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THE SEXUAL LIFE OF WOMAN.
ОглавлениеBy 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 organism 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: περι Γυναικειης Φυσεος,[1] a treatise on the physiology and pathology of woman; περι Αφορων,[2] which discusses sterility in women; περι παρθενιων,[3] a treatise on the pathological states of virgins. These writings of Hippocrates contain 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 Aretæus and Galen on the diseases of women we find striking observations, as for instance, in Galen’s De Locis Affectis,[4] which contains a “Statement of the Similarity and Dissimilarity of Man and Woman.” Another notable work is that of Albertus Magnus, entitled De Secretis Mulierum.[5]
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 eighteenth century, however, bore witness to an increased knowledge of the anatomy of the female reproductive organs, and were illumined by Haller’s researches on the functions of these organs.
The subject with which we are especially concerned is discussed in a work by Boireau-Laffecteur, Essai sur les Maladies Physiques et Morales des femmes,[6] Paris, 1793; and also in Marie-Clement’s Considerations Physiologiques sur les Diverses Epoques de la Vie des Femmes,[7] Paris, 1803. the same connection we must mention von Humboldt’s treatise, Ueber den Geschlechtsunterschied und dessen Einfluss auf die organische Natur.[8] 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 Geschlechtsleben des Weibes,[9] Leipzig, 1839.
In the second half of the nineteenth century a very large number of monographs were published, 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 sexuality, 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 puerperium, finally the involutionary process which accompanies the cessation of menstruation at the climacteric period—every one of these sexual phases entails consecutive physiological processes and pathological changes alike in the individual organs and in the nutritive 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 metabolism. Herein we see a striking illustration of the old saying of von Helmont, propter solum uterum mulier est quod est;[10] also of the similar aphorism of Hippocrates, uterus omnium causa morborum qui mulieres infestant;[11] 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 possibly overlook, by means of which three great epochs are distinguished. 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 reproduction; 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 controls also all the vegetative, physical, and mental processes of the body, and is clearly and incontestably apparent in all vital manifestations. What Madame de Staël said of love is indeed true of the entire sexual life of woman: l’amour n’est qu’unc épisode de la vie de l’homme; c’est l’histoire tout entière de la femme.[12].
The sexual life of woman is coextensive with the peculiar vital activity of the female sex, for it endures from the moment when 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 fifteenth 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. 1.)
Fig. 1.—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 potent determining factor. With that life, religion, philosophy, ethics, natural science, and hygiene, have been most intimately related; 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 societies no restraint is imposed on the sexual impulse, which is gratified 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 reverence 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 child-bearing, refers to yet higher duties. Precise religious and social precepts are furnished for all the phases of sexual life.
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 rôle in the life of the family, than would have been their portion regarded merely in relation to their child-bearing 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 religion 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 requires, 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 unfavorable, manifesting itself in the overpowering frequency of the diseases of women. In one of the most thoughtful books ever written on the subject of woman, Michelet’s L’Amour,[13] the author remarks that every century is characterized by the prevalence of certain diseases: thus, in the thirteenth century, leprosy was the dominant disease; the fourteenth century was devastated by bubonic plague, then known as the black death; the sixteenth century witnessed the appearance of syphilis; finally, as regards the nineteenth century, “se siècle sera nommé celui des maladies de la matrice”.[14] 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 agreeable to nature and those that the laws of health demand.
Even before sexual development begins, before the physical ripening 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 conversation. 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 alcoholic beverages, exhibit their inevitable result in the frequency with which, in this epoch of the sexual life, chlorotic blood-changes, neurasthenic conditions, and diverse symptoms of irritation of the genital organs, make their appearance. Thus, when marriage, so often unduly 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 Prévost in the expression demi-vierge.[15] 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 married women. Even more disastrous in its consequences as regards the future sexual life of the wife is the ever-increasing frequency of gonorrhœal 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 marriage, falls under the yoke of sexual impulses denied satisfaction or gratified by abnormal means, and suffers in consequence both physically 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 children, 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 of the general phenomena of senility, with a cessation of the menstrual 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 which 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 characteristic 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 manifestations 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 increase 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 hyperæmia 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 leading to the formation of a considerable scar. Finally, in the critical period of life in which the menstrual flow ceases, a continually increasing 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, affecting 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, in shape and size, in its muscular substance and mucous lining, and in its vascular and nervous supply.
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 parametrium. (From Toldt: Atlas of Human Anatomy.—Rebman Company, New York.)
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 relations of the body and neck of the organ, in the increasing distension 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 circumstances 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 anatomically 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 processes of generation.
A short account of the nerves and blood vessels of the female genital organs appears indispensable, to facilitate the comprehension of the manner in which sexual processes are influenced by the nervous system, and to demonstrate the intimate connection between 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.
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. anococcygei, 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.)
The greater number of the spinal nerves distributed to the 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 extremity 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 constitutes 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 impulses to the uterus it is often known at the present day as the great uterine plexus (plexus uterinus magnus). 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 downward 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 hypogastric plexus enter the tissues of the internal genital organs, the bladder, and the rectum, small masses of ganglionic matter are interspersed 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 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 layer, 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 sympathetic 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; inferior 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 vesico-vaginal artery supplies the vagina; the internal pudic artery supplies 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.
Fig. 4.—The distribution of the lateral sacral arteries, the superior haemorrhoidal or superior rectal artery, the uterine artery, the ovarian artery and the distal portion of the internal pudic artery. (From Toldt: Atlas of Human Anatomy.—Rebman Company, New York.)
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 upper 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 Rosthorn).
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 physiological investigations and experiments and by the result of operations on the female genital organs.
Thermic and mechanical stimulation of the female genitals has, as my own experiments have shown, 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 augmentation 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, Röhrig 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 pronounced 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 completed 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 immediately reëstablished.
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 confirmation of the well-known physiological fact that irritative disturbances of the female reproductive organs have a reflex influence on the vomiting centre.
It is also clearly established that diverse stimulation of peripheral 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 rise of pressure in the ovary causes swelling and structural changes in the uterine mucous membrane.
Striking also are Neusser’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 hæmatopoietic 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 Fehling’s now generally accepted assumption, with a trophoneurosis of the bones, a stimulation of the vasodilator nerves of the 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 circulation 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 Champonière also observed as a rule diminished frequency of the pulse, but in some cases increased frequency. Mariagalli and Negri have described tachycardia following laparotomy 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 consequence of the performance of version, sudden death has resulted from cardiac syncope.
The psychical influences which proceed from the female genital organs in the different periods of sexual life have also great significance for the organism as a whole. Manifold impulses both stimulating and depressing arising in the reproductive organs affect the workings of the mind. The maiden at puberty is affected by the knowledge of sexuality; the sexually mature woman, by the desire for sexual satisfaction, and by the yearning for motherhood; 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, directly by irradiation, or indirectly by vasomotor processes and spinal hyperæsthesia.
Psychical manifestations and the nervous states associated with these are somewhat frequently, and even actual psychoses occasionally, 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 catamenial period.
Of great interest are the facts which have, in recent times especially, 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, Rabuteau, Reinl 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 temperature and the blood-pressure. A more extensive research was undertaken by Jacobi, who, as the result of her observations, came to the following conclusions. In eight cases she noticed in the premenstrual 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.
Reinl’s observations on healthy women, in whom menstruation ran a normal course, showed that in the great majority of cases in 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 interval, and exhibiting in the post-menstrual epoch a still further depression, giving place, however, to a somewhat higher mean temperature during the first half of the interval. In the second half of the interval 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.)
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. Rhythmic changes corresponding to those observed in the temperature have been recorded—at least in isolated stages of the menstrual cycle—affecting the blood-pressure by Jacobi and by von Ott, affecting the excretion of urea by Jacobi 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.
Schrader, through his researches on metabolism during menstruation in relation to the condition of the bodily functions during this process, has established that immediately before menstruation the elimination of nitrogen in the fæces 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.
Von Ott found in thirteen cases out of fourteen that at the beginning 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 during menstruation was more considerable than could be accounted for by the moderate hæmorrhage. 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 following curve, in which the line A B represents these physiological variations, whilst on the abscissa line c e, the days of observation are recorded, and the interval m n represents the menstrual period. The degree of intensity of the united functions is indicated by the numbers 0–100 on the ordinate.
