190. There are two most important epochs in the life of a woman—namely (1) the commencement, and (2) the close of menstruation. Each is apt, unless carefully watched and prevented, to bring in its train many serious diseases. Moreover, unless menstruation be healthfully and properly performed, conception, as a rule, is not likely to take place: hence the importance of our subject.
191. Menstruation—the appearance of the catamenia or the menses—is then one of the most important epochs in a girl’s life. It is the boundary line, the landmark, between childhood and womanhood; it is the threshold, so to speak, of a woman’s life. Her body now develops and expands, and her mental capacity enlarges and improves. She then ceases to be a child, and she becomes a woman. She is now for the first time, as a rule, able to conceive.
192. Although puberty has at this time commenced, it cannot be said that she is at her full perfection; it takes eight or ten years more to complete her organization, which will bring her to the age of twenty-three or twenty-five years; which perhaps are the best ages for a woman, if she have both the chance and the inclination, to marry.
193. If she marry when very young, marriage weakens her system, and prevents a full development of the body. Besides, if she marry when she be only eighteen or nineteen, the bones of the pelvis—the bones of the lower part of the belly—are not at that time sufficiently developed; are not properly shaped for the purpose of labor; do not allow of sufficient space for the head of the child to readily pass, as though she were of the riper age of twenty-three or twenty-five. She might have in consequence a severe and dangerous confinement. If she marry late in life, say after she be thirty, the soft parts engaged in parturition are more rigid and more tense, and thus become less capable of dilatation, which might cause, for the first time, a hard and tedious labor. Again, when she marries late in life, she might not live to see her children grow up to be men and women. Moreover, as a rule, “the offspring of those that are very young or very old lasts not.” Everything, therefore, points out that the age above indicated—namely, somewhere between twenty and thirty—is the most safe and suitable time for a woman to marry.
194. Menstruation generally comes on once every month—that is to say, every twenty-eight days; usually to the very day, and frequently to the hour. Some ladies, instead of being “regular” every month, are “regular” every three weeks.
195. Each menstruation continues from three to five days; in some for a week; and in others for a longer period. It is estimated that, during each menstruation, from four to six ounces is, on an average, the quantity discharged.
196. A lady seldom conceives unless she be “regular,” although there are cases on record where women have conceived who have never been “unwell;” but such cases are extremely rare.
197. Menstruation in this country usually commences at the ages of from thirteen to sixteen, sometimes earlier; occasionally as early as eleven or twelve; at other times later, and not until a girl be seventeen or eighteen years of age. Menstruation in large towns is supposed to commence at an earlier period than in the country, and earlier in luxurious than in simple life.[44]
198. Menstruation continues for thirty, and sometimes even for thirty-five years; and, while it lasts, is a sign that a lady is liable to become pregnant—unless, indeed, menstruation should be protracted much beyond the usual period of time. As a rule, then, when a woman “ceases to be unwell,” she ceases to have a family; therefore, as menstruation usually leaves her at forty-five, it is seldom, after that age, that she has a child.
199. I have known ladies become mothers when they have been upwards of fifty years of age. I myself delivered a woman in her fifty-first year of a fine healthy child. She had a kind and easy labor, and was the mother of a large family, the youngest being at the time twelve years old.[45] “Dr. Carpenter, of Durham, tells us that he has attended in their confinements several women whose ages were fifty. ‘I well recollect a case occurring in my father’s practice in 1839, where a woman became a widow at forty-nine years of age. Shortly afterwards she married her second husband, and within twelve months of this time gave birth to her first child. These cases belong to the working classes. But I know of two others, where gentlewomen became mothers at fifty-one with her first child, the other with her eighth. I can say nothing of how they menstruated, but I know of a virgin in whom the catamenia appeared regularly and undiminished up to and at the end of sixty.’ Dr. Powell says that he last year attended a woman in her fifty-second year; and Mr. Heckford, that he attended a woman who stated her age to be at least fifty. Mr. Clarke, of Mold, states that he has attended several women whose ages were upwards of forty-four, and that he lately delivered a woman of her first child at forty-eight. Mr. Bloxham, of Portsmouth, delivered at fifty-two, in her first confinement, a woman who had been married thirty-five years.”[46]
200. In very warm climates, such as in Abyssinia and in India, girls menstruate when very young—at ten or eleven years old; indeed, they are sometimes mothers at those ages.[47] But when it commences early, it leaves early; so that they are old women at thirty. “Physically, we know that there is a very large latitude of difference in the periods of human maturity, not merely between individual and individual, but also between nation and nation—differences so great that in some southern regions of Asia we hear of matrons at the age of twelve.”[48] Dr. Montgomery[49] brings forward some interesting cases of early maturity. He says: “Bruce mentions that in Abyssinia he has frequently seen mothers of eleven years of age; and Dunlop witnessed the same in Bengal. Dr. Goodeve, Professor of Midwifery at Calcutta, in reply to a query on the subject, said: ‘The earliest age at which I have known a Hindu woman bear a child is ten years, but I have heard of one at nine.’”
201. In cold climates, such as Russia, women begin to menstruate late in life, frequently not until they are between twenty and thirty years old; and, as it lasts on them thirty or thirty-five years, it is not an unusual occurrence for them to bear children at a very advanced age—even so late as sixty. They are frequently not “regular” oftener than three or four times a year, and when it does occur the menstrual discharge is generally sparing in quantity.
202. The menstrual fluid is not exactly blood, although, both in appearance and in properties, it much resembles it; yet it never in the healthy state clots as blood does. It is a secretion from the womb, and, when healthy, ought to be of a bright-red color, in appearance very much like blood from a recently cut finger.[50]
203. The menstrual fluid ought not, as before observed, to clot. If it does, a lady, during menstruation, suffers intense pain; moreover, she seldom conceives until the clotting has ceased. Application must therefore, in such a case, be made to a medical man, who will soon relieve the above painful symptoms, and, by doing so, will probably pave the way to her becoming pregnant.
204. Menstruation ceases entirely in pregnancy, during suckling, and usually both in diseased and in disordered states of the womb. It also ceases in cases of extreme debility, and in severe illness, especially in consumption; indeed, in the latter disease—consumption—it is one of the most unfavorable of the symptoms.
205. It has been asserted, and by men of great experience, that sometimes a woman menstruates during pregnancy. In this assertion I cannot agree; it appears utterly impossible that she should be able to do so. The moment she conceives, the neck of the womb becomes plugged up by means of mucus; it is, in fact, hermetically sealed. There certainly is sometimes a slight red discharge, looking very much like menstrual fluid, and coming on at her monthly periods; but being usually very sparing in quantity, and lasting only a day or so, and sometimes only for an hour or two; but this discharge does not come from the cavity of, but from some small vessels at, the mouth of the womb, and is not menstrual fluid at all, but a few drops of real blood. If this discharge came from the cavity of the womb, it would probably lead to a miscarriage. My old respected and talented teacher, the late Dr. D. D. Davis,[51] declared that it would be quite impossible during pregnancy for menstruation to occur. He considered that the discharge which was taken for menstruation arose from the rupture of some small vessels about the mouth of the womb.
206. Some ladies, though comparatively few, menstruate during suckling; when they do, it may be considered not the rule, but the exception. It is said, in such instances, that they are more likely to conceive. Many persons have an idea that when a woman, during lactation, menstruates, the milk is both sweeter and purer. Such is an error. Menstruation during suckling is more likely to weaken the mother, and consequently to deteriorate the milk. It therefore behooves a parent never to take a wet nurse who menstruates during the period of suckling.
207. A lady sometimes suffers severe pains both just before and during her “poorly” times. When such be the case, she seldom conceives until the pain be removed. She ought therefore to apply to a medical man, as relief may soon be obtained. When she is freed from the pain, she will, in all probability, in due time become enceinte.
208. If a married woman have painful menstruation, even if she become pregnant, she is more likely, in the early stage, to miscarry. This is an important consideration, and requires the attention of a doctor.
209. If a single lady, who is about to be married, have painful menstruation, it is incumbent on either her mother or a female friend to consult, two or three months before the marriage takes place, an experienced medical man, on her case; if this be not done, she will most likely, after marriage, either labor under ill health, or be afflicted with barrenness, or, if she do conceive, be prone to miscarry.
210. The menstrual discharge, as before remarked, ought, if healthy, to be of the color of blood—of fresh, unclotted blood. If it be either too pale (and it sometimes is almost colorless), or, on the other hand, if it be both dark and thick (it is occasionally as dark, and sometimes nearly as thick, as treacle), there will be but scant hopes of a lady conceiving. A medical man ought, therefore, at once to be consulted, who will in the generality of cases, be able to remedy the defect. The chances are, that as soon as the defect be remedied, she will become pregnant.
211. Menstruation at another time is too sparing; this is a frequent cause of a want of family. Luckily a doctor is, in the majority of cases, able to remedy the defect, and by doing so will probably be the means of bringing the womb into a healthy state, and thus predispose her to become a mother.
212. A married lady is very subject to the “whites;” the more there will be of the “whites” the less there will usually be of the menstrual discharge;—so that in a bad case of the “whites” menstruation might entirely cease, until proper means be used both to restrain the one and to bring back the other. Indeed, as a rule, if the menstrual discharge, by proper treatment, be healthily established and restored, the “whites” will often cease of themselves. Deficient menstruation is a frequent cause of the “whites,” and the consequent failure of a family; and as deficient menstruation is usually curable, a medical man ought, in all such cases, to be consulted.
213. Menstruation at other times is either too profuse or too long continued. Either the one or the other is a frequent source of barrenness, and is also weakening to the constitution, and thus tends to bring a lady into a bad state of health. This, like the former cases, by judicious management may generally be rectified; and being rectified, will in all probability result in the wife becoming a mother.
214. When a lady is neither pregnant nor “regular,” she ought immediately to apply to a doctor, as she may depend upon it there is something wrong about her, and that she is not likely to become enceinte[52] until menstruation be properly established. As soon as menstruation be duly and healthily established, pregnancy will most likely, in due time, ensue.
215. When a lady is said to be “regular,” it is understood that she is “regular” as to quality, and quantity, and time. If she be only “regular” as to the time, and the quantity be either deficient or in excess, or if she be “regular” as to the time, and the quality be bad, either too pale or too dark; or if she be “regular” as to the quality and quantity, and be irregular as to the time, she cannot be well; and the sooner means are adopted to rectify the evil, the better it will be for her health and happiness.
216. There is among young wives, of the higher ranks, of the present time, an immense deal of hysteria; indeed it is, among them, in one form or another, the most frequent complaint of the day. Can it be wondered at? Certainly not. The fashionable system of spending married life, such as late hours, close rooms, excitement, rounds of visiting, luxurious living, is quite enough to account for its prevalence. The menstrual functions in a case of this kind are not duly performed; she is either too much or too little “unwell;” menstruation occurs either too soon, or too late, or at irregular periods. I need scarcely say that such a one, until a different order of things be instituted, and until proper and efficient means be used to restore healthy menstruation, is not likely to conceive; or, if she did conceive, she would most likely either miscarry, or, if she did go her time, bring forth a puny, delicate child. A fashionable wife and happy mother are incompatibilities! Oh, it is sad to contemplate the numerous victims that are sacrificed yearly on the shrine of fashion! The grievous part of the business is, that fashion is not usually amenable to reason and common sense; argument, entreaty, ridicule, are each and all alike in turn powerless in the matter. Be that as it might, I am determined boldly to proclaim the truth, and to make plain the awful danger of a wife becoming a votary of fashion.
217. Many a lady, either from suppressed or from deficient menstruation, who is now chlorotic, hysterical, and dyspeptic, weak and nervous, looking wretchedly, and whose very life is a burden, may, by applying to a medical man, be restored to health and strength.
218. As soon as a lady “ceases to be after the manner of women”—that is to say, as soon as she ceases to menstruate—it is said that she has “a change of life;” and if she does not take care, she will soon have “a change of health” to boot, which, in all probability, will be for the worse.
219. After a period of about thirty years’ continuation of menstruation, a woman ceases to menstruate; that is to say, when she is about forty-four or forty-five years of age, and, occasionally, as late in life as when she is forty-eight years of age, she has “change of life,” or, as it is sometimes called, a “turn of years.” Now, before this takes place, she oftentimes becomes very “irregular;” at one time she is “regular” before her proper period; at another time either before or after; so that it becomes a dodging time with her, as it is so styled. In a case of this kind menstruation is sometimes very profuse; at another it is very sparing; occasionally it is light colored, almost colorless; sometimes it is as red as from a cut finger; while now and then it is as black as ink.
220. When “change of life” is about, and during the time, and for some time afterwards, a lady labors under, at times, great flushings of heat; she, as it were, blushes all over; she goes very hot and red, almost scarlet; then perspires; and afterwards becomes cold and chilly. These flushings occur at very irregular periods; they might come on once or twice a day, at other times only once or twice a week, and occasionally only at what would have been her “poorly times.” These flushings might be looked upon as rather favorable symptoms, and as an effort of nature to relieve itself through the skin. These flushings are occasionally, although rarely, attended with hysterical symptoms. A little appropriate medicine is for these flushings desirable. A lady while laboring under these heats is generally both very much annoyed and distressed; but she ought to comfort herself with the knowledge that they are in all probability doing her good service, and that they might be warding off, from some internal organ of her body, serious mischief.
221. “Change of life” is one of the most important periods of a lady’s existence, and generally determines whether, for the rest of her days, she shall either be healthy or otherwise; it therefore imperatively behooves her to pay attention to the subject, and in all cases when it is about taking place to consult a medical man, who will, in the majority of cases, be of great benefit to her, as he will be able to ward off many important and serious diseases to which she would otherwise be liable. When “change of life” ends favorably, which, if properly managed, it most likely will do, she may improve in constitution, and may really enjoy better health and spirits, and more comfort, then she has done for many previous years. A lady who has during the whole of her wifehood eschewed fashionable society, and who has lived simply, plainly, and sensibly, and who has taken plenty of out-door exercise, will, during the autumn and winter of life, reap her reward by enjoying what is the greatest earthly blessing—health!