6. PUBERTY Puberty is the period in which the general development and growth of the female have so far advance as to render her capable of bearing children.
“The infancy of the girl does not differ essentially from that of the boy. There is, perhaps, a touch of softness, of delicacy, and of pliability of her organisation, that are half-way distinctive, but in general terms they are identical. Their looks, habits, tastes, and predispositions are the same. They grow and thrive upon the same food, in the same schoolroom or nursery, and are full of sympathetic relations, but without the passions and propensities of after life. They are subject to the same diseases, which are curable by the same treatment; and they occupy a like place in the esteem of the family, the friends, and the general community. But time works wonderful changes in the young girl. For it gives a more decided tone to the delicate and the almost imperceptible shades of difference between her and her male companion. Her individuality begins to assert itself; her tastes and inclinations are changed, and she becomes shy and taciturn, or forward and capricious. She is timid and reserved, but sensitive, confiding, and tender-hearted. The womanly traits are soon evolved and matured, and she is no longer the non-sexual creature that she was before her emotional and physical natures were so wonderfully developed.” – Ludlam.
External signs of Puberty: At the approach of puberty a striking change is effected in the general system. The pelvis, although far from being yet mature, enlarges, and takes on its distinctive sexual character; the breasts become rounded and full, and establish their connection and sympathy with the womb; and chest, throat, arms and, indeed, the whole body, acquire the contour of a more mature development; the hair grows more luxuriantly; the skin becomes fresh and blooming, the voice full and mellow; and the whole figures assumes that elegance and symmetry, the complexion that blood of health and beauty, and each feature and action that play of intellect and emotion, and that indescribable gracefulness of action, which are to be found in woman alone.
This combination of attractions which marks the epoch of puberty upon is no doubt designed to subserve the purpose of alluring the opposite sex, and so securing one great object for which the female was created – the reproduction of the species.
Corresponding with the external changes coincident with puberty are internal ones occurring especially in the ovaries and uterus, which now become fully developed both as to size and activity. In short, the woman has now, as a rule, acquired the power to conceive.
The mind, too, at this period, grows rapidly; the mental capacity enlarges, the imagination becomes more vivid, and the nervous system exhibits a heightened sensibility.
Maternal Instruction : As puberty advances, no mother should neglect to teach her daughter to expect the change which is about to take place, so that the first appearance of menstrual flow may neither be arrested by the alarm naturally felt at something hither or inexperienced or unknown, nor by the dangerous applications to which in her ignorance she may otherwise secretly resort. Some young women view the development of this function with such disgust, that they expose themselves carelessly or purposely during the period to cold and wet or use cold baths or other means of suppression, and thus finally bring on disordered menstruation and permanent ill-health. Many such cases have occurred within our own experience.
7. THE FUNCTION OF MENSTRUATION
The menstrual function, which is variously termed menses, periods, catamenia, or courses, is one of the most important functions of the female organisation and constitutes a real monthly crisis. It consists of an exudation of sanguineous fluid, chiefly from the body of the uterus, the average quantity being four to six ounces at each period, and is attended by a congested state of the uterus, ovaries, and contiguous organs. Although the discharge precedes from the uterus; the function depends on the ovaries from the stimulus necessary for its first appearance, for its regular recurrence, and for its due performance. The course of the menses recurs, in the majority of instances, every twenty-eight day, the very day on which it had appeared four weeks previously. The duration of a menstrual period varies in different persons, the most common and normal being about four days.
The menstrual fluid is eliminated from the uterine vessels, and is considered by some as a true secretion and by others as a discharge of pure blood. The latter opinion is the correct one. The discharge is blood, and not a mere secretion. It is prevented from coagulating by being blended with the acid secretion of the uterus and vagina. The addition of small of quantity of acetic, phosphoric or of almost any acid to ordinary blood, with prevent its coagulation, and render it similar in its properties and appearance to menstrual blood. In cases, however, in which the discharge is so profuse that a portion of its coagulating constituents -the fibrin- escapes without inter mixture with the acid secretion, clots are formed. Thus it appears that true menstrual blood, uncombined with the normally acid uterine and vaginal secretion, is like ordinary blood, and equally capable of coagulation; but that being immediately blended with this acid secretion, it is enabled to pass off in an uninterrupted course. And here may be observed one of those wise and beneficent contrivances of the Creator and Preserver of all, which so frequently excite the wonder and admiration of the physiologist. If no such acid solvent as that of the vagina existed, the coagulated menstrual blood would, in consequence of its consistency, be prevented from passing along the vaginal canal, and would thus become a mass of putrid matter, entailing consequences which would be fearful in the extreme.
Purposes of Menstruation: Two ends seem to be especially secured by this function :- 1st, the relief of the general system, by the discharge of superabundant blood which during pregnancy is appropriated to the formation and growth of the foetus; 2nd, a vicarious satisfaction of the sexual instinct, thus shielding female chastity. The modern doctrine, however, is that menstruation takes place when the ovum,
3 not having been impregnated, undergoes degeneration, and is cast off with an escape of blood from the congested uterus in sufficient quantity to relieve the congestion.
FIRST MENSTRUATION. – In this country the most common time for the occurrence of the first menstruation is from the fourteen to the sixteenth year, although the age is liable to considerable variations. In hot climates it commences at an earlier, and in cold climates at a more advanced age. The occurrence of menstruation in this country, one or two, or even three years earlier than the fourteenth year, or as much later than sixteenth, is not sufficiently uncommon to justify any medical interference when the health is otherwise good. Menstruation commences earlier in cities and large towns than in the country. It also occurs in the daughters of the rich-who have every comfort and luxury, everything which enervates and relaxes, or excites -at least nine months before it does in those of the industrious classes of the community in the most comfortable circumstances; and full fourteen months, on the average, before it appears in the poorest classes. Its earlier occurrence among the well-to do classes and later among the poorest, its scantiness among women in the savage state, and its entire absence among the lower mammals, seem to indicate that the function may be due to enervation incident to civic life and a highly artificial state of society, and not to any actual necessity of organism.
It is satisfactory established; that in every country and climate the period of the first menstruation may be retarded, in very many cases much beyond the average age, often without producing ill-health or other inconvenience. Indeed, the longer it can be postponed the less will be the draught on the vascular and nervous energy which are essential to the consideration of the functions of nutrition and growth. And it should be borne in mind that the premature accession of menstruation is almost certain to be followed by the early disappearance of the function. Probably the most successful mode of managing young ladies is to bring them as far towards the perfection of womanhood as possible before the appearance of the menses, at least until the fourteenth year. With this object in view, the following suggestions are offered.
HINTS FOR PREVENTING TOO EARLY MENSTRUATION: The use of hot baths, especially in the addition of mustard, should be avoided; also indulgence in the use of hot, spiced, and stimulating food and drinks; living in overheated or badly ventilated rooms, excessive dancing, excitement from novel-reading, too much sitting, and late hours; such habits and indulgences tend to occasion precocious, frequent, copious, or irregular menstruation.
The education and general habits of our present social condition too frequently produce such a pressure upon life that its successive stages are hurried through, and the testes and peculiarities of one period are anticipated in that which should precede it. Thus, mere boys in age and physical development become young men, and girls young women, before they leave school. Such is the precociousness which the habits and fashions of the present generation engender.
On the other hand, regular healthy occupation of both the body and the mind; the daily use of cold baths, or cold sponging over the entire surface of the body; free exercise in the open air; cool, well-ventilated rooms; plain, digestive diet, and abstinence from hot tea, coffee, and alcoholic stimulants, tend to the healthy and highest development of the female form and constitution.
SUDDEN MENSTRUATION. – It is not always, however, that this function advances gradually and in harmony, with the changes described. Menstruation may occur for the first time prematurely, and be caused by a several fall, violent jumping, great mental emotion, etc. In such cases there may be a considerable flow, amounting in some instances to absolute flooding, and lasting for several days. It is important that these facts should be known by mothers, so that in sudden and extreme instances they may not only maintain their own composure, and inspire it in others, but efficiently carry out the following important.-
TREATMENT – A few doses of Aconitum, if resulting from mental emotions, or of Arnica, if occasioned by injury or severe physical exertion, together with rest in the recumbent posture, light covering, a cool and well ventilated apartment, and cool drinks, will often be sufficient to modify the discharge; but if they should not do so, they will at least suitably precede the application of the more detailed treatment suggested in subsequent parts of the Manual, and prepare the way for the attendance of a homoeopathic practitioner if required.
In other cases, the occurrence of the menses may be long delayed, and the delay attended with excessive languor, drowsiness, periodic sickness, fretfulness, irritability or frequent change of temper, violent pain in the head or along the spine and in the region of the bowels, a feeling of weight or fulness in the pelvic region, with bearing-down or dragging sensation, tenderness or heat; and these symptoms may alternate with feverish reaction, with nervous symptoms, or even with spasms. The local symptoms, and their periodicity, are the most characteristic.
The establishment of menstruation is sometimes accompanied by derangements of the venous, digestive, or lymphatic system, and unless these are successfully treated at the period they may be present, in a greater or less degree, during every subsequent recurrence of the menstrual discharge.
If the catamenial function be well and healthily established, new impulses will be given to every nerve and organ, and the system will acquire superior forces for resisting influences adverse to health. But carelessness, or constitutional delicacy, may render this period extremely dangerous by the propagation of new forms of disease, or by the development of any latent germs of disorder which have existed from birth. Hence the first appearance of the menses should be looked for with some care and anxiety on the part of the mother or guardian, and when it is long retarded, the general health disturbed, and the remedies suggested in this work appear inoperative in developing the desire change, professional advice should be sought without delay. False delicacy and improper treatment have needlessly undermined the health of thousands.
The mother should, for some months at least, keep an account of dates and other particulars, and prevent all unusual exposure for a few days before the expected flow, such as not night air, damp linen, thin dress, wet feet, balls, and evening entertainments. When the function has once become healthily established, it is satisfactory to know that extreme precautions need no longer be observed.
8. – DELAY OF THE FIRST MENSTRUATION (Amenorrhoea)
DEFINITION. – The term Amenorrhoea is used to describe absence of the menstrual discharge, and is usually considered under three divisions, – namely, (1) Emansio mensium, delay of the menses, although the person has attained the proper age; (2) Suppressio mensium, in which they have appeared, but, as the consequence of cold or some other cause, are arrested; and (3) Retentio mensium, in which they accumulate in the uterus and vagina, from what is technically termed imperforate hymen; or more frequently, from occlusion of the vagina by the healing of ulcers, in consequence of sloughing after difficult labours. This condition usually requires surgical measures for its relief.
This Section is devoted to the first form, or Delayed menstruation. As before stated, the period at which the “change” first takes place varies in difficult constitutions, climates, and under different circumstances, and no active medicinal means should be used so long as the health continues good. Emmenagogues, or forcing medicines, such as herb-tea, and other allopathic expedients, must be entirely and imperatively eschewed.
SYMPTOMS – When all the external signs of womanhood have appeared, but without menstruation, there are aching, fulness and heaviness of the head, bleeding from the nose, palpitation of the heart, shortness of breath on slight exertion, weariness of the limb, pains in the small-of-the-back, in the lower part of the bowels, and down the inside of the thighs-and these symptoms may be regarded as so many indications that nature is seeking to establish this important function, and that the administration of one or more of the following medicines according to the indications present may be called for.
CAUSES – It is important, first of all, that the cause should, if possible, be definitely ascertained. The immediate cause is probably an inability of the nervous centres to stimulate the ovaries. Delay of the menses from this cause rarely occurs in healthy and vigorous persons, but usually follows as a consequence of original delicacy of constitution, or of some long-standing affection. The very common notion that a patient suffers because she does not menstruate is very fallacious. Except of Retentio mensium, the patient does not suffer from an accumulation. Hence the impropriety of giving forcing medicines, which is frequently done, often to the permanent injury of the, as yet, imperfectly developed organs. We have known instances of extreme periodic suffering, continued for many years, traceable to this injurious treatment. In many cases, too, it will be found that the disturbances supposed to be due to delayed menstruation really arise from the patient having taken too little, or innutritious food, or from her habits having been too sedentary or artificial, or from too little out-of-door air and exercise; or, in brief, from her being subjected to influences inimical to her general good health, during a critical period of her physical development.
Tardy menstruation is especially significant in those girls who are predisposed to any form of Consumption. In this class of person it implies a depraved habit of body in which the menses may not appear at all, or in which a vicarious flow of blood is very apt to take place from one or another of the mucous surface, more especially from those which line the respiratory passages. If the young girl who has not menstruated, although she may be fourteen or fifteen years of age, has a cough or difficulty of breathing, a sore throat, hoarseness, or pain in her side, it should be taken as a symptom of ill-health, and measures immediately instituted for its relief. The quaint old rule should, however, not be lost sight of: “she is not sick because she does not menstruate because she is sick.” – Ludlam.
TREATMENT – If no congenital deformity or mechanical obstruction exist, the delay being evidently due to constitutional causes, one of the following remedies, the most important of which are Cyclamen, Ferrum, Pulsatilla, and Sepia, together with the accessory measures afterwards referred to, may be expected to be successful.
EPITOME OF MEDICINAL TREATMENT :-
1. For the constitutional Condition. – Calcarea carb., Calc-Phosphorus, Cyclamen, Ferrum, Phosphorus, Sepia, Sulphur
2. For Indigestion – Bryonia, Lycopodium, Nux., Pulsatilla, Sulphur
3. Consumptive Tendency – Calcarea, Phosphorus, Phosphorus
4. Anaemic Patients – China, Ferrum, Helonias, Natrum muriaticum
5. Various other Conditions – Aconite (disturbed circulation); Belladonna, Sepia (Headache); Cim. (Pain in left side; rheumatic tendency).
LEADING INDICATIONS FOR THE PRINCIPAL REMEDIES. –
Arsenicum. Poor appetite: great prostration and emaciation; swelling of the ankles, feet, or face, and corrosive leucorrhoea.
Bryonia. Bleeding from the nose, or spitting of blood instead of the menstrual discharge; hard, dry cough, stitches in the chest, constipation, and muscular rheumatism.
Calcarea Carb. – Scrofulous constitution, chronic indigestion, milky leucorrhoea, glandular swellings of the neck, vertigo, chronic headache, cold extremities, and cough, worse in the morning, are symptoms often present in cases requiring this remedy.
Cimicifuga. – Deficient nervous energy in the ovaries with excess in other organs, manifested by extreme nervousness, hysteria, heavy headache restlessness, sleeplessness, “sinking” sensation, chorea, pain under the left breast, and in the left side generally, and rheumatic pains.
Conium – This medicine is particularly suitable for women with tight, rigid fibres, and who are easily excited. Pain or swelling in the ovaries, with leucorrhoea of a white acrid character, are strong indications for this remedy.
Ferrum. – Debility, languor, palpitation, indigestion, sometimes Leucorrhoea, sickly complexion, puffiness of the face or ankles, and other anaemic and chlorotic symptoms. (See the Section on “Chlorosis.”)
Iodine. – Scrofulous patients, with enlarged glands and a lymphatic constitution, corrosive leucorrhoea, an feeling of much weakness on going upstairs.
Nux vomica. – Congestive morning headache, constipation, frequent acute indigestion, spasms, etc. Nux V., is suited to patients of dark complexion, energetic, vehement, and irritable disposition, and to those who teak too little out-of-door exercise.
Phosphorus. – For delicate constitutions, with sensitive lungs, and a predisposition to disease of those organs. Sometimes, in such cases, instead of the menstrual discharge, expectoration of blood in small quantities occurs, with cough, and pains in the regions of the chest.
Pulsatilla. – Pains in the abdomen and across the back; hysterical symptoms, alternate laughing and crying, nausea and vomiting, palpitation of the heart, indigestion, and loss of appetite; Anaemia – Pulsatilla is chiefly suitable for patients of light complexion, fair hair, and timid, easily vexed, yet uncomplaining disposition.
Senecio. – This remedy, administered during the inter menstrual periods, has proved eminently successful, and seems to possess alike the power to restore the secretion when suppressed, of augmenting it when deficient, and of diminishing it when excessive, as also of alleviating the pains of Dysmenorrhoea. It may be stated to act as a uterine tonic, invigorating the catamenial function, and restoring equilibrium of action.
Sepia. – Delay of the period in persons at the proper age (from venous congestion), with distention or pain in the abdomen, giddiness, nervous headache, easily-flushed face, fine sensitive skin, retiring, melancholic disposition.
Sulphur – Scrofulous patients, troubled with Leucorrhoea and itching of the genital organs.
Veratrum – Cold hands and feet; hysteric and fainting fits; nausea, vomiting, and tendency to diarrhoea.
ADMINISTRATION. – The selected remedy may be administered in the morning on rising, one or two hours before dinner, and on retiring to bed. When the symptoms are urgent, every one, two, or four hours. In chronic cases, morning and night.
ACCESSORY TREATMENT. – The feet should be kept warm and dry, comfort, rather than fashion, should determine the entire clothing arrangements. Delayed menstruation is often the consequence of exposure to cold or defective circulation in the surface, which warm clothing would obviate. It is especially necessary that the abdomen be kept warm; the necessity for wearing drawers, to protect it from cold, must, therefore, be obvious. Too studious and sedentary habits should be corrected; exercise taken out-of-doors, particularly in the morning, including walking, running, and the games of skipping rope, battledore and shuttlecock, trundling the hoop, etc., as they are powerful auxiliaries in obtaining health of body and vigour of mind. These exercises are likely to be yet more efficacious if practised in the country, on a dry, sandy soil, and in pure and bracing air. If pleasant company can be added to the charms afforded by diversity of scene, the advantages will be still greater. All these means should be aided by a carefully selected nourishing diet, taken at regular hours, three times a day, consisting of easily digestible food, in due proportions from the animal and vegetable kingdoms. All made dishes, high seasoning, spices etc. should be especially avoided; also, except in great moderation, the use of tea and coffee.
THE COLD SITZ-BATH – In Amenorrhoea this is a powerful means of stimulating the menstrual function, but is not advisable when the patient is very feeble, or anaemic, or when there is reason to suspect constitutional disease as the cause of the dormant function.