia Utcrina. 

I use the term cardiopathia utcrina to denote the manifold cardiac 
disorders which occur in women as reflex processes excited by the 



236 The Sexual Life of Woman. 

physiological functions and the pathological disorders of the genital 
organs, and take the form of very various disturbances of the cardiac 
function. Every phase of the sexual life of women — that in which 
the reproductive organs attain complete development and m.enstrua- 
tion first appears (the menarche) ; the commencement of sexual 
intercourse ; pregnancy, parturition, and the puerperium ; finally the 
retrogressive process at the climacteric age, of which the menopause 
is the outward manifestation — may give rise to the occurrence of 
such cardiac troubles. In order to explain these troubles as reflex 
in their nature, we must on the one hand recur to the anatomical 
changes in the uterus and its annexa that take place in every one 
of the above-mentioned phases of the sexual life; and on the other 
hand we must take into consideration the mental processes that ac- 
company these anatomical changes, in order to estimate their influ- 
ence upon the motor and sensory nerves of the heart (see the sec- 
tions on the Menarche and the Menopause). 

A certain predisposition to uterine cardiopathy exists in many 
individuals and in many families. This predisposition may be mani- 
fested in this way, that in w^omen who at the time of the menarche 
have suffered from cardiac disorder, similar cardiac disorder is likely 
to recur at the time of the menopause, the symptoms of the recur- 
rent attack being in most cases identical with those that occurred 
during the menarche. In the well-to-do and cultured circles of so- 
ciety, uterine cardiopathy is far more frequently encountered than 
among the working classes. Both unusually early and unusually 
late commencement of menstruation tend to favor the occurrence of 
uterine cardiopathy. The most valuable therapeutic measures that 
we can employ to combat these disorders are suitable dietetic and 
hygienic regulations, in association with favorable mental influences. 

Diseases of the female reproductive organs, including simple 
functional disturbances, are very frequently accompanied — far more 
frequently than has hitherto been supposed — by cardiac disorders. 
But whereas in some cases these cardiac disorders are directly de- 
pendent upon the disease of the genital organs ; in other cases no 
such etiological relationship can be shown to exist, and the associa- 
tion must, therefore, be regarded as fortuitous. 

In cases of the former kind, the dependence of the cardiac disorder 
upon the disease of the genital organs is very variable in its nature. 

Reflex manifestations on the part of the nervous system may be 
aroused by pathological changes in the genital organs, in a manner 
similar to that discussed in other parts of this work in regard to 
the cardiac troubles that are liable to occur during the menarche 
and the menopause ; such cardiac disorders are indeed excited espe- 
cially by changes in the ovaries, by disturbances of menstrual ac- 



The Sexual Epoch of the Menacme. 237 

tivity, by suppression of the menses — as manifestations, that is to 
say, of the menstrual reflex. The cardiac disorder most commonly 
takes the form of tachycardiac paroxysms, recurring- periodically, 
either in association with the menstrual flow, or, if this is in abey- 
ance, at the times at which it ought to appear. We must assume 
in these cases that • the local stimuli aroused by the pathological 
changes in the uterus and the ovaries have a reflex influence upon 
the cardiac nerves, by means of which the heart's action is increased 
in frequency, without inquiring more particularly whether the reflex 
influence is effective by inhibiting the normal action of the vagus, 
or by stimulating the sympathetic, or, perhaps, by a combination of 
these factors. Much more rarely do we notice, in association with 
disorders of the reproductive system, a reflex decrease in the fre- 
quency of the heart's action, this effect being explicable in the same 
manner as the well-known experiment of Goh^ in which, if the 
abdomen of a frog be laid bare, and the intestine be struck sharply 
with the handle of a scalpel, the heart will stand still in diastole with 
all the phenomena of vagus inhibition. 

In another group of diseases of the genital organs, the disturb- 
ances of cardiac activity may be brought about by pressure w^hich, 
in consequence of the morbid processes in the reproductive organs, 
is exercised upon individual nerves or upon an entire nerve plexus. 
Tumefied and prolapsed ovaries, an enlarged and misplaced uterus, 
inflammatory nodules and hyperplasias of the intrapelvic connective 
tissue, contractile processes in the parametric connective tissue,*^ 
tumors of the uterus whether intramural or in the interior of that 
organ, ovarian tumors, prolapse of the uterus, and intrapelvic peri- 
toneal adhesions resulting from inflammatory processes — these are 
the principal conditions liable to occasion reflex cardiac disorder; 
but certain tissue changes, such as endometritis, erosions (chronic 
cervical catarrh), and ulcerations of the genital passages, with or 
without exposure of nerve-endings, are also competent to produce 
the same effect. Here the sympathetic nervous system constitutes 
the channel by means of which the stimuli affecting the nerves of 
the genital organs are conveyed to the central nervous system, and 
by means of which also the reflex manifestations of this stimula- 
tion are produced, taking the form, partly of disorder of the cardiac 
action, of palpitation of the heart and paroxysmal tachycardia, and 
partly of pains in the cardiac region and disturbances along the 
course of the great vessels. 

Further, in cases of long-continued disease of the female genital 

4^Ger. in den Paramctrien. The reasons for preferring the phrase para- 
metric connective tissue to the noun parametrium will be found in the 
English edition of Toldt's Atlas of Human Anatomy, Part IV, App. note 84. 



2'x2> The Sexual Life of Woman. 

organs associated with severe haemorrhage and in some cases fluor 
albus, nutrition in general and hsemotopoiesis may be seriously af- 
fected, and disturbances of cardiac activity may result, as, for in- 
stance, is frequently witnessed in chloro-anaemic states. In sucli 
cases we have palpitation of the heart, both subjective and objective, 
a weak and compressible pulse, often irregularity of the heart's 
action, singularly clear heart sounds, often, however, systolic mur- 
murs at various orifices, increased frequency of heart and respira- 
tion to a disproportionate degree on slight exertion, strong pulsa- 
tion of the carotids, and slight oedema of the ankles. 

Often, however, the disturbance of cardiac activity is dependent 
also upon degenerative processes in the myocardium, upon fatty 
degeneration and the consequent dilatation of the cavities, this de- 
generation being a consequence of the growth of a uterine tumor 
and especially of uterine myomata, or resulting from some constitu- 
tional disorder which is itself dependent upon the affection of the 
genital organs. In such cases the signs of degeneration of the 
heart are very striking : weakening of- the cardiac impulse, notable 
faintness of the sounds of the heart, occasionally reduplication of the 
second sound, a galloping rhythm, while percussion shows the exist- 
ence of considerable dilatation of the left, and still more frequently 
of the right ventricle ; in many cases also we have angina pectoris, 
passive hypersemia of the lungs, the mucous membranes, and the 
extremities ; and sudden death sometimes ensues. 

No less important are the mental influences exercised by diseases 
of the genital organs in which operation is proposed or actually per- 
formed, also by long-lasting diseases of the reproductive organs and 
by the disturbances these diseases produce in the reproductive func- 
tions, miore especially in relation to copulation and the actual process 
of reproduction. In this way cardiac neuroses of various kinds may 
be induced. 

Finally, cases have come under my notice in which the cardiac 
trouble was not the direct result of the disease of the genital organs, 
but was a consequence of the therapeutic measures employed for 
the relief of the latter; and in this connection I must regard as espe- 
cially blameworthy, in addition to intrauterine manipulations, such 
as sounding and cauterization, the modern practice of gynecological 
massage. 

Not all diseases, however, of the female reproductive apparatus, 
tend in a similar manner and with equal frequency to give rise to 
consecutive cardiac disorders. According to my own observations, 
the diseases of the vulva and the vagina, catarrhal inflammation, 
colpitis (vaginitis), leucorrhoea, and prolapse of the vagina 
(cystocele and rectocele), are those which most rarely induce cardi- 



The Sexual Epoch of the Menacme. 239 

opathy; unless, indeed, the diseases just enumerated have led to the 
occurrence of vaginismus, for in this latter condition cardiac trouble 
not uncommonly ensues. More commonly than by vulval and vag- 
inal diseases, cardiac troubles are induced by inflammation of the 
uterine mucous membrane, as by chronic endometritis, by erosion 
and ''ulceration" of the cervix (chronic cervical catarrh); they 
also sometimes occur in connection with perimetritic and parametritic 
exudations. Most frequently of all, and most severely, cardiac dis- 
orders are aroused by displacements of the uterus, flexions or 
versions ; by structural changes of the uterus accompanied by en- 
largement of that organ, such as chronic metritis and the growth of 
myomata (especially intramural) ; by prolapse, enlargement, and 
tumor of the ovary ; by intrapelvic exudations which w^hen extensive 
give rise to displacement or compression of the uterus or its annexa. 
In cases of carcinomatous or other malignant new growths af- 
fecting the reproductive organs, I have in comparison very rarely 
observed the occurrence of reflex cardiac disorders. 

Disturbances of menstrual activity, amenorrhoea, menorrhagia, and 
dysmenorrhoea, owning the most varied causes, very frequently give 
rise to cardiac trouble, a point on which we have already insisted. 
(See page 142, et seq.) 

Very violent forms of cardiac neurosis have been observed by 
me in women suffering from chronic disorder of the reproductive 
organs, who have consulted one gynecologist after another and have 
been subjected to many different methods of local treatment; also 
in women who have for a long time suffered from some gynecological 
ailment hitherto believed to be trifling, but who have at length sud- 
denly been informed that some severe operative procedure has be- 
come necessary. In such cases the cardiac trouble took a paroxysmal 
form, the intervals being usually considerable, several weeks or 
months in duration, and the general system was as a rule seriously 
involved in the attacks. These latter began with severe cardialgia, 
radiating from the cardiac region outward along the intercostal 
spaces, upward to the shoulder and along the left arm, sometimes 
indeed extending into both arms. At the same time the heart's 
action was greatly increased in frequency, there being sometimes 
more than 200 beats per minute, the pulse was soft, small, difficult 
to count, the respiration greatly increased in frequency, sometimes 
very shallow, with respiratory anxiety, and exceptionally severe 
general excitement and sense of impending death. In some cases 
also I observed spasm of various groups of muscles, dizziness (with 
a sense that the objects of vision were flickering), aphasia, and 
mental stupor. The paroxysms lasted for some time, two or three 
hours, as a rule, and gradually passed away. Their character was 



240 The Sexual Life of Woman. 

that of the cardiac disorder variously described under the names 
of pseudo-angina and angina pectoris hysterica. 

Such attacks as these are followed by a sense of severe general 
depression and want of energy, and by a decline in body weight. 
They are distinguished from true angina pectoris by the- absence of 
any signs of arteriosclerosis or of degeneration of the myocardium. 
They may be regarded as cardiac disorder of duplex causation, being 
partly dependent on the disease of the genital organs, which gives 
rise to a number of local afferent stimuli, and partly dependent on 
mental influences which have a depressant, paralyzing influence on 
the cardiac nerves; it is possible also that spasmodic contraction of 
the walls of the coronary arteries or of the myocardium itself is 
induced as a reflex effect of the local disorder of the reproductive 
organs. 

With regard to uterine myoma as the exciting cause of cardiac 
degeneration, very numerous observations and experiments have 
recently been made, and the reality of the occurrence is no longer 
open to dispute, even if its significance is subject to various inter- 
pretations, whilst no satisfactory explanation has yet been forth- 
coming. 

L. Landau writes concerning the disturbances induced in the 
circulatory apparatus by the growth of myomata in the uterus : 
" The formation of varices, the occurrence of thrombosis, and, 
finally, the onset of degeneration of the myocardium, are very com- 
mon. Should the last-named process result — and it is truly alarm- 
ing to observe the frequency with which cardiac affections are as- 
sociated with uterine myomata, — then, by a vicious circle, the 
uterine haemorrhages become continually more profuse, in conse- 
quence of increasing passive hyperemia dependent upon diminishing 
power of the cardiac pump. Venous congestion in the province of 
the inferior vena cava results in ascites, and sometimes in general 
cedema ; and even in cases in which no increase of the uterine haem.or- 
hages is observed, the patient may succumib in consequence of sec- 
ondary disease of the heart. * * * jj^ the great majority of 
cases, the myoma and the uterine haemorrhages that result from its 
growth are the primary cause of the morbus cordis. Naturally in 
cases which come under observation only when both uterine and 
cardiac disease are already present, it is difficult to determine with 
certainty the true causal connection. When, however, a number of 
patients suffering from uteflne myomata are observed, in whom at 
first the heart was found to be healthy, and subsequently to have 
become affected ; and when, on the other hand, we see patients af- 
fected with myoma uteri in whom operation is undertaken notwith- 
standing the existence of cardiac disease, and in whom, after the 



The Sexual Epoch of the Menacme. 241 

operation has been successfully performed, the cardiac murmurs 
disappear as well also as the other signs of heart disease, when dila- 
tation can no longer be detected, when the pulse-frequency declines 
to normal, whilst a previously feeble and compressible pulse gains 
in tension and power — then it is impossible to doubt that the heart 
disease was secondary, and was etiologically dependent upon the 
primary myoma and the uterine haemorrhages." 

Lehmann and P. Strassmann examined the material of the Charite- 
Policlinik at Berlin in order to throw light on the relation between 
uterine myomata and diseases of the heart, a connection already 
proved to exist alike by recent pathologico-anatomical researches, 
by clinical experience of the results of operations (death from 
shock), and, finally, by the subjective troubles of the patients (pal- 
pitation, venous congestion, giddiness, and syncope). Examining 71 
women suffering from myoma uteri, Lehmann and Strassiiiatin found 
in 29 (41^) that some abnormality existed in the cardiovascular 
system, such abnormalities being extremely variable in character, 
as for instance : hypertrophy or dilatation of the heart, irregularity 
of the cardiac action, passive hyperaemias, oedema, albuminuria, an- 
gina pectoris, and cardiac asthma. The next point was to determine 
the mutual relations between the heart disease and the development 
of the uterine myoma. Hitherto it has been assumed that the latter 
is the primary disease, and such a sequence is certainly the commoner, 
more especially in cases in which haemorrhage has been profuse, with 
consecutive anaemia and fatty degeneration of the heart. In these 
cases, a certain time after the commencement of the severe haemor- 
rhages, cardiac troubles make their appearance ; such troubles are 
beyond question secondary, and they disappear as soon as the 
haemorrhage has been controlled. In other patients, however, we 
obtain a history of the appearance of cardiac disorder at a date prior 
to that when any symptoms occurred indicating the growth of a 
myoma ; in these cases, therefore, the heart disease has developed in- 
dependently of the uterine disease, and has run a parallel course to 
the latter ; perhaps, indeed, by leading to venous congestion or to 
rapid changes in blood-pressure, the heart disease may have favored 
the growth of the commencing or fully developed tumor. In some 
of the patients, operative measures were followed by rapid recovery 
from the cardiac disorder (cases of simple anaemia) ; in a second 
group of cases, however, the heart disease was uninfluenced by 
operation (cases of irreparable anaemia, and cases of heart disease 
independent of the myomata) ; and, finally, a considerable number 
of patients remained, constituting a third group, in whom, notwith- 
standing the removal of the tumor by operation, the heart disease 
continued to grow worse (cases of progressive heart disease inde- 
pendent of the myomata, especially cases of arteriosclerosis). 
16 



242 



The Sexual Life of Woman. 



Among 120 women of ages between 17 and 48, in whom I found 
very various functional disorders of or pathological changes in the 
genital organs, and in whom I made a particular investigation con- 
cerning the presence or absence of heart disease and examined the 
heart carefully, I was able to detect the presence of cardiac troubles 
in 38 instances. Thus, heart trouble was found to exist in 32.7 per 
cent, of women suffering from disease of the reproductive organs. 

In these 38 persons suffering from cardiac disorder, I found: 

Nervous Tachycardia in 21 instances, that is, in 

about 55.2 per cent, of the cases. 

Hypertrophy of the Heart in 4 instances, that is, 

in about 10.4 per cent, of the cases. 

Pseudo-Angina Pectoris in 3 instances, that is, 

in about 7-8 per cent, of the cases. 

Asthenia Cordis in 7 instances, that is, in about. 18.4 per cent, of the cases. 
Mitral Incompetence in i instance, that is, in 

about 2.6 per cent, of the cases. 

Fatty Heart in 2 instances, that is, in about 5.2 per cent, of the cases. 

As regards the varieties of functional and organic disease of the 
genitals met with in the 120 cases, and the number of instances com- 
plicated with heart trouble in each variety, I found : 

Chronic Metritis in ^^ patients, complicated with cardiac dis- 
order in 13 instances. 

Chronic Oophoritis in 10 patients, complicated with cardiac 
disorder in 4 instances. 

Parametric Exudations in 14 patients, complicated with cardiac 

disorder in 6 instances. 

Chronic Endometritis in 16 patients, complicated with cardiac 
disorder in 2 instances. 

Flexions and Versions of the Uterus in 26 patients, complicated 

with cardiac disorder in 9 instances. 

Stenosis of^ the Cervix in 6 patients, complicated with cardiac 
disorder in o instances. 

Tumors of the Uterus and its Annexa in 8 patients, compli- 
cated with cardiac disorder in 4 instances. 

Infantile Uterus in 3 patients, complicated with cardiac disorder 

in o instances. 

Colpitis (Vaginitis) in 5 patients, complicated with cardiac dis- 
order in o instances. 

From these figures we obtain the following percentages, showing ^> 

the frequency with which heart trouble occurred as a complication |^; 

of the respective diseases of the genital organs : 

In Chronic Metritis, cardiac disorder was found 

in 40.6 per cent, of the cases. 

In Chronic Oophoritis, cardiac disorder was 

found in 40 per cent, of the cases. 

In Parametric Exudations, cardiac disorder was 

found in 42.8 per cent, of the cases. 

In Chronic Endometritis, cardiac disorder was 

found in 12.5 per cent, of the cases. 

In Versions and Flexions of the Uterus, cardiac 

disorder was found in 34.6 per cent, of the cases. 

In Tumors of the Uterus and its Annexa, 

cardiac disorder was found in 50 per cent, of the cases. 

11 



The Sexual Epoch of the Menacme. 243 

To summarize the result of my observations regarding the cardiac 
disorders secondary to diseases of the female genital organs : 

1. Tachycardial paroxysms in cases of amenorrhoea were pre- 
menstrual in rhythm, the paroxysms occurred, that is to say, some 
days before the due date of the suppressed flow. 

2. In cases of dysmenorrhoea, I observed heart trouble with severe 
dyspnoea and feelings of anxiety, also in some cases symptoms of 
cardiac asthenia ; these symptoms were perhaps dependent upon 
acute dilatation of the heart. The heart trouble associated with pro- 
fuse menorrhagia exhibited similar characters. 

3. Attacks of pseudo-angina pectoris occurred in women in whom 
local treatment for disease of the genital organs had been carried 
out for a long time, and in cases in which operative measures were 
in contemplation. 

4. Paroxysms of tachycardia and cardiac distress were observed 
in connexion with displacements of fhe uterus, and especially in 
cases of retroflexion ; also in association with oophoritis and with 
parametric exudations. 

5. Cases of degeneration of the myocardium, sometimes running a 
rapidly fatal course, were found to be consecutive to tumors of the 
uterus and its annexa, especially to myomata of the uterus. 



Nervous Diseases Seeondary to Diseases of the Genital Organs. 

In earlier chapters of this work we have frequently referred to 
the reflex influence exercised upon the nervous system in general, 
alike by the normal functions and the pathological states of the 
female genital organs. We must now briefly explain the more inti- 
mate connection between nervous diseases and diseases of the genital 
organs, the causal dependence of local nervous disturbances and of 
general neuroses upon diseases of the reproductive organs. 

The origination of a local nervous disease by a primary disease of 
the genital organs is dependent upon a simple mechanical process, 
which is explained by WindseJieid in the following terms : '' In this 
connection, the two principal mechanical factors are pressure and 
traction. Pressure may afifect individual nerves or an entire nerve 
plexus, and may be exercised by a tumour, an exudation or a mis- 
placed organ {He gar) ; further causes of pressure are furnished by 
inflammatory nodules, by connective tissue hyperplasias, and, ac- 
cording to Frev.iid, by contractile processes in the organs them- 
selves and in the ligaments. Traction on the nerves results from 
displacements, as from prolapse of the uterus or the ovaries, and, 
according to Hegar, from traction on the pedicle of small tumours. 
A combination of pressure and traction occurs especially in afifections 



244 ^^^ Sexual Life of Woman. 

of the abdominal attachments of the uterus, also where there is 
scarring of the neck of the uterus and of the vaginal fornices. 
Great importance, also, in relation to the production of local nervous 
disorders, must be attributed to the laying bare of nerve-terminals 
by catarrhal and other inflammatory processes. Abnormal mobility 
of the genital organs as a partial manifestation of enteroptosis 
must also be mentioned as a cause of mechanical stimulation- of the 
nerves. Finally, in this connection, must be considered the paresis 
of the abdominal walls that follows frequent and severe confine- 
ments." 

The symptoms of the local nervous disorders to which these 
mechanical stimuli may give rise, are very various, but may, ac- 
cording to Hcgar, be comprised under the general designation of 
lumbar enlargement symptoms {Lendenmarksymptome), inasmuch 
as the local stimulation of the intrapelvic nerves, affects the nerve- 
centres of the lumbar enlargement of the spinal cord. Among the 
symptoms, severe pains are prominent, either continuous or inter- 
mittent, within the pelvis and in the sacral region, accompanied 
by a sense of weight and pressure in the abdomen, or by dragging 
pain in the region of the hips, in the gluteal region, in the outer 
and back parts of the thighs, in the inner surface of the leg, in the 
calf, in the dorsum of the foot, the sole of the foot, and the heel ; or 
by coccydynia (pain over the coccyx and the lower extremity of the 
sacrum), or hyper^esthesia and anaesthesia of the external genitals in 
the region of the vaginal orifice, or, finally, by disorder of the proc- 
esses of micturition and def?ecation. In some of these cases, the 
weakness of the lower extremities is so severe that a paralytic con- 
dition is simulated. Actual paralysis may however occur, in con- 
sequence of the extension of peritoneal inflammation to the nerve- 
plexuses of the pelvis, leading to the occurrence of neuritis. 

The development of a general neurosis in consequence of disease 
of the genital organs, either as a complication dependent upon the ^. 

nervous stimulation excited by the primary disease, or as a reflex | 

consequence of this disease, implies, as Windscheid strongly main- | 

tains, the existence prior to the occurrence of the disease of the 
genital organs of diminished power of resistance on the part of 
the nervous system. This neuropathic constitution may be the re- 
sult of inheritance, and, according to Engelhardt, was so in 40 per 
cent, of his cases of women suffering from nervous disease second- 
ary to the disease of the genital organs ; or it may be acquired. 
Given this weakness of the nervous system, a local disturbance of the 
genital organs may act as the ultimate exciting cause of the onset 
of the neurosis in one of two different ways {Windscheid) . " i. The 
stimulus which the nerves of the affected genital organ (or those 



The Skxual Epuch of the Menacme. 245 

of some adjacent area, affected by direct extension) have received, 
proceeds upward from segment to segment of the spinal cord, and 
iikimately passes to the highest centres. 2. Or, on the other hand, 
the local nerves are not directly involved in the morbid process in 
the genital organs, but this latter acts as a source of reflex disturb- 
ance, a disturbance which must also pass through nervous channels. 
To this latter class of cases belong the instances, comparatively so 
frequent, in which, for example, a trifling retroflexion of the uterus 
must be regarded as the exciting cause of the neurosis." The com- 
monest neurosis of those that may be excited by local disease of the 
genital organs is undoubtedly hysteria, next in frequency come 
chorea and epileptic seizures. 

Schauta draws attention to the important fact that hereditarily 
predisposed, neurasthenic individuals bear very badly repeated 
gynecological examinations and long-continued local treatment, in- 
asmuch as, in such persons, a notable increase in the severity of the 
nervous affection may result, and even the outbreak of actual mental 
disorder; and he further points out that in hereditarily predisposed 
individuals, psychoses not infrequently occur in consequence of the 
performance of gynecological operations. 

The processes of pregnancy make a deep impression on woman's 
entire nervous system, and more especially on her mental functions. 
This is especially noticeable in the case of primiparge. The fact is 
easily understood, for a w^oman is filled with expectation and anxiety 
concerning the unknown event, the complete revolution in her 
organization, the powerful impressions on her physical ego, the 
formation of a new^ being within her womb. How many joyful 
hopes, how many distressing fears, are connected with that which 
is about to take place, wnth the act of creation within her bosom ; 
what changeful glimpses into the future, on the one hand the glad- 
ness, on the other the terror, of motherhood ; often, also, the anxious 
doubts as to the probable sex of the newcomer. Consider, too, the 
stormy sensations experienced by a woman who, unmarried, has 
become pregnant contrary to her desires and expectations, es])e- 
cially one in a poverty-stricken condition — consider the agonizing 
thoughts in such a case regarding the consequences of giving birth 
to a child. It is only to be expected that in pregnant women in 
general there will almost always be increased irritability of the 
nervous system combined with a tendency to the rapid variation 
of emotional states. Neumann found, in almost all the pregnant 
women he examined in respect to the point, that there was an in- 
crease of the knee-jerks, as a manifestation of the general increase 
of nervous irritability. Nor does this change depend upon mental 
influences exclusively ; there are other factors, such as the reflex 



246 The Sexual Life of Woman. 

processes aroused by the enlargement of the uterus, and also the 
changes in the composition of the blood which occur during preg- 
nancy, and cannot fail to have an influence on the nutrition of the 
brain. Finally, also, the deposit of carbonate of lime on the inner 
surfaces of the cranial bones (the parietal and frontal bones) 
which occurs during pregnancy, may be regarded as having some 
casual connection with the changes in the nervous system ; and, 
again many authors assume that the cerebral circulation is influenced 
by the formation of the placeniial circulation. 

The pathological consequences of pregnancy, as far as they affect 
the nervous system, take the form of neuralgia and of peripheral 
neuritis of various nerves, of chorea, of disturbances of the sense 
organs, and of actual psychoses. 

Peripheral neuritis in pregnant^ women affects chiefly the lower 
extremities, but has been observed in the arms also ; it is char- 
acterized by muscular wasting with reaction of degeneration, by 
trophic disturbances, and by disorders of sensation. A cure may 
ensue even during the pregnancy, but in other cases the illness per- 
sists until after parturition and on into the puerperium. To the same 
cause Windscheid assigns the paraesthesias of pregnancy, burning, 
prickling, and numb sensations of the finger-tips, less commonly 
of the toe-tips ; these sensations are continuous, not paroxysmal, and 
cause very great suffering. 

Pregnancy favors the occurrence of chorea, a circumstance ex- 
plicable by the increased irritability of certain nerve centres char- 
acteristic of the pregnant woman. The chorea of pregnancy occurs 
for the most part in primiparse, it is commoner in young than in 
older pregnant women, and appears especially in the early months 
of pregnancy. In the majority of cases the disease undergoes 
spontaneous cure before the end of the pregnancy, but cases with 
a fatal termination have been observed. 

On the other hand, a curative influence in previously subsisting 
hysteria has been assigned to pregnancy. This in fact only occurs 
in cases in which the hysterical manifestations have been evoked 
by influences which are counteracted or removed by the occurrence 
of pregnancy, such, for instance, as intense longing to bear a child, 
dissatisfaction with the existing circumstances of married life, etc. 
Conversely, it is by no means unusual to observe that, in patients 
who have previously suffered from hysteria, the attacks become more 
frequent during pregnancy, and that other nervous disturbances as- 
sociated with the hysteria become more prominent ; hysterical pa- 
ralysis, even, may appear. Very variable also is the influence of 
pregnancy in epileptics. I\Iost commonly, indeed, a certain quies- 
cence sets in, the attacks becoming less frequent and less severe; 



i 



The Sexual Epoch of the Menacme. 247 

but the reverse of this is at times observed. In the domain of 
the sense organs we observe amblyopia and hemianopia, deafness, 
and tinnitus aurium, and disorders of taste ; all these appear as pure 
nervous disturbances without known anatomical basis (IVindscheid). 

Finally, among neuroses, tetany may be mentioned. In women, 
this disease occurs almost exclusively during pregnancy and the 
puerperal state, in the form of paroxysmal spasm, affecting chiefly 
ihe extremities, and especially the hands; the spasm is bilateral, 
tonic in character, and painful. The tetany of pregnancy usually 
runs a favourable course. 

The slighter forms of mental disorder consist of perversions of 
taste and smell. Of actual psychoses occurring during pregnancy, 
the commonest forms are melancholia and mania. The former con- 
dition, which, according to Ripping, occurs in 84.4 per cent, of the 
cases, is usually very severe, and is characterized by a peculiar 
dreamy condition ; it often leads to suicide, or to infanticide im- 
mediately after parturition. The psychoses of pregnancy are seen 
with greater frequency in the second half of pregnancy, they occur 
especially in primiparse, and are also commoner in unmarried women. 
The prognosis is on the whole an unfavorable one ; sometimes, in- 
deed, the mental disorder terminates with the pregnancy, but in 
other cases it continues during the puerperium. Mental alienation 
occurring in the early months of pregnancy is apt to be less severe 
and to permit of a more favorable prognosis, than that which makes 
its appearance during the later months or at the end of the pregnancy. 

In 32 cases of insanity of pregnancy recorded by Ripping, 8 cases 
occurred in the first pregnancy, 5 in the second, 6 in the third, 3 in 
the fourth, 4 in the fifth, i in the sixth, I in the seventh, 3 in the 
eighth, I in the tenth. Of these women 

3 became affected in the 1st month'*! of pregnancy. 

4 became affected in the 2d month of pregnancy. 

1 became affected in the 3d month of pregnancy. 

2 became affected in the 4th month of pregnancy. 
I became affected in the 5th month of pregnane}^ 
o became affected in the 6th month of pregnancy. 

5 became affected in the 7th month of pregnancy. 
5 became affected in the 8th month of pregnancy. 

5 became affected in the 9th month of pregnancy. 

6 became affected in the loth month of pregnancy. 

The neuralgias of pregnancy affect the most diverse nerve tracts, 
and may occur either spontaneously, without any discernible local 
exciting cause, or in consequence of the pressure exercised by the 

41 It is usual of the Continent of Europe to divide the course of pregnancy 
into ten " months " of four weeks each. This fact must never be forgotten 
when comparisons are made between English and Continental tables, respec- 
tively, of the events of pregnancy. 



248 The Sexual Life of Woman. 

enlarging uterus. To the former class of cases belong severe tri- 
geminal neuralgia, the familiar toothache affecting quite sound 
teeth at the very beginning of pregnancy, intercostal neuralgia, and 
j)aroxysms of mastodynia. The pressure neuralgias affect chiefly 
the domain of the great sciatic nerve, manifesting themselves by 
the occurrence of pain down the back of the thigh, in the calf, and 
on the dorsum of the foot, sometimes associated with formication 
and other kinds of parsesthesia. 

Parturition, by its powerful effect on the emotional nature in 
combination with intense physical suffering, may give rise to numer- 
ous nervous disturbances. The chief of these are, neuralgia, oc- 
casioned by the pressure of the foetal head as it passes through the 
pelvis of the mother, parsesthesias, convulsions, maniacal paroxysms, 
transitory mental alienation, cerebral haemorrhages, and eclampsia. 

The nervous disturbances dependent upon the processes of the 
puerperium are numerous and severe. According to Windscheid, 
four types of aff'ection of the motor nerves may arise at this period. 
I. Pressure-paralysis may occur in cases of generally contracted 
pelvis, or even in the absence of such contraction in cases of pro- 
longed labor, from the pressure exercised by the child's head upon the 
intrapelvic nerves, and above all on the great sciatic nerve ; pressure- 
paralysis may also result from obstetric operations, and especially 
from forceps delivery. The symptoms of pressure-parah sis consist 
chiefly of paralysis of the extensors of the feet and the toes ; sensory 
symptoms are usually wanting. 2. Inflammatory infective paralyses, 
due to the extension to adjacent nerves of puerperal inflammation of 
the pelvic connective tissue. 3. Acute multiple neuritis, occurring 
either during the 'latter half of pregnancy or a few days after de- 
livery, and affecting not only the nerves of the lower extremities, but 
those of remote regions, even the cranial nerves. 4. The rare puer- 
peral hemiplegia due to cerebral haemorrhage, occurring usually 
at the time the patient leaves her bed after delivery ; puerperal 
hemiplegia may also arise from embolism consecutive to endocarditis, 
which may itself have originated before the termination of the 
pregnancy. 

Other puerperal diseases of the nervous system requiring mention 
are, on the one hand, tetany, occurring during lactation, and per- 
mitting of a favorable prognosis, and on the other, the infective 
puerperal tetanus, the prognosis of which is exceedingly unfavorable. 
Finally, the puerperal state has to be considered as a factor in de- 
termining the onset of psychoses. 

The puerperal psychoses are for the most part dependent upon 
the great loss of blood occurring during delivery, leading to anaemia 
iind increased irritabilitv of the brain, in association also with the 



The Sexual Epoch of the Menacme. 249 

circulatory disturbances that arise in the central nervous organs 
in consequence of the sudden emptying of the abdomen by the 
act of childbirth ; but additional causes of mental disorders are to be 
found in the changes in the composition of the blood that occur dur- 
ing pregnancy, and the influence of these changes upon the nutrition 
of the brain. Inherited predisposition plays its usual part in these 
cases ; and accessory factors in producing mental disturbance during 
the puerperal state are to be found in puerperal infection, eclampsia, 
osteomalacia, and emotional shock. 

Thus, for example, among 49 cases of puerperal psychoses, Han- 
sen found that in 42 instances there was puerperal infection ; and 
among 200 cases of puerperal eclampsia, Olshausen found 11 patients 
suffering from mental disorder. The principal forms of insanity 
occurring at the puerperium are mania and melancholia, next in 
frequency come monomania (Ger. Verrilcktheit) , dementia (Ger. 
Blodsinn), alternating or circular insanity {folic circvdairc) , 
hallucinatory paranoia (chronic delusional insanity with hallucina- 
tions), and hysterical mental disorder. 

According to Windscheid, the commonest cases are those which are 
purely puerperal, the rarest those in which the insanity of pregnancy 
continues during the puerperal state ; the age at which puerperal 
psychoses most commonly occur varies between 31 and 35 years, the 
average age being 29.1 ; multiparae are more often affected than 
primiparae ; the outbreak of mental disorder most commonly occurs 
within a week after the birth of the child ; there is nothing specific 
about the various forms of puerperal insanity, which are identical 
with the respective varieties owning another etiology. According 
to this author, before an attack of puerperal mania, prodromal 
symptoms usually occur, such as headache, dizziness (Ger. Augen- 
flinimern) , feelings of anxiety, insomnia, followed by various con- 
gestive symptoms, and either by great restlessness or by great 
apathy, and very often by indifference to the infant ; to these symp- 
toms succeeds the period of motor excitability, characterized by 
great bodily restlessness and by continued talkativeness ; the culmina- 
tion takes the form of a maniacal outburst, in which infanticide 
even may occur ; the delirium runs mostly in erotic and religious 
channels. Puerperal melancholia also exhibits the usual clinical 
picture of this form of mental disorder ; after prodromal headache, 
stupor sets in, often associated with attacks of anxiety and with 
hallucinations of sense, and always characterized by great loss of 
appetite and by a suicidal tendency. 

In relation to the puerperal psychoses, it appears that the first 
menstruation after the birth of the child has, like the very first 
appearance of the menstrual flow during the menarche, a tendency 



2C0 The Sexual Life of Woman. 

to favor the onset of mental disorder. According to Marcc, this 
first post-puerperal menstruation has a very definite significance in 
the causation of psychoses. Among forty-four cases of puerperal 
psychoses, there were eleven instances in which the mental disorder 
made its appearance six weeks after childbirth, exactly at the 
moment, that is to say, in which, had the mothers not given suck to 
their children, menstruation ought to have reappeared. In those 
who did not nurse their infants, and in whom menstruation recom- 
menced at the due date, the psychosis usually began on the first day 
of menstruation, less often on the fourth or fifth day. In some 
instances the psychosis appeared at the time at which menstruation 
might have been expected to occur, but when the flow was still 
in abeyance. And in some women who suckled their children for 
a time and then weaned them, the psychosis made its appearance at 
the time of the first recurrence of menstruation. 

Among diseases of the sense-organs occurring during the men- 
acme, ocular lesions are by no means rare as sequels of pathological 
changes in the genital organs. Thus, in cases of displacements of 
the uterus, especially prolapse, retroflexion, and retroversion, we 
sometimes see retinal hyperaesthesia and reflex amblyopia, pho- 
tophobia and lachrymation, and accommodative or muscular 
asthenopia. Inflammation of the pelvic connective tissue, peri- 
metritic and parametritic exudations, and especially parametritis 
atrophicans, may give rise to functional disorders of the eye, reflex ^ 

hyperaemia of the trigeminal and optic nerves, various painful sen- 
sations, and photophobia. Severe metrorrhagia may also cause dis- 
turbances of vision, either by inducing local anaemia and consequent > 
functional failure of the nervous apparatus, or by leading to serious 
infiltration of the optic nerve which manifests itself also in the 
retina in the form of a transudation. In cases alike of congenital 
and of acquired atrophy of the uterus, and frequently, therefore, in 
sterile women, optic nerve atrophy may occur. 

Competence for Marriage of Women Suffering from Disease. ; 

In this section we must consider the competence for marriage of ^ 

women suffering from heart disease, of those suffering from heredi- ;J 

tary tendency to mental disorders and neurasthenic states, and, * 

finally, of those affected with tuberculosis. -* 

Every doctor is confronted during the practice of his profession l^ 

by the problem whether a young \voman known to suffer from heart f 
disease is justified in entering upon marriage and in exposing her- 
self to the dangers entailed on her diseased heart by copulation, 

pregnancy, parturition, and the puerperium. The solution of this f 

problem is as important as it is difficult. On the one hand-, -it de- J 



The Sexual Epoch of the Menacme. 251 

termiiies the whole future course of a human Hfe which is still 
ascending the upward path of its vital career, and a negative de- 
cision often annuls in a moment the young woman's ideals and 
hopes ; on the other hand, an affirmative decision involves the re- 
sponsibility for the consequences of marriage, often grave in these 
cases. 

The consequences are in fact apt to be very serious indeed. The 
normal act of intercourse, in a young and sensitive woman, has 
already an exciting influence on the nerve apparatus by which the 
movements of the heart are controlled. The frequency of the 
heart's action is greatly increased, the cardiac impulse becomes much 
stronger, there is marked pulsation of the peripheral arteries, the 
conjunctiva is injected, the respiration more frequent. These mani- 
festations, which normally are quite transient, attain a greater in- 
tensity and exhibit a longer duration in persons affected with heart 
disease. In some instances, violent tachycardial paroxysms occur, 
with considerable dyspnoea, pains in the cardiac region, headache, 
and even syncopal attacks. 

Pregnancy, in consequence of the extensive changes undergone not 
only by the reproductive apparatus but also by the general system, and 
further in consequence of the vital needs of the developing embryo, 
involves extensive claims upon the cardiac activity. It is easy to 
understand that the diseased heart must be taxed more severely 
than the healthy heart by the extension of existing vascular areas, 
the addition of new vascular areas, and the increase in the quantity 
of the blood, during pregnancy; and it is not surprising if the over- 
taxed organ threatens sometimes to give way under the strain. 
Thus, during pregnancy in women aft'ected with morbus cordis, we 
observe numerous troubles in the way of disturbances of cardiac 
activity and passive congestion of various organs, culminating at 
times in abortion. 

Parturition and the puerperium, moreover, bring several factors 
into play which tend to affect unfavorably even a heart that is quite 
normal ; and in cases in which there is disease either of the heart or 
of the great vessels, these factors may lead to the occurrence of most 
alarming symptoms. In this connection we may refer to endo- 
carditis, to fatty degeneration of the myocardium, and to the rupture 
of atheromatous arteries. 

From the time of Galen onwards all medical writers have agreed 
that the heart is unfavorably influenced by pregnancy and its con- 
sequences — but from this incontestible proposition to deduce the 
general conclusion that young women affected with heart disease 
must be forbidden to marry is in my opinion too great a jump, and 
altogether too sweeping a statement. The apophthegm of Peters, an 



252 The Sexual Life of Woman. 

jiiithor to whom we are certainly indebted for some of our knowl- 
edge of the accidents gravido-cardiaqiics, that in the case of women 
suffering from morbus cordis the. rule must be enforced, Ulle pas de 
luariaqc, fcniinc pas dc grosscssc, mere pas d'allaitemcnt, has a fine 
air of apodictic brevity, but is entirely devoid of justification. No 
such rigid prohibition is advanced by recent writers on heart disease, 
such as Huchard, von Lcydcn, and Rosenbach ; not, at least, without 
qualifications. 

The question as to the permissibility of marriage to girls and 
women affected with heart disease cannot, in fact, be answered 
by any general proposition ; and each case demands separate inquiry 
and a careful balancing of individual considerations. I have known 
cases in which the marriage of young girls suffering from morbus 
cordis was equivalent to a sentence of death, the execution of which 
was delayed for a few months only. On the other hand, I have known 
many women belonging to the upper classes and suffermg from car- 
diac defects to pass through numerous pregnancies and to give birth 
to a number of children with no more than trifling disturbances of 
compensation. I am acquainted with a lady who when a young 
girl was urgently advised against marriage, on account of extensive 
aortic valvular incompetency, by two celebrated physicians. The 
advice was disregarded, and this lady is now the mother of four 
children, the eldest of whom is twenty-two years of age, and her 
general condition is in no way worse than it was before her mar- 
riage. The dangers of marriage in women suffering from morbus 
cordis are in my opinion generally overrated. 

The degree to which a woman affected with heart disease will be 
injured by married life, will depend on the nature of the cardiac 
aft'ection, on the time it has already existed, on the adequacy of 
compensation or the intensity of existing disturbances of compensa- 
tion, on the general state of nutrition of the patient, on the more or 
less favorable social position, and on the manner in which sexual in- 
tercourse is regulated. 

My own opinions in respect of this question may be summed up 
as follows: A woman who has comparatively recently (within a 
few years) acquired a valvular defect, and in whom the disease has 
run such a course that, in consequence of dilatation of certain 
chambers of the heart and of hypertrophy of those segments of the 
myocardium on which increased work has been thrown, and thus 
in consequence of adaptation of the cardio-vascular apparatus to 
the new conditions, the circulation and distribution of the blood 
take place in a manner closely resembling that in which these func- 
tions are effected in a normal, healthy individual — in a word, a 
woman in whom the valvular disease appears to be adequately com- 



The Sexual Epoch of the Menacme. 253 

pensatcd, — if, in addition, the patient is well nourished, if the 
lueniatopoietic function has not undergone any notable disturbance, 
if the nuiscular system is powerful and the nervous system possesses 
sufficient power of resistance — then marriage may be permitted 
without hesitation. In the case of such a girl or woman, we can 
confidently assume that the adequate compensation of the valvular 
disease will enable the heart to meet with success the claims made 
upon its reserve energies by sexual intercourse, by pregnancy, and 
by parturition, and that these processes will not involve any ex- 
.cessive danger to life. 

A woman with valvular heart disease, even when that disease is 
well compensated, will indeed during pregnancy and still more dur- 
ing parturition and the early days of the puerperium, be liable to 
suffer from various manifestations of cardiac disorder. The action 
of her heart will be subject to paroxysmal increase in frequency and 
force, sometimes also there may be transient attacks of cardiac 
asthenia; at the same time the breathing will become more frequent 
and deeper, and occasionally, even, there may be severe dyspnoea. 
Perhaps also symptoms of venous congestion may manifest them- 
selves, digestive disturbances, sense of pressure in the head, swelling 
of the feet, oedema of the abdominal wall, even slight albuminuria. 
Just after childbirth, moreover, an abnormally intense depression of 
the circulation with in frequency of the heart's action will be liable to 
ensue. In the great majority of cases, however, in which the condi- 
tions detailed above are fulfilled, the disturbances of compensation 
occasioned by pregnancy and the puerperal state will not seriously 
threaten life ; and as soon as the puerperal period has been safely 
passed through, the heart will again be competent for its duties and 
will do its work as well as before. 

These statements apply, not only to cases of well-compensated 
valvular disease, especially mitral insufficiency, mitral stenosis, and 
aortic insufficiency, but also to cases in which the heart has made a 
good recovery after an attack of pericarditis, and to cases of mod- 
erately extensive disease of the myocardium consequent on acute 
articular rheumatism or the acute infections. 

As indispensable conditions for such a favorable prognosis, we 
naturally assume that the pregnant woman is in a position to com- 
mand the extreme bodily care that in her condition is doubly need-' 
ful, that she is able to avoid all severe physical exertion, and that 
she will be subjected to continuous medical supervision in respect of 
the adoption of suitable dietetic and hygienic measures. 

Such a favorable prospect as regards marriage in cases of well- 
compensated heart disease will, however, be clouded in the case of 
Vv^omen who are either very anaemic or predisposed to nervous dis- 
orders ; nor is the prognosis favorable as regards women in whom 
the heart disease is either congenital, or acquired in early youth, or 



254 ' The Sexual Life of Woman. 

as regards women contemplating marriage when already well up in 



years. 



For in very anaemic women, even when the heart is. quite sound, 
frequently recurring attacks of tachycardia often occur during preg- 
nane v, in the absence of any obvious exciting cause ; oedema of the 
lower extremities, and the formation of extensive varices, are also 
common. Increased nervous reflex irritability has also an unfavor- 
able influence upon cardiac innervation. In cases, again, in w^hich 
the heart disease is of long standing, the functional capacity of the 
heart is so notably depressed that the organ is likely to prove in- 
competent to meet the increased demands made upon it by the 
processes of pregnancy. Finally, in elderly women, superadded to 
the valvular defects, we have the dangers dependent upon the already 
beginning arteriosclerotic changes in the blood-vessels. In all such 
cases, therefore, it will be the duty of the physician to advise his 
patient not to marry ; and in any case to impress upon her mind the 
extreme probability, amounting almost to certainty, of serious ag- 
gravation of the heart disease by marriage, with permanent impair- 
ment of the general health. 

In cases of valvular disease accompanied by serious disturbances 
of compensation, and in cases of notable degeneration of the myocar- 
dium in which pronounced symptoms of cardiac muscular insuffi- 
ciency have made their appearance, marriage must be absolutely 
forbidden, as directly imperilling life. When even moderate bodily 
exertion suffices to cause palpitation, increased frequency of the 
pulse, and shortness of breath, when extensive cedema of the lower 
extremities is present and fails to disappear even after the patient 
has been strictlv confined to bed, when the pulse very readily becomes 
irregular both in rhythm and force, whilst the urine is often scanty 
and contains variable quantities of albumin, when conditions of 
cardiac asthenia readily arise, characterized by a small, irregular 
pulse, coldness of the extremities, cyanotic tint, nausea, respiratory 
need,^^ and syncopal attacks — in all such cases, whether the symp- 
toms just described are dependent upon valvular defects, upon patho- 
logical changes in the arteries, or upon diseases of the myocardium, 
in all alike the occurrence of pregnancy is a true disaster, which in 
the vast majority of cases causes a great and enduring aggravation 
of the disease, and frequently enough costs the patient her life. 

Even in such cases as were previously described, in which, the 
heart disease not being severe, the patient was told that marriage 
vvas permissible, it is the duty of the physician to lay down certain 
rigid rules regarding sexual activity. 

Women suflFering from heart disease should not have sexual in- 

42Ger. Lit ft hunger. 



The Sexual Epoch of the Menacme. 255 

tercourse frequently, because, if the peripheral nervous stimula- 
tion of the genital organs is excessive in consequence of too frequent 
acts of coitus, cardiac activity is likely to be influenced powerfully 
in a reflex manner, leading to the occurrence of attacks of cardiac 
asthenia. Again, sexual intercourse must always be effected in 
such a manner that the act attains its physiological conclusion, and 
that in the woman as well as in the man the orgasm has its normal 
outcome, that is to say that at the conclusion of the act the woman's 
cervical glands are evacuated with the accompaniment of the sense 
of ejaculation. The congresstis intcrniptus, which precisely in these 
cases in which the wife suffers from heart disease is so frequently 
practiced by the husband with a view to preventing conception, must 
be strictly forbidden, since this mode of intercourse tends to give 
rise to various forms of reflex cardiac disturbance, most commonly 
to paroxysms in which the cardiac action becomes unduly frequent, 
in association with diminution of vascular tone, vasomotor disturb- 
ances, and states of mental depression ; and where organic heart 
disease already exists, these reflex functional disturbances involve 
various dangers. 

The physician is further justified in advising that a woman with 
organic heart disease should not give birth to more than one or 
two children. This advice is the more needful for the reason that 
with each successive pregnancy the functional capacity of the 
woman's diseased heart diminishes according to a geometrical ratio, 
and to a corresponding degree the danger to life increases. These 
are cases in which in my opinion it is the physician's duty to con- 
cern himself with the subject — in general so equivocal — of the 
use of preventive measures, and, having regard for the preservation 
of a woman's life, and uninfluenced by any false delicacy, but with 
moral earnestness, to inform his patient with respect to the needful 
prophylactic measures. The artificial termination of pregnancy, 
which unquestionably is often justified in women ' suffering from 
heart disease, but which unfortunately is apt to have very unfavor- 
able results, will rarely need to be discussed if by the proper em- 
ployment of preventive measures care is taken that pregnancy does 
not recur too frequently. 

To enable us to answer the question whether, in the case of neu- 
rasthenic and hysterical young women, and in those hereditarily pre- 
disposed to the occurrence of mental disorders, the physician shall 
advise for or against marriage, attention must in the first instance 
be directed to the established facts relating to the favorable or un- 
favorable influence, as the case may be, of sexual intercourse and 
its consequences (pregnancy and childbirth) upon existing nervous 
disorders and upon the predisposition to their occurrence. 



256 The Sexual Life of Woman. 

Without regarding as fully justified the opinion that in the female 
sex sexual abstinence has in all circumstances an unfavorable in- 
fluence upon the nervous system or even that such abstinence is to 
be regarded as the principal cause of nervous and hysterical troubles, 
we must consider it fully proved that in a number of the commonest 
varieties of nervous disease occurring in neurasthenically predisposed 
subjects, such as neurasthenia, hysteria and neurosis of anxiety*, 
the lack of sexual satisfaction aggravates these troubles, whilst 
suitably regulated sexual intercourse has an actively beneficial effect. 
Not, indeed, that it is an infallible means, but none the less the 
eiTects are often striking, as I have frequently had occasion to 
observe, both in young women so affected entering upon marriage 
for the first time, and also in young widows who have remarried. 
Especially is this true of women in whom the sexual impulse is ex- 
ceedingly powerful, and even pathologically increased to the extent of 
marked sexual hyperaesthesia ; hkewise also in women whose social 
circumstances and manner of Hfe induce increased sexual appetite. 
Be it understood, I refer here to regular and moderate sexual inter- 
course, and not to sexual excesses, which latter, by inducing nervous 
v'xhaustion, may have a distinctly deleterious effect. In many cases, 
however, we observe in women suffering from sexual neurasthenia, 
that sexual intercourse, even when practiced at long intervals, gives 
rise to nervous prostration with deep emotional depression and long- 
lasting aggravation of the existing nervous disorder. This state- 
ment applies with especial force to very hysterical epileptic girls 
v/ith hereditary predisposition to mental disorder. 

From the fact that among persons hereditarily predisposed to 
mental disorder, the unmarried are on tlie average more often 
affected with insanity than the married, the inference has been drawn 
that marriage may be recommended to such persons as a measure 
likely to counteract their hereditary tendency to insanity. The argu- 
ment, however, lacks validity, more especially as regards women; 
among whom, moreover, from the age of sixteen to the age of 
thirty, insanity is proportionately more prevalent among the mar- 
ried, though above the age of thirty it is more prevalent among tl:e 
unmarried. 

In the great majority of neurasthenic women, normal sexual inter- 
course, practiced in moderation, has, according to Loivcnfeld, no dele- 
terious effect ; often, indeed, as a consequence of unaccustomed ab- 
stinence, an aggravation of existing nervous troubles may be observed. 
But, as this author maintains, nervous exhaustion may result in the 
complete disappearance of the orgasm during sexual intercourse, or 
in great dif^culty in its production ; this circumstance suf^ces for the 

* See note 2>^ on p. 225. 



The Sexual Epoch of the Men acme. 257 

most part to explain the fact that in women suffering from great 
depression of the nervous functions, the fulfilment of their sexual 
duties has sometimes an unfavorable influence on their general 
condition. As regards hysteria, it cannot be denied, that in many 
hysterical women marriage results in a favorable change in the 
general condition ; we must, however, be careful not to overrate 
the significance of such observations. As a rule all that actually 
takes place is a diminution in the intensity or even a disappearance 
of certain morbid manifestations previously present, without, how- 
ever, an eradication of the hysterical temperament. 

In epileptic young women, the first experience of sexual inter- 
course may precipitate a fit. Cases are indeed on record in which, 
in hereditarily predisposed girls, the first coitus was the exciting 
cause of the first epileptic fit, the fits recurring every time sexual 
intercourse was repeated. 

It is a comparatively frequent occurrence in psychopathically pre- 
disposed girls for severe mental disturbances to make their appear- 
ance during the honeymoon, after the first experience of sexual 
intercourse ; when this occurs, it is doubtless to be accounted for by 
the combined influence upon the mind of all the changes in the cir- 
cumstances of life which have resulted from the marriage. In the 
case of two newly-married women, one of whom had well-marked 
hereditary predisposition, whilst in the other there was no known 
family history of mental disorder, Lo'ivenfcld observed shortly after 
marriage the onset of severe melancholia, with refusal of food. The 
delicate, nervous temperament of these two women, on the one hand, 
and, on the other, possibly, a somewhat too eager and passionate 
attitude on the part of their respective husbands, led their first 
experience of sexual intercourse to result in a nervous impression 
of the nature of shock, which their nervous system was too weak 
to resist. 

Frequently recurring pregnancy and childbirth may, according to 
Kronig, act as the predisposing cause in the production of neu- 
rasthenia. In regard to hysteria also we must admit that the onset • 
of some disease of the organs of generation frequently leads pre- 
viously latent hysteria to manifest itself openly, and further we have 
to recognize that diseases of the reproductive system often 
give the clinical picture of hysteria a quite distinctive coloration ; 
the physiological course of the functions of the generative organs is 
also competent to produce both of these effects. Kronig, however, 
rejects the view that the lack of sexual intercourse has an unfavor- 
able influence upon the nervous system in women, and gives rise to 
hysterical and neurasthenic disorders. The favorable influence 
which marriage is often observed to exercise upon the course of 
nervous disorders is explicable with reference to psychical considera- 
17 



258 The Sexual Life of Woman. 

tions of a very different nature. Sexual abuses, masturbation, and 
the use of preventive measures, give rise in women far less often 
than in men to neurasthenic and hysterical conditions. 

Fere asserts that in certain neurasthenic patients sexual inter- 
course induces a general blunting of the senses, and especially of 
hearing and sight. Actual amaurosis of short duration may even 
be observed ; also cutaneous anaesthesias, paralytic conditions of the 
extremities taking the form either of hemiplegia or paraplegia, con- 
vulsive attacks, and somnolent paroxysms. 

Delasiauz'e observed that epileptic patients, who during residence 
m an asylum had remained almost entirely free from fits, after re- 
turning home and resuming sexual intercourse, even in strict modera- 
tion, suffered from a recrudescence of the convulsive seizures ; when 
intercourse was excessive, the relapse was naturally even more 
severe. 

In two instances, in women who in a single night had practiced 
intercourse to very great excess, Hmiunond observed paralysis of 
both legs to ensue ; he saw also in numerous cases spinal irritation 
and other nervous disturbances as a consequence of sexual excesses. 

Von Krafft-Ebing points out, with reference to the prophylactic 
influence of marriage in respect of mental disorder, that in men 
early marriage diminishes the danger of the occurrence of such 
disorder, whereas in women marriage is undesirable before the at- 
tainment of complete physical maturity. 

With regard to marriage in the case of persons suffering from 
nervous diseases. Ribbing lays down the rule that w^hen such diseases 
have been severe and have occurred in numerous members of a 
family, v/hilst a few only in the family have remained healthy, 
when, moreover, the illness has been accustomed to make its first 
appearance only after the attainment of maturity, no indications of 
its onset being noticeable in childhood or youth — one belonging to 
a family thus afflicted should be advised not to marry. Where, 
however, the hereditary tendency is to a disease likely to manifest 
itself in childhood or youth, a member of such a family who has 
been fortunate enough to pass through the years of development 
without exhibiting any pronounced disturbance of the nervous sys- 
tem, may be permitted to marry if certain precautions are observed. 
A woman with a tendency to alcoholism should in no circumstances 
be allowed to marry. In the cases, fortunately rare, in which the 
drink-craving exists in women, marriage is even more undesirable 
than it is in the case of men similarly afflicted, for the female 
drunkard is in a position in which she can mishandle and neglect 
her children throughout the entire day; and, moreover, this affection 
appears to be even more obstinately incurable in women than it is 
in men. 



The Sexual Epoch of the Menacme. 259 

Lozvcnfcld very rightly insists that in dccichng on the advisabihty 
of marriage in the case of neurasthenic and hysterical girls the 
anticipated influence of sexual intercourse must not be the sole 
iieterminant. " Regulated sexual intercourse, such as is rendered 
possible by marriage, has often a favorable influence on previously 
existing states of nervous weakness. But we should go too far 
if we were to attribute the beneficial effect of married life on such 
conditions solely to sexual intercourse. This latter is but one factor 
among several, the others being no less important. These others 
are : The pleasures of an orderly domestic activity ; the withdrawal 
of the patient's attention from her own condition, partly by domestic 
duties and difficulties, and partly by the novelty of marital com- 
panionship ; the gratification, especially strong in women, at having 
obtained a support in life; and, finally, the joyful expectation of 
motherEood. These factors, however, are not present in every mar- 
riage. When their presence cannot reasonably be anticipated, when, 
:*n consequence of insufficient means, the marriage is likely to en- 
tail increasing troubles, or when, owing to the want of suitability of 
temperament, annoyances and quarrels are likely to occur, we must 
throw the weight of our advice into the scale against the proposed 
marriage, since the advantages of regulated sexual intercourse are 
not likely to outweigh the disadvantages just detailed. Even when 
means are ample and the characters of the couple contemplating 
marriage are unquestionably harmonious, we must nevertheless 
(temporarily, at any rate) advise against marriage, we must, that 
is to say, advise the postponement of marriage, if the bride is suffer- 
ing from severe hysterical or neurasthenic states. Where, further, 
such neurasthenic or hysterical troubles occur in a woman with 
pronounced hereditary predisposition to nervous disease, we must, 
both for the sake of the possible progeny and on account ci the 
uncertain influence of married life on the health of the patient, 
absolutely and unconditionally prohibit marriage. In cases also in 
which severe hereditary predisposition to mental disorder exists 
(especially when derived from both parents), and in addition stig- 
mata of psychopathic degeneration are actually apparent in the 
patient, or she has already suffered from the development of a 
psychosis, we must decisively object to the patient's marriage." 

As regards the marriage of young women suffering from tuber- 
culosis, we must take into consideration a fact that medical ex- 
perience has conclusively established, namely, that the processes of 
generation have an unfavorable influence upon pulmonary phthisis. 
Girls with an inherited predisposition to tubercular disease, some- 
times first manifest the symptoms of pulmonary tuberculosis at the 
time of the menarche. In cases of developed tuberculosis, copulation 



26o The Sexual Life of Woman. 

and the excitement of the vascular system associated therewith have 
a more or less unfavorable influence — and all the more inasmuch 
as, in accordance with the saying omnis phthisicus salax, women 
affected with tuberculosis often exhibit a very lively sexual im- 
})ulse, an almost insatiable sexual appetite. Sexual excesses are, 
nioreover, very likely to lead to the occurrence of haemoptysis. 

In former days it was believed that conception and pregnancy, 
when occurring in women suffering from tuberculosis, had a re- 
straining influence on the progress of the pulmonary disease, a view 
which found expression in the assertion of Bauiucs and Rosier cs de 
la Chassagne that of two women affected with tuberculosis to the 
same degree of severity, one who became pregnant would always 
outlive the other who failed to become so. Careful and sufficient 
observations on the part of physicians and gynecologists have, how- 
ever, shown that this view was fallacious, and, on the contrary, that 
during pregnancy tuberculosis advances with more rapid strides, 
that pregnancy, and lying-in accelerate the fatal event (Grisolle, 
Lebcrt), that tuberculosis acquired shortly before pregnancy or in 
the course of that condition, progresses with exceptional rapidity 
(Larcher), and that the lying-in period is especially perilous to these 
patients (A. Hanaii). In some cases of consumption it is the first 
pregnancy that is the most perilous, but in other cases a later preg- 
nancy proves m.ore destructive. 

Ribbing goes even further, insisting that neither man nor woman 
affected with pulmonary consumption should marry. '' If, indeed," 
he writes, *' consumptives desire to enter upon marriage, merely with 
the aim of being faithful to one another and assisting one another 
for the short time that remains to them, I should offer no opposition. 
But there must be a complete mutual understanding of the facts 
of tlie case, and an unalterable determination on the part of both to 
carry out the resolutions made prior to marriage, for failing this 
the consequences will be most disastrous. In most cases, however, 
the course adopted by Biihvers Pilgrims of the Rhine is to be pre- 
ferred, the lovers contenting themselves with the condition of a 
betrothed pair, and in that state awaiting the approach of death — 
or, if exceptionally fortunate, proceeding to marriage only after 
restoration to health." 

It would certainly appear that in the case of girls suffering from 
pronounced phthisis, we are justified in advising against marriage, 
on account of the great danger which this state entails of a rapid 
advance in the pulmonary disease. 

Based upon the observations of Schauta and Fellncr, the latter au- 
thor advances the rule that in the case of a woman suffering from 
disease, marriage should be forbidden only when the mortality from 



The Sexual Epoch of the Menacme. 261 

the disease in question is not less than 10 per cent. In this category 
we must include severe cases only of pulmonary tuberculosis ; whilst 
cases of laryngeal tuberculosis will, according to this rule, be ab- 
solutely unfitted for marriage. Among heart-affections contra-in- 
dicating marriage, he includes mitral stenosis, other valvular affec- 
tions in which there is serious disturbance of compensation, and 
myocarditis ; he considers marriage inadmissible also in cases of 
chronic nephritis, and, among surgical affections, in cases of ma- 
lignant tumour. In cases in whidh during a previous pregnancy the 
patient has been affected by one of the following diseases, viz., 
severe chorea, mental disorders, severe epilepsy, pulmonary tuber- 
culosis which progressed much during the pregnancy, morbus cordis 
with considerable disturbance of compensation, severe heart trouble 
due to Graves' disease — in all such cases, a repetition of pregnancy 
should be avoided. 

Hygiene During the Menacme. 

During the sexual epoch of the menacme a woman's principal 
hygienic need is marriage completely satisfactory alike to body and 
to mind. It cannot be denied that sufficient sexual gratification, 
regular, of course, and free from all excess, such as is usually ex- 
perienced in married life, is very advantageous to the health of a 
woman who has attained sexual maturity — even though we admit 
that the drawbacks of sexual abstinence, regarded as a cause of 
disease of the female genital organs and the nervous system have 
been as a rule greatly exaggerated. 

The inability to marry always makes a deep impression on the 
mental life of woman, and in many cases also gives rise to burning 
desire and tormenting yearning of an erotic nature. The unmarried 
miss life's true goal and fail to enjoy the natural exercise of their 
functional capacities ; alike in the cultured lady and in the poor 
working woman who has failed to marry, the thoughts and feelings 
return again and again to her own condition in a self-tormenting 
manner. 

The physical and mental disadvantages entailed by sexual gratifi- 
cation when obtained by an unmarried woman, one who, according 
to modern phraseology, ** wishes to secure her natural share of the 
joys of love," and who regards voluntary chastity as *' a sacrifice to 
meaningless prejudices " — need not be more particularly described. 

Free love, moreover, is the most important disseminator of 
gonorrhoeal infection. " In any future commonwealth," says Riinge, 
"m which marriage is abandoned in favour of the general practice of 
free love, the human race will be overwhelmed by gonococci in a 
manner now hardly conceivable, and the reproductive capacity in 



2^2 The Sexual Life of Woman. 

both sexes will be diminished by the results of gonorrhoea to a very 
serious extent." 

Frequently enough, also, free love leads to prostitution, which at 
the present day is so widely prevalent. Various reasons have been 
suggested to account for the increase of prostitution. Among these 
are : The growth of modern industry, with the consequent aggregation 
of the population in large towns ; the decline in the marriage rate ; 
the postponement of marriage ; universal military service ; the freer 
mutual companionship of the sexes ; and many others. At any rate, 
the fact wouM appear to be established, that in the case of woman 
the determining cause of prostitution is hunger rather than the 
sexual impulse. The worst paid classes of workwomen are shown 
by official statistics to furnish the largest number of recruits to the 
ranks of prostitutes ; and it is during times of deficient employment 
that the number of women practicing occasional prostitution in- 
creases. Thus, material need is the most important of the causes 
of prostitution. 

This remains true even though the doctrine of Louibroso and 
Tarnowsky should find fuller justification, the doctrine that the 
practice of prostitution by women is the natural expression of a 
congenital morbid predisposition, " which impels them, in defiance 
of their direct advantage, of reason, and of all counter-advice, to 
adopt this accursed mode of life." Prostitution, in this view, is to 
be regarded as the inevitable outcome of congenital moral insanity. 
This is certainly true of a small proportion of prostitutes, but is as 
certainly false of the great majority, in whom unfavorable, difficult 
conditions of life form the determining cause. A certain inherited 
or acquired mental disposition may, indeed, be assumed to exist 
in these cases also — an unstable moral equilibrium, an insufficient 
development of the force of the will and of the power of resistance. 

The hygienic requirement of married life for woman dtiring the 
menacme is undoubtedly sometimes hard to fulfil in our day, when 
the more elaborate and expensive standard of life has increased the 
difficulty of supporting a family ; but from the medical point of 
view it is necessary to insist forcibly on this categorical imperative, 
in opposition to the view advanced by the modern women's rights' 
party, that " love is moral also in the absence of legal marriage '* 
(Ellen Key) ; in opposition to the yet more extreme opinion of 
George Sand and of Almquist, who, regardless of consequences, 
declare marriage to be immoral; and, finally, in opposition to the 
advocates of '' free love," who wish woman to be as free as man 
in sexual relations. 

Much as we may wish that man and wife should be in complete 
harmony in marriage, and that they should feel themselves to be 



The Sexual Epoch of the Menacme. 263 

firmly united alike by mutual love and by a reciprocal sense of duty, 
none the less we must consider the modern maiden ripe for marriage 
as unjustified in demanding, before undertakmg marriage, ''perfect- 
love as typifying the inner yearning of two beings to become one ;" 
and we must regard the latter-day woman as extravagant in insist- 
ing that the man shall enter upon marriage in a condition as virgin 
as that of his contemplated wife. '' Perfect love " is as rare and as 
little to be expected as perfect beauty; and the sexual life of man 
differs entirely in nature and in the course of its development from 
the sexual activity of women. 

Doubtless they spring deep from the soul of woman, the demands 
expressed by the writer of the book " Vera'' and by her numerous 
imitators, the apostles of '' Veraism," — the demands of the maiden 
entering upon marriage that her husband shall be as chaste and 
sexually as unspotted as herself. Difficult of fulfilment as they 
are, if fulfilment is even possible, these demands must none the less 
be regarded as characteristic of the sexual life of modern woman- 
hood. " Is man's sexual honor," exclaims Vcra^ " then altogether 
different from that of woman? Is not the alleged necessity for 
sexual gratification in youth either a well-organized fraud or an 
enormous error on the part of physicians ? Is it possible that chastity 
can entail diseases as terrible, as destructive to life and happiness as 
those that result from unchastity? And is it not a crying sin, even 
if some of t-hese fears are justified, to ruin both mentally and 
physically the whole race of women ? * '^^ * Man demands from 
the girl of his choice, not chastity alone, but an absolutely un- 
blemished character. And rightly so. But the wife must share her 
husband with street-walkers ? She must bear the pangs of maternity, 
while fortified by the terrible knowledge that the father of her 
children has wasted his youthful virility in purchased embraces, that 
he has not recoiled from impurity, that he has exposed himself to the 
risk of infection with the most horrible diseases, that he has squan- 
dered his virginity in the most bestial sensuality? * * * -yy^ 
girls must also be granted the right to demand from the man of our 
choice the same purity, the same unspottedness by sensuality, that 
he so rigorously demands from ourselves ! We must no longer con- 
tent ourselves with the remnants that are left for us by others ! We 
must no longer be satisfied with man's moral inferiority ! Then 
there will be more happiness, more love, more health and joy of 
life!" 

These accusations and demands so boldly made are not to be dis- 
posed of by mere mockery. With deep sorrow we must admit the 
absolute truth of the charge that too many men clamber out of 
the abyss of debauchery to a blighted marriage. But the demand 



264 The Sexual Life of Woman. 

for equal moral rights, for the abandonment of the hitherto prevalent 
bisexual ethical standards, is in vain conflict with actuality, with 
the defensive instincts of young men, with the difficulties entailed 
bv the struggle for existence, with the increasing pretensions (to 
sexual freedom) of women themselves; but above all is it in con- 
flict with the thousand-year-old notions of sexual honor in the male 
and the female respectively, and with the undeniable fact that the 
mature man is capable of elevating himself out of the base intoxica- 
tion of the senses characteristic of youth, to attain the noblest and 
most intimate married love, whereas the girl who has once descended 
into such an abyss sinks therein and is beyond the possibility of 
rescue. Thus early marriage with equal purity of husband and wife 
remains a postulate which the present can hardly be expected to 
satisfy, and one whose fulfilment must be left to the future. 

In consequence of modern writings and discussions concerning the 
erotic problem, there has arisen a hypersensibility on the part of 
women in respect of the conditions in which they pass their mar- 
ried life, leading them to demand greater independence, a greater ex- 
pansion of their own individuality ; this tendency must, however, be 
resisted, if the marriage is to be a happy one, with mutual comfort 
and reciprocal consideration, one suitable, not for exceptional beings 
in an ideal state, but for men and women as they really are. In such 
a marriage, affection and a sense of duty will strengthen love and 
preserve fidelity. A prudent, clever woman will always understand 
how, notwithstanding all necessary self- surrender, to preserve the 
freedom of her own individuality and the esteem of her husband. 

Marriages based upon true inclination usually result in the birth 
of stronger and more beautiful children than marriages in which 
the money-bags were the sole or the principal determining cause. 
In England, where people commonly marry when still quite young, 
beautiful and healthy children are more often seen than in France, 
where marriages of expediency form the great majority. According 
to Bcrtillon, of 1,000 young men from 20 to 25 years of age, in 
England 120 marry, but in France less than half that number, viz., 57 
only. And 100 wives between the ages of 15 and 40 give birth 
annually, in England to 39 children, in France to 26 only, a number 
less by one-third. 

In deciding upon marriage, hereditary influences deserve careful 
consideration in respect alike of the family of the prospective hus- 
band and that of the prospective wife. For it is well established that 
the law of inheritance relates not only to the peculiarities of ex- 
ternal configuration, to the features, the stature, the tint of the skin, 
but also that children inherit from their parents their mode of 
bodily development, the functional activity of their organs, the dura- 



The Sexual Epoch of the Menacme. 265 

tion of their life, their predisposition to disease, and even their in- 
tellectual and moral qualities. As regards hereditary predisposition 
to disease, the most important are, as is well known, the predisposi- 
tion to tuberculosis, that to malignant tumors, and that to mental 
disorders. 

Great disparity in the respective ages of prospective husband and 
wife entail various kinds of unsuitabihty for marriage. An elderly 
man who marries a young girl, even if he still possesses a certain 
amount of virility, is unlikely to procreate healthy and powerful 
children ; and these latter for the most part will be weakly, scrofulous 
cachectic, endowed with deficient powers of resistance, and often 
badly equipped from the intellectual standpoint. Similar considera- 
tions prevail in respect of marriages in which the husband has been 
exhausted by earlier sexual excesses, so that he retains no more 
than remnants of virility, whilst his semen is of doubtful fertiHzing 
power. D. Richard relates that Louis XIV asked his physician why 
it was that the children he (the king) had by his wife were delicate 
and deformed, whilst those he had by his mistresses were beautiful 
and powerful. " Sire," was the answer, '' c'est parce que vous ne 
donnez a la reine que les rincures." 

Plato maintains that before every marriage the man and the 
woman should both undergo official examination to determine their 
fitness or unfitness for the married state, the man being absolutely 
nude, and the woman stripped to the waist, for the examination. 
This author goes so far as to regard it as '' a form of homicide for 
a man to embrace a woman when he is incapable of fertilizing her." 
How rarely it happens in our day, however, that the physician, the 
official with the requisite knowledge to fulfil Plato's requirements, 
is asked for his opinion regarding the desirability of a contemplated 
marriage ! The only occasion on which this is likely to occur is 
when a man intending to marry wishes to be assured that he is com- 
pletely cured from an earlier infection with syphilis, and, there- 
fore, runs no risk of transmitting the disease to his wife or to 
possible ofifspring. But it never occurs to the parents of a girl about 
to marry to ask the physician whether she is physically suitable for 
marriage. 

In deciding on marriage, however, care should before all be taken 
to determine that the girl has attained complete physical and espe- 
cially complete sexual development. The age at which woman at- 
tains complete sexual maturity is in our climate and race coincident 
on the average with the twentieth year of life. 

For the hygiene of marriage it is necessary that the bride should 
not be extremely youthful. Notwithstanding the fact that the legal 
codes of civilized countries nowhere demand for girls a greater age 



266 The Sexual Life of Woman. 

than fifteen years before permitting marriage, this Umit is, generally 
speaking, fixed far too low. Before becoming a wife, the girl should 
not merely have attained complete physical development, with her 
reproductive organs in a state of maturity, but she must also be 
developed intellectually to such an extent that she is fully capable 
of understanding the nature and significance of marriage. At the 
c>ge at which marriage is legally permissible, a girl is still far from 
having attained physical and mental ripeness for marriage, repro- 
duction, and maternity. 

Especially with reference to the last consideration is it inadvisable 
that in our climates a girl should marry earlier than from 1 8 to 20 
years of age, and preferably even she should first attain the age of 
from 20 to 22. In that case her happiness as a mother will be more 
secure, and there will be a greater probability of her producing a 
healthy progeny. In the East, indeed, quite different views prevail. 
According to the laws of Manns, 2l girl might marry on attaining 
the age of eight years ; if within three years thereafter her father 
failed to provide her with a husband, she might choose one for 
herself. Among the Hindus it is regarded as a disgrace to the 
parents if a girl does not marry quite young, indeed before the first 
appearance of menstruation. Atri and Kasypa state that if a 
girl begins to menstruate before she leaves her father's house, the 
latter must be punished as if he had destroyed a foetus, while the 
daughter herself loses caste. Marriage delayed till after the appear- 
ance of menstruation being regarded as sinful, girls are married 
while still children, in order to prevent the loss of mature ova, which 
is regarded as equivalent to infanticide. Very early marriage has 
thus in India been legally ordained for thousands of years. The 
Hindus, who even now regard every menstruation which has not 
been preceded by coitus in the light of infanticide, marry their 
daughters before the age of puberty. 

According to oriental tradition, Mahomet married Khadijah w^hen 
five years of age, and cohabited w^ith her three years later. In the 
Bible, numerous similar examples are recorded. Among many 
savage tribes, as, for instance, among some of the aborigines of 
India, and among the indigens of Australia, copulation is usually 
effected before girls reach the age of puberty; in India, indeed, 
according to PIoss and Bartcls (Das Wcib in dcr Xafur iind Vol- 
kerkunde), marriage with immature girls is a widely diffused 
custom, and in Australia a child of ten or eleven is often found to 
be the wife of a man of fifty or the concubine of a sailor. In general, 
according to these authors, we find that the age of nubility in girls 
is lower in proportion to the lowness of the stage of civilization 
attained by the race or people to which they belong. Among the 



Tpie Sexual Epoch of the Menacme. 267 

ancient Romans, girls were commonly married between the ages of 
thirteen and sixteen years. 

In the Talmud, Rabbi Joshua gives the following ajivice regard- 
ing early marriage in Jewish girls: " If your daughter has attained 
puberty and is twelve years and six months old, she must be married 
at any cost. If no other means are available, manumit one of your 
slaves, and give her to the freedman to wife." 

Experience proves, however, that in our climate, at any rate, girls 
who marry at a very early age are inferior in fertility to those who 
refrain from marriage until the genital organs have attained com- 
plete maturity; and statistics show that those women who marry 
before attaining the age of twenty must wait longer for their first 
pregnancy than those who marry between the ages of twenty and 
twenty- four. At the higher age also, women bear parturition and 
its consequences more easily than those who marry very young. 
A similar influence in marriage to that resulting from undue ju- 
venility is exercised by its opposite, marriage when a woman is 
already elderly ; in this case fertility is limited, and health also is 
especially apt to suffer. When the indications of the climacteric 
are clearly apparent, marriage is contra-indicated, not only on ac- 
count of the impossibility of fertilization, but also in respect of 
its general unsuitability in the closing stage of the sexual life. 

Not only is the absolute age of the woman of importance in decid- 
ing on the advisability of marriage, but the relative ages of the 
proposed husband and wife must also be taken into account, first 
of all in respect of the wife's possible fertility, and secondly in re- 
spect of her general health. The most suitable arrangement is that 
in which there is no marked difference in age. The husband may 
be, and indeed in existing social circumstances almost necessarily is, 
somewhat older than his wife, as much perhaps as eight or ten 
years. But a very great disparity of age (in either direction) is a 
serious error. If a very young girl marries an elderly man, or a 
developed matron marries a young man, the true purpose of mar- 
riage is unfulfilled, the eternal laws of nature and all ethical princi- 
ples are infringed. In the breeding of animals, the fundamental prin- 
ciple has long prevailed that the animals chosen for coupling should 
be well suited each to the other and should be in perfect physical 
condition; and breeders are also familiar both with the favorable 
influence of good nourishment and with the advantage of the op- 
portune crossing of distinct varieties. The same principles are 
equally applicable to the human race, neglected as they commonly 
are in practice. 

With regard to the marriage of near kin, we can only remark 
that the marriage of those closely related by blood should as far 



268 The Sexual Life of Womax. 

as possible be avoided, and that such a marriage must be absolutely 
prohibited when in both families there is a history of tuberculosis, 
mental disorders, diabetes, and the like. When first cousins con- 
template marriage, it is indispensable, not only that both individuals 
should be in perfect heakh, but also that on neither side there should 
be anv serious family history of transmissible disease or transmissible 
morbid tendency ; and, further, it is absolutely necessary that no 
such marriage of near kin should have taken place in the proximate 
ancestry of the cousins, /. e., their cousmship must not be a double one, 
derived both from the paternal side and the maternal. It is indeed 
to be recommended, with a view to the production of a healthy and 
powerful posterity, that marriage should bring about a crossing of 
healthy individuals proceeding from different families, different 
places, and different constitutional types. An instance of the ad- 
vantage to be found in this practice is pointed out by Ribbing, who 
shows that the most powerful aristocracy in Europe, that of Eng- 
land, by the gradual creation of new peers, on the one hand, and 
by the gradual decline of younger sons and their descendants into 
the middle class, on the other, has undergone a continual crossing 
with less exalted but originally soimder stocks ; in this way its vigor 
and fertility have been maintained, in contrast to the nobility of 
many continental states, which has so largely perished, in conse- 
quence of its exclusiveness in the matter of marriage. 

'* In this connection," continues Ribbing, " we must bear in mind, 
that blood-relationship is not the only matter that has to be con- 
sidered ; in the interest alike of the family, and of society, it is neces- 
sary to demand that certain degrees of relationship by marriage 
alone, should fall within the ' prohibited degrees ' of love and 
marriage. There are certain groups related by marriage and held 
together by the bond of aft'ection, from which foster-parents and 
guardians may most suitably be selected to fulfil the duties as re- 
gards education and training of children who have been orphaned in 
early years. For such a purpose none seem better adapted than the 
brothers and sisters of the deceased parents ; but the upbringing of 
the children can be confidently entrusted to the former only if the 
relationship between the older and the younger branches of the 
family is one regarded by law, and still more by morality and 
custom, as one precluding the possibility of the occurrence of sexual 
love and marriage." 

Mohius, writing on '' The Ennobling of the Human Race by Se- 
lection in Marriage," observes : " The m^ost important aim of 
natural development is the perfection of humanity. The qualities 
of the coming generation depend for the most part upon the qualities 
of the parents. Marriage from affection ensures the fulfilment of 



i 



The Sexual Epoch of the MenAcme. 269 

nature's aims with more security than marriage from reason ; since 
what we have to think of is not the happiness of the married pair 
but the quahty of their children. Of great importance, also, to the 
development of the human race are the conditions during the com- 
mencement of life, and the mode of education. The improvement of 
the race has not hitherto been the conscious aim of the generality of 
people. The lav/ does not as yet, as it should, take into account 
the advantage of posterity. Capital punishment is fully justified 
and purposive. Criminals should not be allowed to marry. The 
perpetuation of disease by inheritance should be checked by the ut- 
most powers of the state. Any one marrying while suffering from 
any venereal disease still in an infective condition should be pun- 
ished. The marriage of persons suffering from tuberculosis should 
be prohibited. For the prevention of disease is more important than 
its cure. The most important factor in preventive medicine is an 
improvement in the conditions of life. The human ideal should be, 
goodness of heart in association with physical and mental health. 
Goodness, beauty, and strength should be simultaneously pursued. 
Since, however, man is made by birth far more than by education, 
selection in marriage is of fundamental importance. In the choice 
of a partner, attention is rightly paid to beauty, since beauty and 
health are fundamentally identical ; moreover, a human being en- 
dowed with beauty is usually also more moral than one devoid of 
that attribute. Equality of birth is as a rule desirable in marriage; 
but not the family only is to be considered in determining the exist- 
ence of such equaUty, individual characteristics must likewise be 
taken into account. Whether the crossing of races is desirable is 
not yet certainly determined." 

From the hygienic standpoint it is necessary that in marriage 
also the frequency and the manner of sexual intercourse should be 
regulated. 

Wise men and law-givers of all the nations of antiquity have in- 
sisted upon the necessity of certain intervals between the acts of 
intercourse. Thus, Mahomet prescribed 8 days, Zoroaster 9 days, 
Solon 10 days, Socrates also 10 days. Moses forbade intercourse 
during menstruation and for a week after the cessation of the flow. 
Luther prescribed intercourse '' twice a v^eek." 

Birds and many mammals are competent to perform intercourse 
at exceedingly short intervals. A well-bred cock will repeat this 
act 50 times daily ; a sparrow, 20 times in an hour ; a bull, 3 to 4 
times in an hour. In the human species, however, too rapid repeti- 
tion of intercourse is deleterious not only to the male, but to the 
female also, though the latter certainly suffers in less degree. For 
in this act the female plays a more passive part, and for this reason 



270 The Sexual Life of Woman.- 

can repeat it with impunity more frequently than the male, who 
loses semen at each repetition. It is not possible, however, to lay 
down precise rules as to the permissible frequency of intercourse 
in either sex; the matter must depend upon physical needs. Mod- 
erate and regular indulgence in sexual intercourse is unquestionably 
advantageous to women both physically and mentally, regulating all 
the functions of the body, and tending to produce a contented and 
cheerful frame of mind. 

During menstruation, a woman should refrain from intercourse. 
By the Mosaic law the death punishment was allotted both to the 
man and to the woman who indulged in coitus while the latter was 
menstruating. As a matter of fact, considerations alike of hygienic 
cleanliness and of sanitary precaution prohibit the performance of 
coitus during this period. Severe menorrhagia, perimetritic irrita- 
tion, and parametritic inflamm.ations, have been observed to follow 
such indiscretions. On the other hand, it is more than doubtful 
whether, in the event of pregnancy resulting from intercourse per- 
formed during menstruation (and conception is especially apt to 
occur at this time), the child is likely, as earlier authors maintained, 
to be unfavorably affected, and to suffer from cachexia, scrofula, 
or rickets. 

After the act of intercourse, a woman should rest ; and indeed 
sleep for some hours is especially to be recommended. A vaginal 
douche should not be administered until several hours have elapsed, 
otherwise there will be a risk of preventing fertilization of the 
ovum. The water employed for vaginal irrigation should never be 
quite cold; a temperature of 79°-82° F. (26°-28° C.) is best. 

All measures for the purpose of artificially increasing sexual de- 
sire, such as alcoholic beverages (especially champagne), and certain 
drugs (especially cantharides), are even more harmful to women 
than they are to men. The woman who conceives while in a state 
of intoxication commits a great sin against the coming generation.^^ 
Just as harmful, however, are the anaphrodisiacs sometimes em- 
ployed to diminish the intensity of sexual desire when this cannot be 
gratified. When affected with intense sexual excitement, a woman 
is much more unfavorably situated than a man, since man claims 
the right to indulge in sexual intercourse whenever he feels disposed, 

*SThc statement is so often made that conception occurring when one or 
both parents are intoxicated is likely to be harmful to the offspring, that it 
seems expedient to point out that neither the author of this work, nor any 
other author known to me, has ever brought forward any rigorous scientific 
evidence in proof of the alleged fact. It is one of those crude generalizations 
whose superficial verisimilitude leads to their continued though unsupported 
reassertion. The fact that the notion of procreation by inebriated progenitors 
is repugnant to our aesthetic sensibilities has, of course, nothing w^hatever 
to do with the logical proof of the assertion that such an act is harmful to the 
fruit of conception. — Tr. 



TiiE Sexual Erucii of the Menacme. 271 

and has, moreover, ample opportunity for sexual gratification. A 
woman, however, properly endowed with self-respect, will under- 
stand how to bridle her senses. Bodily exercise, moderate, unstimu- 
lating diet, intellectual occupation with serious matters, the avoid- 
ance of equivocal literature and of sensual dramatic representa- 
tions, cold bathing, and the use of a hard mattress and Hght bed- 
clothing — these means will cooperate powerfully toward the pre- 
vention of excessive sexual desire. Horace already remarked : 
" Otia si tolles, periere Cupidinis arcus.'' 

Tlie wife should know how to bridle, not her own desires only, 
but also those of her husband. She must not demand too much 
during the intoxication of youthful vigor ; she must prevent the com- 
plete combustion of the flames of masculine passion, and must keep 
sparks glowing in the ashes. Economy during the sexual prime 
preserves sexual power, enables a man to continue intercourse to a 
ripe age, and avoids premature exhaustion and satiety. When the 
husband is drawing near the end of his sixth decade, the wife must 
accustom herself to see in him rather the father of her children 
than her own husband, and must reduce her sexual demands to that 
measure which will not be injurious to his health. Demosthenes, 
writing of the sexual life of the Athenians of his time, said : " In 
order to obtain legitimate offspring and to provide a faithful 
guardian of our household, we marry a wife; for our service and 
for the performance of daily household duties, we keep concubines ; 
for the joys of love, we seek the hetairai." The task is extremely 
difficult, but a clever and virtuous modern wife must endeavor to 
combine in her single personaHty the sensual attractiveness of an 
Aspasia, the chastity of a Lucrece, and the intellectual greatness of 
a Cornelia; she must bear in mind the epigram of Bacon, "A wife 
must be a young man's mistress, a middle-aged man's companion, 
an old man's nurse." 

In the act of intercourse the woman must always play the more 
passive part; she must be desired, rather than desire. Woman's 
modesty increases man's desire. By this coquetry, permissible be- 
cause natural, the woman can bind the man to herself, and can 
give the lie to the assertion that marriage is the grave of love. 
Partial concealment of her desire on the part of the woman is more 
stimulating to the man than an open manifestation of the sexual 
impulse ; and a certain amount of modest reluctance is more alluring 
to him than a plain invitation. Plenty of room must be left for 
the play of fancy and imagination. Schiller makes Fiesco say to 
the Countess Julia, as he covers up her bosom, " The senses must 
be blind letter-carriers only, and must not be aware of that which 
nature and the imagination communicate each to the other. The 
best of news is stale as soon as it has become the talk of the town." 



272 



The Sexual Life of Woman. 



For this reason, also, it is more suitable that intercourse should 
take place, not by day, consequent on the brutal prompting of 
vision, but by night only, beneath the protecting veil of darkness. 
A night's rest, moreover, will serve to restore the exhausted nerves, 
and to replace the expended secretions. Less advisable is coitus in 
the morning, on awaking from sleep, since the labors of the day must 
immediately thereafter be undertaken. Partially impotent men only, 
who wake up with an erected penis, endeavour to avail themselves 
without delay of this favorable opportunity, bearing in mind the 
French proverb, " On aime quand on pent, et non pas quand on 
veut." 

The French custom, in accordance with which the married pair 
sleep together in a double-bed is undesirable on several hygienic 
grounds, and, in the first place, for the reason that this continuous 
nocturnal proximity is likely to give rise to the habit of indulging 
in excessively frequent acts of intercourse. The best and most af- 
fectionate of men has neither disposition nor capacity to play the 
part of Romeo every night, and thus the value and enjoyment of 
marital duties becomes lessened. The fulfilment of his desires should 
not be rendered quite so easy to the husband ; he should always ap- 
pear the lover, one who seeks a woman's favours because he longs 
for her ; he should not be the master, exacting an unquestioned right. 
For this reason, separate beds are advisable for the married pair, 
and, when possible, even separate bedrooms. 

Among the ancients, Lycurgiis, the Spartan law-giver, regarded 
maternity as woman's principal attribute, and considered the sexual 
impulse to be the means merely by which healthy citizens were pro- 
vided for the state. In accordance with this view, the sanctity of 
marriage was violated, and every powerful, handsome, and valiant 
Spartan had the right to request the privilege of intercourse with the 
wife of another, in order to enrich that other's family with his seed. 
Elderly, impotent men conducted well-formed young men into the 
arms of their own wives. The girls, like the young men, went 
through a course of gymnastic exercises, in order to harden their 
bodies, and to fit them for the bearing of strong and healthy chil- 
dren. No man might marry before attaining the age of thirty, no 
woman before attaining the age of twenty. Girls ripe, for marriage 
were assembled in a dark place, and there the young men chose 
their brid-es, as chance might direct. The young men were al- 
lowed to visit their wives by night only, and secretly, in order that 
the vigor of the sexual impulse might be increased and maintained. 

Among the Spartans, it happened quite frequently, that a man 
whose wife had remained childless, and who believed himself to be 



The Sexual Epoch of the Menacme. 273 

at fault in the matter, would beg one of his fellow-countrymen, or 
even a foreigner, to come to his assistance. It was enacted by one 
of Solon's laws, to prevent a man from neglecting his marital duties^ 
that he should have intercourse with his wife not less than three 
times monthly. According to another of Solon's laws, an Athenian 
heiress might call upon her nearest relative for the gratification of 
her sexual desires. 

The bluntest contrast to this Spartan simplicity is furnished by 
the unbridled lasciviousness that prevailed in Rome under the 
Caesars, when women's sole desire was sexual enjoyment, while 
maternity was a state to be avoided. To such an extreme was this 
carried, that the Roman ladies of that day preferred to marry 
eunuchs, and further, as Pliny reports, hermaphrodites were in great 
request. Juvenal writes : " There are women w'ho prize the infertile 
embraces of base eunuchs; thus they are able to dispense with the 
use of abortifacients." 

The hygiene of the nuptial night deserves from the physician 
more attention than it has hitherto generally received. He should 
warn and enlighten the young husband, in order that the brutality 
with which the act of defloration is apt to be performed may be 
lessened, and further in order that mistakes in this connection, re- 
sulting from ignorance and likely to have serious consequences, may 
be avoided. It is w^ell known that lacerations of the hymen and its 
environment, and even serious injuries of the genital organs, may 
result from maladroit attempts at penetration. The physician will 
admonish the husband in the words of Michelet: " Bear in mind in 
this hour that thou art an enemy, a tender, considerate, and gentle 
enemy ! " 

The young woman entering upon marriage should receive instruc- 
tion from her mother regarding all the sexual processes of copula- 
tion, instruction at once earnest and complete. By such enlighten- 
ment, the young bride will be spared much sufTering, and a sudden 
disillusionment which might seriously affect the whole of her future 
life will be avoided ; complete ignorance, on the other hand may 
lead, not merely to needless mental and physical sufifering, but to 
the most tragic consequences on the bridal night. In one case known 
to me, the young wife, who before marriage was utterly ignorant 
of the nature of physical love, was so completely overwhelmed in 
her ideals by the somewhat energetic procedure of the bridegroom as 
soon as he found himself alone with his wife, that she fled from 
her new home then and there in the night, and by no persuasions 
could be induced to return. 

In that decisive moment in which the maiden loses her virginity, 
she must find in her husband, not the brutal man who forcibly takes 

18 



274 The Sexual Life of Woman. 

possession of her body, but the chosen man of all, to whom her love 
can refuse nothing. 

'' Delicate foresight and restraint," writes Ribbings " are needful 
above all at the commencement of married life. The young wife, 
coming to the bridal bed a pure virgin, is not, like her husband, 
fully prepared for what is to take place. In all cases she is some- 
what fearful of the new experience. The first act of intercourse 
involves for her a certain amount of pain, and this pain is not solely 
physical. ''' * * Moreover, we must remember that the entire 
change in her mode of life makes a deep impression upon a woman's 
mind; time and quiet are needed before she can find herself at 
home in the novel surroundings, before she can adapt to the changed 
circumstances her moral and religious convictions, and before she 
can ' think true love acted simple modesty ' (Romeo and Juliet, III, 
2.16). Impatient husbands, through want of knowledge and lack 
of consideration during the honeymoon, have often ruined the happi- 
ness of subsequent married life." 

It happens often, unfortunately, that the wife has reason to com- 
plain of the reckless manner in which her husband has used, or 
misused, his sexual powers. Frequently enough, on the bridal night, 
the man proceeds with such violence in his assault on the virgin 
reproductive organs of his newly-wedded wife, that we must actually 
speak of him as ravishing an ignorant and timid girl. Later, when 
the stimulus of novelty has passed away, the husband often performs 
intercourse in a manner more calculated to awaken his wife's sexual 
desires, but in seeking his own lordly gratification and obtaining it 
he is still apt to leave out of the reckoning the need for effecting 
coitus in such a way as will give complete satisfaction also to his 
wife. 

The wedding journey likewise deserves consideration from the 
hygienic standpoint. Much is to be said in favor of such a journey, 
inasmuch as it endows the necessarily somewhat brutal first act of 
intercourse with an aspect of romance. The removal to a foreign 
country, to a strange environment, will spare the chaste maiden 
much shame and vexation. On the journey, moreover, the young 
couple are much in each other's company, and the process of mutual 
adaptation is agreeably favored. And yet this modern custom of 
making a wedding journey entails certain serious disadvantages. 
The young woman leaves her home and her nearest relatives, and 
is in a moment involved in the excitement of travel, an excitement 
liable to increase to the degree of morbid anxiety. The fatigues 
of railway-travel, of wandering about strange towns, of visits to 
museums and picture-galleries, are apt to cause general loss of 
nervous tone, and also local hyperaemia of the genital organs. In 



The Sexual Epoch of the MenaCxMe. 275 

ackiition, false modesty and the prescribed arrangements for the 
journey may lead the onset of menstruation to be ignored and the 
customary rest at this period to be dispensed with. Still more, 
the possibility of the occurrence of conception and of the commence- 
ment of pregnancy is usually left altogether out of the account. 
Many an attack of menorrhagia, of perimetritis, and of endometritis, 
many a miscarriage, and many instances of protracted sterility, are 
dependent upon the hygienic mistakes of the wedding journey, and 
less, indeed, upon the abuses arising out of the intoxication of pas- 
sion, than upon the fatigues of excessive travel both by day and by 
night. The bride who on her wedding-day was young, healthy, and 
full of vitality, not infrequently returns from the wedding journey 
a sickly and debilitated woman. 

With regard to wedding journeys in relation to the causation of 
chronic metritis, Scanzoni has expressed an authoritative opinion. 
"After many weeks of unsatisfied sexual desire, the young mar- 
ried pair, now freed from all restraint, give themselves up to 
the joys of love ; the intense sexual excitement causes great stimula- 
tion and hypersemia of the female sexual organs ; in addition, the 
noxious influences of travel make themselves felt, and also hygienic 
indiscretions are perpetrated, dependent upon the young wife's 
modesty ; it is, therefore, by no means to be wondered at that, having 
left home a perfectly healthy woman, she returns from her wedding 
journey with the germs of an illness from which she never fully 
recovers, and which is the source of unending suffering, and more 
particularly of a sterile marriage." 

Sexual hygiene demands a certain moderation in the enjoyment of 
physical love, and also a certain constancy, such as may be ex- 
pected in a happy marriage. 

It is not possible to lay down a general rule with regard to the 
frequency of sexual intercourse, notwithstanding the earnestness 
with which religious zealots, physicians, and moral teachers have 
in all ages endeavored to determine how often it was proper for 
a man to cohabit with his wife. The rules that have been prescribed 
by the various authorities had in view, for the most part, the pro- 
tection of the wife from excessive demands on the part of her hus- 
band ; sometimes, however, by the establishment of a minimum 
period, a certain amount of sexual gratification was secured to the 
wife ; finally, also, the generation of a healthy posterity had to be 
taken into consideration. Ribbing, however, justly observes : " Sex- 
ual intercourse results from a natural impulse, and he whose senses 
are unimpaired, and who has learned, at the same time, amid the 
tumult of his sensations, to preserve proper consideration for his 
wife — such a man runs little danger of making any mistake. In 



276 The Sexual Life of Woman. 

opposition to the opinion of many, I regard it as entirely right and 
reasonable that husband and wife should have intercourse whenever 
physically and mentally impelled to that act. Nor do I see any 
reason why, during the first period in which they are able to enjoy 
without intermission the pleasures of sexual intercourse, they should, 
in accordance with any theory whatever, mipose on themselves 
further restraints than those demanded by care for their physical 
and mental health. The touchstone of marital hygiene is this, that 
on the day following intercourse both husband and wife should feel 
perfectly fresh, vigorous, and lively, alike in body and mind — even 
more so, perhaps, than on other days. In the absence of such feel- 
ings, we may feel assured of the occurrence of sexual excesses." 
The same author quotes a saying of Pomeroy's: '' We may quaff 
the nectar as freely as we will — nature herself mixes the draught 
and holds the goblet to our lips ; if, however, we drink too much, 
she first dilutes the draught with water, later adds gall, and ulti- 
mately perhaps deadly poison." 

The occupation, trade, or profession, and the nutritive condition 
and physical constitution of the married pair, have an important 
bearing on the frequency with which, without detriment to health, 
cohabitation is permissible. The rules of the Hebrew Talmud al- 
ready take these circumstances into account, ordering as they do 
that young and powerful men not engaged in any regular occupa- 
tion shall have intercourse with their wives daily ; manual labourers, 
on the other hand, once a week only ; whilst brain-workers, finally, 
or those whose work is extremely arduous, should allow an interval 
of one or more months to elapse between the acts of intercourse. 
Acton also prescribes that in the case of brain-workers and of those 
manual workers whose labours are exhausting, intercourse must not 
occur more frequently than once every week or ten days. 

The married couple should understand how to impose on them- 
selves a certain restraint in the matter of marital intercourse, with- 
out, however, going so far as on altogether trifling grounds to 
refuse the husband access to his wife. In this respect also, the 
opinions that have recently come to prevail concerning the rights 
of women have had an influence. W. Acton relates a case that 
came under his observation in which the wife refused to allow her 
husband any voice in determining when and how often intercourse 
should take place ; the wife, she maintained without hesitation, since 
she had to bear the consequences of intercourse, was fully justified, 
W'henever she thought fit, in refusing her husband's embraces. 

The dangers to the sexual life of woman which are involved by 
the modern woman's rights agitation are seen already in the changes 
which the emancipation of women in North America has produced 



The Sexual Epoch of the Menacme. 277 

in the functions of woman as wife and mother. In that part of tlie 
world, everything possible has been done " to transform " (to quote 
the words of a brilliant journalist) *' the doll into an independent 
existence, to enable the helpless woman to earn her own sub- 
sistence, and the result of these endeavors has been most strik- 
ing. The American woman has obtained the right to enter every 
profession and to follow every kind of occupation which have 
hitherto been reserved for men; -she is physician, lawyer, merchant, 
professor; her boudoir has become an ofihce, often connected with 
the stock exchange by a private wire. Legally, also, she now pos- 
sesses the same rights as man ; in many States she has both the 
suffrage and the right of entering the house of representatives ; she 
has fully emancipated herself from her former condition of tutelage, 
and in her shrillest tones can cry to heaven ' I am free, I am inde- 
pendent, I am emancipated, I am myself ! ' And observe, as the 
result of all these attempts at the conversion of woman into man, 
that in the matter of marriage also she acts as if she were no longer 
woman. The American woman no longer marries ; perhaps, indeed, 
because' she no longer has the capacity. So long and so eagerly has 
she given herself up to masculine occupations, that her inward 
feminine nature has also perhaps undergone transformation, so 
that she has become affected with a kind of neutral lack of desire. 
Unquestionably, the desire for marriage on the part of this modern 
' emancipated ' woman has vanished in the most alarming manner, 
there is a notable fall in the birth-rate, and the indigenous (white) 
population actually threatens to disappear." 

The wife acts wisely, not on hygienic grounds alone, in not 
always acceding at once and unconditionally to her husband's de- 
mand for the repetition of intercourse. Her modest reluctance en- 
hances her desirability in the eyes of her amorous husband. Thus, 
Shakespeare makes Posthumus exclaim (Cymbeline, Act II., Sc. 5, 

1.9): 

" Me of my lawful pleasure she restrained 
And pre3^'d me oft forbearance ; did it with 
A pudency so rosy the sweet view on't 
Might well have warmed Old Saturn." 

Especially justified is such refusal when coitus has been already once 
or twice performed, or when the consumption of alcoholic beverages 
has made the husband unduly lustful. On the other hand, the re- 
fusal of intercourse when demanded by the husband should never 
depend upon baseless feminine caprice, or upon the now so fre- 
quently asserted " rights of women." 

Experience has long ago established as a fact that unduly fre- 
quent satisfaction of the sexual impulse entails serious consequences 
to the health of the individual. And m the case of the wife these 



278 Tpie Sexual Life of Woman. 

consequences may be especially disastrous when intercourse is in- 
dulged in recklessly during menstruation, during all stages of preg- 
nancy, and even during the puerperium. '"Incontinence during 
menstruation leadc to serious circulatory disturbances and to the 
consequences of these disturbances; during pregnancy it is likely 
to give rise to miscarriage; during the puerperium, to congestions 
and inflammations. Should conception occur as a result of inter- 
course during the lying-in period (and this may happen very shortly 
after childbirth), abortion, and even more serious consequences, are 
likely to ensue. By intercourse during lactation, the premature 
recurrence of the menstrual flow is induced, and the gradual re- 
version of the reproductive apparatus to the condition in which it 
was before pregnancy (the process of involution) is hindered ; more- 
over, the secretion of milk is diminished or even entirely suppressed." 
In these terms //(?^^ar depicts the consequences of premature resump- 
tion of marital intercourse, taking perhaps a somewhat extreme view 
of the matter. 

Nevertheless, this author is undoubtedly right in declaring that 
one of the principal disadvantages to a woman of excessively fre- 
quent sexual intercourse is that pregnancy occurs too often. It 
is astonishing to observe the number of full-term deliveries and 
miscarriages that a woman will experience within a comparatively 
short period of time, as is seen too frequently among the labouring 
classes and more especially among factory workers. *' If we assume 
the ordinary mortality of childbed to be 6 per mille, a woman who 
in the course of 15 years undergoes labour (at full term or pre- 
maturely) 16 times, runs a risk of death to be expressed by the 
ratio of 6X16 = 96 per mille; that is to say, on the average, of 
1,000 women who become pregnant as often as this, nearly i in 10 
will die in childbed." 

Young men who have previously suffered from gonorrhoea and 
who wish to marry, must, unless they wish to cause unspeakable 
misery, undergo an exact and thorough examination ; not only must 
the physician iriquire as to the presence of certain symptoms, such 
as smarting during micturition, adhesion of the lips of the urethral 
meatus, '' clap-threads " in the urine, etc., but during a considerable 
period of time repeated microscopical examinations of the urine must 
be undertaken, and the filaments, if present, must be examined for 
gonococci. The physician will also have to determine whether any 
vestiges remain of epididymitis, and whether the quality of the 
semen has been impaired by the attack of gonorrhoea. Unfortu- 
nately, it is not yet within our power absolutely to forbid marriage 
to a man exhibiting all the symptoms of chronic gonorrhoea ; but it 
is the duty of the physician to explain to such a man the scientific 



The Sexual Epoch of the Menacme. 279 

views reg-arding this matter that now prevail, in order to furnish 
him with the grounds for a decision. 

It is not possible, when discussing the hygiene of married life, 
to preserve silence respecting the extremely pressing question of 
the use of measures for the prevention of conception, for in recent 
years their use has become extraordinarily general, chiefly, indeed, 
in the upper and middle classes of society, but to some extent also 
among the working-class population. Although we devote a special 
chapter to this topic, we must here express the opinion that, except 
in certam instances in which their employment can be justified on 
carefully weighed and well-established medical grounds, the use of 
any mechanical or chemical means for the prevention of conception 
must be discountenanced as injurious to health. The wife who 
wishes to preserve her psychical purity and moral chastity, which is 
not only possible in marriage but also greatly to be desired, must 
not concern herself much with the technique of the sexual life, but 
must give herself up to sexual enjoyment only as the result of a 
delicate and immediate bodily and mental desire. Not only for 
reasons of national economy regarding the means of providing for 
the family, but also for well-grounded personal reasons regarding 
the wife's health, must the latter be spared an unduly rapid succes- 
sion of pregnancies and confinements. And this should be effected 
by a certain degree of continence and by the observation of exten- 
sive periods of sexual quiescence. 

To preserve a woman's health during the acme of her sexual 
activity, a careful general hygiene is an important requisite. The 
dwelling should be dry and roomy ; above all the bedroom should 
not be too small, neither damp nor dark, and it should be well venti- 
lated. The wife's occupations should be so arranged as to afford a 
suitable alternation of activity and repose, and there should be as little 
night work as possible. Certain occupations are especially potent in 
the causation of the diseases peculiar to women, principally, for the 
reason that they do not permit of the requisite repose during men- 
struation. Thus, washerwomen, vocalists, and sewing-machine oper- 
atives, suffer with especial frequency from diseases of the genital 
organs. 

Great care in the cleansing of the genital organs is indispensable 
in the case of women ; the vulva and its environment should be fre- 
quently" and carefully washed; and an occasional vaginal injection 
is advantageous. As regards the last-named measure, however, we 
must point out that it is possible to err by excess as well as by 
defect, and that a daily vaginal douche can by no means be regarded 
as a necessary part of the hygiene of the reproductive organs. For 
recent researches have shown, on the one hand, that the vagina con- 



28o The Sexual Life of Woman. 

stitutes a natural mechanism for the destruction of pathogenic organ- 
isms, and on the other iiand, that complete disinfection of the vagina 
is extremely difficult to effect. Inflammations of the vulva, which 
are somewhat frequent in consequence of excessive perspiration and 
undue discharge from the genital canal, demand careful cleansing 
with soap and water and the use of a soft brush. The addition to 
the water of lysol (in the proportion of j^.l to j/z per cent.) is 
advantageous. A general bath or a local sitz bath, the water being 
moderately warm (95°-99° F. ; 35°-37'' C), may be recommended 
on grounds of beauty as well as of health, and should be taken at 
least once a week. 

The regular use of lukewarm sitz baths is a most valuable hygienic 
measure for the prevention of various general or local disturbances 
consequent upon increased flow of blood to the genital organs. 
These local baths are best taken at a temperature of 95° F. (35° C), 
and should last twenty minutes ; they should be taken just before 
going to bed, and while sitting in the hip bath the skin of the abdo- 
men and of the lower part of the back should be rubbed with the 
hand encased in a friction-glove. The bather on leaving the bath 
should get straight into bed, and should dry herself beneath the bed- 
clothes, rubbing the skin till it glows. Such sitz baths serve also to 
keep the external genitals clean, and to guard against infection. For 
vaginal douching, water sterilized by boiling should be employed, 
and where any catarrh of the vaginal mucous membrane is present, 
some alum, permanganate of potassium, or boric acid. may be added 
with advantage; the pressure of water, when a vaginal douche is 
given, should never be high, the reservoir of the irrigator being 
raised not more than twenty inches above the outlet of the nozzle ; 
as a rule the w^ater should be lukewarm ; the patient should be in 
the recumbent posture. The reservoir of the irrigator and the 
intravaginal nozzle are most suitably made of glass, to insure 
cleanliness ; the nozzle should not be thrust too far in, two inches 
being quite sufficient. After the use of the douche, the woman 
should remain ten or fifteen minutes in the recumbent posture. 

In addition to the hygenic employment of such full baths and 
local baths, a number of mineral baths have important therapeutic 
applications in cases of disease of the female genital organs, the 
traditional value of such baths having been scientifically endorsed by 
the modern science of balneo-therapeutics. By means of suitably 
selected mineral water baths, a powerful derivative stimulus may be 
given to the skin, and the affecited reproductive organs may thus be 
beneficially influenced. Further, in acute inflammatory conditions 
or hyperremia of the uterus or its annexa, these baths have an an- 
tiphlogistic influence ; on the other hand, when intrapelvic exuda- 



The Sexual Epoch of the Men acme. 281 

tioiis have formed, the baths promote the absorption of tliese in- 
flammatory products; again, in congestive states of the female 
genital organs, with relaxation, thickening, and hypersecretion of 
the genital mucous membrane, the baths have an astringent and 
tonic influence on the tissues; finally, they have a favorable effect 
on the innervation and nutrition, not only of the reproductive appa- 
ratus, but of the entire organism. It is easy to understand why 
women during the menacme are frequent visitors to spas. 

At this period of life, and especially in women who lead luxurious 
" society " lives, the thoughts tend strongly in the sexual direction ; 
to avoid this, and to prevent the ever more and more frequent 
breaches of marital fidelity, the best means are the practice of vigor- 
ous bodily exercises, and active employment, either in household af- 
fairs or in intellectual occupations. Cold sponging of the body or 
cold full baths will also be found an excellent measure for the pre- 
vention of sexual excess. In such cases also the diet should be 
Hmited, strong and stimulating food should be avoided, but little 
butcher's meat should be taken, whilst green vegetables and raw 
and cooked fruits should be liberally consumed ; at the same time, 
all alcoholic beverages must be rigidly prohibited. Moreover, care 
must be taken that during the night there should be no undue physi- 
cal stimulation in consequence of excessively warm and soft bedding; 
hair mattresses are to be preferred to feather beds, with light down 
quilts for a covering. Finally, no stimulation of an erotic character 
should be offered to the imagination, and for this reason equivocal 
literature and lascivious dramatic representations must be avoided. 
By a sufficiency of occupation, regular, interesting, and demanding 
a considerable expenditure of physical energy, a woman may be 
enabled to a great extent to escape the inconvenience and distress 
attendant on entire or partial lack of gratification of the sexual 
impulse. 

It cannot be disputed that a certain and moderate amount of 
sexual gratification is requisite for the perfect maintenance of physi- 
cal health in woman, and that the absence of this gratification, or 
the gratification of the impulse in an abnormal or incomplete man- 
ner, entails disturbance of alike the mental and the physical equi- 
librium ; but, on the other hand, the deleterious consequences of 
sexual abstinence have been greatly exaggerated by many writers — 
both by physicians and social economists. Owing to the fact that 
to the cultivated woman sexual gratification is possible only in the 
married state, whilst social conditions render marriage impossible 
to many women greatly in need of such gratification ; in consequence, 
also, of the modern and ever more widely diffused practice by hus- 
bands of coitus interruptus altogether regardless of the woman's 
need for complete sexual gratification — there arise in women nu- 



282 The Sexual Life of Woman. 

merous local disorders and nervous disturbances, hysteria and even 
insanity being results by no means infrequent. The significance 
of ungratified sexual impulse in the pathogenesis of nervous dis- 
orders has been established by von Krafft-Ebing, who points out 
that in unmarried women insanity most frequently occurs between 
the ages of twenty-five and thirty-five years, during the decade, 
that is to say, in which youthful bloom and the hopes of marriage 
simultaneously disappear; whereas in the male sex the greatest in- 
cidence of insanity is between the ages of thirty-five and fifty years, 
the period of life in which the struggle for existence is fiercest. 

Hegar, on the other hand, is a firm opponent of the view that 
the favourable influence of marriage is overrated. According to 
this author, the favourable effect of marriage in respect of mental 
disorders is to be found, not in the gratification of the sexual im- 
pulse, but in the ethical factors of marriage. Statistics show that 
even in the favourable circumstances of marriage, sexual gratification 
has in women an unfavourable influence, inasmuch as the proportion 
of sufferers from mental disorders is higher among married women 
than it is among married men. A study of the mental- disorders 
which in women are especially associated with the process of re- 
production (puerperal mania) confirms thi§ impression. He gar 
insists that he has never seen nymphomania arise in women in con- 
sequence of forcible repression of the sexual impulse; but that he 
has not infrequently seen this disorder result from unnatural ex- 
cesses or from long-continued sexual irritation, especially in heredi- 
tarily predisposed persons. vSuch unnatural stimulation of the female 
is not infrequently practiced by the male — by the lover and even 
by the husband — it may be because he himself derives pleas- 
ure from such perverted practices, and wishes to obtain sexual 
gratification without the risk of impregnation, or because he 
is himself incompetent for normal complete intercourse. Hegar 
is further of opinion that in the causation of hysteria and also 
in that of chlorosis the repression of the sexual impulse plays 
a quite subordinate role. And he regards as pure fable the be- 
lief that continence in women is liable to lead to the formation 
of mammary, uterine, or ovarian tumors. He w^ould more 
readily incline to the contrary opinion ; the reproductive proc- 
ess being in this respect distinctly disadvantageous to the female 
sex. The unfavorable influence of the reproductive process is 
shown most clearly in the case of carcinoma of the uterus ; the 
majority of the patients suffering from this disease are either mar- 
ried or widowed, and many of them have given birth to a large 
number of children. " Gratification of the sexual impulse, and more 
particularly the reproductive process, give rise in women to the 



The Sexual Epoch of the Menacme. 283 

formation and growth of tumors, cause numerous mechanical dis- 
turbances, and open the way to infection with various pathogenic 
organisms." 

He gar considers that there is hygienic justification for the Hmita- 
lion of the number of children to which a woman gives birth. 
The most suitable age for motherhood lies in his opinion between 
the ages of twenty and forty years. Childbirth in women } ounger 
or older than this entails too much danger both to mother and child. 
At least two and a half years ought to elapse between two successive 
births ; and these figures give us eight as the maximum family. 
If we assume that the duration of pregnancy is nine months, and 
that of lactation nine to twelve months (or in cases in which the 
mother does not nurse her own infant, that a like period must be 
devoted to the careful supervision of the wet-nurse or of the methods 
of artificial feeding), we cannot consider it unreasonable to devote 
a further period of from six to nine months to the complete re- 
establishment of the woman's health. " Moreover, woman does not 
exist solely for the purpose of subserving during two decades of 
her life the processes of reproduction. And to permit the maximum 
number of children to be as great as eight, we must presuppose 
that the woman is in perfect 'health, and that she lives in a perfectly 
healthy environment. Any illness or infirmity which renders the 
duties of housekeeping and the rearing of the existing family unduly 
difficult, indicates the need for a further limitation of childbe.aring. 
And if the reproductive function is to be rationally controlled, we 
must above all attend to the age and the health of the parents. 
Occupation, habitation, and general environment have also to be 
considered. The correct ideal is indeed not difficult to discover." 

Hegar concludes that strict moderation and even absolute con- 
tinence in sexual matters are often, and for long periods of time, 
a pressing duty. " The numerous and various disasters which are 
brought upon the world by unbridled and unregulated sexual 
passion can be prevented only by enlightenment, moderation, and 
continence. If marriage were postponed until the attainment of 
complete physical maturity, in women till the age of 20, in men till 
the age of 25, while at the same time procreation were no longer 
undertaken by women above the age of 40 or by men above the 
age of 45 to 50 years ; if, again, between successive pregnancies 
a sufficient pause for the woman's recuperation were insisted upon, 
and intercurrent illnesses and states of debility were taken into 
account ; and if, finally, sickly individuals, those hereditarily pre- 
disposed to disease, and those in any way below par either mentally 
or physically, were more than heretofore prevented from marrying; 
then the increase of population, which in Germany is unquestionably 



284 The Sexual Life of Woman. 

too rapid, would to some extent be checked. Thoroughgoing 
regulation of the reproductive process will not, however, be thus 
attained without the adoption of a method of selection too rigorous 
for present-day notions ; and for a further advance we must in 
the meantime depend upon moderation and continence." As regards 
the modern demand of the "right to love," the same experienced 
gynecologist writes : " Whoever preaches to mankind the doctrine 
that ' a man sins against his own personality if he neglects to exer- 
cise every limb he possesses, and if he denies himself the gratification 
of every natural impulse,' or the doctrine that ' it is the duty of 
every human being to gratify all his natural impulses, since these 
are most intimately inter-connected with his personality — are indeed 
his personality itself ;' such a preacher does harm to his kind. Such 
rights and such duties are chimerical for this reason if for no other, 
because two persons are necessary in the case of sexual gratification, 
and sometimes — though not as often as might be wished — Hans 
fails to find his Grete, without anv consequent loss to society at 
large." 

An especially important chapter in the history of woman at this 
period of life relates to the dietetics of pregnancy and parturition, 
and to the regulations to be observed for the maintenance of 
health at this time and in connection with the processes of preg- 
nancy, parturition, puerperal involution of the uterus, and lactation. 
This subject cannot now however be considered at length, and for 
our present purposes it is sufficient to point out how important 
it is alike for mother and child, alike for family and society, that 
the ever more and more widely and generally diffused practice of the 
artificial feeding of infants should be abandoned, and that there 
should be a return to the natural method according to which each 
mother nurses her owm infant. The prevailing custom costs every 
year thousands of mothers their health, and thousands of children 
their lives. 

Copulation and Conception. 

Copulation. 

The reproduction of the species is efifected by means of an act of 
copulation on the part of a male and a female individual, both 
of whom must have attained complete sexual development. In 
all the sequence of reproductive processes it is copulation alone 
that is a voluntary act. all the other processes being independent 
of the will and even of consciousness. 

A characteristic difference between man and the low^er animals 
lies in the fact that in the human species sexual pleasure and the 
act of copulation may occur at any season of the year; and a 



The Sexual Epoch of the Menacme. 285 

further characteristic difference may perhaps be found in the fact 
that in the great majority of individuals of the human species the 
psychical process of " love " plays a determinative part. Voltaire 
|)ointed out that to man alone among animals are known the em.- 
brace and the joy of the kiss. 

The significance of the kiss is depicted by Grillparzer in the fol- 
lowing verses : 

Auf die Hande kiisst die Achtung, 
Auf die Wangen Wohlgef alien, 
Seelige Liebe auf den Mund. 
Auf den Nacken das Verlangen; 
Uberall sonsthin Raserei.* 

In this act of conjugation between two individuals of the same 
species, differentiated each from the other by the characteristics of 
sex, the active, provocative role is allotted to the male, the passive, 
receptive role, to the female. The modest and coy reluctance char- 
acteristic alike of the maiden and of the w^ife, promote an increase 
of sexual excitement in the opposite sex, and this not only in a 
man of purely sensual character, whose vanity is stimulated by his 
being the chosen one among many — a circumstance which, in view 
of the great dependence of the sexual act upon psychical processes 
and imaginative influences, is by no means devoid of importance. 
The woman's coy reluctance must be overcome by means of a 
tender strategy before she is willing to grant the final possession of 
her body ; and the act of copulation forms at the same time the con- 
clusion of the physical and mental yearnings of the lover, and the 
commencement of the new-coming being. There is thus a physio- 
logical reason for the advice given by the celebrated surgeon. Am- 
broise Pare, that a man, before completing coitus, should employ 
some of the delicate and sensually stimulating manipulations of the 
earlier stages of courtship, for, he writes, " aucunes femmes ne 
sont pas si promptes a ce jeu que les hommes." 

The potency for intercourse of the sexually rnature man, his 
capacity for the introduction of the erect penis during the act of 
copulation, is dependent on the fact that sexual excitement gives 
rise to a sufficient stimulus which, acting on the erection centre 
(and presuming that the centre and its afferent and efferent tracts 
are normal), leads to an increased flow of arterial blood to the penis 

* Respect kisses the hand, 

Affection kisses the cheek, 

Spiritual love kisses the mouth. 
.Desire the neck; 

Amatory frenzy kisses the v/hole body. 



286 The Sexual Life of Woman. 

and a diminished outflow through the veins of that organ, and 
consequently to its erection. The cerebrum is the organ in which 
the sensation of hbido sexuahs, of sexual excitement, has its seat; 
with this higher centre is connected by means of intercentral nerve 
tracts a lower, mechanical, reflex centre, situated in the lumbar en- 
largement of the spinal cord, and presiding over the performance 
of the act of copulation ; it is moreover probable that nerve fibres 
proceed from the spinal cord direct to the blood vessels of the 
erectile tissue, by means of which the calibre of these vessels can 
be lessened or their extensibility diminished. The relation of the 
erector nerves (nervi erigentes) to the penis is by many physiologists 
compared to the relation of the vagus nerve to the heart. In the 
quiescent state the small arteries of the penis and perhaps also the 
cavernous spaces of that organ are in a state of mean contraction, 
so that they offer a considerable resistance to the passage of the 
blood current. When now the nervi erigentes are excited to activity, 
the hitherto tonically contracted vessels of the penis undergo, ac- 
cording to the school of physiologists just mentioned, relaxation, so 
that they dilate under the pressure of the blood within their walls, 
and, the previous resistance to the flow being now removed, the 
blood pours freely into the cavernous spaces of the penis, and 
distends these to the uttermost. In this manner erection is effected, 
rendering possible the insertion of the penis into the genital passage 
of the female; with the culmination of the sexual act, the semen is 
ejaculated, the muscles of the prostate and the membranous portion 
of the urethra together with the ischiocavernosus and bulbocaver- 
nosus muscles, all acting strongly and simultaneously. 

By the contraction of the muscular apparatus jus't described, the 
penis is constricted in the neighborhood of the pubic symphysis, 
and this further hinders the outflow of the blood from the corpora 
cavernosa, increasing the intensity of the state of erection of the 
penis. Should the relaxation of the corpora cavernosa, dependent 
upon the stimulation of the nervi erigentes, be incomplete, it is not 
possible for sufficient blood to pass into the cavernous spaces to 
exercise considerable pressure upon the efferent veins, and thus 
complete erection fails to occur. If, again, the contraction of the 
muscular apparatus at the root of the penis is insufficiently vigorous, 
complete erection likewise fails to occur ; the organ becomes semi- 
erect only, or erect for a period too short to permit of the com- 
pletion of intercourse. 

Since, physiologically speaking, conception is the purpose with 
which copulation is effected, the ejaculation of the semen must 
be regarded as the principal object of that act ; now in normal 
conditions, ejaculation takes place only when the penis is fully erect. 



The Sexual Epoch of the Menacme. 287 

Associated with the erection of the corpora cavernosa is a svvelUng 
of the caput galHnaginis, whereby the orifices of the ejaculatory 
ducts are directed forwards toward the membranous portion of the 
urethra, and at the same time the backward passage to the bladder 
is cut off. By this mechanism, the urethra, which usually serves 
as the canal for the outflow of urine, is made for the time being 
solely subservient to the purposes of the sexual act. That the outlet 
from the bladder is obstructed by the swollen caput gallinaginis 
w'hen the penis is erect, is shown by the familiar fact that a man 
whose penis is erect cannot pass water, although the way is freely 
open for the ejaculation of the semen. 

Before ejaculation begins, the urethral glands already begin to 
secrete; and when erection is powerful and prolonged, this secre- 
tion often makes its appearance at the urethral orifice in the form 
of drops of a clear somewhat tenacious fluid. Ultzmann considers 
that the function of this secretion is probably to moisten the walls 
of the urethra, over which the acid urinary secretion is continually 
flowing, with a protective alkaline fluid, and thus to prepare the 
canal for the passage of the semen. An analogy may be found in 
the secretion of the cervical glands of the uterus in the female, for 
this secretion has been found to enhance the activity of the move- 
ments of the spermatozoa. If now during copulation the moment 
of ejaculation begins, the male experiences at the same time a sense 
of voluptuous pleasure and a feeling of muscular spasm in the 
perineal region, and this indicates the commencing evacuation of 
the contents of the seminal vesicles through the ejaculatory ducts. 
Simultaneously, the secretion of the prostate is poured into the 
urethra. The semen now gradually passes out through the narrow 
ejaculatory ducts, and, since in consequence of the swelling of the 
caput gallinaginis, it cannot pass backwards towards the bladder, 
it runs forwards, and accumulates in the bulb of the urethra, the 
physiological excavation of that tube. As soon as a considerable 
quantity of the semen has collected in this situation, so that the 
bulb of the urethra becomes distended, reflex contractions of the 
bulbocavernosus m.uscles ensue, by means of which the seminal 
fluid is forced out of the urethral orifice. In cases in which this 
muscular apparatus does not function properly, as in the paralytic 
form of impotence, the semen during ejaculation is not ejected in a 
forcible jet, but rather flows slowly, as from a lax tube partially 
filled with fluid, from the urethral orifice. 

We are indebted to Roubaud for a classical description of the 
phenomena of copulation, and this description is here appended. 
It runs as follows : ''As soon as the penis enters the vaginal vesti- 
bule, it first of all pushes against the glans clitoridis, which yields 



288 The Sexual Life of Woman. 

and bends before it. After this preliminary stimulation of the two 
chief centres of sexual sensibility, the glans penis glides over the 
inner surfaces of the two vaginal bulbs; the coUum and the body 
of the penis are then grasped between the projecting surfaces of 
the vaginal bulbs, but the glans penis itself, which has passed 
further onward, is now in contact with the fine and delicate surface 
of the vaginal mucous membrane, which membrane itself, owing to 
the presence of erectile tissue between its layers, is now in an elastic, 
resilient condition. This elasticity, which enables the vagina to adapt 
itself to the size of the penis, increases at once the turgescence and 
the sensibility of the clitoris, inasmuch as the blood that is driven 
out of the vessels of the vaginal wall passes thence to those of the 
vaginal bulbs and the clitoris. On the other hand, the turgescence 
and the sensitiveness of the glans penis itself are heightened by 
compression of that organ, in consequence of the ever increasing 
fulness of the vessels of the vaginal nuicous membrane and the two 
vaginal bulbs. 

"At the same time the clitoris is pressed downward by the an- 
terior portion of the compressor muscle, so that it is brought into 
contact with the dorsal surface of the glans and of the body of the 
penis ; in this way a reciprocal friction between these two organs 
takes place, repeated at each copulatory movement made by the two 
parties to the action, until at length the voluptuous sensation rises 
to its highest intensity and culminates in the sexual orgasm, marked 
in the male by the ejaculation of the seminal fluid, and in the female 
by the aspiration of that fluid into the gaping external orifice of the 
cervical canal ; so true, indeed, is this, that it is a difficult matter 
to give a picture at once accurate and complete of the phenomena 
attending the normal act of copulation. Whilst in one individual 
the sense of sexual pleasure amounts to no more than a barely 
perceptible titillation, in another that sense reaches the acme of 
both mental and physical exaltation. 

*' Between these two extremes we meet with innumerable states of 
transition. In cases of intense exaltation, various pathological 
symptoms make themselves manifest, such as quickening of the 
general circulation, and violent pulsation of the arteries ; the venous 
blood, being retained in the larger vessels by general muscular con- 
tractions, leads to an increased warmth of the body; and further, 
this venous stagnation, which is still more marked in the brain in 
consequence of the contraction of the cervical muscles and the back- 
ward flexion of the neck, may cause cerebral congestion, during 
which the consciousness and all mental manifestations are momentar- 
ily in abeyance. The eyes, reddened by injection of the conjunctiva, 
become fixed, and the expression becomes vacant; lids close con- 



The Sexual Erocii of the Menacme. 289 

cliisivcly, to exclude the light. In some, the breathing becomes 
panting and labouring ; but in others, it is temporarily suspended, in 
consequence of laryngeal spasm, and the air, after being pent up for 
a time in the lungs, is finally forcibly expelled, and they utter in- 
coherent and incomprehensible words." 

The impulses proceeding from the congested nerve-centres are 
Qonfused. There is an indescribable disorder both of motion and 
of sensation, the extremities are affected with convulsive twitchings, 
and may be either moved in various directions or extended straight 
and stiff; the jaws are pressed together so that the teeth grind 
against each other; and certain individuals are affected by erotic 
delirium to such as an extent that they will seize the unguarded 
shoulder, for instance, of their partner in the sexual act, and bite 
it till the blood flows. 

A period of exhaustion follows, which is the more intense in pro- 
portion to the intensity of the preceding excitement. The sudden 
fatigue, the general sense of weakness, and the inclination to sleep, 
which habitually affect the male after the act of intercourse, are 
in part to be ascribed to the loss of semen ; for in the female, how- 
ever energetic the part she may have played in the sexual act, a 
mere transient fatigue is observed, much less in degree than that 
which affects the male, and permitting far sooner of a repetition of 
the act. *' Triste est onine animal post coitum, praeter mulierem 
galhunque/' wrote Galen, and the axiom is essentially true, at any 
rate so far as the human species is concerned. 

The question has been mooted, and many earnest inquirers have 
devoted much thought thereto, whether in this moment of most 
intense sexual gratification it is the male or the female that ex- 
periences the greatest amount of pleasure. As in the case of all 
questions the data for the solution of which are at once very various 
and very variable, so in this case also, very different opinions have 
been put forward. " In fact," writes Rouhaiid, '' when we take into 
consideration all the circumstances by which the intensity of sexual 
sensation is influenced, it may well be doubted if it is at all possible 
to find an a priori solution for the problem. When we take into 
consideration the influence exercised by temperament, constitution, 
and a large number of conditions both general and special, on 
sexual sensibility, we cannot fail to be convinced that this problem, 
in consequence of all the complicated characteristics it presents, is 
actually insoluble. 

In regard to the pleasure experienced in the act of intercourse, 
a remarkable distinction is drawn by Gutceit. The male, in every 
case and with every woman, experiences the full degree of pleasure ; 
and even though from the mental point of view this pleasure may 
be enhanced by inclination, attraction, and mutual love, from the 
19 



290 The Sexual Life of Woman. 

physical point of view there is no difference between different acts 
of intercourse, so that the cynical old Roman was right when he 
wrote, " Snblata lucerna nullum discrirnen inter foeminas/' But 
in the case of the female it is very different. Her first experience 
of sexual relations is a very painful one, and this pain prevents all 
enjoyment as long as it continues, as it does in many women for 
one, two, or even four weeks. And when this period is once over, 
not more than two women in every ten experience the pleasure 
of sexual intercourse in its full intensity. Of the remaining eight, 
four have indeed an agreeable sensation during the rubbing move- 
ments of the sexual act, but it is a long time before they experience 
a sensation analogous in its intensity to that which in man accom- 
panies the act of ejaculation. In some women it may be six months 
after marriage before the true sexual orgasm is experienced, in 
others it may be a year, or even several years ; in a considerable 
number this does not happen until after they have given birth to 
several children. As a result of numerous observations on this 
point, Gutceit asserts that in women sexual pleasure is experienced 
only in intercourse with a man who is beloved, or against whom, at 
least, no repulsion is felt ; and that no pleasure is felt by a woman 
in intercourse with a man towards whom she feels an actual dis- 
like. Further, he maintains, that a woman, loving another man, and 
feeling pleasure in intercourse with him, has on the other hand no 
voluptuous sensations during intercourse with her husband, whose 
embraces she permits only from a sense of duty. Thus in the male, 
intercourse is always pleasurable, while in the female, pleasure is 
experienced only when certain conditions are fulfilled. 

Contact with the male genital organs stimulates in the female 
the sensory nerves of the vulva, the vestibule, and the vagina; the 
nervous stimulus is transmitted to the cerebral cortex, where it 
gives rise to the sensation of sexual pleasure, and causes, through 
the intermediation of the genito-spinal centre, a number of reflex 
actions. As sensory nerve terminals of such reflex arcs, the final 
ramifications of the pudic branch of the sciatic plexus play the most 
important part ; in the clitoris these nerves are beset with a peculiar 
kind of end-bulbs, the genital corpuscles discovered by W. Krause; 
from their structure these corpuscles seem admirably adapted to 
respond to the very slightest stimulation, producing voluptuous 
sensations and perceptions, and giving rise to various reflex mani- 
festations. The first part of the path of the afferent impulses by 
which sexual pleasure is aroused is constituted by the dorsal 
nerves of the clitoris. The reflex changes consequent upon sexual 
excitement begin already in the vestibule, inasmuch as the secretion 
of Bartholin's glands, which are compressed by the action of the 



The Sexual Epoch of the Menacme. 291 

constictor cunni muscle, is expelled during coitus, the secretion, 
owing to the situation of the orifices of Bartholin's ducts, passing 
over the external genitals. The clitoris becomes erect ; the blood in 
the bulbs of the vestibule, the venous plexus situated around the 
margin of the vestibule along the boundary between the labia majora 
and the labia minora, is pressed into the glans clitoridis, the 
erection and sensibility of this structure being proportionately 
heightened. By the action of the constrictor cunni and ishiocaver- 
nosus muscles, the clitoris, the distal extremity of which is bent 
downwards at a right angle, is drawn down and pressed against the 
penis. 

At the entrance of the vagina is the sphincter vaginae muscle, 
whose action is reinforced by muscular fibres running in the middle 
coat of the vagina itself. It is probabk that the muscular activity 
of the vagina and the uterus facilitates the entrance of the semen 
into the cavity of the uterus. 

Dorsal decubitus is rightly regarded as the most correct position, 
physiologically speaking, for the woman to assume during coitus. 
That from the earliest times and in the most diverse races, this 
position has been customary, is shown by numerous antique paint- 
ings and statues, and by the reports of those who have studied 
the customs of savage races. Various other positions are, how- 
ever, occasionally assumed ; thus, Ploss and Bartels report, that 
among the Soudanese, coitus is practiced in the erect posture, with 
the man standing behind the woman ; that among the Inuits 
(Eskimo), the act is performed in the manner usual among quad- 
rupeds ; that among the Swahelis in Zanibar, and among the indi- 
gens of Kamschatka, the lateral posture is customary ; and that 
among the Australian blacks, coitus is usually effected in the crouch- 
ing posture, both parties squatting on their hams. The same 
writers remind us, that in the old calendars of the fifteenth, six- 
teenth, seventeenth, and eighteenth centuries, definite commands 
and prohibitions for the conduct of marital intercourse are to be 
found, and that lucky and unlucky days, respectively, are specified 
for the performance of the act. These recommendations would 
appear to be relics of antiquity, for in the Sanscrit work Kok- 
kogam, under the heading ''Sexual Intercourse Acccrrding to the 
Days of the Month," exact instructions are given for the proper 
performance of coitus. 

In the Kaniasutra (the Indian ars amatoria, a work only in 
recent days rendered accessible to European readers in the trans- 
lation of R. Schmidt), several chapters are devoted to the detailed 
description of the various methods of copulation, and rules are 
given for the carnal union of man and wife. But, as the Indian 



292 The Sexual Life of Woman; 

author justly remarks, *' Rules are of value only for the control of 
moderate desire; when the wheel of passion has once begun to roll, 
to prescribe a course is no longer of any avail." In this work, 
sixty-four varieties of erotic enjoyment are enumerated, and we 
find an explicatio coitus secundum mensuram, tempus, natiiram, de 
}nodis inter coitum procmnhendi, de minis coitibus, de coitii inverso, 
de viri inter coitum consuetudinibus. 

At times, in order that coitus may be effective, some other 
position than the natural one is indispensable. Such a necessity 
has been recognized even by theologians, by whom any divergence 
from nature in this matter has usually been regarded as sinful. For 
instance, in the work of Craisson, De Rebus Venereis ad Usum 
Confessariorum, we read: ''Situs naturalis est ut miilier sit succuba 
et vir incubus, hie enim modus aptior est effusionis seminis virilis 
et receptioni in vas feniineum ad prolem procreandum. Unde si 
■coitus aliter Hat, nenipe sedendo, stando, de latere, vel praepostere 
{more pecudum), vel si vir sit succubus et mulier incuba, innaturalis 
est. , . . Sed tamen minime peccant conjuges si ex justa causa 
situm miitent, nempe ob acgritudincm, vel viri pinquetudinem, vel 
ob periculum abortus; quandoque ait St. Thomas, sine peccato esse 
potest quando dispositio corporis alium moduni non patitur." 

In certain pathological states, as for the prevention of sterility, 
an abnormal posture during coitus may advantageously be recom- 
mended, in order to favour the entrance of the semen into the 
cervical canal, and to allow the semen to stay longer in the vagina 
before it flows out. An old and often efficacious means for this 
purpose is the performance of coitus with the woman in the knee- 
elbow posture. In order to favour the entrance of the semen into 
the deeper portion of the genital tract, He gar and Kaltenbach 
recommend that after coitus the woman should remain for some 
time in the knee-elbow posture, while the man from time to time 
gently presses up the anterior abdominal wall, and then abruptly 
relaxes the pressure. — In the Talmud, coitus was regarded as un- 
fruitful if performed when the woman was in the erect posture. 

Casper reports the case of a woman with severe scoliosis, who had 
long remained sterile, and who only conceived (and was subse- 
quently happily delivered) after performing coitus in the abdominal 
decubitus. 

Gueneau de Mussy suggests the following, very characteristic, 
method of ensuring fertilization, one which also certainly dates 
from great antiquity : '' Sed hand illicitum mihi visum est, si post 
diver sa tentamina diutius uxor infecunda manserit, ipsum maritum 
digitum post coitum in vaginam immittere, et ita receptum semen 
uteri osteo admovere. Et cum ostiolo uteri haeret, ut in pervium 



The Sexual Epoch of the Menacme. 293 

canalem spermatozoidum tnotibus faventibus, prodeat, sperare non 
absurduin." Enstachc reports a case, the wife of a physician, in 
which this manoeuvre was effective in ensuring conception. 

A similar procedure has been employed with success by Kehrer, 
in a case of enfeebled potency on the part of the male, leading to 
premature ejaculation. A speculum was introduced into the 
vagina, and through this instrument the semen, ejaculated in conse- 
quence of sexual excitement, was introduced into the vaginal fornix ; 
conception ensued. In an analogous manner, A. Peyer recommended, 
in a case of partial impotence, in which special manipulations were 
needed to bring about ejaculation, that conception should be 
favoured in the following manner : Erection having been effected 
by ordinary sexual contact, the manipulations needed to produce 
ejaculation were carried out, and the penis was intromitted into the 
vagina the moment before ejaculation occurred. This has been 
done with fruitful results. Englisch reports the case of a hypos- 
padiac who, in order to render coitus effective, used a condom in 
the anterior extremity of which he made an aperture. In this 
way he became the father of three children. 

In very obese men with extremely protuberant abdomens, we 
may recommend for the furtherance of conception that they should 
have intercourse with their wives a parte posteriori; and the same 
recommendation may be made in cases in which the wife herself is 
extremely obese. In AustraHa, it is said that among the indigens, 
coitus is usually practiced a posteriori; and there is a saying in the 
Talmud to the effect that sexual intercourse performed in the 
ordinary manner does not lead to the conception of infants so good, 
wise, talented, and promising as those whose conception is the 
result of coitus a posteriori. Mohammed, on the other hand, de- 
clares, " Your waives are your tillage, go therefore unto it in what- 
soever manner ye will." 

In cases of retroflexion of the uterus, with a markedly forward 
direction of the vaginal portion of the cervix, I have recommended 
to the husband that he should perform coitus with his wife in the 
upright sitting posture. In this posture the fundus uteri passes 
downwards and forwards, whilst the vaginal portion of the cervix 
passes upwards and backwards. 

In cases of retroversion of the uterus with the formation of a 
cul-de-sac in the posterior vagixial fornix, Pajot recommends, with 
the aim of temporarily restoring the uterus to a position in which 
the occurrence of conception is favored, that for three or four days 
prior to coitus the patient should retain the faeces, eating the while 
freely of eggs and rice, and taking a small opium pill every even- 
ing; in cases of anteversion, the patient should retain her urine for 



294 The Sexual Life of Woman. 

a considerable time — five or six hours — before coitus; and in 
cases of lateral version he recommends that the patient should have 
intercourse while lying on that side towards which the vaginal por- 
tion of the cervix is directed. 

Edis recommends that in cases in which there is sterility depend- 
ent upon backward displacements of the uterus, that the organ 
should be replaced while the patient is in the genu-pectoral posture, 
and a pessary inserted; coitus should then be effected without the 
patient's changing her posture. 

In the human species as compared with the lower animals, there 
has been a notable diminution in the frequency of the separate acts 
of intercourse, a diminution dependent upon the higher vital aims 
of the former. Burdach formulates as a physiological law that the 
frequency of sexual intercourse is inversely related to the duration 
of the act. 

Amongst all civilized races, sexual intercourse ceases during men- 
struation, since in the normal man there is aversion to intercourse 
with a menstruating female. 

By the Mosaic law, intercourse with a woman during menstrua- 
tion and for seven days after the cessation of the flow, was forbidden 
under pain of death. The Talmud further ordains that a purifying 
bath shall be taken by the woman a week after menstruation. By 
intercourse itself, moreover, both man and woman were rendered 
unclean to the evening ; and, according to the Mosaic law, both must 
bathe after the act of coitus. In the Koran, also, intercourse is for- 
bidden during menstruation, and until the woman has been purified 
with water. The laws of. Islam demand from a man who marries 
a virgin that he shall have intercourse with her the first seven nights 
in succession ; whilst he who marries a wife no longer virgin, needs 
to visit her only the first three nights in succession. Subsequently, 
during married life, the Mohammedan shall have intercourse with 
his wife regularly once a week. Amongst many savage races, inter- 
course is forbidden with a woman during pregnancy, the puerperium, 
and lactation. 

The first act of intercourse is difificult and painful to the virgin. 
At times the rupture of the hymen is exceedingly difficult. Even 
after this, it is some time before genuine pleasure is experienced 
in sexual intercourse. 

To the female, intercourse is harmful when performed with un- 
due frequency, or during menstruation, or indiscriminately through- 
out pregnancy, or during the puerperium, or incompletely or in an 
unnatural manner, or finally when performed in an unsuitable bodily 
attitude. 

" Unduly frequent performance of the act of coitus," writes 
Hegar, " which is liable to occur either in marital or in illicit inter- 



The Sexual Epoch of the Menacme. 295 

course, gives rise to anaemia, defective nutrition, muscular weak- 
ness, intellectual and nervous exhaustion. Young and healthy in- 
dividuals recuperate rapidly after excesses of brief duration, as is 
often seen in young married pairs. Sickly and elderly persons, on 
the other hand, are much more severely affected by sexual excess, 
and recover therefrom but slowly if at all. Long continued sexual 
excesses ultimately wear out even the strongest." 

Intercourse effected by force, or with a girl of immature age, is 
distinguished as rape, a punishable offence both in Germany and in 
Austria. The offence is defined as extra-marital intercourse with a 
female under the age of fourteen years, with or without the latter's 
consent ; or extra-marital intercourse with a female of any age 
against her will or deprived of the power of resistance — either by 
the use of actual force, by the employment of threats, or by loss of 
consciousness. With regard to the last specification, the law re- 
gards as rape intercourse with a woman unable to resist through 
loss of consciousness, whether that loss of consciousness is or is not 
produced by the direct action of the violator. 

In the female, the act of intercourse, alike physically, in its natu- 
ral consequences, and mentally, is at once more difficult and of more 
enduring results than in the male. A writer of the new school, 
who according to his own admission has no other interest than the 
study of the sexual life, writes of himself : " I have often enough had 
intercourse with members of the other sex, in a few cases, indeed, 
out of pure inclination ; but in all cases alike the aim and the result 
were the same — as soon as I had gained my end, the affair was 
finished. Passion, a bestial act, exhaustion, commonly a feeling of 
loathing; in the best possible case a fugitive but not an agreeable 
memory; voila tout." To women, such a description, happily, is 
applicable only in the most exceptional cases. 

With the completion of coitus, the voluntary and conscious action 
of the two parties to the act is at an end ; the subsequent stages of 
the function of generation are independent alike of consciousness 
and will. 

When complete intromission of the penis has been effected, and 
ejaculation takes place, the semen is usually deposited at the os 
uteri or in the immediate neighborhood of that orifice. During 
the act of ejaculation, a peristaltic contraction of the vagina occurs, 
by means of which the semen at the os uteri is subjected to a mod- 
erate degree of pressure ; the contraction and the pressure may 
perhaps persist for some little time after the completion of the 
coitus. In rabbits on heat, such contractions of the vagina, by 
means of which the semen was forced under pressure into the in- 
terior of the uterus, have been actually observed. 

During coitus, the uterine muscle is also active. During strong 



296 The Sexual Life of Woman. 

sexual excitement, the uterus descends in the pelvis, the downward 
movement being increased by the pressure on the woman's abdomen. 
The OS uteri externum is drawn open, and the aperture, hitherto 
flattened, now becomes rounded. At the same time, the secretion of 
the cervical glands is expelled, and small quantities of semen are 
sucked into the cervical canal. The plicae pahnatae offer a certain 
hindrance to the entrance of the semen; but the surface of the in- 
terior of the canal is rendered much smoother by the free secretion 
of mucus by the cervical glands. Further, it appears highly probable 
that during the excitement of coitus, the mouths of the Fallopian 
tubes, ordinarily more or less tightly closed, become widely opened, 
so that the entrance of the spermatozoa is favored. 

The muscular movements of the uterus were observed by /. Beck 
in a woman suffering from prolapse. During sexual excitement, the 
OS uteri opened and closed rapidly five or six times in succession, 
remaining at last firmly closed. Further, in bitches on heat, Basch 
and Hoifmann observed the vaginal portion of the cervix to descend 
in the vagina, the os uteri opened, mucus was extruded, and the 
OS was then retracted. 

Hohl, Litzmann, and others have reported, that in women en- 
dowed with great nervous susceptibility, friction of the vaginal 
portion of the cervix with the finger arouses sexual sensation, with 
rounding of the os uteri externum, descent of the uterus, and hard- 
ening of the vaginal portion ; this latter is regarded by Graily 
Hewitt and by Weniich as a necessary accompaniment of copula- 
tion. Henle believes that the hardening and protrusion of the vagi- 
nal portion of the cervix are due to a change in the tension of the 
delicate vessels of this structure, which have an exceptionally thick 
muscular coat ; Rouget compares the mechanism with that by which 
erection of the penis is produced. These authors consider that 
sexual excitement is indispensable for the erection of the vaginal 
portion of the cervix. 

Thus, Hohl writes : " Numerous observations have shown that in 
females endowed with a considerable degree of nervous suscep- 
tibility, and especially in nulliparae, during examination and during 
any increasing irritation, not only is there an increased secretion 
of the vaginal mucus, but also a momentary descent of the uterus 
and an opening of the os uteri externum, so that this orifice has 
the appearance for the instant of the open mouth of .a tube. Litz- 
mann reports that during the vaginal examination of a young, ex- 
tremely erethistic woman, the uterus suddenly assumed a more 
vertical position, and came lower down in the pelvis ; at the 
same time, the lips of the cervix became equal in length, the os 
uteri externum became rounded, soft, and penetrable by the finger; 



The Sexual Epoch of the Menacme. 297 

whilst the breathing- and the voice indicated the occurrence of in- 
tense sexual excitement. Ron get assumes that the body and the 
fundus of the uterus constitute an erectile organ, which however 
possesses capability for erection only during the period of ovulation ; 
Hewitt, on the other hand, considers it extremely probable that the 
erection may occur at any time during sexual intercourse, whether 
ovulation is proceeding or not. A. Wernich considers, basing his 
views in part on personal observations, that erection of the lower 
segment of the uterus occurs, like erection of the penis, whenever a 
moderate degree of sexual excitement is experienced ; in women, 
however, he believes that erection is seldom extreme, and that it 
declines with the other symptoms of sexual excitement, viz., flush- 
ing of the face, moisture and glistening of the eyes, peculiar groan- 
ing expiration, etc. Whereas during ovulation, erection is merely 
a necessary concomitant of the other menstrual processes ; during 
coitus, erection not only occurs much more powerfully, but it is 
also an important — perhaps the most important — contributory 
factor in effecting fertilization. 

It is no longer possible to accept the view of earlier physiologists 
that the purpose of this erection of the lower segment of the 
uterus is *' to constitute with the penis a continuous canal between 
the male and the female genital organs." Contact between the 
glans penis and the os uteri externum is not indeed an occurrence 
of extreme rarity ; but, on the other hand, it is in no sense a constant 
nor even a frequent incident of sexual intercourse. It is ejacula- 
tion, especially, which is subserved by the erection of the vaginal 
portion of the cervix. In the female, ejaculation occurs at the mo- 
ment of the most intense sexual pleasure, and is marked by the 
evacuation from the os uteri externum of a moderate quantity of 
mucous fluid with an alkaline reaction. In some cases, in which a 
chronic discharge of this cervical mucus occurs, it forms an 
elongated coagulum of delicate vitreous jelly, the "mucus-string" 
of Kristeller. The last-mentioned author is of opinion that the 
spermatozoa slowly, but by active movements, find their way along 
this string into the cavity of the uterus. This assumption, however, 
is met by C. Mayer and Marion Sims with the objection, that 
Kristeller's observations were for the most part carried out on 
women who were out of health, and that a gelatinous secretion of 
this character obstructs the orifice of the cervical canal, and hinders 
the occurrence of conception. From the erection of the portio 
vaginalis during sexual excitement, and its sudden relaxation post 
cohabitationem, Wernich deduces the occurrence of a process of 
aspiration, by which the semen is drawn up through the cervical 
canal into the cavity of the uterus ; a process which has been seen 



2g8 The Sexual Life of Woman. 

in actual occurrence in vivisected animals. It is said that to many 
women this feeling of a process of suction is so well known, that 
thereon, in association with the consequent almost complete ab- 
sence of mucus and seminal fluid from the vagina, they are accus- 
tomed to base a belief that conception will occur. It is said that 
this aspiratory activity on the part of the uterus may be perceived 
during coitus by the male also (?). It is assumed by Grohe that 
the wave motion of the cilia of the epithelium lining the cervical 
canal, is of importance in promoting the ascent of the spermatozoa ; 
it may be that the vibration of the cilia exercises a motile stimulus 
on the spermatozoa, it may be that the continually repeated stroke 
of the cilia serves to prevent the permanent agglutination of the 
spermatozoa into groups. 

According to Sims, the aspiratory action of the uterus is effected 
in the following manner: By the contraction of the constrictor 
vaginae superior muscle, the cervix is pressed downwards against 
the glans penis, and by this pressure its contents are evacuated ; the 
parts then relax, the uterus suddenly returns to its normal state, and 
thus the seminal fluid with which the vagina is filled is drawn into 
the interior of the cervical canal. 

Eichstadt also attributes to the uterus an aspiratory force, depend- 
ent upon coitus, and competent to force into the interior of the 
uterus the semen ejaculated into the os uteri. The changes in the 
uterus which are the necessary antecedents of this aspiration, 
namely, an engorgement with blood whereby the flattened form of 
the uterus gives place to a more rounded form, and the cavity of 
the organ is increased in capacity, take place, in the opinion of this 
author, only when during intercourse the woman has attained the 
acme of sexual gratification, by which alone can the aforesaid 
change in the uterus be brought about. E. Martin and Chrobak 
have also directed attention to the fact, that some importance in 
this connexion must be attached to the facultative enlargement in 
the size of the os uteri externum. 

Lott, by his researches into the behaviour of the cervix uteri in 
relation to the act of conception, is led to the conclusion that the 
locomotive capacity of the spermatozoa forms the principal factor 
in effecting a fertilizing contact between the spermatozoa and the 
ovum. This locomotive capacity may be increased or diminished 
by a number of conditions, among which the principal are: the 
activity of the cervix uteri (the ciliated epithelium) ; the character 
of the secretions ; and the position, shape, and size of the cervix. 



The Sexual Epoch of the Menacme. 299 

Thus, this author conckides, the part played in conception by the 
normal cervical canal is a purely passive one, with the sole exception 
of the activity of the ciliated epithelium — and the influence of this 
factor must be regarded as extremely doubtful. That during 
ejaculation the external orifice of the male uretha and the os uteri 
externum are in close apposition, is denied by Lott, who adduces in 
support of his views data derived from comparative investigations 
on various animals. In the dog, the configuration of .the genital 
organs is such that it is impossible to suppose that any apposition 
can occur ; the same is the case with the sheep ; and still more so 
with the rabbit, who possesses two quite distinct portiones vagi- 
nales, projecting freely into the vagina. In the human species also, 
the character of the walls of the cervical canal, where in the normal 
state the plicae palmatae may almost be said to interlock, separated 
only by a thin stratum of mucus, offers a hindrance to the entrance 
of the ejaculated semen by the direct force of ejaculation itself. 
As regards the independent motile powers of the spermatozoa, the 
researches of Lott showed that not only can they overcome strong 
capillary currents, and can traverse the width of a coverglass 
(i8mm. — about ^ in.) in about five minutes; but further that they 
are capable of migration through the finest interstices (those of an 
animal membrane) provided that the fluid with which the mem- 
brane is moistened is one favourable to their vital activity. 

Kehrer, who in general supports the view that the modus coeundi 
and an active attitude on the part of the female have an important 
influence on the occurrence of conception, assumes that independent 
contractions of the cervix occur, whereby is expelled the delicate 
plug of mucus that fills the cervical canal and offers an obstacle 
to the passage of the spermatozoa. He believes that the duration 
of the act of intercoi;irse, the mechanical relations between the penis 
a^d the vagina, the activity of the uterine muscle, the secretory 
activity of the utero-vaginal mucosa during the act, and the posture 
of the female post coitiim, are all important factors in the occur- 
rence of conception. Thus, he believes that if during intercourse 
there is a failure of the uterine contractions, which should expel 
the plug of cervical mucus, the semen flows away without effecting 
fertilization ; if an unsuitable posture is assumed during intercourse 
the woman remains sterile, but can be fertilized without difficulty 
by coitus effected in the proper manner. 

Haiismann has shown, that in the same woman, and in similar 
conditions, spermatozoa will on one occasion be found in the cer- 



300 The Sexual Life of Woman. 

vical canal, and on another occasion will not be found there; and 
he has further shown, that in some women we fail to find sperma- 
tozoa in the cervical canal in circumstances in which, in other 
women, we regularly find them in that situation. 

Far as we may be from a complete knowledge of the conditions 
upon which conception depends, this at least is certain, that the 
passage of spermatozoa through the os uteri externum is a sine 
qua non of fertilization. Indeed, it would seem that we must ac- 
cept as true the assumption of Meyerhofer, that fertilization is 
possible only if the semen passes at once into the cervical canal, 
mingles, that is, at once with the alkaline cervical mucus — unless, 
indeed, the coitus takes place during the catamenial flow, when 
the blood has neutralized the acid reaction in the vagina, or takes 
place when some morbid condition has had the same result. The 
theory of Joliann Miiller, regarding the piston-like action of the 
penis during coitus, by which the semen is actually forced through 
the cervix, must be rejected; equally unsound is Hoist's assumption 
that during intercourse the semen is ejaculated through the enlarged 
cervical canal directly into the cavity of the uterus. It would ap- 
pear, however, to be a necessary condition of fertilization, that the 
semen should be ejaculated into the uppermost segment of the 
vagina, so that the fluid comes into actual contact w^th the os uteri 
externum ; it may be that the alleged aspiratory force of the uterus 
then comes into play, by means of which the semen is sucked into 
the cavity of that organ ; it may be, on the other hand, that Beigel 
is right in his theory of the existence of a rcccptacidum scminis, 
formed by the anterior and posterior lips of the cervix uteri and 
the uppermost segment of the vagina — in this space, he supposes, 
a part of the semen is retained in contact with the orifice of the 
cervical canal. 

It is, also, exceedingly probable that during coitus a reflex ner- 
vous mechanism becomes active, by means of which the uterine 
orifices of the Fallopian tubes are opened, the vaginal portion of 
the cervix descends in the vagina, the os uteri externum enlarges, 
the orifice becoming rounded where before it was flattened, and 
finally small quantities of semen may be aspirated into the cavity of 
the uterus. 

I further regard it as important in promoting conception, that 
simultaneously with the changes above described, the reflex ner- 
vous stimulation should lead to the secretion by the cervical glands 
of a gelatinous material, alkaline in reaction, and therefore adapted 



The Sexual Epoch of the Menacme. 301 

to increase the locomotive powers of the spermatozoa, so that these 
latter, aided by the activit}^ of the ciliated epithelium lining- the 
cervical canal, will gain the interior of the cavity of the uterus, and 
thence pass onwards to the Fallopian tubes. The significance of the 
glands in the mucous membrane lining the cervical canal has hitherto 
been underestimated in this connexion. 

Whereas in the primitive state of mankind, among savage races 
at the present day, as among our own prehistoric ancestry, naked- 
ness is the rule, so also intercourse in these circumstances is ef- 
fected altogether without any regulation by law or custom, on the 
mere prompting of unbridled natural passion, and, moreover, there 
is the fullest promiscuity in sexual relations ; but civilization has led 
man to impose restraints upon sexual intercourse, and has intro- 
duced marriage as a sacred institution. Among certain primitive 
peoples, however, among whom the wives are common to all the 
men, transitory pairings nevertheless occur, especially when a 
woman becomes pregnant ; to cease, however, during the period of 
lactation. " This is the origin of marriage, which has evolved 
from rape and prostitution, as law has evolved from crime '' 
(Lombroso) . This author makes an interesting observation when 
describing the entire freedom of sexual intercourse that obtains 
among the Red Indians of North America, to the effect that " often, 
times of general promiscuity occur, as with rutting animals, gen- 
erally in the warm season of the year, when nutriment is abundant ; 
it is difficult to indicate any distinction between the tumultuous 
orgies of the baboon, and those of the Australian Blackfellows, 
among whom the sexes keep apart during the greater part of the 
year, to intermingle like rutting beasts during the season of the 
yam-harvest." 

The paths of civilization, from the complete promiscuity of sexual 
intercourse to the lofty ideal of life-long monogamic union, has not 
been a straightforward one, but has been marked by various aberra- 
tions of sexual relationship; hetairism, prostitution, polyandry, in- 
cest, rape, the jus primae noctis, etc. The anthropologist is able 
to trace the successive stages of the development of the institution 
of monogamic marriage ; the community of wives within the clan ; 
free sale of wives and daughters ; bestowal of a man's wife or con- 
cubine for the honour of a guest ; ritual prostitution for the honour 
of the gods and at numerous religious festivals ; aesthetic and lite- 
rary hetairism, with bestowal of favours according to free inclina- 
tion ; community of wives among all males of the same family ; the 



302 The Sexual Life of Woman. 

claim of the wife to as many as five or six husbands; the right of 
brothers to their sisters; the defloration of virgins by the priests in 
heathen temples; the temporary possession of the wife by the chief 
of the community, prior to her possession by her permanent hus- 
band ; defloration of the bride by the bonze before her marriage; 
the feudal right of the mediaeval seigneur to the prima nox of the 
bride of his retainer. 

In the lower stages of civilization, copulation appears so natural 
an action that it is performed in public entirely without shame. 
Thus, Cook, in his first voyage, describes having seen an indigen 
engage in sexual intercourse with a girl of eleven years, under the 
very eyes of the queen, with whom Cook was then having audience ; 
the sexual act was, according to Cook, the favourite topic of con- 
versation between the sexes. Herodotus reports that many peoples 
of antiquity had no regard for privacy in sexual intercourse, but 
that, like the lower animals, they had connexion in any company. 
In the Bible, also, it is recorded that sexual intercourse was prac- 
tised in public : '' So they spread Absalom a tent upon the top of 
the house ; and Absalom went in unto his father's concubines in the 
sight of all Israel." (II. Samuel, XVI. 22.) According to 
Athenacns, the Etruscans, at their public banquets, were eqiially un- 
restrained. Plutarch reports that among the Spartans the maidens 
and the young men went about naked together. Even, indeed, after 
the sense of modesty had begun to develop, it was long before any 
secret was made about the act of intercourse. In classical antiquity, 
it was very frequently the subject of pictorial and plastic representa- 
tion. Even in more recent days, there have been artists who have not 
hesitated to depict the sexual act : thus we have the Venus with a 
Faun by Caracci; the Jupiter and lo of Correggio; the Leda and the 
Swan of Tintoretto; and similar pictures by Luca. Giordano, Rubens, 
Titian, and Franceschini. 

Even in the early centuries of the Christian era, the sect of the 
Adamites practised intercourse openly in the Hght of day, on the 
ground that that which was right in the dark, could not be wrong 
in the light. The same is reported of the sect of Turlupins, in 
France in the fourteenth century. We cannot refrain from quoting 
at length from Lombroso and Ferrero a passage relating to the 
evolution of sexual manners in the female sex (Woman as Criminal 
and Prostitute) : " In the lowest stages of development, the feel- 
ing of modesty is entirely wanting; limitless freedom in sexual 
intercourse is the general rule; and even where no system of 



The Sexual Epoch of the Menacme. 303 

promiscuity prevails, marriage rather fosters than discourages pros- 
titution, especially in countries in which husbands are accustomed 
to expose their wives for sale. This fact may be brought into rela- 
tion with the well known lasciviousness of apes and other animals 
high in the scale, showing that sexual excitability increases pari 
passu with intelligence, so that to man it is as impossible as to an 
ape to satisfy his sexual needs with a single female. Whilst among 
the apes, a single male possesses a number of wives, we find in the 
gregarious life of primitive man that community of wives has taken 
the place of polygamy, which institution, however, reappears in a 
higher stage of culture for the benefit of the more powerful mascu- 
line natures. 

. " To the dominion of prostitution as a normal institution succeeds 
the period in which it persists as a variously metamorphosed sur- 
vival : it may be as the duty of the wife to surrender her person to 
any other male of the same family ; or the woman may have to 
bestow her favors on a religious or political chief, as in the institu- 
tion of temple-prostitution, where the wife must give herself, it may 
be to any one and at any time, or it may be to defined persons only 
and at stated festivals. Frequently we meet with another develop- 
ment of prostitution, finding that while the wife must remain chaste, 
the unmarried woman is allowed unrestricted intercourse ; or, again, 
the wife at certain definite periods may dispense with fidelity to her 
husband, and return to the primitive condition of promiscuity. In 
certain instances prostitution is combined with the duties of hos- 
pitality, and marriage, though approximating to the monogamic 
ideal, must tolerate the intrusion of the guest into the marriage 
bed." 

" In a third period, prostitution no longer fills the place of a 
traditional survival, but is a m-orbid manifestation confined to a cer- 
tain class of the community. But bridging this transition of pros- 
titution from a normal to a morbid manifestation, we have the 
remarkable phenomenon of aesthetic prostitution. Thus, in India 
and in Japan, an agreeable class of prostitutes practices the arts of 
singing and dancing, and forms a privileged caste ; similarly, in th'e 
most flourishing period of Grecian culture, the leading men of the 
time formed a social circle around the hetairae, from whom they 
derived a fruitful stimulus to intellectual and political activity. In 
this respect, history repeated itself in Italy in the sixteenth century. 
Alike in classical Greece and in mediaeval Italy, this aesthetic pros- 
titution fanned the flames of a period of intense spiritual activity — 



304 The Sexual Life of Woman. 

for in individuals as in races, intellectual quickening is ever accom- 
panied by erotic excitability." 

The unbridled passion of the primitive races of mankind, the 
coercive love of beauty felt by the ancient Greeks, the swelling flood 
of erotism of the great mass of people of all times, is gradually 
guided into the quiet channel of the marriage bed ; and even though 
monogamic marriage is incapable of fully providing for all mani- 
festations of sexual passion, still, from the medical point of view, 
we must maintain that marriage is for women the most hygienic 
and the most proper means of gratification of the sexual impulse. 

Conception. 

The union between ovum and spermatozoon, whereby fertilization 
is effected, appears to occur in the human species as a rule in the 
outer third of the Fallopian tube, the ampulla of this structure 
(receptaculum seminis in Henles terminology) serving to store the 
semen for a considerable period ; in the lower animals, the usual 
occurrence of fertilization in this region has been established by 
direct observation. The open mouth of the tube receives the ma- 
ture ovum, guided thither from the ovary by appropriate movements 
of the ovarian fimbriae; these movements have been seen in active 
occurrence in the guinea pig by Hensen. Once within the tube, the 
onward movement of the ovum is effected by the cilia of the epithe- 
lium lining of the canal. 

His has formulated the theory that in the human species fertiliza- 
tion is possible only in the uppermost segment of the tube; an as- 
sumption that is probable enough, but cannot be regarded as 
definitely established. An analogy certainly exists among the lower 
divisions of the animal kingdom, for Coste, His, and Ohlschldger 
have proved that an ovum which passes through the Fallopian tube 
without being fertilized, undergoes notable alterations. Further, 
Caste has shown, in the case of the ovum of the domestic fowl, that 
this is no longer capable of being fertilized after it has passed 
through the upper segment of the oviduct. Other authorities, how- 
ever, namely Ldzventhal, Mayrhofer, and Wyder, oppose the exten- 
sion of this rule to the human species. Lbwenthal assumes that in 
the human female, fertilization ordinarily occurs in the cavity of 
the uterus, in the wall of which the unfertilized ovum has already 
embedded itself; and he supports his contention by the statement 
that spermatozoa are not to be found in the Fallopian tubes or on 
the surface of the ovaries. Mayrhofer and Wyder point out that 



The Sexual Epoch of the Menacme. 305 

the movement of the ciHa of the cihated epithehum is in the interior 
of the uterus in an upward direction, but in the Fallopian tubes is 
downwards in the direction of the uterus. 

The contention of L'diventhal was disproved by Birch and Hirsch- 
fcld, who, in a prostitute dying during the act of intercourse, found, 
fifteen hours after death, living spermatozoa in the Fallopian tubes. 
On the other hand, more recent investigations, those, for instance, 
of Hofmeicr, Mandl, and Bonn, have confirmed the data given 
above with regard to the direction of the ciliary movement in the 
interior of the genital passages. Moreover, O. Becker has shown 
that the ciliated epithelium of the tubes extends over the fimbriae 
and even on to the adjoining pavement epithelium of the peri- 
toneum; and he believes that the ciliary movement of this region 
keeps up a constant current, the purpose of which is to sweep the 
ovum into the ostium of the tube, and thence down towards the 
uterus. Lode has adduced positive experimental evidence of the 
occurrence of such a movement of translation. 

The general result of anatomical investigation is, that the con- 
jugation of the ovum with the spermatozoon takes places in the am- 
pulla of the Fallopian tube ; but it is established that fertilization 
may also take place lower down in the tubes, or in the uterine cavity, 
or even on the surface of the ovary, i. e., in the abdominal cavity. 

The fertilization of the mature ovum — maturation having oc- 
curred within the ovarian follicle before its rupture — has been 
shown by numerous researches on the ova of other animals to con- 
sist in the fusion of the male and the female nuclear substance ; and 
it appears that of the enormous number of spermatozoa, estimated 
by Lode at 226 million at a single ejaculation, that enter the female 
genital passage, but a single one penetrates the ovum. Towards 
the head of this spermatozoon there extends from the surface of 
the ovum a process, fiat at first, but becoming more and more 
prominent, until it surrounds the head, and fuses with it. The 
motile tail of the spermatozoon disappears, whilst the head, which 
has now passed through the vitelline membrane and entered the 
ovum, assumes the appearance of a nucleus, and is called the male 
pro-nucleus. The original nucleus of the ovum has previously pre- 
pared itself for fertilization by the extrusion through the vitelline 
membrane of portions of its substance (known as polar globules), 
and now constitutes the female pro-nucleus. Towards this latter, 
situated somewhere near the centre of the cell, the male pro-nucleus 
continues to move, the vitelline granules meanwhile being disposed 
20 



3o6 



The Sexual Life of Woman. 



round about it in radiating lines, forming a star-shaped figure. 
Having come into contact, the two pro-nuclei fuse completely to 
term a new nucleus, the nucleus of the now fertilized egg-cell. 
The result of fertilization is the formation of the first segmentation- 





FiG. 55 A.— First Stage. Fig. 55B.— Second Stage, 

Entrance of a spermatozoon into the ovum of ascaris mezalocephala. 

After preparations by M. Nusbaum. (Half of the ova only are depicted.) 

Sphere, from which, by further subdivision, the new individual is 
formed. Thus is eiTected that which Hippocrates describes in the 
words: '' The seed possessed both by man and by woman, flow to- 
gether from all parts of the body ; the fruit is formed by the min- 
gling of the two seeds." 

The most favourable period for the occurrence of fertilization 
appears to be when intercourse takes places from eight to ten days 








Fig 56.— Ovum of Asterakanthion Fig. 57.— Fusion of male pro-nu- 
ten minutes after fertilization. cleus and female pro-nucleus to form 

the segmentation nucleus of the fer- 
tilized ovum. 



after the termination of the menstrual flow. In 248 instances in 
which the date of the fruitful coitus was exactly known, it was 
ascertained by Hasler that in 82 >4 per cent, of all cases, conception 
was effected in the fourteen days succeeding the menstrual period. 
In general it may be stated that the theory of the periodicity of 
ovulation and of the causal relation of this process to menstruation, 
has not been shaken by the result of researches recently undertaken 



The Sexual Erocii of the Menacme. 



307 



by opponents of that theory; hence it appears that the fertiHzed 
ovum is the ovum of the last completed menstruation. 

Already in the writings of the old Indian physician Susruta, we 
find expression of the view that the period that immediately suc- 
ceeds the cessation of the menstrual flow is one most favourable to 
conception. " The time of generation," he says, *' is the twelfth 
night after the commencement of menstruation." In the Jewish 
Talmud, the day before the onset of menstruation, and the days im- 
mediately succeeding the cessation of the flow, are indicated as 
those most favourable to the occurrence of conception ; moreover, 
in the Talmud, notwithstanding the fact that intercourse during 
menstruation is prohibited on pain of death, and that coitus is not 





Fig. 58.— Passage of spermatozoon FiG, 59.— Ovum of scorpsena scrofa 
through the zona pellucida of the thirty-five minutes after fertihza- 
ovum of asterakanthion. tion. 



regarded as permissible until the lapse of twelve clear days after 
the cessation of the flow, nevertheless the assertion is made that 
intercourse during menstruation may lead to conception. 




Fig. 60. — Male pro-nucleus and female pro-nucleus in fertilized ovum 
of frog, prior to the formation of the segmentation nucleus. 

Hippocrates writes: Hac nempe post mcnstruam purgatioucm 
utcro concipat. Aristotle says: Plerasque post mcnsiim fliixum 
nonnullas vero duentihus adhuc menstruis. Galen writes: Hoc 
auteni conceptionis tcmpus est vel incipientibus vel cessantibus 
menstruis. 



3o8 The Sexual Life of Woman. 

Soraiiiis writes to a similar effect : Just as the soil is suitable only 
at certain seasons for the reception of the seed, so also in the 
human race intercourse does not always take place at a time suited 
for the reception of the semen. To be effective, coitus must occur 
at the proper time. . . . The act of intercourse that is to lead 
to conception may best occur, either just before or just after the 
menstrual flow, when, moreover, there is strong desire for the 
sexual embrace, and neither when the body is fasting, nor when it 
is full of drink and undigested food. The time before menstrua- 
tion is, however, unsuitable, for then the w^omb is heavy from the 
flow of blood, and two conflicting tendencies will come into opera- 
tion, one for the absorption of material and the other for its out- 
flow. During menstruation, again, conception is unlikely to occur, 
for then the semen is wetted and washed away by the flowing blood. 
The sole proper time is that immediately after the flow, when the 
womb has freed itself from its humours, and warmth and moisture 
stand in harmonious relationship. 

Among many of the castes of Hindustan, it is a religious ordinance 
that on the fourth day of menstruation a man shall have intercourse 
with his wife, " since this day is that on which conception is most 
likely to occur." Indian physicians advise, in order to bring about 
conception, " that coitus be effected always as soon as the menstrual 
flow has ceased, at the end of the day, and when the lotus has 
closed." In Japan, medical opinion is to the effect that a woman 
is capable of conceiving during the first ten days after menstrua- 
tion, but not later (PIoss and Bartels). 

The view that the first days of the inter-menstrual interval are 
those most favourable to the occurrence of conception, is further 
confirmed by the statistical data collected by Lowenfeld, Ahlfeld, 
Hecker, and Veit; and it appears that as the date of the next men- 
struation is approached, there is a continual decline in the frequency 
of conception; just before the flow, conception hardly ever occurs. 
Hcnsen, from the records of 248 conceptions in which the date of 
the fruitful intercourse was exactly known, draws the following con- 
clusions : 

1. The greatest number of conceptions follow coitus effected 
during the first days after the cessation of the menstrual flow. 

2. When coitus is effected during menstruation, the probability 
of conception increases day by day as the end of the flow is ap- 
proached; 

3. The number of conceptions following coitus effected shortly 
before menstruation is minimal 



The Sexual Epoch of the Menacme. 309 

4. However, there is no single day either of the menstrual flow 
or of the inter^nenstrual interval, on which the possibility of the 
occurrence of conception can be excluded. 

Fcokstitozv has drawn up from statistical data an ideal " concep- 
tion-curve," which teaches that conception most readily ensues upon 
coitus efifected soon after the end of the menstrual flow,, in the first 
week, that is to say, of the inter-menstrual interval ; moreover, the 
curve shows that the highest percentage of conceptions occurs on 
the very first day after the cessation of the flow, and that after 
this day the percentage of conceptions declines. The percentage 
frequency of conceptions from coitus effected on the last day of 
menstruation, and on the first, ninth, eleventh, and twenty-third 
days, respectively, of the inter-menstrual interval, is expressed by 
the ratio 48:62:13:9:1; and between the points given, the course 
of the curve is almost rectilinear. The probability of the occur- 
rence of conception on the twenty-third day of the interval (on 
which day the curve reaches its lowest point), is one-sixty-second 
of the maximum probability. 

The proper performance of coitus depends upon the potentia 
coeundi of the male ; the attainment of conception depends upon his 
potentia generandi. The potentia generandi demands from the man 
the functional competence of the testicles, the perviousness of the 
seminal passages (namely, of the vasa deferentia and the urethra), 
the secretion of a normal semen, and, finally, a proper formation of 
the penis, whereby during ejaculation the semen may be deposited 
in sufficient proximity to the os uteri externum. 

Normal semen is a w^hitish, semi-transparent fluid, of the con- 
sistency of thin cream. It contains aggregations of a nearly 
spherical shape, consisting of a vitreous, transparent, colourless or 
light yellow, gelatinous, elastic substance. Under the microscope 
this substance has a hyaline appearance, and exhibits in its interior 
innumerable clear spaces of varying size, which are apparently filled 
with a clear fluid. Not infrequently, these spaces are extremely nar- 
row and therewith greatly elongated and disposed in parallels, so 
that the whole substance thus obtains a striated appearance. When 
treated with water, this material becomes whitish and non-trans- 
parent, and assumes under the microscope a finely granular aspect. 
When allowed to stand without agitation for twenty-four hours, 
this substance dissolves and becomes so intimately mingled with the 
seminal fluid that it can no longer be clearly differentiated there- 
from. In all probability it is merely a secretory product of the 
seminal vesicles. 



310 The Sexual Life of Woman. 

The truly fluid portion of the semen contains the following 
morphological elements: 

1. Microscopic aggregations of hyaline substance, variously 
shaped. 

2. Very numerous granules, small and extremely pale, albuminous 
in their nature, and disappearing on treatment with acetic acid. 

3. A small number of rounded or oval cells, about the size of 
leucocytes, containing one, or sometimes two small round nuclei. 

4. Prostatic calculi. These are an inconstant constituent, but 
are very frequently met with after repeated coitus. According to 
some observers they are derived also from the bladder and urethra. 
They are distinguished by their yellowish colour, their irregular 
form (sometimes triangular, sometimes rounded or oval), and by 
their characteristic structure. They are composed of a substance 
arranged in concentric laminae, which in the centre has a granulated 
appearance ; they often exhibit one or more oval nuclei. 

5. Spermatozoa in countless numbers. 

In exceptional cases we find as additional morphological elements, 
especially in elderly people, scattered erythrocytes, cylinder-epithe- 
lium cells, and masses or granules of yellow pigment. 

The spermatozoa are about fifty micromillimetres in length. Two 
];arts may be distinguished in each, a head and a tail. The head, 
four or five micromillimetres in length, is flattened, and differs in 
apparent shape — though generally more or less pear-shaped — 
according as to whether it is seen sideways or on the flat. 

The tail, which is about forty-five micromillimetres in length, nar- 
rows from before backwards. The fine posterior extremity is said 
to contain the contractile element, so that it is upon this portion 
that the familiar movements of the spermatozoa depend (Fig. 61). 

The speramatozoa are made up of a substance very rich in 
sodium chloride, and strongly resistent to reagents and to putrefac- 
tion. In consequence of their richness in mineral constitutents, the 
ash, when they are calcined, retains their original form. 

The movements of the spermatozoa can be properly observed only 
in fresh, pure semen (Fig. 62). 

If freshly ejaculated semen is treated with water, the movements 
of the spermatozoa very shortly cease, and their tails become rolled 
up in a spiral form. 

If semen is left undisturbed for twenty-four hours or longer, the 
vitreous substance dissolves in the surrounding fluid, and this latter 
separates into two layers, an upper which is thinner, and a lower. 



The Sexual Epoch of the Menacme. 



3it 



which is thicker and non-transparent. In the former, the morpho- 
logical elements are found but sparingly, whilst in the latter, they 
are plentiful. In addition to the elements already described, we 
find often two varieties of crystals. One of these varieties, which 




Fig. 62. — Normal semen. 



Fig. 61. — a. b. c. Pros- 
tatic calculi from normal 
semen, d. Spermatozoa, e. 
Large and small cells, some 
containing granules, as mor- 
phological elements of se- 
men, f. Spermatozoon dis- 
torted by imbibition of 
water, g. Crystals. (After 
Bizzozero.) 



appears only when decomposition is far advanced, consists of am- 
monium magnesium phosphate. The other variety has a chemical 
composition not yet determined. These crystals belong to the mono- 
clinic system, forming prisms or pyramids, often with curved sur- 
faces ; they are colourless or light yellow ; they lie superimposed, 



312 The Sexual Life of Woman. 

often forming beautiful star-shaped figures. They are soluble in 
mineral and vegetable acids, and in ammonia, but are insoluble in 
alcohol, ether, and chloroform ; they are remarkably resistent to the 
solvent powers of cold water, but not so to those of boiling water. 
Shreiner has proved that these crystals consist of a phosphate of a 
base which is represented by the formula C2. H5. N. According to 
Fiirbringcr, these crystals are produced as a result of the action of 
the semen upon the prostatic secretion. 

The quantity of semen ejaculated during coitus is very variable, 
depending upon the age and size of the individual and the formation 
of his testicles, upon his individual sexual capacity, and upon the 
question whether antecedently there has been sexual excess on the 
one hand or long continued continence on the other. In general, 
the quantity of semen ejaculated at one time varies between 0.75 
and 6 c.c. (10 to 100 minims). 

If healthy, normal semen, with adequate fertilizing potency, is 
properly preserved from cold and light, we may, even after the 
lapse of twenty- four hours, find under the microscope spermatozoa 
still engaged in active movement. Ultzmann employs for the de- 
scription of a drop of fresh semen, the comparison that it is full of 
m.ovement, " like a stirred up ant-heap." Influenced by the whip- 
like lashings of "the tail, the spermatozoon moves steadily forwards, 
finding its way through the narrowest passages on the microscopic 
field without striking any of the cellular structures that may lie in 
its path. The longer the semen remains under observation, the less 
active are these movements of the spermatozoa, for after ejacula- 
tion they gradually die, exhibiting after death an extended, or at 
most a slightly curved tail ; those spermatozoa, on the other hand, 
that were dead before ejaculation, have the tail spirally twisted, 
rolled up, or acutely bent. In the case of spermatozoa which have 
been destroyed by the action of some other deleterious secretion, as 
by urine or by acid vaginal secretion, such a condition of the tail 
is very commonly seen. When the semen is treated with w^ater, the 
m.ovements of the spermatozoa soon cease, and the ends of their 
tails frequently roll up to form loops. By the addition, however, 
of concentrated solutions of neutral salts, of albumen, of urea, etc., 
it is possible to reanimate these motionless spermatozoa, so that 
they once more are seen to perform active movements. Moderately 
concentrated animal secretions of an alkaline reaction are favourable 
to the motor activity of the spermatozoa, whilst on the other hand 
dilute and acid secretions, such as urine, acid mucus (including the 



TiiK Sexual Epoch of the Menacme. 313 

acid vaginal mucus), and catarrhal secretions, even when alkahne 
in reaction, have a depressant influence on this activity. Caustic 
potash and caustic soda stimulate the movements of the sperma- 
tozoa. When they are cooled down to a temperature below 15° C. 
(59° F.), the movements cease entirely. Salts of the heavy metals, 
and mineral acids in solution, also bring their movements to a pause. 
Frequent repetition of coitus causes a diminution in the number and 
in the motor activity of the spermatozoa. 

Semen which contains no spermatozoa, or in which the sperma- 
tozoa are motionless, is absolutely devoid of fertilizing power ; in 
the case of such semen, it makes no difference whatever that the 
external genitals of the man generating it are strongly formed, that 
his testicles are of normal size, and that erection and ejaculation 
take place promptly. Of very little value, though not absolutely 
sterile, is semen containing very few living spermatozoa, or, among 
very numerous motionless spermatozoa, containing a few only that 
are engaged in active movement. Suspect, is semen which does 
not possess the normal light greyish white tint, but is brownish-red, 
brownish-yellow, yellow, or violet ; these variations in colour indi- 
cating an admixture with the semen of varying quantities of blood 
or pus, in consequence of disease of the urethra, the prostate, the 
seminal vesicles, or some other part of the uropoietic system ; such 
admixtures seriously impair the quality of the semen. An unfavour- 
able judgment must also be passed on semen which, at each suc- 
cessive ejaculation, is voided in very small quantities only ^ — from 
half a drachm to a drachm. When thus scanty, semen is often 
found to contain an exceptionally large proportion of dead sperma- 
tozoa. We may regard very favourably semen which is voided in 
quantities considerably in excess of the average ; sometimes, when 
there is a veritable polyspermia, there may be an ounce or upwards, 
m.ore than three times as much as normal — provided, of course, 
that this semen so richly voided is of a satisfactory quality, and 
contains an ample proportion of active spermatozoa. The most 
valuable characteristic in semen is exhibited when the spermatozoa 
it contains are not only very numerous and vigorously active, but 
when they are also very long-lived, when, that is to say, they retain 
the power of active movement sometimes for as long as three days. 
A decisive opinion as to the quality of a man's semen can be given 
only as the result of precise and repeated microscopic examinations, 
and the medical man must be most careful, when in his first exami- 
nation he has not been able to detect the presence of any living 



314 The Sexual Life of Woman. 

spermatozoa, to abstain from giving, on that account alone, an ad- 
verse decision — from pronouncing sentence of death on the man's 
reproductive potency. 

It has not hitherto been accurately determined how long sperma- 
tozoa can continue to live in the interior of the uterus, although the 
point is of great importance, not only in relation to conception, but 
also in regard to the theory of menstruation. Percy has published 
a case in which, eight and a half days after the last coitus, he saw 
living spematozoa emerge from the os uteri externum. Sims bases 
upon his own researches the decisive opinion that in the vaginal 
mucus, spermatozoa can never survive longer than twelve hours, 
but states that in the mucus of the cervical canal they can live much 
longer. If thirty-six to forty hours after coitus, we examine the 
cervical mucus under the microscope, we commonly find living and 
dead spermatozoa in about equal numbers. Many of the living ones 
will survive their removal from the cervix for as much as six hours 
longer. 

Of especial interest are the conditions which are liable to deprive 
a man of the power to produce fertilizing semen. In the first place 
must be mentioned congenital absence of both testicles — a con- 
dition which, in otherwise normally formed male individuals, is one 
of extreme rarity. Congenital absence of one testicle is less rare, 
and is usually accompanied by absence also of the epidydimis, vas 
deferens, and seminal vesicle of the same side. The potentia ges- 
tandi of a monorchid depends upon the proper development of his 
single testicle, and the functional capacity of this organ must be as- 
certained by a careful microscopic examination of his semen. Much 
more frequent than absence of the testicle, though still sufficiently 
rare, is the condition of cryptorchism, non-descent of one or both 
testicles, a state not necessarily associated with functional incapacity 
of the organ. Most commonly, however, an undescended testis is 
an imperfectly developed testis, and in the very great majority of 
cases the ejaculated fluid contains no spermatozoa. 

A further cause of the lack of potent semen is atrophy of the 
testicles with notable diminution in the size of the glands, and more 
or less complete disappearance of the seminiferous tubules and their 
cellular contents. This state is rarely congenital, being nearly al- 
ways acquired : in consequence of inflammatory conditions affecting 
the testicle proper or the epididymis (syphilitic inflammation, 
especially, is apt to lead to overgrowth of the interstitial connective 
tissue and to gradual destruction by pressure of the seminal tu- 



The Sexual Epoch of the Menacme. 



315 



bules)*; or in consequence of the pressure of a hernia, a varicocele, 
a hydrocele, or a tubercular, carcinomatous, or other new growth ; 
or in consequence of constitutional disorders, especially long-last- 
ing, severe, and exhausting diseases, such as diphtheria, diabetes, 
or chronic alcoholism ; in consequence of diseases affecting that 
portion of the central nervous system from which the nerves sup- 
plying the genital organs arise ; in consequence of degenerative 
changes resulting from sexual excesses ; or, finally, in consequence 
of senile changes, such as fatty changes in the cells of the semini- 
ferous tubules. Certain drugs also, digitalis, salicylic acid, mercury, 
iodide of potassium, arsenic, and morphine, have an unfavourable 
influence alike on the quality of the testicular secretion and on the 
potency of the individual. Von Gyurkovechky reports that in 
Bosnia a plant locally known as " neven " is employed among the 
peasantry for the temporary suppression of sexual potency, wives 
giving it to their husbands when the latter are about to leave them 
and go upon a journey, and sprinkling the leaves of the plant 
among the underclothing. 




Fig. 63 — Semen consisting chiefly of sperm-crystals, cylindrical spithclium 
and small granules exhibiting molecular movement — but containing no 
spermatozoa. 



By the name of azoospermia is denoted a condition whose exist- 
ence can be determined only by microscopic examination. 

* The author omits special reference to the metastatic orchitis that so 
frequently complicates epidemic parotitis (mumps) when that disease occurs 
after puberty.^ Though usually benign in character, the inflammation very 
often results in atrophy of the testicle. Fortunately, bilateral atrophy from 
this cause is very rare ; and even when it does occur, both testicles being 
extremely small, potentia cociindi and potentia gestandi may nevertheless 
remain. But^ when double atrophy from this cause takes place before 
puberty (happily an occurrence of the utmost rarity), sexual development is 
usually arrested^ the sufferer being in effect a eunuch. — Tr. 



3i6 The Sexual Life of Woman. 

The subject of this affection has normal potentia coeundi, the 
semen is ejaculated in quite normal fashion, and it is its constitu- 
tion only that is faulty. In appearance it is extremely fluid, and is 
somewhat cloudy; its sediment contains molecular detritus and 
spermatic crystals, but no spermatozoa (Fig. 63). If the medical 
m.an makes it his rule, in all cases in which he is consulted on ac- 
count of sterility, in deciding how far this sterility is dependent on 
the condition of the husband, not to confine himself solely to the 
customary questions, whether intercourse is regularly practised, 
whether before or after menstruation, etc. — but if in every case he 
makes a careful examination of the semen under the microscope, he 
will be astonished to learn the comparative frequency with which 
he will note the complete or nearly complete absence of sperma- 
tozoa. This condition of azoospermia may be permanent or 
transitory. 

To Kehrer belongs the credit of having pointed out that sterility 
is less often due to impotence or to aspermatism than to azoo- 
spermia — a condition often unsuspected by husband and wife, and 
one to be diagnosed by the physician only after repeated micro- 
scopic examinations of the semen. Fo'r this reason, indeed, its 
existence is often overlooked. Kehrer believes himself to be justi- 
fied in asserting that one-fourth of all cases of steriHty (if not 
indeed more) must be referred to conditions affecting the husband, 
and most often to azoospermia ; hence he concludes, that the hus- 
band must still more often be regarded as the one to blame for the 
occurrence of sterility, when the cases are borne in mind in which 
a man marries with an imperfectly healed gonorrhcea, and infects 
his wife, giving rise to a chronic tubo-uterine blenorrhoea, and ulti- 
mately to sealing up of the tubes and to sterility. 

Complete absence or marked scarcity of spermatozoa in the 
semen may occur also without any change in the testicle that can 
be detected by an external examination, as a consequence of con- 
tusions of the testicle, or of gonorrhoeal inflammation of the epididy- 
mis or vas deferens ; further as a sequel of severe general diseases, 
long-continued physical exertion, or great sexual excess. 

In some cases, a microscopical examination reveals, not azoo- 
spermia, but oligozoospermia, that is to say^ the number of living 
spermatozoa in the semen is remarkably small. Or, again, the 
anomaly may be of this character that the spermatozoa are smaller 
than normal, that they are motionless, and that their tails are broken 
off — such are the peculiarities, as a rule, of the semen of old men. 



The Sexual Epoch of the Menacme. 



317 



A less common condition than azoospermia, but one the patho- 
logical importance of which is equally great, is aspermatism, in 
which the man, neither during coitus, nor in any other form of 
sexual excitement, is able to ejaculate any semen. This condition 
may be congenital or acquired ; it may be permanent, or transitory 
(lasting a few weeks or months). In these cases we have to do 
with organic changes in the testicles, diseases of the prostate, 
gonorrhoeal processes, or nervous disturbances resulting in a loss 
of irritability in the reflex centre for ejaculation. Aspermatism in 
the narrower sense of the term, a condition, that is to say, in which 
there is total suspension of the activity of all the three glands which 
combine to secrete the composite fluid known as semen, namely, of 
the testicle, the prostate, and the seminal vesicles — is, according 
to Fiirhringer, probably non-existent. The pathological state un- 
derlying aspermatism would rather appear to be, not a failure to 
secrete semen, but a failure to ejaculate it. 

Last of all, we have to speak of conception without copulation, 
of artificial fertilization. In consequence of the mechanical hin- 
drances which in many cases prevent the entrance of the semen into 
the interior of the uterus, the idea has arisen to introduce the semen 
by means of instruments directly into the cervical canal, dispensing 
with the natural act of copulation. Experience long ago gained in 




Fig. 64 — Oligozoospermia. a. Living spermatozoa, b. Dead spermatozoa, 
c. Pus corpuscles, d. Erythrocyte, e. Seminal granules. 



artificial pisciculture, no doubt gave rise to this idea. Spallancani 
and Rossi by means of a syringe injected the semen of a dog into 
the vagina of a bitch, the procedure resulting in impregnation. 



3i8 The Sexual Life of Woman. 

Girault appears to have been the first,* in the year 1838, to intro- 
duce semen artifically into the human uterus, if we leave out of con- 
sideration the experiment of Leseurs, who introduced a tampon 
moistened with semen into the interior of the vagina. The proce- 
dure employed by Girault is thus described: The patient having 
been placed in the position usually employed for gynecological ex- 
amination, a canula resembling a male catheter with the eye in its 
point, and with a funnel-shaped enlargement at the opposite ex- 
tremity, is introduced into the uterus, this instrument having first 
been prepared by moistening its interior with mucilage and filling 
it with semen ; by insufflation, the semen is now expelled into the 
uterine cavity. It is stated that neither uterine colic nor any other 
dangerous symptom has ever been brought on by this procedure. 
The experiments were made at various periods between the year 
1838 and the year 1861 ; they were ten in number, and of these eight 
proved successful, two unsuccessful. In the ten cases, the total 
number of insufflations made was twenty-one — the minimum num- 
ber in any single case being one, the maximum five. In one case, 
the insufflation was effected immediately after the cessation of men- 
struation ; in the majority, from one to four days after the cessation 
of menstruation; in one case twelve days, in one case twenty-three 
days, after the cessation of the flow. Gauticr, instead of insuffla- 
tions, has employed injections of semen, using two injections in 
each case, one just before menstruation was expected, the other a 
day or two after the cessation of the flow. Marion Sims en- 
deavoured in twenty-seven cases to bring about conception by the 
injection of semen into the uterus; in one of these cases only was 
the desired result obtained. In this latter instance the patient was 
twenty-eight years of age, had been married for nine years, but had 
remained barren. Throughout her menstrual life, she had suffered 
more or less from dysmenorrhcea, often accompanied by severe con- 
stitutional disturbance, such as syncope, vomiting, and headache. 
Local examination disclosed the existence of retroversion of the 
uterus with hypertrophy of the posterior wall, an indurated, conical 
cervix, with 'stricture of the cervical canal, especially in the region 
of the OS uteri internum. In addition to all these mechanical ob- 
stacles to conception, it was found that the semen was never retained 
in the vagina after coitus. Sims examined the patient immediately 

* It is recorded of John Hunter that in a case of hypospadias, he advised 
the patient to draw his semen into a syringe and inject it into his wife's 
vagina, with fruitful result. Tr. 



The Sexual Erocii of the Menacme. . 319 

after coitus had taken place, but never found a single drop of semen 
in the vagina, notwithstanding the fact that this fluid had been 
ejaculated in abundance. Sim's first care was to bring about reposi- 
tion of the uterus, and to keep the organ in its proper place by the 
insertion of a suitable pessary. Injections of semen were then un- 
dertaken, and were continued throughout a period of nearly twelve 
months. In two instances, the injection was effected immediately 
before the onset of the menstrual flow; in eight instances it was 
effected at varying times (two to seven days) after the cessation 
of the flow. At first, three drops of semen were injected, but later 
only half a drop. The semen (first ejaculated into the vagina dur- 
ing normal intercourse) was injected by means of a glass syringe, 
which was kept in a vessel of warm water at a temperature of 98° F. 
Since during the removal of the instrument from the water and its in- 
sertion into the vagina, some fall in temperature necessarily occurred 
in the vagina, Sims allowed the syringe to remain for some minutes 
in the vagina before he drew the semen into it, in order that he might 
feel assured that syringe and vagina had regained the tempera- 
ture most adapted to the vital activity of the spermatozoa. The 
nozzle of the syringe was then carefully introduced into the cervical 
canal, and half a drop of semen was slowly injected into the uterine 
cavity. For two or three hours after the operation, the patient re- 
mained lying quiet in bed. After the tenth experiment, conception 
ensued — the first recorded case of artificial fertilization in the 
human species. 

With right, however, this case of Sinis was not regarded as con- 
clusive, since both before and after the injection, ordinary coitus 
had been effected, and it is therefore impossible to determine 
whether the fertilizing spennatozoon was one of those introduced 
by means of the syringe, or in the antecedent or subsequent coitus — 
more especially in view of the fact that by the insertion of a pessary 
Sims had, previously to undertaking the injections, restored the 
uterus to a position more suited to the occurrence of conception in 
the natural manner. 

In a case which a priori seemed exceedingly well adapted for 
the performance of artificial fertilization, one of marked hypospadias 
in a man whose semen was abundant and contained a large number 
of vigorously moving spermatozoa, *I saw this experiment fail, in 
spite of all possible care in its performance. In fact, not a single 
conclusive instance of successful artificial fertilization in the human 
species is known to me, though I have seen reports of numerous 



320 The Sexual Life of Woman. 

disagreeable and even dangerous results of attempts to effect it. 
Both parametritis and perimetritis have occurred in such cases ; and 
semen, being a material in a state of most intense molecular move- 
ment, may be regarded as extremely liable to noxious transfor- 
mations. 

Sim's procedure has been modified by other gynecologists. Thus, 
Coiirtys plan was that during coitus the semen should be collected 
in a condom, fitting not too closely, from which receptacle it wa.^ 
drawn up into a syringe and carefully injected into the cervical 
canal. Pa jot's plan was that the semen should be ejaculated into 
the vagina in natural coitus, and should thence be pressed into the 
uterine cavity by means of a piston-like instrument introduced into 
the vagina. 

In London, Harlcy frequently made the experiment of injecting 
semen into the uterine cavity, but in all cases without any result. 

P. Midler, in two cases, on account of extreme anteflexion of the 
uterus, performed this experiment. Though the general conditions 
were in both cases extremely favourable, in neither instance was 
there any result. It must, however, be mentioned that in one of 
his cases only had there been any preliminary examination of the 
semen under the microscope. 

Fritsch reports a case in which gonorrhoeal secretion w^as injected 
in place of semen. Peritonitis, which for a month endangered life, 
was the result. 

In Paris, Lutaud has earnestly advocated artificial impregnation 
in cases of sterility in which all other means have failed. It is 
obvious that it would be useless to employ this measure after the 
menopause, or in women in whom menstrual activity has ceased 
prematurely, with simultaneous disappearance of all menstrual 
molimina. Equally useless would it be in uterine atrophy and in 
cases of irremediable malformation of the female genitals. Further 
contra-indications, according to Lutaud, are offered by chronic pelvic 
peritonitis, since here, on account of the obliteration of the lumen 
of the Fallopian tubes, the operation is foredoomed to failure. 
Chronic inflammatory states of the uterus and its mucous mem- 
brane, will also render the attempt useless. Moreover, it is a con- 
dition indispensable to success that the semen to be employed shall 
have been examined microscopically, and shall have been found to 
be thoroughly healthy. The operation has the greatest prospect of 
success when undertaken from three to two days before the due 
date of menstruation. The method employed is that of Sims. If 



The Sexual Epoch of the Mekacme. 321 

after the first attempt, the due menstruation should begin, the in- 
jection should be repeated a week after the flow has ceased ; the 
attempt should not, however, be repeated more than about six times 
in all, since the probability of success rapidly diminishes with each 
successive endeavour. Before the operation is undertaken, the per- 
meability of the cervical canal must be ascertained. Further, in 
order that the spermatozoa shall be placed in conditions in which 
they have the best possible chance of survival, a weak alkaline solu- 
tion, such as I per cent, of potassium bicarbonate, should as a pre- 
liminary measure be injected into the vagina. 

Ltitaiid thus describes the procedure he employs. Immediately 
after the woman has had intercourse with her husband, a Fergus- 
son's speculum is introduced into the vagina, the patient remaining 
in the dorsal decubitus. As the speculum passes in, its margin 
scrapes the surface of the vagina, and by this means the semen is 
collected in the vicinity of the cervix. The semen is then drawn 
up into a Pravaz syringe or an analogous instrument, such as a 
uterine catheter armed at one end with a rubber ball. The fluid is 
then carefully injected into the cervical canal, or preferably into 
the uterine cavity, great care being taken not to injure the mucous 
membrane in any wa3f, since the slightest bleeding may nullify the 
whole procedure. Finally, a small tampon of absorbent cotton-wool 
is inserted into the os uteri externum. For some hours the woman 
must remain quiet in bed ; the tampon is not removed for ten hours. 
As regards results, Ltttaud informs us that he has in this way treated 
twenty-six cases. In twenty-two of these, failure was complete; in 
one case, success was partial — -the patient was impregnated, but 
abortion occurred two weeks later ; in another case, abortion oc- 
curred after three months pregnancy ; finally, in two cases, success 
was complete. 

Indications for the employment of artificial impregnation are: 
first, the existence of stenosis in the upper part of the cervical canal, 
especially stenosis in the upper part of the cervical canal, especially 
stenosis from flexion, provided, of course, that other measures are 
contra-indicated or have been fruitlessly employed ; secondly, a dele- 
terious character of the secretion of the cervical canal ; thirdly, ex- 
treme cases of hypospadias in the male. Haussmann recommends 
the employment of artificial impregnation in cases in which the 
spermatozoa are found to enter the cervical canal, but fail to pass 
through the os uteri internum. Whilst artificial impregnation is 
theoretically a sound measure, yet in the practice the indications for 

21 



^22 The Sexual Life of Woman. 

its performance are by no means easy to establish. For, in cases 
in which there is some mechanical hindrance to the contact of the 
spermatozoon with the ovum (and it is for such cases only that this 
method of artificial fertilization can properly be employed), it is 
often extremely difficult, and may even be quite impossible, to ex- 
clude the possibility of there being. some failure in ovulation itself,, 
or in the maturation of the ova; or, again, sterility may depend, 
not on the fact that no ova are fertilized, but on the fact that when 
fertilized they always fail, for some reason, to find a resting place 
in the uterus; in a word, in any case in which sterility appears to 
be due to mechanical obstacles to conception, it may in reality be 
due to some other disease which has escaped recognition, some 
organic disease of the uterus, the tubes, the ovaries, of the peri- 
ivterine tissues. 

Finally, it must be remembered that the manipulation is far from 
easy in its performance. Above all, the semen must be subjected to 
a most rigorous microscopical examination in respect of its fertiliz- 
ing capacity. But this examination cannot be made in the case of 
the semen that is actually used for the attempt at artificial fertiliza- 
tion ; it can only be done with an earlier specimen from the same 
man. If the semen contains no living spermatozoa, or very few 
only and these sluggish in their movements, still more if it con- 
tains pus corpuscles or gonococci, all idea of its employment for 
artificial fertilization must be rejected. 

The method employed by Sims, in which the semen is drawn into 
a syringe inserted into the vagina post coitum, is one which I am 
not able to recommend, since in this way together with the semen 
some vaginal mucus is drawn up, thus, instead of pure semen, we 
inject into the vagina semen mixed with various impurities, and 
more especially with an acid secretion known to be unfavourable 
to the life of the spermatozoa — a circumstance that will doubtless 
explain many of the failures that have hitherto taken place. It is 
certainly better that the semen of the husband should be collected 
in a rubber condom. The preservation of the material to be in- 
jected at a suitable temperature (the normal body-temperature), is 
by no means easy. The syringe, an ordinary Braun's uterine 
syringe, is first disinfected, and then lies ready in water of the 
proper temperature. The semen is rapidly drawn up into the 
syringe, the nozzle of which is then passed down to the fundus 
uteri. Quite a small quantity of semen will suffice. After the 
manipulation, which should of course be undertaken at the time most 



The Sexual Epoch of the ]\1enacme. 323 

favourable to conception, just after menstruation, the woman should 
lie quiet in bed for some hours. 

In considering the probabihty of a successful issue to any such 
attempt to secure artificial fertilization, we cannot leave out of con- 
sideration the likelihood that that result may be prejudiced by the 
lack of all normal sexual feeling on the part of the wife ; concerning 
the significance of such feeling in relation to the sexual act, we have 
however as yet no certain knowledge. 

That this procedure of artificial fertilization is extremely dis- 
agreeable to all concerned therein, the physician not excepted, and 
that various moral and social considerations can be alleged against 
it, is incontestable. It is indeed recorded that in Bordeaux a legal 
penalty was inflicted on a medical man who undertook to bring 
about artificial fertilization. The Society of Medical Jurists debated 
this matter, and came to the conclusion that, whilst a medical man 
was not justified in recommending the practice, neither was he 
justified in refusing to undertake it when requested by his patients. 
In Paris, a candidate for the degree of Doctor of Medicine made 
artificial fecundation the subject of his thesis, and maintained that 
its practice, when effected with all proper social precautions and ac- 
cording to scientific principles, was possible, reasonable, useful, and 
moral, and that in many instances it should be recommended by the 
physician. After a long and stormy debate, the Faculty of Medi- 
cine determined to reject the thesis and to destroy all specimens of 
it already printed, on the ground that '' they feared, if they gave 
their sanction to the practice, that a number of more or less un- 
scrupulous physicians would make that sanction the basis of im- 
proper practices, dangerous alike to the family and to the state, 
since the operative method under consideration was one likely to 
be eagerly exploited by the whole tribe of medical charlatans." This 
weighty pronouncement would appear to be sufficient ground for re- 
jecting artificial fecundation as a matter of routine practice; still, 
very exceptional cases may be encountered in which it may be seized 
as an ultimum refugium. 

Pathology of Copulation. 

The act of copulation may be interfered with or entirely prevented 
by pathological conditions affecting the genital canal of the woman, 
and also by disturbances of the nervous system — naturally also by 
any abnormality affecting the performance of the male partner in 
the act. 



324 



The Sexual Life of Woman. 



Abnormality of the hymen, such as excessive strength and rigid- 
ity, rendering the organ unduly persistent, is a not infrequent hin- 
drance to intercourse, one that sometimes is not overcome even after 
years of married life; to such a state of affairs ignorance on the part 
of the married pair in respect to the proper method of intercourse, 
lack of sufficient sexual power on the part of the male, or inflam- 
mation of the fossa navicularis brought on by maladroit attempts 
at penetration, may contribute, likewise undue passivity on the part 
of the female partner. 

A notable and sometimes an insuperable obstacle (of which it has 
been written, nee Hannibal quidem has portas perfringere valuisset) 
is constituted by that abnormality of the hymen in which the aper- 
ture in that membrane is guarded by a sagittally placed or sometimes 
oblique septum, dense and almost tendinous in structure. In a 
woman of twenty-four years, who for two years had lived in sterile 
wedlock, I found such a tendinous hymen septum. She had men- 
struated regularly since the age of seventeen years, but always pain- 
fully. She complained that her husband was " very weak," inas- 
much as on her bridal night he was unable to succeed in completing 
intercourse, and since then whenever he attempted intercourse, 
premature ejaculation resulted, before penetration of the penis 



\ 




Fig. 65.— Septate Hymen, the septum having a tendinous consistency. 

had been effected. In consequence of this repeated inef- 
fectual sexual excitement, she had herself become very nervous. 
On local examination, I found an elongated oval hymen, not com- 



The Sexual Epoch of the Men acme. 325 

pletely covering the vaginal orifice, rather strong and thick, and 
divided in two halves by a median sagittal septum, of a densely 
tendinous consistency. On either side of the septum, the vaginal 
orifice would admit no more than the head of an ordinary uterme 
sound. I divided this septum, and was informed later that the 
woman had become pregnant as a result of the first subsequent act 
of intercourse (Fig. 65). 

A remarkable case of abnormality of the hymen is recorded by 
Heitzmanii, having been observed by him in a woman aged twenty- 
seven years. In this instance, the hymen was represented by a swell- 
ing, smooth on the surface and separated from the nymphse by a 
deep furrow. Behind this swelling, between it and the posterior 
commissure, there was a deep depression, into which the finger 
could be passed to a depth of an inch and a half or more. Anteriorly, 
the very firm and fleshy prominence was bounded by a ridge, from 
the middle of which to the urethral orifice ran a short but strong 
and tense septum. Right and left of this septum were small aper- 
tures, with difficulty admitting the point of a probe. Between the 
anterior extermity of the septum and the urethral orifice was a 
nodular representative of the swelling normally present in this situa- 
tion. Surrounding the urethral orifice were two or three additional 
small nodules. The two lateral margins of the hymen were pro- 
longed around the urethral orifice, and united in front thereof to 
form a raphe, which could be traced as far as the base of the clitoris. 
The young woman had been married for some months, and asserted 
that she had repeatedly had intercourse. With such a condition of 
the female genitals, penetration of the penis into the vagina was 
however quite impossible. During coitus, the penis must have been 
inserted into the aforesaid depression behind the swelling, which 
was sufficiently extensible for the purpose. 

A less serious hindrance to intercourse, but one more frequently 
encountered, is a partial persistence of the septum of the hymeneal 
orifice, in such a manner that there is a projecting tongue of mem- 
brane from the anterior and posterior margins of the orifice, 
partially blocking this latter; or there may be a single median pro- 
jection only, either in front or behind. Such processes may be re- 
markable alike for their size and their shape. Liman describes a 
cordiform hymeneal orifice, constituted by an anterior or posterior 
protection of the kind here described. 

In cases of imperforate hymen in which the occlusion of the 
vagina is not complete, impregnation may in rare instances occur, 



3^6 



The Sexual Life of Woman.^ 



even though proper intromission of the penis is quite impossible. 
Cases of this kind have been observed by Scanzoni, Norton, K, 
Brann, Leopold, Brille, Breisky, and others. 




Fig. 66. 

In most of these cases there v^as a thick, dense, " imperforate/* 
or rather persistent hymen, with an orifice no larger than the head 
of an ordinary probe, notwithstanding which pregnancy had oc- 
curred. The cases reported by Brill were of a different character, 
being those of two young unmarried Russian girls, with normal 
undestroyed hymens, who were found to be pregnant. According 
to Brill, such cases are by no means uncommon among the peasantry 
of Little Russia, where the barbarous practice prevails of adolescent 
girls and boys sleeping together. In these circumstances_, sexual in- 
tercourse takes place, but, from fear of consequences, it is often 
incomplete. Hence, in occasiotial cases, results pregnancy in a 
young girl with intact hymen. 

In the first complete act of intercourse, the defloration of the 
virgin, the hymen is as a rule torn in several directions, and in 
consequence there is usually moderate bleeding. The lacerations of 



The Sexual Epoch of the Menacme. 327 

the hymen soon skin OA^er. When the initial coitus is effected mala- 
droitly or roughly, more extensive lacerations are apt to occur, and 
the injury may not he limited to the hymen, hut may extend longi- 
tudinally along the vaginal wall, and even involve the posterior 
vaginal fornix. Or, again, without any such extensive laceration, 
there may result very profuse bleeding, in consequence of abnor- 
mally profuse vascularization of the hymen. Cases are also re- 
corded in which (presumably not from normal coitus alone, but 
from other, unacknowledged manipulations), whilst the hymen has 
been left intact, false passages have been made, leading to the for- 
mation of fistulae, with subsequent death from haemorrhage or 
sepsis. 

Apart from impotence in the male, the hymen may remain intact 
when it is not touched at all during coitus. Inexperience, as Veit 
remarks, will in this matter lead to results almost incredible. This 
author has been informed by such inexperienced married couples, 
that in attempts at intercourse " the penis of the man is introduced 
between the thighs of the woman, which are closely pressed to- 
gether, the man having his legs on either side. Naturally, in this 
method of intercourse, the hymen escapes destruction. In such at- 
tempts at coitus, things are done which can hardly be compared with 
the normal act of copulation." 

In isolated instances, the introduction of the penis is prevented by 
congenital or acquired defects in the formation of the external 
genitals. Adhesion between the labia majora and the labia minora 
i.s sometimes met with a congenital deformity, which may or may 
not be associated with atresia of the urethral orifice ; in some cases 
the adhesion is dependent merely upon a superficial epithelial con- 
tinuity, but in others the labia are firmly adherent throughout. 
Less rare are acquired adhesions, the result of accident, between 
the labia majora and the labia minora, leading to atresia of the 
vulva, and thus making copulation impossible. 

Intromission of the penis may be rendered quite impossible by 
excessive size of the labia majora, consequent upon elephantiasis, 
in which disease there is enormous hypertrophy of the subcutaneous 
connective tissue. New growths may have the same result, fibroids, 
for instance, lipomata, and cysts, which may attain a remarkable 
size in the cellular tissue of the labia, the mons veneris, and the 
perineum, and also in the nymphae and in the cellular tissue be- 
tween the clitoris and the urethral orifice. In a very obese woman 
twenty-eight years of age I saw a lipoma attached to the right 



S2S 



The Sexual Life of "Woman. . 



labium majiis. In the course of six years it had grown to such an 
enormous size, that it extended downwards over the thigh, blocked 
the entrance to the vagina, and made coitus absolutely impossible 




Fig. 67. — Lipoma of the right labium majus, occluding the vaginal inlet 



(Fig. 67). Various forms of labial hernia are also competent to 
occlude the vaginal orifice. 

Hypertrophy of the nymphae, which, as the so-called Hottentot 
Apron has to be regarded as a racial peculiarity, is known also in 
Europe as a pathological condition which may at times constitute a 
hindrance to sexual intercourse (Fig. 68). According to Otto there 
are three fundamental forms of the Hottentot apron, viz., excessive 
enlargement of the nymphae, overgrowth of the labia majora, and, 
lastly, the formation of a peculiar lobe of flesh and skin, attached 
to the mons veneris by a pedicle, containing the clitoris, and cover- 
ing the genital fissure as with a valve. Hypertrophy of the nymphae 
is said to be common also in Turkish and in Persian women. Ow- 
ing to the obstacle to intercourse presented by hypertrophied 
nymphae, it is among certain races an established custom to ampu- 
tate clitoris and nymphae together. Virey writes : " The Portuguese 
Jesuit missionaries to Abyssinia in the sixteenth century, en- 
deavoured to abolish this practice of the circumcision of women, 
which they regarded as a relic of Mohammedanism ; the uncircum- 
cised maidens, however, could find no husbands, owing to the in- 
convenient length of their nymphae. The pope sent surgeons 



The Sexual Epoch of the Menacme. 



329 



to the country, to enquire into the matter, and their reports were in 
such sense that circumcision was permitted as necessary." Davis 
reports observations made by Sonini on the female indigens of 






Fig. 68. — " Hottentot apron " in an adult woman, hanging down between 
the thighs. (After Zweifel.) 



lower Egypt, in whom the vulva hangs down in the form of a loose, 
flabby mass of flesh, of striking length and thickness, completely 
covering the genital fissure. He believes that the circumcision that 
was practised on the women of ancient Egypt consisted in the re- 
moval of this hypertrophied vulva. 

Courty saw a case in which the remarkable length of the labia 
minora, which when an attempt was made to introduce the penis, 
covered the vaginal orifice, had rendered coitus inefifective, and had 



330 



The Sexual Life of Woman. 



caused sterility for five years. Resection of the labia minora was 
followed by successful intercourse and conception. 

The lipomatous form, especially, of elephantiasis vulvae often 
attains a gigantic size. Growths of this nature, of the size of a 
child's head, weighing six or seven kilo (thirteen to fifteen pounds), 
and reaching down. to below the knee, are by no means rare. I 
have known several cases in which an excessive accumulation of 
fat in the vulva associated with pendulous belly has constituted a 
mechanical obstacle to the completion of sexual intercourse. 




Fig. 69. — Elephantiasis of the labia majora 



Hypertrophy of the clitoris may constitute an obstacle to coitus. 
In exceptional cases, this organ is as large as the male penis, and 
hangs down over the genital fissure like a valve. Hyrtl relates that 
in certain African races, this congenital enlargement of the clitoris 
is so enormous, that the organ, made fast to the perineum with 
rings, serves for the protection .of virginity. Schonfcld describes 
the case of a woman aged twenty-eight years, in whom the vaginal 
orifice was almost completely occluded by a dry and firm growth; 
with a granulated surface. Close observation proved this growth 
to be produced by a hypertrophied and degenerated clitoris, which 
had attained the size of a child's head. Elephantiasis of the clitoris 



The Sexual Epoch of the Menacme. 331 

is especially inconvenient in consequence of the hindrance which the 
enlarged organ offers to sexual intercourse. Dainhridge describes 
a case of tumour of the clitoris measuring 8 cm. {:i,.2 in.) in length 
and 5 cm. (2 in.) in width. The following remarkable case is re- 
corded by Oesterlen: A young man wished to break off his engage- 
ment on the ground that his intended wife was a hermaphrodite. 
Examination, however, disclosed the existence of a strong intact 
hymen, a very large clitoris, and pregnancy of the twentieth week. 

Injuries of the vagina resulting from coitus are, generally speak- 
ing, rare. The usual cause of such injuries is disproportion in size 
between the erect penis and the calibre of the vagina, or else brutal 
violence in the performance of coitus ; sometimes, however; it is de- 
pendent on the pathological state of the female genital organs, which 
have undergone senile atrophy. 

To the first group belongs the case reported by Albert, in which 
a girl of eleven years was found to have a laceration of the vagina 
communicating with the peritoneal cavity, the injury resulting from 
coitus. To the second group belongs the case reported by Bohni, 
of lacerations of the vaginal mucous membrane resulting from 
forcible coitus in elderly women. E. Frank reports a case of injury 
due to violent coitus in a woman in whom the vagina was already 
greatly stretched by retroflexion ; and another case in which injury 
occurred during intercourse in a woman with vagina duplex • — in 
this case, not only was the hymen of the right vagina torn, but also 
the septum between the two vaginae. 

By no means extremely rare are injuries to the vagina in the 
act of defloration, causing severe hemorrhage. Martin records a 
fatal case of this nature. Maschka and Hofmann, the authorities 
on Forensic Medicine, deny that vaginal laceration is the result of 
simple coitus, and Hofmann maintains that such serious injury can 
occur only from digital manipulations ; in fact, these writers believe 
that the penis alone cannot be employed with sufficient force to 
cause laceration. Barthel and Anderson, however, saw vaginal 
lacerations in nulliparous women ; and Zeis records a case of vaginal 
laceration in a woman twenty-five years of age, with whom, six 
weeks after parturition, her husband, then in a state of intoxication, 
had had intercourse in the position a la vache. 

Anomalies of the vagina, absence, stricture, duplication, and ab- 
normal apertures, also diseases of the vaginal tissues, may induce 
incapacity for sexual intercourse. In frequency as in significance, 
among these disorders, absence of the vagina and stenosis and atresia 



332 The Sexual Life of Woman. 

of the canal, stand in the first rank. Congenital atresia may be 
complete or only partial, according as the two ducts of Mitller from 
the fusion of which the tube is formed, remain totally or only par- 
tially solid — or, having duly canalized, subsequently, by a foetal 
inflammatory process, become transformed into a thick, more or less 
solid cord. If the obliteration of the vagina is at the lower extrem- 
ity of the canal, coitus is impossible, unless, as sometimes happens, 
by frequent attempts at intercourse, the short blind sac representing 
the lower end of the vagina has been stretched upwards in the form 
of a pouch. When the obliteration of the ducts of Midler is complete, 
we have total atresia of the vagina, in which case the uterus is also 
as a rule wanting, or is but imperfectly represented. In some cases, 
from the ducts of Milllcr, instead of the normal vagina, there is 
formed a tract of membrane of varying density and w^idth, through 
which passes a small canal for the passage of the menstrual dis- 
charge ; this condition is known as atresia vaginalis membranacea. 

When, notwithstanding malformation of the external genital 
organs and partial absence of the vagina, there is no defect in the 
internal genital organs, conceptions may sometimes be effected 
through some abnormal channel, as for instance through a communi- 
cation established per anum ; or, again, some operative procedure 
may bring relief. Rossi reports a case of congenital absence of the 
external genital organs, in wdiich an incision was made in the region 
of the absent vagina, and an artificial vagina was thus constructed ; 
copulation was in this way rendered possible, and conception ensued. 
In this connection, we may turn with interest to the essay by Louis, 
entitled Deficiente Vagina, Possuntne per Rectum Concipere Mii- 
lieres? Here we are told of a case in which vulva and vagina were 
absent, and there was a monthly discharge of blood per anum ; the 
woman's lover employed this passage also ad immissioncm penis, 
and the woman became pregnant. Pope Benedict XIV expressly 
allowed to women suffering from imperforatio vaginae the practice 
of coitus parte posteriori. 

Further, in cases of atresia vaginae in which the genital canal 
terminates in the urethra, conception can result from urethral coitus, 
as is proved by cases recorded by K. von Braun, IVeinbaum, and 
Wyder. In Weinhaunis case, the obliteration of the vagina was 
complete, neither eye nor finger could detect the slightest aperture; 
the w^oman having become pregnant after coitus per nrethrani, de- 
livery was effected by Caesarian section. In Wyder s case, the vagi- 
nal orifice was closed, with the exception of a minute aperture, by 



The Sexual Epoch of the Menacme. 333 

means of dense fibrous tissue ; the woman was in labour and the 
head of the ehild was in the pelvis. Under anaesthesia, the septum, 
which was nearly an inch thick, was divided, the opening was en- 
larged, and the child was extracted by forceps. An investigation 
disclosed that the husband had always had intercourse by introduc- 
ing his penis into the dilated urethra ; it was evident that the semen 
had passed through the urethra into the bladder, and thence had 
found its way through a vesico-vaginal fistula into the vagina and 
uterus. 

Acquired obliteration and stricture of the vagina from the con- 
traction of scar tissue, in consequence of deep ulceration, especially 
when croupous or diphtheritic in nature, following typhus or ty- 
phoid, pyaemia, puerperal sepsis, and the acute exanthemata 
(especially variola) — may likewise serve as obstacles to coitus. 
Syphilitic affections also, through contraction of exudations, the ad- 
hesion of ulcerated opposing surfaces, condylomata, etc., may give 
rise to stricture or obhteration of the vagina. The same conditions 
may be induced by trauma, as by wounds, by attempts at rape, or 
by the use of caustic acids and alkalis. 

Thus, Ah! f eld saw severe stricture of the vagina as a sequel of 
the excision of four large condylomata. Hennig the same, after 
variola, and again in lunatics who had introduced caustic fluids into 
the vagina. By L. Mayer, atresia vaginae was seen as a sequel 
of typhoid; by Weiss as a sequel of diphtheria; by Martin from 
the action of irritant secretions in cases of uterine tumour; by 
Billroth as a result of continued irrigation of the vagina with alka- 
line urine after lithotomy or urethrotomy, and in cases of vesico- 
vaginal fistula. Ulcerative processes set up by the long continued 
action of a vaginal tampon, a pessary, or some other foreign body, 
have been noted as leading to consecutive obliteration of the vagina. 
• Such stenosis, when partial only, may prevent complete coitus, 
and yet allow conception to occur. Cases illustrating this fact have 
been numerously recorded. Thus, van Szi'ieten already reported the 
case of a girl aged sixteen years, wdiose vagina was strictured to 
such an extent that the passage would barely admit a crow-quill ; 
nevertheless she became pregnant, and was successfully delivered. 
Similar cases are mentioned by von Scan.-2oni, Kennedy, Devilliers, 
Varge, Moreau, and Plenk. 

Serious obstacles to coitus, of a nature analogous to acquired 
stenosis of the vagina, are constituted by the irregular ligamentous 
bridges which sometimes arise in the vagina from the adhesion of a 



334 



The Sexual Life of Womax. 



strip torn from the mucous membrane on one side of the vagina to 
the other side of that tube — or, again, a ponion of a lacerated 
cer\-ix may adhere to the wall of the vagina. An interesting case 
of this nature came under my own observation. It was a woman 
aged thirty-two years, who had twice had difficult deliveries, the 
last time nine years before. Since then she had been barren. On 
local examination I found in the vagina a fleshy bridge, about 4 cm. 
(1.6 in.) wide and 6 cm. (2.4 in.) long, extending from the left 
side of the portio vaginalis to the right wall of the vagina ; this 
mass of tissue was so placed that the intromitted penis must neces- 
sarilv have slipped past it into a blind sac, such as the French name 
ufie poche topulatrice. Similar membranes in the vagina have been 
described by Breisky, Murphy, and Thomson. 

\'arious tumours may narrow or even completely close the vaginal 
passage, myoma, sarcoma, carcinoma, and especially the polypoid 
form of fibro-myoma, which may even project without the vaginal 
orifice. And even when tumours of or in the vagina do not actually 
hinder coitus by the space they occupy, they may affect that opera- 
tion by bleeding whenever it is undenaken, a manifestation ex- 
tremely alarming to young married persons. 

The vagina may also be partially occupied, and coitus may be 
impeded, by elongation of the hypertrophied cer\'ix uteri, by inver- 
sion or prolapse of the uterus, by cyctocele or rectocele, and by 
uterine poh-pi. Hom^tz records the case of a woman aged twenty- 
two years in whom impotcutia coeiindi was dependent upon the 
occlusion of the vaginal orifice by a rounded, strongly projecting 
body, which proved on closer examination to be a hypertrophied 
vaginal bulb. 

Tumours of the rectum and other intra-pelvic growths may en- 
croach upon the vaginal passage and impede coitus. Closure of the 
vagina has been brought about even by abnormal size and abnormal 
toughness of the perineum. 

Finally, in extreme degrees of pelvic contraction, the vagina may 
be so much narrowed as to interfere with coitus. Von Hofmann 
records a case of this nature : In a woman thirty years of age, 
affected with kypho-scoliosis, who suffered extreme pain whenever 
her husband attempted sexual intercourse, the pelvis was twisted 
and narrowed to such an extent that the conjugate measured barely 
one inch, and the vagina was so small as barely to admit the finger. 

Duplication of the vagina will constitute an obstacle to coitus 
when both halves of the passage are too narrow to allow of intro- 



The Sexual Epoch of the Menacme. 335 

mission of the penis. Difficulty in intercourse will also be caused 
by abnormal termination of the vagina, as by its termination in the 
rectum, likewise by severe perineal laceration which has converted 
the lower parts of the vagina and rectum into a cloaca, likewise by 
recto-vaginal and vesico-vaginal fistulae ; in the case of all these 
latter states a feeling of disgust is apt to be aroused in the male 
which may effectually check sexual desire. Still, coitus, and even 
conception, are quite possible in these conditions. Kroner, among 
sixty cases of vaginal fistula, observed six in which conception took 
place while the fistula was actually open. 

Apart from all local pathological conditions, coitus may be inter- 
fered with by general nervous disturbances, manifesting themselves 
locally, and depriving the woman so affected of potentia coeundi. 
First among such states must be mentioned vaginismus, a condition 
so important as to demand discussion in a separate chapter. 

An important and by no means rare obstacle to the completion 
of intercourse, affecting the male partner in the act, is partial or com- 
plete incapacity for erection of the penis. Even excessive smallness 
of the penis may render coitus inadequate ; still more so, however, 
organic diseases of the membrum, such as obliteration of the cor- 
pora cavernosa, or of some of the trabecular channels of these 
bodies, nodular formations resulting from injury, or cavernitis from 
gonorrhoea. In such cases, erection is extremely irregular, and 
the erect penis is sharply bent (chordee) instead of being straight, 
a condition which renders intromission mechanically difficult if not 
impossible. A similar effect is produced by ossification of some part 
of the tunica albuginea of the corpora cavernosa — the so-called 
penis bone. Mechanical obstacles to coitus are also offered by in- 
guinal and scrotal hernias ; and by excessive obesity, where the 
increase in thickness of the panniculus adiposus of the abdominal 
wall and the mons pubis, whilst the penis itself remains as slender 
as before, causes the organ almost to disappear from view. 

Psychical impotence in the male is much more frequently observed 
than organic impotence. We meet with this condition especially in 
neurasthenically predisposed individuals, or in men who have been 
given to excessive venery or have masturbated excessively in youth, 
and who, when entering upon married life, fear they will be unable 
to satisfy the legitimate desires of their wives ; or in newly married 
men who have suffered often from gonorrhoeal inflammations, such 
as prostatitis, vesical catarrh, and epididymitis. The fear and anxi- 
ety from which such persons suffer has an inhibitory influence upon 



^^(j The Sexual Life of Woman. 

the erection of the penis. In some instances, this inhibitory influence 
is partial only, and the man thus affected, while perfectly competent 
in intercourse with a prostitute, who employs means of sexual 
stimulation to which he has become accustomed, is unable to com- 
plete intercourse with his wife, who is ignorant and innocent, and 
assumes a purely passive role ; or it may be that erection is not suffi- 
ciently powerful to bring about rupture of the hymen, and thus to 
overcome the difficulties primae noctis. 

As regards gonorrhoeal infection, it appears that in men who in 
other respects are perfectly competent, this disease has an inhibi- 
tory influence upon the nervous mechanism concerned in producing 
erection of the penis. 

Psychical impotence is usually transitory, but it may endure for 
a very long time; and it may be many months before the husband, 
whose nervousness has led to failure in the decisive moment at the 
outset of married life, is able to command an erection sufficiently 
powerful to bring about the defloration of his wife. Occasionally 
such psychical impotence is not absolute but relative, it relates, that 
is to say, to one particular woman — unfortunately, as a rule, a 
man's own lawful wife, — wdiilst coitus with another woman, even 
in default of any measures for artificial sexual stimulation, is easily 
effected. This fatal misfortune is especially liable to occur in cases 
in which a man fully experienced in sexual matters marries a woman 
whom he dislikes or for whom he has no regard, the marriage being 
determined by material considerations. From such women I have 
heard the painful confession that the husband, a man renowned for 
his gallantries, played a very poor part in the bridal bed. 

The impotence of irritable zveakness is characterized by pre- 
mature, and therefore fruitless ejaculation. A man thus affected 
has a powerful erection of the penis, preparatory to coitus, but at 
the moment of contact with the female genital organs, before there 
has been time for penetration to occur, ejaculation takes place, and 
is immediately follow^ed by relaxation of the penis. Such irritative 
impotence is often met with in young men at the outset of their 
sexual career, in beginners, whose sexual passion is very readily ex- 
cited, whose imagination shoots forward to the goal, and who are 
unable to restrain themselves. This form of impotence can also be 
cured by wisely chosen measures. 

The paralytic form of impotence, on the other hand, is character- 
ized by the entire absence of erections of the penis, both overnight 
in bed, and during the early morning hours; the penis always re- 



The Skxl'al Erucu of the Menacme. 337 

mains flaccid, or at most becomes semi-erect only, insufficiently rigid 
for penetration. Ejaculation is much retarded or altogether 
wanting. 

Impotentia coeundi in the male may be complete, in cases in 
which the erection-apparatus is entirely inactive, and in which even 
an attempt at intercourse is out of the question ; or, and this is 
more frequently met with, it may be partial only, and manifests 
itself in various degrees of imperfection in the performance of 
coitus. 

This latter form may often escape the woman's notice. Whilst 
complete impotentia coeundi, in which intromission of the penis is 
impossible, is a state about which neither husband and wife can fail 
to be fully informed, cases of partial impotence, with semi-erection 
of the penis or premature ejaculation, are often glozed over by the 
husband, ignored by the wife, and underestimated by the physician — 
and yet such incomplete intercourse entails a series of ill-conse- 
quences alike upon the genital organs and upon the nervous system 
of the wife. Erection is incomplete, and thus the penis passes into 
the vestibule only, and not deep into the vagina ; even if penetration 
is more thorough, the venous return of the blood from the corpora 
cavernosa is not checked sufficiently to distend the penis to its full 
size, and to bring it into close contact with the vaginal walls ; or 
ejaculation occurs prematurely, before the sexual organism of the 
wife has attained that supreme degree which is needful alike for 
the attainment of sexual gratification and for the occurrence of 
conception. 

Vaginismus. 

Vaginismus is a disordered state, characterized by hyperaesthesia 
of the hymen and of the entrance to the vagina, so extreme that, 
even though the organs may be entirely free from any anatomical 
abnormality, coitus is prevented, whenever attempted, by violent, 
involuntary spasmodic contractions of the constrictor cunni and the 
other muscles of the urogenital and anal region. 

The centripetal paths of the reflex spasm characteristic of 
vaginismus, run through the branches of the inferior hypogastric 
plexus, and especially through the utero-vaginal plexus. The 
spinal nerves connected with this part of the sympathetic are the 
2d, 3d, and 4th sacral. The plexuses are constituted by fibres in 
part from sympathic and in part from tl>e 2d, 3d, and 4th sacral 
nerves. Through the same nerves passes the centripetal motor tract 

22 



o^S The Sexual Life of Woman. 

for the transversus perinei muscle, and for the sphincter and levator 
ani muscles. According to Eulenburg, the centre for this reflex is 
to be found at the level of the first sacral nerve; when the dis- 
turbane irradiates more widely, the lumbar and sacral plexuses as 
a wdiole are involved. The. constrictor cunni (sphincter vaginae or 
bulbo-cavcrnosus muscle) is supplied by the perineal branch of the 
pudic nerve. The symptom-complex of vaginismus consists of 
violent spastic contraction, for a term varying greatly in duration, 
of the constrictor cunni (bulbo-cavernosus), sphincter ani, levator 
ani, and transversus perinei muscles, the spasm spreading, in severe 
cases, to other muscles in the neighbourhood, and especially to the 
adductor muscles of the thigh; the spasm comes on when any at- 
tempt at intercourse is made, and even when the genitals are merely 
touched. 

In young married couples especially, vaginismus is an extremely 
distressing condition, and one that entails very serious consequences, 
inasmuch as the pains and reflex spasms which result from any 
attempt at coitus, and even from the mere approximation of the 
penis to the female genital organs, render sexual intercourse abso- 
lutely impossible. The cause of this pathological manifestation is 
in part to be found in unskilful attempts at intercourse, which have 
stimulated the female genital organs at some improper region. It 
may be that the young husband is not fully instructed in sexual 
m.atters, and does not really know how coitus ought to be effected; 
in other cases there is some abnormality of the hymen, which has 
rendered the rupture of that membrane extremely difficult ; in some 
cases there is partial impotence in the male, whose penis becomes 
semi-erect only, so that ever renewed attempts at intercourse are 
followed by ever-renewed failure. Any of these causes may suffice, 
in susceptible women, to originate vaginismus. The sufferer in these 
cases will usually be found on enquiry to be hereditarily predisposed 
to nervous disorder, and to be extremely sensitive to pain. By the 
fruitless efforts of her ignorant or partially impotent husband, she is 
sensually excited without ever being satisfied; the injured nervous 
system responds by these local spasms, whilst ultimately, in some of 
these cases, an actual psychosis ensues. 

In a certain number of cases, however, the husband is in no way 
responsible for the origin of vaginismus, which may depend on 
pathological states of the female external genitals, leading to 
hyperaesthesia ; or, again, on primary hyperaesthesia of the pudic 
nerve and its branches; or, finally, on general neurasthenia and 



The Sexual Epoch of the Menacme. 339 

hysteria, on excessive sensibility and lack of self-control on the 
part of a young girl, who has entered upon married life under the 
dominion of extravagant ideas. Vaginismus dependent upon gen- 
eral neurasthenia especially in cases in which there is no strong 
affection for the husband to give the spur to desire, and to enable 
the woman to bear with fortitude the pangs which form the neces- 
sary introduction to the joys of wedded life. It must not be for- 
gotten, as throwing light on the origin of vaginismus, that in the 
digital vaginal examination of a virgin or even of a young wife, 
unless extreme care is taken, pain and painful muscular spasms are 
liable to be evoked. 

The local pathological conditions of the female genital organs 
that are most often met with in cases of vaginismus are : a very 
rigid state of the hymen ; inflammation and excoriation of the hymen 
and its surroundings ; fissures at the vaginal orifice ; inflammatory 
affections of the vaginal follicles ; inflammation of the carunculae 
myrtiformes ; a peculiar formation of the vulva, which extends 
forwards over the pubic symphysis, whereby the urethal orifice 
and the hymenal aperture come to lie upon the pubic symphysis 
or the subpubic ligament ; vulvitis ; herpes or eczema of the vulva ; 
kolpitis ; urethritis ; fissure of the anus ; papillary growths ; pruritus 
papules : urethral caruncle ; inflammation of Bartholin's glands ; at 
times gonorrhoeal infection. 

A case came under my own observation in which a newly mar- 
ried woman suffered from vaginismus. The husband believed the 
cause of the trouble was his own partial impotence, consequent 
upon youthful venereal excesses, and yielded to the desire of his 
wife and her relatives that a divorce should be obtained. A year 
later, the woman remarried, when, to her horror, the symptoms re- 
turned in full force. Now for the first time she consulted me, and 
on local examination I could detect no abnormality whatever. The 
vaginismus was in this instance a pure neurosis, the only possible 
cause of which was to be found in bygone overstimulation of the 
vaginal orifice, the wife admitting previous onanistic excesses. In 
another case known to me, vaginismus in the wife made the hus- 
band an involuntary sodomite. The movements of the wife when 
the spasm came on led to the introduction of the penis per anum, 
and coitus had repeatedly been effected by this abnormal route, 
when the fact first became apparent as the result of a local 
examination. 

Le Fort reports the case of a young Russian wedded pair who 



240 The Sexu/VL Life of Woman. 

were spending their honeymoon in Paris. The husband took so 
nmch to heart his inabiHty to fulfil his marital obligations in conse- 
quence of the vaginismus from which his wife suffered, that he 
shot himself through the heart. The distressing situation of a 
husband whose wife suffers from vaginismus, rendering coitus im- 
possible, is depicted in the well-known French romance, ''Made- 
moiselle Giraiid, Ma Femmef From a false shame, women often 
continue to suffer from vaginismus for months and even years, 
without a single effective coitus having ever taken place ; it is only 
the consequent sterility which at last leads to medical advice being 
sought. The physician then usually ascertains that the hymen is 
still intact, or at least incompletely destroyed, that on this mem- 
brane and on various parts of the vulva there are erosions, and 
that the whole of the external genitals outside the hymen are in a 
state of inflammation more or less acute. In other cases, however, 
neither excoriations, erosions, nor inflammation can be detected, and 
the existence of vaginismus can be proved only by the pain and 
the muscular spasm set up by contact with the vagina. Often, in- 
deed, the cause of this most distressing affection cannot be dis- 
covered. 

Introduction of the penis may be rendered impossible by spasm 
of the constrictor cunni (bulbo-cavernosus) muscle, but equally so 
by spasm of the transversus perinei or the levator ani muscle. 
Sometimes the spasm affects all three muscular groups; in which 
case the narrowing of the vagina is extreme, and extends for some 
way up into the canal. When the levator ani alone is affected by 
the spasm, the penis can, indeed, be introduced into the vagina, to 
encounter a powerful obstacle in the interior of that canal *, and 
it may happen, when the spasm comes on and affects the levator 
ani only after complete intromission of the penis, that the glans is 
retained in the vaginal fornix by the active contraction of the pelvic 
floor. 

More or less credible instances of penis captivus thus brought 
about are on record. The following history is by Davis: A gentle- 
man entering his stable found therein his coachman and a servant- 
maid in a most compromising position. All endeavours of the pair 
thus surprised to separate proved ineffectual, and their attempts to 
draw apart caused them intense pain. Davis was sent for, and 
ordered an iced douche, which, however, failed to liberate the im- 
prisoned penis. Release was impossible until the woman had been 
placed under chloroform. The swollen and livid penis exhibited 



The Sexual Epoch of the Menacme. 341 

two strangulation-furrows, a proof that two distinct areas of the 
levator ani muscle had been spasmodically contracted. 

Hildcbrand records three cases observed by himself in which there 
was spasm of the upper part only of the vagina, unaccompanied by 
vaginismus (/. e., by pain). In two of these cases, the spasm v/as 
originated by the contact of the examining finger with very painful 
ulcers of the portio vaginalis ; the third patient had a very sensitive 
prolapsed ovary. Fritsch reports having had on one occasion to 
give a woman chloroform for the release of a swollen and im- 
prisoned penis. 

Hildcbrand suggests that vaginismus may be caused by an ab- 
normal size of the penis, or by a condition occurring in weaklings 
and alcoholic subjects, in whom the greatest swellings of the glans 
penis occurs before intromission, whilst this greatest swelling is 
normally deferred until towards the end of the act, when the glans 
is in the vaginal fornix. 

Schroder writes as follows regarding the etiology of vaginismus : 
'*' The affection is dependent upon trauma, sustained in maladroit, 
frequently repeated attempts at sexual intercourse; for this reason 
it is met with, in the great majority of cases in young, newly mar- 
ried women. Impotence in the male is by no means necessary for 
its production, and such impotence is not even a frequent antecedent. 
Abnormal narrowness of the vagina, or extreme firmness of the 
hymen, is occasionally found, but neither is in any way necessary ; 
all that can be said in this connection of a small vaginal orifice is, 
that it predisposes to vaginismus. • If the husband is devoid of pre- 
vious experience in sexual matters, maladroit attempts at intercourse 
are exceedingly likely to occur. The penis is thrust in the wrong 
direction, pressing against either the anterior or the posterior com- 
missure of the vulva. Very often, moreover, the position of the 
vulva, which is subject to very striking individual variations, is 
concerned in the production of vaginismus. There are many women 
in whom the vulva lies in part in front of the symphysis pubis, so 
that the lower border of the symphysis lies below the urethral orifice. 
In such cases the penis is directed too far backwards, and instead of 
passing into the vaginal orifice, slips into the fossa navicu- 
laris. The frequent repetition of such maladroit attempts at Inter- 
course gives rise to a gradually increasing sensitiveness of the 
parts concerned, with the formation of excoriations. It now results 
that, on the one hand, the woman dreads attempts at Intercourse 
on account of the pain to which they give rise; she shrinks away 



342 The Sexual Life of Woman. 

from the man, so that penetration of the vagina by the penis is 
rendered even more difficult than it was before; and, on the other 
hand, ungratined sexual desire leads to the frequent repetition of 
attempts at complete intercourse (from which, moreover, if con- 
ception should ensue, a cure of the trouble is expected) . In this way, 
the trauma is rendered more severe, the congestion and excoriation 
of the fossa navicularis or of the urethral region are aggravated, 
and the sensitiveness of the parts increases to such a degree that the 
woman thus affected screams out when the vulva is merely touched. 
Ultimately reflex cramps set in whenever intercourse is attempted, 
and we then have the fully developed clinical picture of va- 
ginismus." 

]YmckeI maintains that in most cases there are two principal 
elements in the causation of vaginismus. In the first place, in con- 
sequence of more or less pronounced anatomical changes, there is 
undue sensitiveness and tenderness of the vaginal inlet and its 
neighbourhood, and in exceptional cases also of the upper part of 
the vagina, the uterus, and the ovaries. In the second place, the 
patient manifests an increased general sensitiveness and nervous 
irritability ; this is in some cases primary, but in others it is entirely 
the result of the repeated stimulation; and in either case it is 
heightened by the effects of ungratified sexual desire. 

A. Martin points out that the spasm of the muscles of the pelvic 
floor, and especially of the levator ani muscle, upon which vaginis- 
mus depends, may be due in some cases to the influence of chill, 
since the same cause will lead to pathological contractions in other 
muscular areas. But in such cases it is always open to question if 
masturbation or some other sexual perversion is not the true cause 
of the disorder. In some instances vaginismus is merely a symp- 
tom, in extremely sensitive women, of various diseases of the re- 
productive organs, and is brought on by the increased pain which 
in such cases is caused by attempts at intercourse ; when produced 
in this way, vaginismus is usually a transient manifestation. 

Vcit considers that among the pathological conditions giving rise 
to vaginismus, we must also enumerate diseases of the internal 
pelvic organs, such as chronic metritis, displacements of the uterus, 
oophoritis, etc. ; but he also attaches great importance to nervous 
predisposition, consequent upon previous sexual stimulation, and 
upon pre-existing inflammatory changes due to gonorrhoeal infec- 
tion. A peculiar form of vaginismus is, according to Veit, some- 
times observed after the birth of the first child; happily the dura- 
tion of this is usually brief. After parturition the vulval mucous 



The Sexual Epoch of the Menacme. 343 

Inembrane remains for a time very tender, and when cohabitation 
is resumed, often too soon, and perhaps, after the enforced absti- 
nence, too frequently repeated at brief intervals, fissures are readily 
produced. Moreover, vaginismus which has existed prior to par- 
turition may, in some cases, recur after that event. An unusual 
position of the vulva, undue smallness of the vaginal inlet, and 
relative impotence of the man, may combine to cause such a recur- 
rence. Finally, vaginismus often persists throughout pregnancy, 
and manifests itself during parturition. The magical effect which 
chloroform has in some primiparae, when the head is delayed at 
the vulva, is explicable only by the supposition of vaginismus. 

According to Arndt, vaginismus is not purely a local disorder, 
but is in many cases the local manifestation of a neuropathic diath- 
esis, which may in some instances lead to general mental disorder. 

Olshausen regards hypersesthesia and vaginismus as different 
stages of a single disease ; he believes that the excessive sensitiveness 
is seated chiefly in the hymen; he explains the spasm as the reflex 
result of fissures and inflammatory changes. Pozzi considers that 
excessive nervous irritability and an irritable state of the vulva 
are the indispensable preliminaries to the occurrence of vaginismus. 
Herman distinguishes between excessive smallness of the vaginal 
inlet and vaginismus ; he regards the latter as a nervous disorder, 
characterized by hypersesthesia of the vulva, and by spasmodic 
contraction of the levator ani and adjoining muscles. Frost dis- 
tinguishes vaginodynia from vaginismus ; in vaginodynia the pain 
is so intense as to cause syncope, and the muscular spasm involves 
the entire length of the vagina. 

It is a notable fact, to which Veit has especially drawn attention, 
that among the poorer classes of the population, vaginismus is 
practically unknown. Among women of these classes, their sex- 
sual needs, not having been so much lessened by " culture," suffice 
to withdraw their attention even from the pains of defloration, 
which would otherwise often be very severe; whereas the sexually 
neurasthenic woman of the upper classes, filled with dread at the 
idea of the pain she expects to suffer, and not infrequently in a 
condition of hyperexcitability or hypersensibility dependent upon 
previously employed abnormal means of sexual gratification, is 
unable to endure the pains of defloration even when these might be 
expected to prove far from severe. 

In some cases, painful contractions of the vagina, to which we 
cannot properly give the name of vaginismus, arise from organic 
diseases of the uterus and the uterine annexa; these painful con- 



344 The Sexual Life of Woman. 

tractions render copulation impossible. Von Hofmann reports the 
case of a young prostitute, who found herself unable to continue 
the practice of her profession owing to the severe pain she suffered 
during nitercourse ; she died, and the post mortem examination dis- 
closed bilateral salpingitis, with reproductive organs in other 
respects normal. i 

Maladroit and incomplete attempts at intercourse, and the con- | 

sequent repeated failure to obtain complete sexual gratification, t 

affect a woman's nervous system to a varying degree; but apart 
from this, in women who have long cohabited with men of deficient 
sexual potency, we often find a remarkable condition of complete 
relaxation of the genital organs, associated with great hypersecre- 
tion of the mucous membrane, flaccidity of the muscles of the 
pelvic floor, and displacements of the uterus. Moreover, the ner- 
vous shock to which the repeated but unsatisfying attempts at inter- 
course give rise, affects the spinal cord in such a manner that 
symptoms of spinal irritation ensue. The patient complains of 
pains in the back, the loins, and the nape of the neck ; these pains 
also radiate round the front of the abdomen and along the inter- 
costal spaces ; hyperaesthetic points may be detected when the finger 
is passed along the spine; there is weakness of the limbs with a 
sensation of numbness; and neuralgic manifestations of varying 
nature occur. 

The dangers which sexual intercourse may entail upon women 
— over and above the irritable conditions and inflammatory dis- 
orders of the female reproductive organs, dependent upon impetu- 
ous or unduly frequent coitus, or upon coitus practised during 
menstruation — are principally due to gonorrhceal and syphilitic 
infection transmitted by the cohabitating male. 

Cardiac Troubles Due to Sexual Intercourse. 

Among the troubles from which women at times suffer as a re- 
sult of sexual intercourse, certain cardiac disorders are especially 
worthy of attention. 

Every act of sexual intercourse in a young and sensitive woman 
exercises an exciting influence on the nervous mechanism con- 
trolling the cardiac movements, and this influence is more clearly 
manifested in a degree directly proportional to the intensity of 
the sexual orgasm. The heart's action is markedly increased in 
frequency, the cardiac impulse is more powerful, the large arteries 
of the neck are seen to pulsate far more vigorously, the conjunctiva 



The Sexual Epoch of the Menacme. 345 

is markedly injected, the respiration is increased in frequency, the 
respiratory movements are more superficial and have a panting 
character. 

But when, in a woman who is sexually irritable in an excessive 
degree, the peripheral stimulation occurring in the act of sexual 
intercourse is unusually powerful, there may result a notable in- 
crease or modification of the reflex manifestations which normally 
occur during sexual intercourse in the province of cardiac activity; 
similar results ensue when there is a summation of stimuli owing 
to excessive sexual intercourse, or contrariwise when the act of 
intercourse is broken ofif just before its physiological climax and 
the natural termination of the orgasm fails to occur. 

The former cause is not infrequent in young wives during the 
period of the honeymoon. The latter cause is in operation when 
there are diseases of the female reproductive organs preventing the 
physiological completion of intercourse ; but especially in conse- 
quence of the modern practice of coitus inter ruptus, in which the 
man breaks ofT the act of intercourse the moment he feels that 
ejaculation is imminent, without troubling himself regarding the 
natural course of sexual excitement in the woman. Yet another 
cause of excessive cardiac reflex manifestations in women is in- 
complete potency of the male, which may either cause a premature 
ejaculation of semen, or may lead to incomplete penetration of the 
penis. 

In all such cases, as a result of sexual intercourse, there may 
arise cardiac disorders of various kinds; among these, tachycardia! 
paroxysms are the most frequent, occurring either inter actum, 
or at a longer or shorter interval after intercourse. 

In several cases of vaginismus occurring in young married women 
which have come under my notice, it was observed that the at- 
tempts at intercourse gave rise to violent involuntary spasmodic 
contractions of the constrictor cunni and the other muscles of the 
urogenital and anal regions, and in addition it was found that 
these attempts were followed by tachycardia! paroxysms with 
dyspnoeic manifestations, lasting for a considerable period, it might 
be as long as one or two hours. 

In women who had practised coitus reservatus for a prolonged 
period, in fact for several years, in such a manner that, notwith-' 
standing the occurrence of intense voluptuous excitement, complete 
sexual gratification rarely, if ever, occurred — in such women, in 
whom these marital m.alpract ices seemed to have profoundly influ- 



^46 The Sexual Life of Woman. 

enced their psychical Hfe, I have frequently witnessed a form of 
reflex cardiac disorder which I must regard as a variety of the 
multiform neurasthenia cordis vasomotoria. In such women, still 
at the climax of their physical powers and of their sexual needs, 
attacks of palpitation suddenly occur at irregular intervals, several 
times daily or less frequently. Associated with this increased fre- 
quency of the cardiac activity are an extremely distressing feeling 
of anxiety, a sensation of faintness, headache,, vertigo, a weakness 
of the muscular system, and at times actual attacks of syncope. 
Physically, the women are extremely depressed, irritable, inclined 
to weep, unhappy, and weary of life. At the same time, digestion 
is impaired, the appetite is small, and there is constipation. The 
pulse is in most cases feeble, small, of low tension, easily com- 
pressible, increased in frequency, often intermittent, sometimes 
more distinctly arhythmical. The heart is found to be sound on 
physical examination, nor can any abnormality be detected in the 
great vessels. The lower extremities are free from oedema; the 
urine does not contain albumen. 

Women thus affected are sometimes believed to be suffering 
from cardiac disorder, in other cases they are subjected to various 
modes of gynecological treatment ; until at length the physician, by 
appropriate questions, becomes enlightened regarding the true 
cause of the cardiac disorder, namely, coitus interruptus. If it is 
possible to prohibit effectually this unwholesome practice, the car- 
diac symptoms soon cease to recur. 

Finally, in women at the climacteric age, cardiac troubles some- 
times ensue, which are dependent on interference with sexual inter- 
course in consequence of anatomical changes in the vagina; changes 
of this character frequently occur at the time of the menopause; 
owing to hyperaemic or inflammatory processes, a partial or general 
stricture of the vaginal passage results; in many cases this passage 
becomes narrower, shorter, and almost conical in shape, whilst the 
vaginal inlet is greatly diminished in size. Such a vaginal stric- 
ture, which Hegar has also seen in younger women after an arti- 
ficial climacteric (oophorectomy), interferes with sexual inter- 
course ; and the incomplete sexual gratification gives rise to a series 
of nervous manifestations, and, among others, to the above de- 
scribed reflex cardiac neurosis. 

Whether, and in which cases, the cardiac disorders evoked as a 
result of the local stimulatory influences of sexual intercourse, are 
dependent on a reflex stimulation of the sympathetic nerve on the 



The Sexual Epoch of the Menacme. 347 

one hand, or upon a transient paresis of the inhibitory centre of 
the heart and of the vasomotor centre on the other, cannot here 
be fully discussed; just as little can we consider in what manner 
the psyche is sympathetically affected by the irritative processes in 
the genital organs, and its functional activity thus impaired. 

Here I can do no more than briefly state that experience has 
taught me that sexual intercourse is competent to originate cardiac 
troubles in women. 

1. In extremely sensitive, sexually very irritable women, tachy- 
cardial paroxysms may result from sexual excesses. 

2. Tachycardial paroxysms with dyspnoea occur in young women 
affected with vaginismus ; also in women at the climacteric with 
constrictive changes in the vagina. 

3. Cardiac troubles, characterized mainly by symptoms indicating 
diminished vascular tone, occur in women who have long prac- 
tised coitus interruptus with incomplete gratification of their volup- 
tuous desires. 

Dysparcunia. 

In normal conditions the act of sexual intercourse is accom- 
panied in women, as in men, by a voluptuous sensation, and this 
sensation must be regarded as a necessary link in the chain of those 
processes by which gratification of the sexual impulse — the most 
powerful of all our natural impulses — is obtained. The absence 
of this voluptuous sensation in a woman, the state in which she 
experiences during coitus no voluptuous sensations, but feels either 
apathy, or positive distaste, is termed dyspareunia : in former times 
it was also known as anaphrodisia. This abnormal state of sexual 
sensibility, which up to the present is hardly alluded to in gyneco- 
logical textbooks, has received remarkably little attention from 
the medical standpoint, and its importance has been underesti- 
mated. Most unfortunately so, for dyspareunia is an important 
symptom, exercising a powerful influence on the general health of 
the woman who suffers from it, upon her social status in marriage, 
and, as is easy to understand, upon her procreative capacity. 

Dyspareunia must be clearly distinguished • from two somewhat 
similar conditions, with which at first sight it is liable to be con- 
fused, namely, from anaesthesia sexualis, and from vaginismus. By 
sexual anaesthesia we understand, as previously explained, the absence 
of the sexual impulse, a symptom which, when the reproductive or- 
gans are normal in structure and function, is either of central nervous 
origin, a result of disease of the brain or spinal cord, or else is 
due to general nutritive disorders such as diabetes, morphinism, 



348 The Sexual Life of Woman. 

or alcoholism. A woman affected with dyspareunia does, however, 
experience the sexual impulse, it may be very actively, but sexual 
intercourse brings about no gratification of her desires. In 
vaginismus, on the other hand, the introduction of a foreign body, 
that is to say of the membrum virile, into the vagina, gives rise to 
painful reflex cramps of the sphincter vaginae, or of the muscles 
of the pelvic floor, whereby the completion of coitus is rendered 
impossible : whereas in dyspareunia coitus can be effected, but gives 
rise to no voluptuous sensations. 

The pleasure which normally occurs in woman during sexual in- 
tercourse is brought about in this way, that contact with and fric- 
tion by the penis stimulates the sensory nerves of* the clitoris, the 
vulva, the vestibule, and the vagina ; this stimulus is propagated to 
the cerebral cortex, where it gives rise to voluptuous sensations, and 
then, by reflex stimulation of the genito-spinal centre, gives rise to 
a series of reflex discharges. The pudic nerve, a branch of the 
sacral plexus, supplies the female external genital organs. Some 
of its branches pass in the clitoris to a peculiar form of nervous 
end-organ discovered by W. Kraiise, Krause's genital corpuscles: 
the structure of these corpuscles appears to fit them exceptionally 
well for the transmission of stimulatory waves to the nerve centres. 
" When this stimulus," says Hcnsen, in his work on the physiology 
of reproduction, ^* in addition to other effects, also gives rise to a 
voluptuous sensation, the cause must be sought in central nervous 
connections and apparatus. Similar relations are to be found in 
connection with the mechanism of nutrition, for example, in the 
association of hunger, appetite, agreeable sensations of taste, the 
act of mastication, and .the secretion of saliva." By means of this 
stimulus, several reflex processes are originated in the reproductive 
canal, the most notable of which are the erection of the clitoris, 
and the ejaculation of the secretions of various glands. The cav- 
ernous tissue of the clitoris is connected with that of the bulbus 
vestibuli, and the dorsal nerve of the clitoris is one of the principal 
nerves of voluptuous sensation. The venous plexus constituting 
the bulb of the vestibule lies at either side along the margin of the 
vestibule at the boundary between the labium majus and the labium 
minus, and laterally it is covered by the constrictor cunni* muscle. 

* Constrictor Cunni Muscle. — In women the hulhocavcrnosus muscles, 
right and left, form, as it were, a sphincter to the vaginal outlet. Hence the 
alternative names of sphincter vaginae and constrictor cunni muscle. The 
latter name is in common use in Germany, but, though appropriate, is rarely 
employed in England. — Transl. 



The Sexual Erocii of the Menacme. 349 

During coitus the blood is driven out of this bulb into the glans 
clitoridis, and thus the sensibility and the erection of the glans are 
increased. The constrictor cunni and ischiocavernosus muscles 
draw the clitoris, which is bent at a right angle downwards, into 
contact with the penis. By means of the pressure of the con- 
strictor cunni, the mucous secretion of Bartholin's glands, which 
open into the vulva at the back of the labia majora, is expressed. 

As additional reflex actions, dependent upon the activity of the 
reflex centre in the lumbar enlargement of the spinal cord, there 
ensue contractions of the vagina, peristaltic movement of the tubes, 
some descent of the uterus, relaxation of the os uteri and rounding 
of this orifice, and induration of the portio vaginalis, whereby the 
tubal and uterine mucus and the secretion of the cervical glands 
are expressed. This process of ejaculation constitutes the culmi- 
nating- point of the voluptuous sensation occurring in the sexual 
act; this act thus exhibits two phases, the sensation of friction, and 
the sensation of ejaculation. 

With regard to voluptuous sensations, and processes analagous 
to pollutions, occurring in women, we append an extract from 
voji Krafft-Ebing. 

*' The occurrence of voluptuous excitment during coitus is de- 
pendent in the women, just as in the man, upon: 

'' I. The peripheral influence of the intensity and duration of the 
sensory stimulation (anaesthesia of the genital passage may be the 
cause of the absence of voluptuous sensation). 2. The condition 
of excitability of the reflex (ejaculation) centre in the lumbar 
spinal cord. The activity of this centre varies within wide limits, 
not merely in different individuals, but in the same individual at 
different times. There are, indeed, women in whom it seems as 
if this centre were always in vigorous activity. In normal women, 
the irritability of the centre appears to be most marked at the 
menstrual epoch, and to decline rapidly soon after menstruation. 
In pathological conditions, the activity of the centre may be tem- 
porarily in abeyance (organic inhibitory processes, such as are seen 
in certain cases of hysteria with temporary frigidity) ; or again 
the centre may be abnormally active owing to irritable weakness 
(neurasthenia sexualis), in consequence of which ejaculation may, 
just as in the male in similar circumstances, occur too easily. 3. 
The occurrence of the voluptuous sensation in woman is unfavour- 
ably influenced by psychical inhibitory perceptions (analogous to the 
inhibitory influence of psychical processes in the male, such as, for 
example, fear of incapacity to perform sexual intercourse). As 



350 



The Sexual Life of Woman. 



examples of such inhibitory perceptions in women may be men- 
tioned, disHke of the man, physical loathing to sexual inter- 
course, etc." 

Gutceit records interesting experiences, which are readily intelli- 
gible in view of what we have already quoted. He finds that of 
ten women after defloration, two only immediately experience full 
sexual pleasure. Of the eight others, four only have an agreeable 
sensation produced by the friction during coitus: but the sensation 
of ejaculation does not make its appearance until the lapse of at 
least six months, or it may be even several years, after marriage. 
In the remaining four women, pleasure during sexual intercourse 
may never become properly established. The women of the first 
class are described by the author as being of a very ardent tem- 
perament, and passionately attached to their husbands. In such 
women, the sensation of ejaculation occurs during intercourse with 
any man toward whom they are sympathetic. Women of the second 
class are of a less ardent temperament, and are often comparatively 
indifferent toward the man with whom they cohabit. Women of 
the third class have little or no amatory feeling, and they either 
hate the man with whom they are cohabiting, or at least feel 
physical repulsion to the idea of intercourse with him. Gutceit 
considers that meretrices usually belong to the third category. In 
the practice of their trade, they make a counterfeit of voluptuous 
enjoyment, and only experience real sexual gratification in inter- 
course with the man of their choice. 

It is of great practical interest, alike from the gynecological and 
from the neuropathological standpoint, to determine the conse- 
quences in women of ungratifying sexual intercourse. In the pres- 
ent state of our experience it must be assumed that the effect of 
abnormal sexual intercourse, that is of intercourse wliich does not 
culminate in gratification produced by the sensation of ejaculation, 
is deleterious. This is explained by the fact that, owing to the 
absence of the muscular contraction of the genital passage, the 
latter remains engorged with blood ; the resultant hypersemia passes 
away very slowly, and, when frequently repeated, gives rise to 
chronic tissue changes, manifesting themselves as diseases of the 
reproductive organs. Injury to the nervous system ensues, partly 
in consequence of these organic changes, partly also in consequence 
of psychical non-gratification in the widest sense of the term. The 
nervous disorders thus produced are typical forms of (sexual) 
neurasthenia; and in cases in which the pathogenesis is predomi- 
nantly psychical (antipathy to the husband, etc.) hysterical types 



The Sexual Epoch of the Men acme. 351 

of disorder are especially frequent. Von Krafft-Ebing believes that 
incomplete coitus, that is, coitus not culminating in the sensation 
of ejaculation, is a frequent cause of hysterical disorders in women. 

When once the clinical picture of neurasthenia sexualis is fully 
developed, each act of intercourse (like pollutions or coitus in the 
sexually neurasthenic male) gives rise to renewed troubles, which 
are easily recognized as symptoms of venous stasis in the repro- 
ductive organs (sacrache, sensations of weight and bearing-down 
in the pelvis, fluor albus) : in addition we observe exacerbations 
of the lumbar spinal disorder, in the form of spinal irritation, 
irradiating pains in the sacral plexus, etc. In this way general 
neurasthenia develops. The conditions found in such cases on 
gynecological examination (chronic endometritis, metritis, oopho- 
ritis, etc.) are produced by the same cause as the nervous symp- 
toms, namely, by an unhygienic mode of sexual intercourse. Tliey 
are not the cause of the neurosis, but important concomitant dis- 
orders ; and their effect in rendering the nervous disturbances more 
severe must be freely admitted. 

Among important causes of ungratifying coitus must be enumer- 
ated : weak erection and ejaculatio prsecox in the male, rendering 
the stimulation inefficient; in addition, coitus reservatus, coitus in- 
terruptus, and coitus condomatus. If the noxious influence is fre- 
quently repeated, the occurrence of neurasthenia sexualis and its 
consequences is greatly to be feared, and in women of neuropathic 
constitution it is practically inevitable. 

Unsympathetic coitus appears to act, not merely in a somatic 
manner, but mainly upon the psyche, and to originate states of 
hystero-neurasthenia or pure hysteria. If the influence of such un- 
hygienic conditions of the vita sexualis co-operates with that of 
inherited or acquired sensuality, further dangers ensue : in cases 
of ungratifying sexual intercourse, the danger of manustupration ; 
in cases of unsympathetic intercourse, the danger of psychical onan- 
ism, or that of marital infidelity. 

Although until recently the matter received but little attention, 
it must now be regarded as a well-established fact, that in the 
female (as in the male) the climax of voluptuous sensation in sexual 
intercourse is normally characterized by a process of ejaculation, 
accompanied by a voluptuous sensation of ejaculation, dependent 
upon the acme of excitement of a reflex centre in the lumbar en- 
largement of the spinal cord. 

Just as in the male, this centre may be excited to action, not only 
by local stimulation of the genital organs, but also by (psychical) 



352 The Sexual Life of Woman. 

stimuli proceeding from the brain (pollutions), so also in the 
female a similar process may occur, and for this reason it is cor- 
rect to speak of " pollutions in the female." Rosenthal appears to 
have been the first writer to speak of pollutions in women. In his 
clinical study of nervous diseases, Rosenthal described processes of 
the nature of pollutions, originated in erotically over-stimulated 
women by lascivious dreams. In one case he detected the outflow 
of a " mucus-like " fluid from the apparently intact genital organs ; 
he believed this to proceed from the ducts of Bartholin's glands, 
and from the mucous glands surrounding the urethral orifice. Fere 
reports the case of a patient who had an erogenic zone in the region 
of the upper part of the sternum; pressure on this zone gave rise 
to a profuse secretion of vulvo-vaginal fluid. In this connection 
we may also recall the " clitoris-crises " to which tabetic women 
are subject. Guteeit described the process of pollution in women 
in the following words : " It is remarkable that in dreams 
such women experience the sensation of ejaculation." 

The psychical preliminary is invariably constituted by lascivious 
dream perceptions. It merely remains open to question whether 
this process, which in the male is indisputably physiological, in the 
female may be said to occur within physiological limits. The re- 
searches published by z'on Krafft-Ehing more than twenty years 
ago, under the title " Concerning Processes Analogous to Pollu- 
tions Occurring in the Female," gave negative results as far as 
healthy individuals were concerned ; on the other hand, the phe- 
nomenon in question was by no means rare in nervously disordered, 
and above all in sexually asthenic women. The neurosis was in 
part found as a result of psychical or manual onanism in virgins 
wdth morbidly intensified libido : in part in married women, as a 
result of ungratifying coitus, as previously described: in part, also, 
in married w^omen with powerful libido and enforced abstinence 
from intercourse, owing to acquired impotence or death of the 
husband. 

Just as in the case of the neurasthenic male, these pollutions 
made the primary neurosis more severe, and relief from the nervous 
trouble was not obtained until the factor of the " pollutions " had 
been recognized, and made the object of special treatment. In ex- 
ceptional cases the " pollutions " appeared to be the starting point 
of the entire neurosis. 

It was further remarkable, again here displaying analogy with 
what occurs in the male, how much stronger and more deleterious 



The Sexual Erocii of the Menacme. 353 

was the shock-effect of an inadequate process of ejaculation occur- 
ring in a sexual dream, as compared with the far less deleterious 
influence of similar incomplete ejaculation when occurring via 
coitus. In very severe degrees of neurasthenia sexualis, just as 
in the male, the waking imagination may give rise to a '' pollution." 
In such cases the shock-effect on the nerve centres tends to be 
excessively severe. A still higher degree of irritability of the genital 
system appears to exist in cases in which excitement and orgasm of 
the reproductive organs may culminate in a " pollution " by purely 
spinal paths, without the intervention of the imagination. The sig- 
nificance of this fact would appear to be considerable for the proper 
comprehension and for the treatment of certain conditions of neu- 
rasthenia (sexualis) in the female. The ''pollution" may here 
be the actual cause of the neurosis. But in any case, in the female, 
the occurrence of pollutions is an extremely important symptom 
as regards both diagnosis and therapeutics. It is extremely prob- 
able that hallucinations of coitus, and the complaints made by in- 
sane women of attempted violation during the night, are really 
dependent upon such " pollutions." 

Von Krafft-Ehing reports the following characteristic case. Miss 
X., thirty years of age, belonging to a family predisposed to in- 
sanity, and herself neuropathic since early childhood, declared that 
since she was six years old she had been subject to lascivious 
imaginations, to which she became continually more liable as she 
grew older. Ultimately, typical psychical onanism developed, and 
in recent years her trouble assumed the form of sexual neurasthe- 
nia. The patient herself suspected- there was a connection between 
her nervous disorder and her evil habit. The popular work by 
Bock finally brought her full enlightenment, associated with severe 
emotional disturbance. This latter was now increased by misfortunes 
from which the family suffered. The patient then relinquished her bad 
habit, but her state of health nevertheless became worse. She was 
nervously extremely irritable ; her sleep was insufficient, un- 
refreshing, and disturbed by lascivious dreams ; she suffered from 
spinal irritation, anaemia, scanty and painful menstruation. Inclina- 
tion toward the opposite sex and toward marriage, hitherto but 
slight, now sank to a minimum: on the other hand, the patient, in 
spite of all efforts to the contrary became more and more subject 
to a condition analogous to priapism in the male, a genital orgasm 
by no means voluptuous in character, and often indeed actually 
painful. Associated therewith, nocturnal pollutions occurred, the 

23 



354 



The Sexual Life of Woman. 



patient awaking from lascivious dreams with a voluptuous sensa- 
tion and moistness of the external genital organs. After such pollu- 
tions, throughout the ensuing day, she felt extremely weary and 
depressed and suffered from severe spinal irritation. After a time, 
the nocturnal pollutions occurred without being preceded by lasciv- 
ious dreams, and ultimately analogous states were experienced in 
the daytime. With much difficulty the patient now made up her 
mind to seek medical advice. She was anaemic, emaciated, 
emotional, and moody. The lumbar and cervical regions of the 
spine were extremely sensitive to pressure. Sleep was scanty and 
unre freshing, the patient felt weary and miserable, she complained 
of dragging sensation and other paralgic sensations, in the regions 
supplied by the lumbar and sacral plexuses. The deep reflexes were 
increased. She dreaded the onset of disease of the spinal cord, and 
believed that the cause of her illness was to be found in the pro- 
longed indulgence in psychical onanism. The perusal of Bock's 
book had first made her understand the true nature of her miscon- 
duct. She had never practised manual masturbation. Her prin- 
cipal complaint was of an almost unceasing uneasiness and excite- 
ment in the genital organs. She compared it to the uneasiness in 
the stomach produced by hunger. In the genital organs (which on 
examination appeared quite normal), she had a distressing sense 
of burning heat, of pulsation, of disquiet as if there were ^ clock- 
work mechanism working there. Very rarely now were these sen- 
sations associated with voluptuous ideas. This sexual neurosis had 
an intensely depressing constitutional effect. She had transient 
relief only when the local sensations culminated in pollution; but 
this, on the other hand, increased her general neuropathic troubles. 
She suffered most severely during the menstrual period. She was 
ordered sitz-baths at a temperature of 23° to 19° R. (84° to 75° F.), 
suppositories of monobromide of camphor, 0.6 (9 grains), with extr. 
belladon. 0.04 (^ gi"-)» sodium bromide 3.0 to 4.0 (45 to 60 
grains), every evening; also powders containing camphor o.i (i^ 
grains), lupulin 0.5 (^ grain), extr. secal 0.08 (1^4 grains), 
twice daily. This treatment gave the patient great relief, and 
secured complete ease during the daytime. Therewith returned her 
greatly impaired trust in the future, and her emotional calm was 
restored. 

The frequent occurrence of pollutions in women, the so-called 
vulvo-vaginal crises and clitoris-crises, is regarded by Eulcnhurg 
as a striking manifestation of sexual neurasthenia in woman; in 



The Sexual Epoch of the Menacme. 355 

such cases a lascivious dream is spontaneously followed by a more 
or less abundant discharge of the clear gelatino-mucous secretion 
of Bartholin's glands. In women who masturbate, and in tribadists, 
a profuse and even violent secretion of these glands is produced by 
touching the clitoris or the erogenic zones at the entrance to the 
vagina, close to the orifices of Bartholin's ducts. 

Dyspareunia, the absence of voluptuous sensation in women 
during coitus, may be referred to three fundamental causes: 

1. Insufficient or completely wanting peripheral stimulation of 
the sensory nerve terminals in the female reproductive canal : in 
these cases the conducting tracts to the nerve centres never become 
active. 

2. Diminution or cessation of the excitability of the reflex centre 
in the lumbar enlargement of the spinal cord: this leads to failure 
of the sensation of ejaculation. 

3. Inhibitory influences proceeding from the cerebral cortex 
whereby voluptuous sensations and perceptions are checked. 

The first-named of these etiological influences is in my experi- 
ence the commonest. Incomplete or quite inadequate stimulation of 
the sensory nerves of the genital canal may be due to the maladroit 
performance of copulation on the part of the male, owing to inex- 
perience, or it may depend on gross disproportion in size between 
the reproductive organs of the man and the woman; in other cases 
it may be due to disease of the reproductive organs in either sex, 
influencing unfavourably the sensibility to stimulation of the nerves 
of the genital canal. Awkward or incomplete performance of 
coitus may thus lead to failure of voluptuous sensation, and this 
may ultimately pass into permanent dyspareunia. Temporary dys- 
pareunia is very common in young wives during the first months 
of married Hfe, ensuing on the pains of defloration; and very grad- 
ually gives place to normal voluptuous sensation. It may be one 
or two years after marriage before the sensation of ejaculation is 
first experienced. Not infrequently, dyspareunia depends on in- 
complete potency in the husband, who is incompetent to arouse 
voluptuous sensation in his wife. For this reason, dyspareunia is 
common in young women married to elderly men ; but is common 
also, where (as so frequently among Russo-Polish Jews) the men 
also marry very young, at an age of from sixteen to seventeen years, 
and where, moreover, the husband has often before marriage im- 
paired his potency by masturbation: finally dyspareunia is common 
when girls still undeveloped sexually are married to powerfully 
built men. 



356 The Sexual Life of Woman. 

Regarding the pathological conditions of the female reproductive 
organs which counteract the peripheral sensory excitants of volup- 
tuous sensation, we exclude from further consideration the obvious 
causes, absence and atrophy of the reproductive organs, and senile 
marasmus. Of prime importance as a cause of the failure of sexual 
sensibility in the early period of married life must be mentioned 
inflammation of the fossa navicularis, due to awkward attempts at 
intercourse. Other causes of deficient sensibility are: complete or 
partial persistence of the hymen, lesions of the vaginal inlet, acute 
or chronic vulvitis in consequence of irritating abundant secretion, 
especially as a sequel of gonorrhoeal vaginitis. The last named in- 
fective disorder is especially harmful, because Bartholin's glands 
are involved in the associated vulvitis. Even after the cure of the 
vulvitis, permanent dyspareunia may remain. Perineal fissures may 
result in the stimulant effect of coitus being insufficient, owing to 
the slight friction possible at the vaginal inlet in these cases. Not 
less serious sometimes are small, hardly discernible fissures in the 
vagina. Additional causes of deficient sexual sensibility are recto- 
vaginal, and vesico-vaginal fistulae. 

The second cause of dyspareunia, diminution or complete lack 
of irritability of the reflex centre of the lumbar enlargement of 
the spinal cord, appears to be less frequently operative. We must, 
however, assume that certain nervous disorders, such as hysteria 
and pathological changes in the spinal cord, are responsible in this 
connection. The activity of the lumbar sexual centre appears in 
women to be normally subject to variation within certain limits; 
and seems usually to attain its maximum irritability during men- 
struation. But normally these variations are never so great as to pro- 
duce in women complete though merely temporary dyspareunia; in 
this respect offering a marked contrast to what occurs in other 
animals at other times than the rutting season, and of which every 
bitch not on heat furnishes an example when she refuses the sexual 
advances of the dog. 

As regards the third causal influence in the production of dys- 
pareunia, the influence of the brain, this, though important, is less 
frequently in operation. Diseases of the brain, degenerative proc- 
esses, may constitute a cerebral cause for the failure of sexual 
sensation. But more frequently, certain cortical perceptions, such 
as dislike or hatred of the cohabiting male, an ardent passion for 
some other lover, grief and trouble, exercise inhibitory influences, 
which render the occurrence of voluptuous pleasure during the 
sexual act difficult or quite impossible. 



The Sexual Epoch of the Menacme. 357 

A condition like dyspareunia, our knowledge of which depends 
entirely upon the subjective sensations of the woman concerned, is 
naturally one regarding whose existence accurate information is 
difficult to obtain. Very rarely does it happen that women spon- 
taneously approach the physician with complaints of this condi- 
tion ; indeed, in my experience, they do so only when they are 
sterile, and when they assume, in accordance with the widespread 
popular belief, that their sterility is connected with the absence of 
voluptuous sensation during sexual intercourse. More commonly, 
however, it is the husband who feels it his duty to confide to the 
medical man the remarkable apathy of his wife in sexual inter- 
course. But when once the medical man's attention has been 
directed to this question, and when he institutes enquiries among 
his patients in a scientific, passionless manner, one making due al- 
lowance for a woman's modesty, as the moral importance of the 
subject demands, he will be astonished at the frequency of dyspa- 
reunia, and he will find herein the explanation of many obscure 
phenomena in the life of women. On the other hand, it must never 
be forgotten that a certain number of women complain of dyspa- 
reunia without any justification whatever, in order to arouse inter- 
est and sympathy, by representing themselves as unwilling sacri- 
fices on the marital altar : the experienced gynecologist will readily 
detect the cases in which he is being misinformed ; he can, more- 
over, always check the wife's statements by conversation with the 
husband. 

The constant sign of dyspareunia is the failure of ejaculation 
during coitus. We have previously described the muscular con- 
tractions which lead to ejaculation of the secretion of Bartholin's 
glands and to the expulsion of the uterine and cervical mucus, 
as reflex actions evoked by the sensory stimulus dependent on 
friction of the female genital organs. The voluptuous sensation of 
ejaculation, associated with these muscular contractions, which the 
woman whose sensibility is normal experiences as the culminating 
point of her sexual '' gratification," is either cjuite unknown to a 
woman affected by dyspareunia, or is experienced by her only in a 
voluptuous dream, as a pollution, in which the sexual dream- 
perceptions act as the psychical stimuli by which the refle-x dis- 
charge is originated. It has repeatedly happened to me, that on 
enquiring of women suffering from dyspareunia regarding their 
experience of the sensation of ejaculation, I have been informed 
that such sensations are known to them only from the descriptions 
of their female friends, or occasionally from dreams from which 



358 The Sexual Life of Woman. 

they have awakened with a feehng of moisture in the external geni- 
tals. Von Kraitt-Ebing refers this process to a peristaltic contrac- 
tion of the muscular fibres of the Fallopian tubes and the uterus, 
" whereby the tubal and uterine mucus is expressed ;" whereas, for 
my part, I am of opinion, that ejaculation affects in the first place 
and principally the glands of Bartholin, the secretion of which is 
expressed by the contraction of the constrictor cunni muscles, and 
secondarily only affects the cervical glands of the uterus. 

As a second sign of dyspareunia, I recognize a remarkably rapid 
outflow 01 the male semen from the female genital canal, imme- 
diately after co'itns, {profluviiun seminis). The woman thus affected 
complains, when suitably questioned, that she is unable to retain 
the semen, and that it flows out of the vagina immediately after 
ejaculation. The cause of this remarkable phenomenon no doubt 
lies in the fact, that, owing to the absence of the voluptuous sensa- 
tion, the reflex contractions of the muscles of the female genital 
organs, normally accompanying this sensation during intercourse, 
fail to occur. At the vaginal inlet, in normal conditions, the con- 
strictor cunni muscle contracts, and farther up in the vagina a 
peristaltic contraction of the circularly disposed muscular fibres 
of the tunica media occurs: in this way the semen ejaculated into 
the vagina is for a time retained under a certain pressure. But in 
the absence of these muscular contractions, as well as of the mus- 
cular contraction of the pelvic floor, retention of the semen fails 
to occur. Cattle-breeders and horse-breeders have, made similar 
observations regarding cows and mares, namely, that these animals 
are sometimes unable, to retain the semen after coitus, and it is 
suggested that in these cases the animals are not properly on heat. 
Experienced cattle-breeders recommend in such cases that the re- 
tention of the semen should be promoted by douching the root of 
the tail and the external genitals with cold water. It is well known 
that by stimulating the peripheral sensory nerves in the neighbour- 
hood of the genital organs, a reflex excitement of the lumbar sexual 
nerve centre is produced, as is seen, for example, in the practice 
of flagellation of the buttocks, for the increase of sexual desire. 

Passing to the consideration of the pathological changes to be 
found in the reproductive organs of women suffering from dyspa- 
reunia, the nature of these will for the most part be obvious in rela- 
tion to the etiology of the disorder. Most frequent, in my experi- 
ence, were chronic inflammatory states of the vulva and of the 
vaginal and uterine mucous membrane, chronic metritis and para- 



"vj 



The Sexual Epoch of the Menacme. 359 

metritis. A very frequent appearance, and one practically charac- 
teristic of dyspareunia when of long standing, is a marked total 
relaxation of the reproductive apparatus. The uterus is extremely 
mobile, usually retroverted and partially prolapsed, thin, with lax 
walls, and usually an enlarged cavity ; the portio vaginalis is flaccid, 
and runs to a point ; the vagina is roomy ; there is marked hyper- 
secretion of the mucous membrane of the entire genital canal; 
there is great flaccidity of the constrictor cunni and levator ani 
muscles, and of the perineum. In several women with dyspareunia, 
I found old unhealed lacerations of the perineum. In some cases, 
the very small size of the clitoris is noteworthy. In one case 
amenorrhoea was present with an infantile uterus. In a large pro- 
portion of the cases I was able to detect a diminution both of the 
tactile and algic sensibility of the vaginal mucous membrane. The 
women were for the most part anaemic; many were extremely 
obese, and of lymphatic constitution. In some cases, however, no 
pathological changes whatever could be detected in the reproductive 
apparatus. 

Dyspareunia is a condition which affects a woman's whole nature, 
powerfully influences her mental life, and thus gives rise to greater 
psychical than physical damage. The consciousness of being de- 
prived of the greatest joy of physical love produces great emo- 
tional depression, even in a -woman by no means sensually inclined, 
and gives rise to a hypochondriacal state, at times even to melan- 
cholia. In other cases, the idea, not infrequently suggested by 
more happily situated women friends, that the woman herself is 
not to blame for this condition, has a demoralizing effect upon her, 
and destroys the happiness of married life. (It has been confessed 
to me, in isolated cases, that the dyspareunia was relative only.) 
Apart from this, the absence of sexual gratification gives rise to a 
series of nervous troubles, presenting either the variable characters 
of hysteria, or else the symptoms of neurasthenia. Finally, the fre- 
quently repeated incomplete coitus, incomplete inasmuch as the 
woman does not experience the sensation of ejaculation, induces 
chronic hyperaemia in the female reproductive organs, passing on 
into blood stasis, and ultimately into chronic inflammatory tissue 
changes ; in this way arise metritis, perimetritis, and parametritis, 
salpingitis, oophoritis, disorders of menstruation, menorrhagia, and 
atypical uterine haemorrhages. The possibility cannot be disproved, 
that in this way new-growths of the reproductive organs may also 
originate. The act of sexual intercourse, which at first may be to 



360 The Sexual Life, ^f Woman. 

the woman a matter of comparative indifference, and in which she 
plays her part merely from a sense of duty, becomes, in cases of 
long-standing dyspareunia, something to which she feels a positive 
dislike, and is recognized by her as the actual cause of the troubles 
that ensue upon intercourse, such as sacrache, sensations of weight 
and pressure yn the pelvis, strangury, fluor albus, a feeling of ex- 
haustion, etc. 

At times, perverse sexual sensation is associated with dyspa- 
reunia. Women who find no enjoyment in normal sexual inter- 
course with a male, sometimes masturbate, sometimes indulge in 
amor lesbicus, etc. 

Of great importance appears to me the relation between dyspa^ 
reunia and sterility in women. As already pointed out, dyspareunia 
comes chiefly under medical observation in cases in which it is 
associated with sterility. The husband, seeking advice concerning 
his w^ife's failure to conceive, complains of her frigidity in sexual 
intercourse as the probable cause; or the wife comes to seek ad- 
vice, saying that she never experiences sexual gratification, and 
that for this reason she has failed to become pregnant. As a matter 
of actual fact, dyspareunia and sterility are associated with such 
remarkable frequency, that my own experience leads me to be- 
lieve in the existence of an etiological connection between the two 
conditions, at least in a certain proportion of the cases. Among 
69 sterile women whom I questioned regarding dyspareunia, the lat- 
ter condition was present in 26, that is to say, in 38,'/ of the cases. 
MattJiczvs Duncan reported that of 191 sterile women, 62 did not 
experience sexual enjoyment. Sexual excitement of the woman 
during copulation would certainly appear to have a definite bearing 
upon the occurrence of conception, for we know that by the volup- 
tuous sensation reflex actions are aroused in the genital canal, 
favouring the retention of semen and its passage through the os to 
the interior of the uterus, and perhaps also giving rise to reflex 
changes in the cervical secretion which favour the passage of the 
spermatozoa into the uterine cavity. 

In cases of relative dyspareunia, the influence of this condition 
m producing sterility is also manifested, the unfaithful wife being 
impregnated by her lover though she has remained sterile in inter- 
course v/ith the husband to whom she is indifferent. To dyspa- 
reunia of this nature (dependent upon sexual disharmony), we 
may also refer the sterility of a married pair who have for some 
time lived together in unfruitful intercourse, whereas, after divorce 
tiind the contraction of fresh unions, both the man and the woman 



The Sexual Epoch of the Menacme. 361 

prove normally fertile. Such cases have been personally known 
to me; and similar instances aroused the attention of the natural 
philosophers of antiquity, for instance, that of Aristotle. The im- 
portance of voluptuous sensation in promoting conception is also 
manifest from the fact that in the majority of women, after the 
pains of defloration, dyspareunia usually persists for a season during 
the early period of married life; and, corresponding with this, the 
first conception is usually deferred for some little time after mar- 
riage, to a period corresponding with the awakening of the sen- 
sation of ejaculation. ■ In this connection, Courty reports the case 
of a lady who, although in blooming health, remained sterile during 
the first fifteen years of her married life; she then gave birth to 
;a child whose father was unquestionably her lover ; and after this 
in succession to two other children whose progenitor was the legal 
husband. • This lady had never experienced voluptuous sensation 
in intercourse prior to the time of her first conception. Similar 
circumstances with an even clearer significance have been fre- 
quently observed among the lower animals ; and Darwin records 
several striking observations of this character. Taking all the 
evidence into consideration, we are compelled to regard dyspareunia 
as a condition capable of causing sterility in women, although the 
sequence is not an absolutely necessary or invariable one. 

In order to excite voluptuous sensation during intercourse, sav- 
age races make use of various means, some of which we here 
transcribe from the work of Ploss-Bartels. In Abyssinia, and on 
the Zanzibar coast, young girls receive instruction in certain rotary 
muscular movements known by the name of duk-duk, which they 
employ during coitus for the increase of sexual pleasure. Many 
Daiaks perforate the glans penis with a silver needle from above 
downwards ; this needle is kept in place like a seton, until a per- 
manent canal is formed through the glans : in order during coitus 
to stimulate the woman more powerfully, into this canal, just 
before coitus, various small articles are inserted, such as little 
rods of brass, ivory, silver, or bamboo, or silver instruments end- 
ing in small bundles of bristles; these project from the surface of 
the glans, and exercise a more powerful friction of the vagina, 
thus increasing the sexual pleasure of the woman. Men without 
such an apparatus are rejected by the women, whilst those who 
have made several such canals in the glans, and can therefore in- 
sert several instruments, are especially sought after and prized by 
the women. Such an apparatus is known as an ampallang, and 



2JS2 The Sexual Life of Woman. 

in a symbolic manner the woman indicates to a man of her choice 
her desire that he should make use of one; he finds in his bowl 
of rice a rolled-up leaf, enclosing a cigarette which represents the 
size of the desired ampallang. Among the Alfurs of North Cele- 
bes, in order to increase the voluptuous pleasure of the woman 
during intercourse, the men bind round the corona glandis the 
eyelids of a goat, beset with the eyelashes, thus forming a bristly 
collar ; in Java and in Sunda, before coitus, the men surround the 
penis with strips of goat-skin, leaving the glans free. In China they 
wind round the corona glandis torn fragments of a bird's wing; 
these also project like bristles and increase the friction. Among 
the Batta of Sumatra, travelling medicine-men perform an opera- 
tion by means of which they insert, beneath the skin of the penis, 
small stones, sometimes to the number of ten, at times also angular 
fragments of gold or silver; these heal in beneath the skin, and 
increase the stimulus of coitus for the women. Among the Malays 
of Borneo the penis is perforated, and some fine brass wire with 
the ends turned inwards is inserted: before coitus, the sharp ends 
of the wire are drawn out so as to project from the skin. 

In our own part of the world, voluptuaries make use of an india- 
rubber ring beset with spines, which before coitus is passed over 
the corona glandis, in order to promote sexual gratification in the 
woman during intercourse. In cases of diminished potency in the 
male, in order to produce suf^cient sexual excitement in the female 
by more powerful erection of the penis, various mechanical means 
are now employed. For instance, in such a partially impotent 
man, a constricting band of india-rubber may be passed over the 
root of the penis, whereby the reflux of blood from the corpora 
cavernosa is hindered, and a more complete and more enduring 
erection is induced. Elderly men have frequently declared to me 
that they were well satisfied by the employment of this simple 
measure, whilst behind their backs, their wives have assured me 
that the results were far from satisfactory. The apparatus de- 
scribed by Ronbaud for the enlargement of the penis is no longer 
employed. Partially impotent men make use, however, of an in- 
strument known by the name of " schlitten," made of gold, silver, 
or white-metal; it consists of two delicate laminae, united at the 
base by a metal ring, and at the upper end by an india rubber ring. 
This small apparatus, which must be made exactly to measure, ren- 
ders possible the introduction of the imperfectly erect penis into 
the vagina; it supports the penis, and readily accommodates itself 
to the change in size of the organ as it slowly becomes erect. 



The Sexual Epoch of the Menacme. 363 

Fertility in Women. 

Fertility in women is the basis of the fecundity of a nation, of 
its growth, its power, and its importance. It is especially the 
fertility of married women which enters here into consideration, 
and forms the source of the statistical data of fertility; these are 
usually obtained by drawing a ratio between the number of mar- 
riages contracted in a given period, and the number of children 
born in the same period. 

The fertility of women is a function beginning at an age vary- 
ing in dependence on many conditions, and undergoing extinction at 
a definite period of life. It is, in fact, associated with the duration 
of the sexual life of woman, and, generally speaking, extends 
from the sixteenth to the fiftieth year of life. Climate, 
race, constitution, and morbid conditions, influence alike the first 
appearance of menstruation and the first pregnancy; and as they 
influence the duration of menstrual activity, so also do they in- 
fluence the duration of fertility. 

In the Bible are recorded numerous instances of Jdie early 
commencement of fertility. At the present time also, in 
warm climates we meet with many examples of early mother- 
hood. From the great work of Ploss-Bartels, from which we 
have already frequently quoted, we extract and summarize the 
following ethnographical details. Among the wives of the Bos- 
jesman, mothers aged ten are frequently seen; travellers in New 
Zealand often saw mothers of eleven years, and mothers of the 
same age among the Samoyedes and in Palestine ; mothers of 
twelve in British Guiana, in Jamaica, among the Schangallas, at 
Shiraz in Persia, among the Copts in Egypt ; mothers aged thir- 
teen in Cuba, among the Sioux and the Dakotas, and in New 
Caledonia; mothers aged fourteen among the Negroes of Gaboon. 

According to the observations of Robertson, of sixty-five Indian 
women there gave birth for the first time : 

At the age of 10 years i 

At the age of 1 1 years 4 

At the age of 1 2 years 11 

At the age of 1 3 years 11 

At the age of 1 4 years 18 

At the age of i 5 years . . : : 12 

At the age of i 6 years 7 

At the age of i 7 years i 

Moreover, in the records of European countries, we find numer- 
ous instances of very early motherhood. Molitor^s case, a girl nine 



364 The Sexual Life of Woman. 

years old giving birth to a vesicular mole with an embryo; von 
Nailer's case, pregnancy in the ninth year of life; Cams' case, 
pregnancy at the age of eight. Caspar saw a girl in Berlin who 
became pregnant at the age of twelve, and was delivered of a 
living child. Riittcl saw a girl nine years of age pregnant. King 
attended the confinement of a girl who at the time of her delivery 
was not yet eleven years old. Taylor reports the case of a girl 
twelve years and six months of age who was then in the last month 
of pregnancy. Kohlanck attended a girl of fourteen who was 
delivered of a child weighing four and a half pounds. 

In most of these cases the premature fertility is followed by a 
premature cesssation of fertility. And there is more or less truth 
in Briicc's statement regarding the Arab women in Africa, that 
those who began to bear children at the age of eleven were seldom 
still fertile at the age of twenty. 

At times we may observe a remarkable extension of fertility be- 
yond the average age, that is, beyond the age of fifty years. 

In northern Europe pregnancy at a comparatively advanced age 
is by no means rare. From the official statistics of Denmark we 
learn that among 10,000 women, 465 were delivered at ages be- 
tween 50 and 55 years. In Sweden, of 10,000 mothers, 300 gave 
birth to children when more than 50 years of age. In Ireland, the 
proportion of mothers over* 50 was 345 per 10,000. In England 
the official figures dealing with the delivery of 483,613 women, 
showed that 7,022 were between 45 and 50 years of age, and 167 
over 50 years of age. 

The Surgical Academy of Paris, in an authoritative statement 
regarding the late age at which conception could take place, alluded 
to the fact that Cornelia, of the family of the Scipios, gave birth 
to Volusius Saturninus when sixty years of age, that the physician 
Marsa in Venice recorded the existence of pregnancy in a woman 
of sixty, that de la Motte recorded pregnancy in a woman of fifty- 
one, and that he believed it to be true that another Parisian woman 
had given birth to a girl at the age of sixty-three, and had herself 
suckled the infant. 

In an important case, however, which came before the Court of 
Chancery in England, the court held that there was no definite 
evidence of the possibility of pregnancy in a woman sixty years 
of age; but that the greatest age at which, in England, pregnancy 
had Indisputably occurred, was 54. 

Among 4,925 deliveries occurring in the Prague Maternity PIos- 



The Sexual Epoch of the Menacme. 365 

pital, Schzving reports that there were 9 women deUvered for the 
first time when over 40 years of age. Of these: 

3 were 41 years of age. 
2 were 42 years of age. 

1 was 43 years of age. 

2 were 44 years of age. 
I was 47 years of age.^ 

Haller reports the cases of two women who gave birth to chil- 
dren, one at the age of 63, the other at the age of 70 years. Mciss- 
ner dehvered a woman of 60 years of her seventh child ; Rush 
attended the delivery of a woman aged 60; Dczvees that of a 
woman aged 61. Mende and Bernstein report cases of delivery 
at the age of 60. Marion Sims saw, in the state of Alabama, a 
negro w^oman 58 to 60 years of age, who gave birth to a child at 
this age, at an interval of twenty years since her last pregnancy. 
Nieden reports a case in which the first pregnancy occurred 26 
years after marriage. When married, the wife was 18 years of 
age, the husband 30; during their first twenty-five years of married 
life there was no sign of pregnancy, but when the wife was 44 
years of age, menstruation, hitherto regular, suddenly ceased ; the 
cause of the cessation proved to be pregnancy, and at term a 
healthy girl weighing nine pounds was born ; the mother was able 
to nurse the child herself. Smith attended a woman aged 52 who 
was delivered of twins; the youngest of her eight other children, 
who were then all living, was ten years of age. 

Rodsezvitsch collected from the Russian literature of the years 
1872 to 1881, eleven cases in which women aged 50 to 55 had given 
birth to children. Talquist reports that in Finland, in the year 
1883, a woman 58 years of age was delivered; whilst Ansell re- 
cords the case of an Englishwoman who became a mother when 
59 years of age. John Kennedy records the case of a woman of 
62 who was normally delivered at this age ; she had begun to 
menstruate at the age of 13, and since the age of 20 had pre- 
viously given birth to 21 children, the last five when she was 47, 
49' S^y SZy ^^^ 56 years of age, respectively. Prior even reports 
the case of a woman y2 years of age, who not only menstruated, but 
had an abortion ( !) 

The ideal of fertility in women is that the first completed act of 
sexual intercourse should be followed immediately by conception, 
that the pregnancy should terminate after the normal lapse of 
time in the birth of a child, and that the same process should be 



7f£ The Sexual Life of Woman. 

repeated at intervals of about ten months until the end of active 
sexual life. In actual experience, however, this never occurs. 
Fertilization as an immediate consequence of the first act of sexual 
intercourse (which in the lower animals is regarded as the rule) 
is a very rare occurrence in human beings. Moreover, in no 
single marriage is the reproductive capacity of the wife utilized 
to the full, up to the time of extinction of her generative faculty ; 
either because the potency of the male partner undergoes a gradual 
decline, or, it may be, because, after a while, sexual intercourse 
becomes less frequent, or because precautions against procreation 
are taken. 

The number of children to which during the three decades of 
her sexual life, from the menarche to the menopause, a woman 
might theoretically give birth, is never actually born. If we as- 
sume that, during the period of active sexual life, a woman re- 
quires a period of fifteen months to two years for each pregnancy, 
parturition, and lactation, a woman could easily during this period 
have fifteen or sixteen children, and this figure would represent 
the normal product of the normal fertility of the human female. 
There are indeed, women who, it may be in consequence of an 
exceptionally long period of sexual activity, or through giving 
birth repeatedly to twins or triplets, or because they have married 
several husbands in succession, have given birth to twenty- four 
children or even more. In Berlin, in the year 1901, there lived a 
woman 41 years of age who had had 23 children; there were three 
women, aged respectively 40, 43, and 46 years, who had had each 21 
children; 246 women with families numbering 13 to 20; and 169 
women each of whom had given birth to 12 children. In the 
very great majority of cases, however, the fertility of the wife of 
the present day is never fully developed. It is modified in various 
ways by the conditions of marriage, by social circumstances, by 
considerations relating to the health of husband or wife, by actual 
illnesses, and by voluntary limitation of fertility. Generally speak- 
ing, according to the investigations of Quetelet, Sadler, and Finlay- 
son, the fertility of women is greatest in marriages in which the 
husband is as old as the wife, or a little older, but without marked 
difference in age. Alarriages contracted at a very early age are 
less fruitful ; the highest fertility is found in marriages contracted 
when the husband is 23 and the wife 26 years of age. 

Conception does not generally take place until sexual intercourse 
has been frequently repeated. As the result of a statistical enquiry 



The Sexual Epoch of the Menacme. 367 

of my own, relating to 556 fruitful marriages, I ascertained that in 
these the first delivery occurred : 

Within 10 months after marriage in 156 cases. 
Within II to 15 months after marriage in 199 cases. 
Within 16 to 24 inonths after marriage in 115 cases. 
Within 2 to 3 years after marriage in 60 cases. 
More than 3 years after marriage in 26 cases. 

Thus we learn that in 35.5% of the cases the first delivery occurred 
within I !4 years after marriage; in 15.6% within 10 months; and in 
19.9% within 15 months after marriage; and 11.5% of the cases, the 
firs-t delivery was more than 1% years and less than 2 years after 
marriage; in 6.0% it was between 2 and 3 years after marriage ; and 
in 2.6%, the first delivery did not occur until more than 3 years 
after marriage. 

From examination of the birth registers of Edinburgh and Glas- 
gow, Matthezvs Duncan determined the mean interval between mar- 
riage and the birth of a living child to be seventeen months. In 
the majority of cases, the first delivery does not occur until a com- 
plete year has elapsed since marriage ; in fact, in nearly two-thirds 
of the instances the first delivery occurs during the second year of 
married life. 

The interval between two successive births is, according to 
Matthews Duncan, on the average 18 to 24 months, according to- 
Goehlert, 24 to 26 months ; the latter, however, points out that in 
cases in which the child dies very soon after birth, the birth of the 
next child ensues on the average in 16 to 18 months. In this con- 
nection, we must not fail to take into consideration the influence 
of lactation, inasmuch as mothers who do not suckle their children 
become pregnant considerably earlier, on the average, than those 
who undertake this duty. In reigning families, for instance, it is 
by no means uncommon for the consort to be delivered twice 
within a single year. The degree to which lactation hinders concep- 
tion is so widely known, that women often suckle their infant for a 
very long period, with the definite aim of preventing the speedy re- 
currence of pregnancy. A high official from the Dutch Indies in- 
formed me that for this reason the native women were accustomed 
to suckle their infants for several years, and that it was by no 
means uncommon to see a small boy running about smoking a cigar, 
and then hurrying to his mother in order to be suckled. 

The age at which a woman contracts marriage has also to this 
extent an influence upon her fertility, inasmuch as it appears that 
those who marry very young are far less fertile than those who 



368 



The Sexual Life of Woman. 



marry between the ages of 20 and 25 years; the latter moreover 
have, on the average, a shorter time to wait for their first concep- 
tion than women who marry before the age of 20. Women who 
marry after the age of 25 have to wait longer after marriage for 
their first delivery ; in fact the older the woman after 25, the 
greater, on the average, the interval between marriage and the 
first delivery. 

Arranging the data already referred to, regarding 556 fruitful 
women, in relation to this point of view, it appears that the first 
birth ensued: 



Within 

10 
months 
of 
mar- 
riage. 



10 to 15 
months 
after 
mar- 
riage. 



15 
months 
to 2 
years 
after 
mar- 
riage. 



2 to 3 
years 
after 
mar- 
riage. 



More 
than 
3 years 
after 
mar- 
riage. 



In 163 women marrying at 

ages 15 to 20 years 

In 313 women marrying at 

ages 20 to 25 years 

In 70 women marrying at 

ages 25 to S3 years 

In 10 women marrying at 

ages over 2i3 years 



36 


53 


98 


113 


18 


30 


4 


3 



46 
56 

12 
I 



18 
32 

9 
I 



10 

14 

I 

I 



To give percentages, the first birth occurred, 





Within 

10 
months 
of 
mar- 
riage. 


10 to 15 
months 
after 
mar- 
riage. 


months 
2 to 
years 
after 
mar- 
riage. 


2 to 3 
years 
after 
mar- 
riage. 


More 
than 
3 years 
after 
mar- 
riage. 


Women marrying at ages 1 5 
to 20 years, in 

Women marrying at ages 20 
to 2 1^ years, in . 


22.0% 
3^-3% 
25-7% 
40.0% 


32.5% 
36.1% 
42.8% 

30-0% 


28.2% 

17-8% 

17-1% 
10.0% 


11.0% 
10.2% 
12.8% 
10.0% 


8-1% 

4.4% 

1-4% 

10.0% 


Women marrymg at ages 25 
to 33 years, in 


Women marrying at ages 
over 33 years, in 



The Sexual Epoch of the Menacme. 



3^9 



Thus whereas in women who contracted marriage between the 
ages of 15 and 20 years, only 54.5% were confined for the first time 
within 15 months after marriage, in women who contracted mar- 
riage between the ages of 20 and 25 years, in 67.4% the first de- 
hvery occurred within 15 months of marriage. And whereas in 
those who married at the earher age, the percentage of first de- 
liveries occurring between 15 months and 2 years after marriage 
was 28.2, in those who married between the ages of 20 and 25, 
the percentage of first deUveries after the stated interval was 
only 17.8. 

The figures compiled by Whitehead and Pfannkuch give similar 
results. Of 700 women who married between the ages of 15 to 
20 years, there were 306 only who gave birth to a child within the 
first two years after marriage; whereas of 1,835 women who mar- 
ried between the ages of 20 and 25 years, no less than 1,661 gave 
birth to a child within two years after marriage — a percentage 
of 43.7 in the former case, and 90.6 in the latter case. Pfannkuch, 
as the result of a very large collection of figures relating to this 
question, found that in women marrying before the age of 20 
years, the average number of months before the first delivery was 
26', whereas in women marrying after the age of 20 years, the 
average number of months before the first delivery was 20. 

According to Matthezvs Duncan 





There Become Mothers 


Of Every 100 Women Who Marry 


In the 

I St year of 

married 

life. 


In the 

2d year of 

married 

Hfe. 


Between the ages of 15 and 20 years 


13-71 
18.48 
12 .41 

11.44 
9.27 


43 70 
90-51 
75-80 
62.93 
40.97 


Between the ages of 20 and 25 years 


Between the ages of 25 and 30 years 


Between the ages of 30 and 35 years 


Between the ages of 35 and 40 years 





Sadler examined the relationship between the age at which mar- 
riage was contracted and the number of offspring in the case of 
the wives of English peers. He obtained the following results: 

Age at marriage. Births per marri.age 

12 to 16 years 4.40 

16 to 20. years 4-63 

20 to 24 years 5-2i 

24 to 28 years 5-43 

24 



3/0 



The Sexual Life of Woman. 



From exact statistical data of births in the Scandinavian coun- 
tries of Europe (Denmark, Sweden and Norway), Gochlert com- 
piled the following table, showing the percentages of fertility at 
various ages : 



Ages. 



Under 20 
From 20 
From 25 
From 30 
From 35 
From 40 
Over 45 



years 

to 25 years 
to 30 years, 
to 35 years, 
to 40 years 
to 45 years, 
years 



Married Women. 



Den- 
mark. 



I . o 

139 
26. 5 
26. 7 
21.0 
9.9 
I . I 



Swe- 
den. 



1 .0 
12.8 
24.7 
26 . I 
21.6 
12 .0 

1.8 



Nor- 
way. 



Unmarried Women. 



Den- 
mark. 



9.1 

43-9 

28.1 

II .4 

5-4 

2 . I 



Swe- 
den. 



7.0 

351 

27.9 

16.8 

9.0 

4.2 



Nor- 
way. 



4 

37 
32 
14 

7 



From this table it appears that the fertility of married women 
increases steadily up to the age of 35 years, but after this age it 
begins to decline. What a marked influence the age at marriage 
has upon fertility is shown by the comparison of the figures relat- 
ing to married women with those relating to unmarried women; 
the fertility of unmarried mothers attains its maximum at the 
ages of 20 to 25 years. In the countries under consideration the 
average age of women at the time of marriage is 25 to 2^ years. 

In order to obtain a still clearer picture of the fertility of 
women in relation to age, Goehlert has combined the figures relat- 
ing to the married and the unmarried, and then calculated the 
percentages, with the following results: 



Ages. 



Under 20 years 

From 20 to 25 years 

From 25 to 30 years 

From 30 to 35 years 

From 35 to 40 years 

From 40 to 45 years 

From 45 to 50 years \ 

Over 50 years J 



Married and Unmarried 
Women. 



Denmark. 



1-7 
16.6 
26.6 

253 

19.6 

9.2 



Sw^eden. 



1.6 

151 
25.0 

251 
20 . 4 
II . 2 

1.6 



Norway. 



I 
14 
25 
24 
20 
12 



2.9 



The Sexual Epoch of the Menacme. 371 

If, finally, we combine into a single table the figures relating to 
all three of these countries, we obtain the following results: 

Under 20 years i-5% 

From 20 to 25 years 15.3% 

From 25 to 30 years 25.6% 

From 30 to 35 years 24.9% 

From 3 5 to 40 years 20.0% 

From 40 to 45 years 10.9% 

Over 45 years i.S% 

From these figures it appears that the maximum fertility of 
married women is attained, in Denmark at the age of 31, in Nor- 
way at the age of 31.7, and in Sweden at the age of 32 years. In 
the case of unmarried women, the maximum fertility is at the 
ages of 24 to 26 years. In the Austrian Empire, the maximum 
fertility of women is attained at about the age of 30 years; in 
England it is attained between the ages of 20 and 25 years. 

Divergent results as regards the fertility of married women at 

different ages were obtained by Goehlert from the examination of 

5,290 cases from the reigning families of Europe. In the favourable 

position as regards means of subsistence occupied by the members 

of these families, marriage naturally occurs, in most cases, much 

earlier in life, the mean age at marriage being between 19 and 22 

years — the youngest mother (in the Capet dynasty) was only 

13 years of age — and for this reason the figures relating to the 

younger age-classes are larger than in the previous tables. But as 

a result of this, the reproductive capacity also undergoes an earlier 

extinction, so that of these women, not one gave birth to a child 

when she was over 50 years of age. Goehlert gives the following 

table, compiled from these 5,290 instances : 

Under 20 years 8 . 8% 

From 20 to 25 years 25 .4% 

From 25 to 30 years 29.4% 

From 30 to 35 years 21.6% 

From 3 5 to 40 years 11.5% 

Over 40 years 3-3% 

In these cases the maximum fertility was obtained at the age 
of 2y. 

The physiological fertility of women is much more clearly mani- 
fested when we compare the fertility of women who have been 
married a few years only, with the fertility of women in the 
later years of married life. In the earlier period, the effective 
fertility more nearly approaches the physiological fertility, because 
at this time the various influences by means of which fertility is 



372 



The Sexual Life of Woman, 



later so greatly diminished have not yet come into operation. In 
this connection the following data, published by Korosi, regarding 
the percentage fertility of recently married women, and that of 
married women in general, will be found of interest: 




All 
married 
women. 



At ages 20 to 35 years 
At ages 35 to 40 years 
At ages 40 to 45 years 



20.6% 

14.7% 
5-9% 



Inasmuch as we learn from this table that in the case of women 
aged 40 and upward, the newly-married exhibit a fertility of four 
times as great as that of married women in general, in whom 
pregnancy has already become rare, we can infer the influence 
upon fertility of abstinence and of artificial measures for the pre- 
vention of conception. 

On the average, the maximum fertility of woman, that is, the 
maximum of effective fertility, is attained at the age of 18 to 20 
years. Extreme youth fulness, and also the opposite condition, 
too advanced an age, when marriage is entered on, impair a wo- 
man's fertility; whereas the conditions most favourable to fertility 
are that, at the time of marriage, the uterus should have attained 
its fullest development, and the ovaries also should be completely 
mature ; this is not usually the case at puberty, but rather at the 
age of 20, 21, or 22 years. In Austria-Hungary, of 100 marriages 
in which 'the wife's age at marriage was less than 18 years, the 
average offspring in the course of a single year were 36 to 38 
children; in the case of 100 marriages in which the wife's age at 
marriage was 18 to 20 years, the average offspring in a year were 
40 ; this being the maximum fertility, the number of offspring in a 
year per hundred marriages (i. e., the percentage fertility), now 
undergoes a regular decline as the wife's age at marriage increases ; 
at an age of 25, the percentage fertility is 32; at the age of 30 
years, the fertility is 24% ; at the age of 35, 17% ; at the age of 
40 years barely 10% ; at the age of 45, 7% ; at ages 45 to 50, 
6.1%. Thus, from the last figure, we see that of a thousand women 
marrying at the age of 50 years, one only gives birth to a child. 



The Sexual Epoch of the Menacme. 



373 



Men obtain their maximum fertility (i. e., procreative capacity) 
at the age of 25 or 26 years; at this age their fertihty amounts to 
35% (that is, of 100 marriages -at this age, 35 children will on the 
average be born within a single year) ; at the age of 35 years, the 
percentage fertility of men falls to 23 ; at the age of 45 years, it is 
9>^%; at 55, 2.2%; at 65, ^% {Kdrosi-Blaschko). 

Whereas hitherto we have considered only the monogenous fer- 
tility of married women, we must remember that the figures relat- 
ing to their biogenous fertility are also of interest — that is to say, 
the changes which a woman's fertility experiences in married life 
in respect of the peculiarities of her husband ; and of these pecu- 
liarities, the easiest to make the object of statistical investigation is 
the husband's age. The age of the husband exercises an important 
influence upon the fertility of the wife, as is proved by the follow- 
ing figures published by Kbrosi: 



Age of the Father. 



25 to 30 years 
30 to 35 years, 
35 to 40 years . 
40 to 45 years. 
45 to 50 years. 
50 to 55 years, 



Age op the Mother. 



25 years. 



35-6% 
31-2% 



30 years. 



25 


0% 


23 


6% 


21 


8% 


16 


7% 


14 


4% 



35 years 



21.2% 
19-9% 
19-4% 
14.0% 

10.9% 
10.9% 



Also: 



Age of the Mother. 



Age of the Father. 



25 years. 



35 years. 



45 years. 



55 years. 



Under 20 years. 
20 to 25 years. . 
25 to 30 years, . 
30 to 35 years.. 
35 to 40 years.. 
40 to 45 years. . 



49-1% 
43-o% 
30.8% 
33-5% 



31 
27 
23 
18 
6 



3% 
3% 
7% 
9% 
6% 



16.0% 
18.5% 
14-4% 
11.8% 
6.1% 



8.1% 
6.7% 
3-o% 



We learn from these figures that the maximum fertility is ex- 
hibited by a woman 18 years of age, when married to a man 25 
years of age; less fertile is a woman 25 to 30 years of age married 
to a man 28 years of age ; still less fertile is a woman 35 years of 
age married to a man 29 years of age. Neither the age of the 



374 The Sexual Life of Woman. 

mother alone, nor that of the father alone, is determinative of the 
fertility of the marriage, for the fertility of young wives married 
to elderly husbands is quite different from that of young wives 
married to young husbands. Very various age-combinations are 
possible, and each exhibits an average fertility peculiar to itself. 

We can also regard the question from the standpoint of the 
difference between the ages of husband and wife respectively. In 
this connection, Korosi is led by his tables to the conclusion that 
wives between the ages of i8 and 20 years attain their maximum 
fertility when married to men 7 years older than themselves ; women 
of 25 years when married to men 3, years older than themselves; 
women of 29 years when married to men of the same age ; women 
of 30 years and upward attain their maximum fertility only when 
married to men younger than themselves. Men, on the contrary, 
always attain their maximum fertility when married to women 
younger than themselves. The age of maximum fertility differs 
in the two sexes, and those marriages will be most fruitful in which 
husband and wife are each of the age most favorable to fertility. 
This will be the case when the age of the wife is 18 to 20 years, 
and that of the husband 24 to 26 or perhaps 29 years. 

In connection with the question of fertility, we have also to take 
into consideration the vitality of the children born, that is, what 
proportion of those born survive. According to Korosi s interest- 
ing papers regarding the fertility of the inhabitants of Buda- 
Pesth, we learn that for every 100 marriages which have persisted 
for thirty years and upward, there were born, on the average, 539 
children, of whom- during this period 241 died, so that the per- 
centage of survivals was 55.28. Parents who have lost one only 
of several children must, therefore regard themselves as excep- 
tionally favoured by fortune. 

Social position, occupation, and religion, have, according to the 
last-quoted author, a notable influence on fertility. His investiga- 
tions showed that the Roman Catholics and the Jews exhibited the 
greatest fertility; among the Catholics there were 541 children, 
and among the Jews 557 children, per 100 marriages. Amongst 
100 Protestant families, on the other hand, only 479 children had 
been born. It will be seen that the theory of the comparatively 
enormous fertility of the Jewish race is not supported by these 
statistics. The Jews do, however, exhibit a greater power of rear- 
ing children, for among them the marriages of more than 30 
years* duration had 61 2^% of the children still living; among the 
Protestants 57)4% survived; and among the Catholics only 52)/^%. 



The Sexual Epoch of the Menacme. 375 

It thus appears that the surviving offspring per 100 marriages of 30 
years' duration were, among the CathoUcs 278, among the i'rotest- 
ants 252, and among the Jews 349. 

The question whether, and to what extent, the age of the parents 
has an intluence on the vitahty of the children, is answered hy 
Kordsi's mortahty statistics in the sense that mothers below 20 
years of age give birth to a larger proportion of children deficient 
in vital power. Where the mothers had married at the age of 16, 
the mortality of their offspring was, among Catholics 43%, among 
Jews 33% ; married at 17, Catholic mortality 44%, Jewish 
30% ; married at 18, Catholic mortality 42%, Jewish 32% ; married 
at 19, Catholic mortality 41%, Jewish 29% ; married at 20, Catholic 
mortality 40%, Jewish 26%. Of the children whose fathers had 
married at the age of 24, 32% had died; of those whose fathers had 
married at 23, 37% had died; of those whose fathers had married 
at 20, 42% had died; and of those whose fathers had married be- 
fore 20, actually 44% had died. It thus appears that the children 
alike of very young mothers and of very young fathers have a 
lessened chance of survival. 

Inasmuch as the fertility of the wife is a product of two factors, 
her own peculiar fertility, and that of the procreating male, the 
question of the fertility of women cannot be accurately treated in- 
dependently of this second consideration; hereby, however, is intro- 
duced a multiplicity of obscure combinations, by which the value of 
all the statistical data of fertility in women is seriously impaired. 

These data give as the measure of fertility, the number of chil- 
dren per marriage actually brought up, embracing fruitful mar- 
riages, sterile marriages, and those not yet fruitful. In Berlin, in 
Copenhagen, and in Buda-Pesth, the average thus attained was 
slightly less than three births to each family, whilst the number 
of children actually living averaged two per family. A more ac- 
curate representation of fertility is obtained by ascertaining the 
number of children born, and the number of children living in 
relation to the duration of marriages reckoned in years, that is 
beginning with marriages of one year's duration, and proceeding 
year by year to the highest recorded duration of marriage. In 
this way interesting statistics have been obtained; for example, one 
who has completed thirty years of married life may count on the 
average that five or six children will have been born to him, but 
may also reckon on having buried two or three at least of these. 
(Korosi.) 



3^6 The Sexual Life of Woman. 

Fertility is, as many facts indicate, also dependent on nutrition. 
A distinct proof, says Spencer, writing on the '' Coincidence be- 
tween high Nutrition and Genesis," that abundant nutriment in- 
creases the number of births, and vice versa, is found among the 
mammalia; compare, for instance, the litter of the dog with that 
of the wolf and the fox. Whilst the dog's litter numbers 6 to 14, 
that of the wolf numbers 5 to 7, that of the fox 4 to 6. The 
wild cat gives birth to 4 or 5 kittens once a year, the domesticated 
cat to 5 or 6, twice or thrice annually. The most remarkable con- 
trast, in this respect, exists between the wild and the domesticated 
breeds of swine. The wild sow gives birth once a year to a litter 
of 4, 8, or 10 pigs (the number increasing in successive litters) ; the 
domesticated sow has often as many as 17 in a single litter, whilst 
in two years five litters, each numbering 10 pigs, are commonly 
born. 

Darwin also draws attention to the fact that animals under 
domestication, being fed more abundantly and regularly than their 
wild allies, procreate at shorter intervals and are markedly more 
fertile than the latter. He states that the wild rabbit has four 
litters annually, each numbering 4 to 8 young; whereas the tame 
rabbit reproduces its kind six to seven times annually, and gives 
birth to litters numbering 4 to 11. Among birds, analogous phe- 
nomena are observed. The wild duck, for instance, lays 5 to 10 
eggs in the course of the year, whereas the tame duck lays from 
80 to 100; the wild grey goose lays 5 to 8 eggs, the domesticated 
goose 13 to 18. 

It must be added that this exceptional fertility is manifested in 
animals that are quite inactive in comparison with their wild allies ; 
not only are they richly fed, but they get their food without work- 
ing for it. Moreover, it is easy to observe that among the domes- 
ticated mammals the well-fed are more fertile than the ill-fed. 

That in the human species also, fertility is influenced to a notable 
degree by nutritive conditions, is shown by statistical investigation. 
After years distinguished by an exceptionally good harvest the 
number of children born is considerably greater than in normal 
conditions ; whereas after a famine the opposite is observed. 
MalfJnts's law of population states, inter alia, that the population 
increases when the amount of available nutriment increases, that 
is, that favourable nutritive conditions cause an increase, that un- 
favourable nutritive conditions cause a decrease, of population. 
Hardships and exhausting occupations diminish the fertility of 
women. The remarkable fertility of the Kaffirs is referred to the 



The Sexual Epoch of the Menacme. 377 

fact that this people, possessing large herds of cattle, lead a life 
comparatively free from care ; it is no less true that the Boer 
women, who lead a life of well-fed leisure, have very large fami- 
lies ; whereas the Ilottentot women, poor, ill-nourished, and hard 
working, seldom bear more than three children. 

Generally speaking, it may be said that fertility of the soil, in 
connection with an easily gained livelihood, favours also human 
fertility, notwithstanding the fact that certain statistical data seem 
to conflict with this proposition. Sadler, for instance, concludes that 
an increase in the price of the necessaries of life does not perse 
check fertility, but, indeed, rather increases it ; he considers that 
the apparent decline in fertility is due to the fact that the number 
of marriages diminishes, owing to the rise in prices. We must, 
however, point out, that an increase in price of the necessaries of 
life is often associated with a rise in wages, and is therefore not 
necessarily identified with deficient nutrition ; when, however, such 
a rise in prices leads to actual want, a limitation of fertility will 
certainly result ; this has been proved by Legoyt and Villermc with 
regard to failure of the crops. Famine and disease lower the 
number of births; a less severe deficiency of nutriment often lowers 
only the quality of those born. Malthus was of opinion that the 
population of a country at any time was related to the quantity of 
nutriment proiluced or imported therein, on the one hand, and, 
on the other, to the liberality with which this nutriment was dis- 
tributed to the individual. In countries where corn forms the 
principal crop, we find a thicker population than in pasture lands ; 
and where rice is the principal crop, the population is even more 
abundant than it is in corn growing countries. 

Passing to the consideration of the individual nutritive elements, 
we find that these also influence fertility. Above all, it has been 
proved that alcohol notably diminishes the fertility of women. 
Lippich states that of 100 women in Karnten and Krain suffering 
from chronic alcoholism, 28.3 were barren. In England, where the 
abuse of alcoholic beverages is also very frequently observed in 
women, the same phenomenon has been noted. Matthews Duncan 
held that alcohol exercised a specific deleterious influence on fer- 
tility. Moreover, in addition to the constitutional disturbances pro- 
duced by the abuse of alcohol, this beverage also exercises a well- 
known pathogenetic influence upon the female reproductive or- 
gans ; with especial frequency, chronic oophoritis may be shown to 
depend on this exciting cause. 



378 The Sexual Life of Woman. 

A diet consisting mainly of fish is known to increase the sexual 
impulse, and is said also to increase fertility. Further, a diet con- 
sisting mainly of potatoes or rice is said to favour reproduction; 
compare, for instance, the fertility of the Hindoos, who abstain 
entirely from animal food, and of the Chinese, who live chiefly on 
rice. Davy maintained that the women of races living chiefly on 
fish were handsomer and more fertile than others : and Mon- 
tesquieu suggested that there was an association between the abun- 
dant population of sea-ports and also of Japan and China, and the 
large quantity of fish consumed in those places. On the other 
hand, a diet consisting chiefly of meat is said to have an unfavour- 
able influence in this direction ; in support of this view it is pointed 
out that races living by the chase, and living therefore almost en- 
tirely on meat, have very small families. This generalization is 
invalidated by the fact that Englishwomen, who eat far more 
meat than the women of the Latin races, are nevertheless dis- 
tinguished by their great fertility. 

In his " History of Civilisation in England " Buckle writes : ** The 
population of a country, although influenced by many other con- 
ditions, unquestionably rises and falls in proportion as the supply 
of nutriment is abundant or the reverse." Herbert Spencer also 
states that " every increment in the supply of nutriment is followed 
by an increment in fertility." 

It must not be forgotten that, in addition to the more or less 
abundant supply of nutriment, there are always other influences 
afifecting fertility; the general mode of life, race, climatic condi- 
tions, etc., may, in various ways, co-operate with or countervail the 
influence of nutritive conditions. If, with the best possible supply 
of nutriment, there is associated a luxurious and enervating mode 
of life, the abuse of alcohol, severe intellectual exertion, or sexual 
excesses, the general result will be a diminution in fertility. And 
it is easy to understand why Cros, although perhaps with little jus- 
tification, goes so far as to regard easy circumstances as an active 
cause of depopulation. '' It is the poor," he writes, " and the less 
wealthy departments of France, in which we find the most chil- 
dren." In estimating fertility, however, we must never fail to take 
into consideration the more extensive employment of means for the 
prevention of pregnancy among the upper classes of society. 

To a certain extent we can trace the influence of climate and of 
season upon fertility. Heat appears to favour fertility; Haycraffs 
figures for the eight largest towns of Scotland show clearly how 
the number of conceptions rises and falls pari passu with the tem- 



f 



The Sexual Epoch of the Menacme. 379 

perature. Lower animals also, when brought from a colder to a 
warmer neighbourhood, exhibit an earlier and more frequently 
recurring '' heat." In Europe, however, the Northern races appear 
more fertile than those of the south. 

Of the seasons, spring is the one especially favourable to 
fertility. Quetelct, who proves by numerous statistical data that 
the maximum of conceptions occurs in May, attributes this fact to 
a general increase in the vital forces occurring in spring, after the 
cold of winter. Villerme, however, goes back to the older expla- 
nation, that the increase in the number of conceptions in May and 
June is due to social and economic conditions. The return of 
spring, especially the end of spring and the beginning of summer, 
a time of year in which the means of subsistence are provided in 
exceptional quantity, and of especially good quality, the season also 
of festivals and social reunion, when the two sexes are brought 
into more intimate contact and when the majority of marriages 
occur — these are the conditions associated with the season of 
greatest fertility. The figures of Wappaeus also confirm the in- 
fluence of spring in favouring fertility. He found, however, that 
there were two seasons of maximal fertility. The first at the end 
of spring and the beginning of summer ; the second in winter, 
especially in December. Mid-winter is for most people a period 
of domestic amusement and relaxation, one of exceptionally good 
nutrition, and of social reunion; the spring increase in fertility is 
a part of the awakening and increase of the reproductive forces 
of nature at large, which recurs every spring-time. 

Every marked and sudden change in the mode of life has an 
unfavourable influence on fertility. Darzvin reports that mares who 
have for some time been stall-fed with dry fodder and are then 
put out to grass are at first infertile after the change. Europeans 
going to reside in the tropics experience a notable decline in fer- 
tility as a result of the change of climate. According to Virchow, 
the fertility of European women who become acclimatized in the 
tropics declines very gradually, but in the course of a few -genera- 
tions is almost completely annulled. 

The marriage of near kin is believed also to diminish fertility. 
As regards in-breeding in the lower animals, it is well known that 
when nearly related animals copulate, the number of the offspring 
is below the average. Nathusius paired a sow with its own uncle, 
the boar having proved productive in intercourse with other sows ; 
the litter numbered five to six only. This sow, which belonged to 
the great Yorkshire race, was then paired with a small black boar, 



380 The Sexual Life of Woman. 

which in intercourse with sows of its own variety had procreated 
Utters numhering six or seven ; as a result of her first pairing with 
the black boar, the sow cast a litter numbering twenty-one whilst 
the second attempt produced a litter of eighteen. Similar results 
were obtained by Crampc, in his experiments in the inbreeding of 
rats. 

Some authorities declare that the results of in-breeding are simi- 
lar in the human species, that the marriages of near kin are less 
fruitful than the average. Darivin writes in this connection: 
" With regard to human beings, the question whether breeding 
in-and-in is also deleterious, will probably never receive a direct 
answer, for man reproduces his kind so very slowly, and cannot be 
made the object of experiment. The very general disinclination 
of nearly all races to the marriage of near kin, which has existed 
from the very earliest times, is of weight in relation to this ques- 
tion. Indeed we appear almost justified in applying to the human 
race the experience gained by experiment on the higher mammals." 
Darwin s assumption regarding the effect upon fertility of the 
marriage of near kin in the human species, cannot, however, be 
accepted without qualification. In ancient times there was no uni- 
formity of opinion on this topic. It is well known that among 
the Phoenicians, a son might marry his mother, and a father his 
daughter; and among the ancient Arabs it w^as the legal duty of 
the son to marry his widowed mother. Moses, on the contrary, 
forbade marriages between parents and children, between brothers 
and sisters, also marriage with a father's sister, with a wife's mother, 
and with an uncle's widow. 

Darwin considered that the marriage of first cousins was not un- 
favourable to fertility. Of 97 such marriages, 14 were sterile, 
whilst of 217 marriages of those not akin, 35 w^ere sterile; the per- 
centage in both cases being almost identical. Mantcgazza, who re- 
gards kinship in marriage as unfavourable to fertility, found never- 
theless that among 512 marriages of near kin, only 8 to ()fc were 
sterile. It is widely believed that the dying out of many aristo- 
cratic families is dependent on the in-breeding so common in this 
class — but it must be admitted that scientific evidence in support 
of this belief is lacking. Incest in the human species may certainly 
result in fertilization. Among the Jews, marriages of near kin are 
very common, and often prove extremely fruitful. 

Gohlert made a statistical investigation of the fertility of the 
reigning families of Europe, in order to throw light on this question. 
In the Capet dynasty, 118 marriages of near kin took place, and of 



The Sexual Epoch of the Menacme. 



3S1 



these 41 were sterile; in the Wettiii dynasty (Saxony), there were 
28 such marriages, of which 7 were sterile, and i produced one 
child only ; in the W'ittelsbach dynasty (Bavaria), 29 such marriages, 
of which 9 were sterile, and 3 produced only one child each. Thus 
of 175 marriages of near kin, 57, or 32.6;^ remained sterile. Fur- 
ther, in the liabsburg-Lothringen dynasty, of no marriages, 25 
were marriages of near kin, and of these 33;^ remained sterile. 

It has been assumed since the days of antiquity that temperament 
and constitution exercise some influence on fertility. Hippocrates, 
Soranus, and Diokles, are among the ancient authors who refer to 
this matter. Soranus says very justly: " Since most marriages are 
contracted, not from love, but for the procreation of children, it 
is irrational, when choosing a wife, to have regard, not to her prob- 
able fruit fulness, but instead of this to the social position and the 
wealth of her parents." 

It would appear that a certain dissimilarity in physical consti- 
tution and temperament between husband and wife is favourable 
to the fertility of the marriage. For instance, a vivacious, dark 
husband, and a lethargic, fair wife, are better suited to one another 
than a husband and wife both extremely active, or both of ex- 
tremely phlegmatic temperament. 

Toussaint Lona published the following figures regarding the 
fertility of the women of the various countries of Europe: 



Country. 



Number of 

births per 

hundred 

inhabitants. 



Fertility of Women Between 
THE Ages of 15 and 45 Years.] 



Married. Unmarried. Average 



Hungary . . . 

Russia 

Austria. . . . , 
Germany . . , 

Italy 

Holland. . . , 
Finland . . . . 
England . . . . 
Scotland . . . 
Belgium. . . 
Denmark. . 
Roumania. 
Norway . . . 
Sweden ... 
Switzerland 
Greece .... 
Ireland .... 
France .... 



4-94 
4. 12 

3-93 
3-7«7 
3-67 
367 

3 
3 
3 
3 
3 



58 
53 
25 
12 
12 
3.10 
3-05 
3-04 
2 . 96 
2 . 69 
2.63 







34 


8 


28 


8 


35 


3 


29 


7 


32 


8 


33 


7 


28 


5 


29 


3 


29 


I 


29 


7 



29.-8 
20.3 



2.9 

2.4 

1 .0 



1.6 

2-5 

1.8 
2.8 



2 . 2 

2-5 

I . I 



17.8 
20.5 

16 . 4 
17.7 
16. I 
16.0 
15.8 

15-5 
15.8 
14.8 
14.4 
135 
14 . o 

13 
13 



^82 The Sexual Life of Woman. 

In towns, conjugal fertility is less, extra-conjugal fertility greater, 
than in the country. An increase in factory-labour gives rise to an 
increase in the population, but to a decline in the vitality of the 
oitspring; that is to say, it causes a quantitative increase, and a 
qualitative decrease, in fertility. An increase in agricultural labour 
has precisely the opposite effect. The influence of war upon fer- 
tility is unfavourable both quantitatively, and qualitatively. Accord- 
ing to TschourUoff, the introduction of universal military service, 
by withdrawing for a time all the most vigorous men from domestic 
life, tends to diminish fertility. Extensive emigration from a 
country in which the soil is fertile, and wliere the vital conditions 
are generally favourable, is stated by Bertillon to cause an increased 
fertility in the mother country; he further states that an increase 
in the number of the proprietors of the soil is followed by dimin- 
ished fertility, and vice versa. 

Prostitutes show as a rule a very low fertility. According to 
the data of Taruozvskaja, the fertility of prostitutes in Russia is 
^4^, whilst married women of similar ages in Russia exhibit a fer- 
tility of 51.8'f. Gurricri found 60;/ of prostitutes childless. 

The fertility of female criminals was found by Lomhroso to be 
undiminished. On the average, poisoners had given birth to 4.5 
children, other murderesses to 3.2 children, child-murderesses to 2 
children ; thus the prisoners whose crime is commonly dependent 
on an abnormal eroticism had a fertility above the average. 

The diminished fertility of prostitutes depends in part upon fre- 
quent venereal infection, in part upon the unfavourable influence 
of the mercury and iodide of potassium administered for the cure 
of such infection, also upon the frequency w^ith which they con- 
sume excessive quantities of alcohol, upon the excessive frequency 
of coitus, which exercises a traumatic influence, upon the irregular 
mode of life, and upon their disinclination to be burdened with 
children. 

Conjugal fertility, that is to say, the ratio between legitimate 
births and the number of married women between the ages of 
15 and 50 years, has declined in Germany during the last decades. 
It was : 

During tlie years 1872 to 1875 29.7% 

During the years 1879 to 1882 27.4% 

During the years t88o to tRc)2 26.5% 



The Sexual Epoch of the Menacme. 383 

I 
This decline is small, but it is much more manifest in urban 
than in rural districts. This fact is shown by the following figures, 
relating to fertility in Prussia : 

1872 to 1879. 1894 to 1897. 

In all towns 26.9 24.0 

In Berlin 23.8 16.9 

In other large towns 26.7 23.5 

In rural districts 28.8 29.0 

This difference depends principally on the fact that in the large 
towns of Germany (and still more in those of France) the use of 
means for the prevention of pregnancy is continually increasing, 
whereas the population of the rural districts is as yet less familiar 
with the use of these measures. 

According to Hellstenius, conjugal fertility, that is, the number 
of children per married couple, is as follows : 



In the Netherlands 4 

Norway 4 

Prussia 4 

Bavaria 4 

Sweden 4 

Saxony 4 

England 4 

Belgium . ; 4 

Denmark 4 

France 3 



70 
60 

55 
52 
35 

23 

18 

46 



Tallquist, who has published a statistical investigation concerning 
the modern tendency to diminished fertility, arrives at lower figures 
than Hellstenius. According to him, conjugal fertility is: 

In Prussia 4. 11 

England 4.10 

Belgium 4.12 

France 2.09 

In various States of the American Union 2 . 5 to 3 . o 

From the Almanach de Gotha Vacher obtained figures showing 
that each family of the higher aristocracy has on the average the 
following number of children. 

In France 2.0 

Italy 3.0 

Germany 4.8 

England 4,9 

Russia 5.1 

According to the figures we have published, the fertility of women 
suffices for the production during the sexual life of a small number 



384 The Sexual Life of Woman. 

only of children, averaging, in fact, 4 to 5 children per marriage. 
Many mothers, however, give birth to a very large number of chil- 
dren. Among 73,000 families inhabiting Buda-Pesth, Korosi found 
300 mother