BE PR OD UCTION. 459 



and, according to some authorities, their mucous membrane degenerates and 

 bleeds like that of the uterus. The ovaries are likewise congested. As has 

 been stated, it is commonly believed, but not definitely proved, that ovulation 

 accompanies each period. Frequent accompaniments are turgescence of the 

 breasts, swelling of the thyroid and the parotid glands and the tonsils, conges- 

 tion of the skin, dull complexion, tendency toward the development of pigment, 

 and dark rings about the eyes. The skin and the breath may have a character- 

 istic odor. In singers the voice is often impaired, which is one instance of 

 a general nervous and muscular enervation. Mental depression often exists. 

 Pain is a frequent accompaniment, and nervous and congestive pathological 

 phenomena may, at times, become very pronounced. Recent work has shown 

 that the various phenomena accompanying menstruation are evidences of a 

 profound physiological change, with a monthly periodicity, that the female 

 human organism undergoes, and of which the uterine changes are only a part. 

 Thus, during the intermenstrual period there is a gradual increase of nervous 

 tension and general mobility, of vascular tension manifested by turgescence of 

 the blood-vessels, a gradual increase of nutritive activity manifested by 

 increased production and excretion of urea and increased temperature, and 

 a gradual increase of the heart's action in strength and rate. 1 These various 

 activities of the organism usually attain a maximum a few days before the 

 menstrual flow begins and then undergo a rapid fall, which reaches a minimum 

 toward the close of the flow ; a second lesser maximum may occur a few days 

 after the flow ceases. All organic activities that have been carefully investi- 

 gated show evidences of such a monthly rhythm. It is not known that the 

 male possesses such a period. 



The first menstruation is usually regarded as the index of the oncoming of 

 puberty or sexual maturity, and in temperate climates occurs usually at the age 

 of fourteen to seventeen. Its onset is earlier in warm than in cold climates, in 

 city than in country girls, and varies in time with food, growth, and environ- 

 ment. Exceptionally menstruation may begin in infancy or later than puberty, 

 and it has even been known to be wholly wanting in otherwise normal women. 

 Normally, it ceases during pregnancy, and probably usually during lactation, 

 although there are frequent exceptions to the latter rule. In nearly all cases 

 complete removal of the ovaries puts an end to menstruation. Removal of the 

 ovaries and Fallopian tubes diminishes the number of exceptional cases. The 

 final cessation of menstruation, which is a gradual process extending over 

 several months, usually marks the climacteric (menopause), or end of the 

 sexual life, and occurs usually at the age of forty-five to forty-eight. Excep- 

 tionally the flow may cease early in life or extend to extreme old age. 



( 'omparative Physiology of Menstrua/ion. — The comparative physiology of 

 menstruation, although it has been studied only incompletely in a few domesti- 



1 Of. Mary Putnam Jacobi: "The Question of lust tor Women during Menstruation," 

 Boylston Prize Essay, 1870; C. ReinI : Smnmlung kliniache Vortrdge, 1884, No. 243; 0. Ott: 

 NouveUea archives a" obsUtrique et de gynecologic, 1890, v.; and A. E. Giles: Transactions of (he 

 Obstetrical Society of London, 1897, xxxix. p. 115. 



