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to their great size, were presumed to be reservoirs, and hence were called uterine sinuses.
The objection to these views is, that we have no evidence of the existence of any such accumulation; and that when the interior of the uterus of one, who has died during menstruation, is examined, there are no signs of any such rupture as that described; whilst the enlarged vessels exist only during pregnancy or during the expanded state of the uterus; the veins, in the unimpregnated uterus, being extremely small, and totally inadequate to such a purpose.
The menstrual fluid is a true exhalation, effected from the inner surface of the uterus. This is evident from the change in the lining of the organ during the period of its flow. It is rendered softer and more villous, and exhibits bloody spots, with numerous pores from which the fluid may be expressed. An injection, sent into the arteries of the uterus, also readily transudes through the lining membrane. The appearance of the menstrual fluid in the cavity of the uterus, during the period of its flow; its suppression in various morbid conditions of the organ; and the direct evidence, furnished in cases of prolapsus uteri, where the fluid has been seen distilling from the os uteri, likewise show that it is a uterine exhalation.
It has been a question, whether the fluid proceeds from the arteries or veins; and this has arisen from the circumstance of its being regarded as mere blood, which it is not. It is in truth but little like blood except in its colour; and it may be distinguished from blood by the smell, which is sui generis, and also by its not being, in general, coagulable. "It is," says Mr. Hunter, "neither similar to blood taken from a vein of the same person, nor to that which is extravasated by accident in any other part of the body; but is a species of blood, changed, separated, or thrown off from the common mass by an action of the vessels of the uterus, similar to that of secretion, by which action the blood loses the principle of coagulation and, I suppose, life."
The fact of the injection, sent into the arteries, transuding through the inner lining of the uterus is in favour of the exhalation taking place from the arteries, and the analogy of all the other exhalations, is confirmatory of the position.
The efficient cause of menstruation has afforded ample scope for speculation and hypothesis. As its recurrence corresponds to a revolution of the moon around the earth, lunar influence has been invoked; but before this solution can be admitted it must be shown, that the effect of lunar attraction is different in the various relative positions of the moon and earth. There is no day of the month, in which numerous females do not commence their menstrual flux, and whilst the discharge is beginning with some, it is at its acme or decline with others. The hypothesis of lunar influence must therefore be rejected.
In the time of Van Helmont, it was believed that a ferment exists in the uterus, which gives occasion to a periodical, intestine motion in the vessels, and a recurrence of the discharge; but independently of the want of evidence of the existence of such a ferment, the difficulty remains of accounting for its regular renovation every month.
Local, and general plethora have been assigned as causes, and many of the circumstances, that modify the flow, favour the opinion. The fact of, what has been called, vicarious menstruation, has been urged in favour of this view. In these cases, instead of the menstrual flux taking place from the uterus, hemorrhages occur from various other parts of the body, as the breasts, lungs, ears, eyes, nose, &c.
It does not seem, however, that in any of these cases, the term menstruation is appropriate; inasmuch as the fluid is not menstrual, but consists of blood periodically extravasated. Still they would appear to indicate, that there is a necessity for the monthly evacuation, or purgations, as the French term it; and that if this be obstructed, a vicarious hemorrhage may be established; yet the loss of several times the quantity of blood from the arm, previous to, or in the very act of, menstruation does not always prevent or interrupt the flow of the catamenia; and in those maladies, that are caused by their obstruction, greater relief is afforded by the flow of a few drops from the uterus itself, than by ten times the quantity from any other part.
Some of the believers in local plethora of the uterus have maintained, that the arteries of the pelvis are more relaxed in the female than in the male; whilst the veins are more unyielding; and hence, that the first of these vessels convey more blood than the second return. It has been also affirmed, that whilst the arteries of the head predominate in man, by reason of his being more disposed for intellectual meditation; the pelvic and uterine arteries predominate in the female, owing to her destination being more especially for reproduction.
Setting aside all these gratuitous assumptions, it is obvious that a state, if not of plethora, at least of irritation, must occur in the uterus every month, which gives occasion to the menstrual secretion; but, as Adelon has properly remarked, it is not possible to say why this irritation is renewed monthly, any more than to explain why the predominance of one organ succeeds that of another in the succession of ages. The function is as natural, as instinctive, to the female, as the development of the whole sexual system at the period of puberty. That it is connected most materially with the capability of reproduction is shown by the fact, that it does not make its appearance until puberty,—the period at which the young female is capable of conceiving,—and that it disappears at the critical time of life, when conception is impracticable. It is arrested, too, as a general principle, during pregnancy, and lactation; and in VOL. II.
amenorrhoea or obstruction of the menses fecundation is not readily effected. In that variety, indeed, of menstruation, which is accomplished with much pain, at every period, and is accompanied by the secretion of a membranous substance having the shape of the uterine cavity, conception may be esteemed impracticable. Professor Hamilton, of the University of Edinburgh, is, indeed, in the habit of adducing this, in his lectures, as one of two circumstancesthe other being the want of a uterus—which are alone invincible obstacles to fecundation. Yet, in the case of dysmenorrhoea, of the kind mentioned, if the female can be made to pass one monthly period without suffering, or without the morbid secretion from the uterine cavity, she will sometimes become pregnant, and the whole of the evil will be removed: for, the effect of pregnancy being to arrest the catamenia, the morbid habit is usually got rid of during gestation, and lactation, and does not subsequently recur.
Gall strangely supposes, that some general, but extraneous cause of menstruation exists,—not the influence of the moon; and he affirms that, in all countries, females generally menstruate about the same time; that there are, consequently, periods of the month in which none are in that condition; and he affirms, that all females may, in this respect, be divided into two classes: the one comprising those that menstruate in the first eight days of the month, and the other, those that are "unwell"—as it is termed by them, in some countries—in the last fortnight. He does not, however, attempt to divine what this cause may be. We are satisfied that his positions are erroneous. Some considerable attention to the matter has led us to the belief, already expressed, that there is no period of the moon, at which the catamenial discharge is not taking place in some, and we have not the slightest reason for believing, that on the average more females are menstruating at any one part of the month than at another.
After these comments, it is unnecessary to notice the visionary speculations of those, who have regarded menstruation as a mechanical consequence of the erect attitude, or the opinion of RousSEL, that it originally did not exist, but that being produced artificially by too succulent a regimen, it was afterwards propagated from generation to generation; or finally, that of Aubert, who maintained, that if the first amorous inclinations were satisfied, the resulting pregnancy would totally prevent the establishment of menstruation. The function, it need scarcely be said, is instinctive, and forms an essential part of the female constitution.
The age, at which menstruation commences, varies in individuals and in different climates. It is a general law, that the warmer the climate, the earlier the discharge takes place, and the sooner it ceases. In some climates, it begins at nine years of age, whilst in northern regions, women may not arrive at puberty until they are seventeen or eighteen years old. In the temperate zone, the most common period is from thirteen to fifteen years. Men
struation commonly ceases in the same zone at from forty to fifty years of age. In oriental climes, the menses begin soon, flow copiously, and end early: females being old when those of the temperate regions would be still in their prime. In northern regions, on the contrary, they begin late, flow sparingly, and continue long. These rules are, however, liable to many exceptions. The menses, with powers of fecundity, have continued, in particular instances, much beyond the ages that have been specified; some of these protracted cases having had regular catamenia; in others, the discharge, after a long suppression, having returned. A relation of Haller had two sons after her fiftieth year; and children are said to have been born, even after the mother had attained the age of sixty. Holdefreund relates the case of a female, in whom menstruation continued till the age of seventy-one; Bourgeois till the age of eighty; and Hagendorn to ninety; but it is probable, that these were not cases of true menstruation, but perhaps of irregularly periodical discharges of true blood from the uterus or vagina.
During the existence of menstruation the system of the female is more irritable than at other times; so that all exposure to sudden and irregular checks of transpiration should be avoided, as well as every kind of mental and corporeal agitation, otherwise the process may be impeded, or hysterical and other troublesome affections be excited.
Physiology of Generation.
In man and the superior animals, in which each sex is possessed by a distinct individual, it is necessary that there should be a union of the sexes, and that the fecundating fluid of the male should be conveyed within the appropriate organs of the female; in order that, from the concourse of the matters furnished by both sexes, a new individual may result.
To this union we are incited by an imperious instinct, established within us for the preservation of the species; as the senses of hunger and thirst are placed within us for the preservation of the individual. This has been termed the desire or instinct of reproduction; and, for wise purposes, its gratification is attended with the most pleasurable feelings which man or animals can experience. Prior to the period of puberty, or whilst the individual is incapable of procreation, this desire does not exist; but it suddenly makes its appearance at puberty, persists vehemently during youth and the adult age, and disappears in advanced life, when procreation becomes again impracticable. It is strikingly exhibited in those animals, in which generation can only be effected at particular periods of the year, or whilst they are in heat: as in the deer during the rutting season.
The views that have been entertained, regarding the seat of this
instinct—whether in the encephalon or genital organs—were considered under the head of the mental and moral manifestations. It was there stated, that Cabanis and Broussais make the internal impressions to proceed from the genital organs, but to form a part of the psychology of the individual; and that Gall assigns an encephalic organ—the cerebellum—for its production, and ranks the instinct of reproduction amongst the primary faculties of the mind. In farther proof of the idea, which refers it to the encephalon, it may be remarked, that the instinct has been observed in those who, owing to original malformation, have wanted the principal part of the genital organs, whilst it has continued in the case of eunuchs, not castrated till after the age of puberty.
In opposition to this view, it has been urged, that simple titillation of the organs will excite the desire. This, however, may be entirely dependent upon association, in which the brain is largely concerned. In many cases, the desire is produced through the agency of vision; when the brain must necessarily be first excited, and, through its influence, the generative apparatus.
The cause of the desire has, by some, been ascribed to the presence of sperm, in the requisite quantity, in the vesiculæ seminales; but, in answer to this, it is urged, that eunuchs, as under the circumstances above mentioned, and females, in whom there is no spermatic secretion, have the desire.
The fact is, we have no more precise knowledge of the nature of this instinct, than we have of any of the internal sensations or moral faculties. We know, however, that it exhibits itself in various degrees of intensity, and occasionally assumes an opposite character—constituting anaphrodisia.
In the union of the sexes, the part performed by the male is the introduction of the penis,—the organ for the conveyance of the sperm to the uterus,—and the excretion of that fluid, during its introduction. In the flaccid state of the organ this penetration is impracticable; it is first of all necessary, that, under the excitement of the venereal desire, the organ should attain a necessary state of rigidity, which is termed erection. In this state, the organ becomes enlarged, and raised towards the abdomen; its arteries beat forcibly; the veins become tumid; the skin more coloured, and the heat augmented. It becomes also of a triangular shape, and these changes are indicated by an indescribable feeling of pleasure.
Erection is not dependent upon volition. At times, it manifests itself against the will; at others, it refuses to obey it; yet it requires, apparently, the constant excitement of the encephalic organ concerned in its production;—the slightest distraction of the mind causing its cessation. The modest and retiring spouse is, at times, unable to consummate the marriage for nights, perhaps weeks; yet, he is only temporarily impotent; for the inclination and the con