Part 23

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; that 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 the loss of blood continues to have an effect after the flow has ceased, if a woman recovers but slowly, or even fails to recover fully from one loss before another begins, if symptoms of increasing anæmia become apparent, 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 anæmic 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 abnormally 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 life, 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 constitution; 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 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, who 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 women, that is in 87.83 per cent. The inconstant type in 690 women, that is in 12.16 per cent.

Of the cases in which the type was 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 27 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 1.66 per cent. 27 days in 1.45 per cent.

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

Szukits, as a result of an investigation into the menstrual functions of Austrian women, determined that among 1,013 women menstruation occurred:

Every 28 to 30 days in 642 women. Every 8 to 21 days in 169 women. Every 35 to 56 days in 128 women. And was quite irregular in 74 women.

In 500 Jewish women, Hirsch found that menstruation occurred:

23 days after the beginning of the last menstruation in 19 24 days after the beginning of the last 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 73 ——— 275 ===

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 Brierre de Boismont, among 100 women menstruation recurred:

Every 4 weeks in 61 women. Every 3 weeks in 28 women. Every 2 weeks in 1 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 1 woman. Every 6 weeks in 5 women.

Foster instituted inquiries regarding this matter in 56 healthy women. In 380 periods, 45 recurred after an interval of 28 days, 225 after a shorter interval than this, 110 after a longer interval. The duration of the flow varied from 1 to 14 days; most commonly it lasted from 3 to 5 days.

A peculiar change in the type of menstruation sometimes manifests 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 lower belly, sacrache, sensation of weight, and bearing-down pains. Courty, Dubois, and Pajot Négrier have described such cases of molimen utérin intermenstruel, which Tilt denotes by the term remittent menstruation.

From the earliest times 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 menstruation 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 accepted, 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 ordinances 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 Sintemma, 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 bloodvessels give rise to the menstrual bleeding (1728).