robust men and adolescents are often subject to recurrent periods of wakefulness, which often coincide with the full moon, and may be due to its light. Indeed, Mantegazza holds that the menstrual periods were established because moonlight nights were favorable to courtship, and later, when the rhythm was well established, they became independent of lunar periods. The Sabbath had a great influence in fixing the twenty-eight- day period. Koster (Periodische Irresein) thinks that nearly all periods in periodic disease are compounded of various mul- tiples of seven days, and that the anomalistic period of physio- logical month of twenty-eight days makes a veritable tide in the health of man, so independent of sea tides that Darwin's suggestion of these as causative of the menstrual rhythm is unnecessary. The moon is 47-55 thousand miles nearer the earth in perigee than in apogee, and exerts nearly one-sixth greater magnetic and gravitational effect upon the earth. Kern, in his treatment of periodic psychoses, thinks most of those with prominent psychic symptoms develop at adolescence. Sometimes melancholy and mania succeed each other with lucid intervals, in great regularity. Where there is much vari- ation averages sometimes bring it out, and where other, e. g., seasonal periods are more prominent, this rhythm is neverthe- less present. Bartel, who ascribed one-third of the cases of female insanity to this cause, classifies periodic diseases into those which do and those which do not coincide with the men- sal unit of time.
Nelson,^ who was a good dreamer, and whose methods and results are so far the best, habituated himself to recording im- mediately, without rising from bed, all his dreams and com- puting them by a method designed to show the amount of dream energy each night for thirty months, and found a distinct mensal period. His sexual activity during sleep, measured by involuntary emissions or "ekboles," showed a still more marked monthly rhythm. His major climax also was near the summer solstice, near which Boring's curves show the maximal number of conceptions.
It is singular that a process eternally and regularly repeated in the life of woman has never been regarded as quite normal » A Study of Dreams. Am. Jour, of Psy., vol. i, p. 367.
> PERIODICITY 503 or physiological. It is somewhat less unaccountable that it should have been everywhere considered as a badge of infe- riority or a basis of exclusion or disgust. In accepting this view woman has exposed herself to the constant temptation to a dissimulation that too often becomes constitutional, by try- ing in every way to conceal it, even though she aggravate its dangers by efforts she should not then put forth. This lack of candor and naturalness must affect character in the direction of frankness and honesty. On the other hand, this aversion has been, as we saw, favorable so far as it tended to secure se- clusion and rest, so that in this respect superstition did the work of science. This strange chronometry, in mysterious rapport with moon, tides, reproduction, race, climate, and all the environment in its every item, has contributed not a little among many savages to make woman an object of superstitious awe; and even if it has had nothing to do with keeping her stature inferior to man's, has made her more many-sided, so that she may have thus been better able to reduce his polyga- mous instincts by becoming herself in the course of the month several different kinds of person and appealing by turns to his pity, his passion, and ruling him now by sympathy, now by service, now by admiration, while her repertory of changes gives her an added charm and ever-stimulating interest.
Ever since Hippocrates the period of first menstruation has been thought to be very critical for the development of the nervous system. The entire genital organism is congested; the volume of the uterus and ovaries increases; the Fallopian tubes grow turgescent; the breasts are enlarged and tender; the thy- roid gland swells; the nerves are tense and irritable; from 250 to 500 grams of venous and often clotted blood are lost normally, and this of itself in girls not properly instructed may cause great alarm, aggravated, as it often is, by idiopathic hor- ror of blood, which indeed it may cause, and which may still more prompt unhygienic and even dangerous modes of con- cealment, removal, stanching, etc. It may thus lay deep in the nervous system, the foundation of psychic perturbations at every period. Few more pitiable objects exist in nature than a girl, especially if nervous or overworked, who must encounter this experience for the first time, uninstructed or alone. The quality of motherhood has nowhere a more crucial test than in 504 THE PSYCHOLOGY OF ADOLESCENCE meeting the needs of this epoch. The individual variations are so very v^ide that every girl should be a special case by herself, and all reasoning from one person to another is apt to be fal- lacious. All of the physical and psychic phenomena are peculiarly prone to abnormal defect or perversion, and for a considerable time everything that in the least degree jeop- ards the harmony and balance of the many factors involved in the settled establishment of regularity and normality should give way. Now begins a great and ineradicable difference be- tween the physical and psychic life of woman and that of man. Gynecology is by general consent the largest, with the pos- sible exception of neurology, of all the specialties of medicine. Few departments of the profession are more important, and it can boast some of the greatest and noblest of practitioners. But the limitations in this field are peculiar. They are seen in the complacency in partial views that ascribe everything to some one simple theory which is utterly inadequate to the sub- tleties of nature — nerve cycle, endometric degeneration, ovula- tion as primal and all-conditioning in menstruation, or make pelvic anomalies, or metritis, or engorgement of the base, the keystone of the arch. The diversity of theories is probably not so wide as the range of individual variations, and while the latter graduate into each other by imperceptible gradations, the former remain rigid and unmediated, and their representatives sometimes resemble hostile camps. So in treatment, what Dr. Jacobi^ said eighteen years ago, is still too true. Some pre- fer the knife, others the cautery, others the curette and irriga- tion with lotions or tamponing, others supports, internal and external, pessaries, etc. In the present confusion, the chief points of safety should be to avoid heroic or premature treat- ment until we know more what constitutes excess or chronicity; what is the pathological significance of versions, catarrh, in- flammations; until discussions concerning the nature of the disease are at least as discriminating and animated as those concerning treatment. There is a classic treatment of certain diseases like pneumonia, typhoid, and nephritis, but the whole field of uterine troubles has been, and still is, one of great dis- traction and uncertainty.
1 Studies in Endometritis. Am. Jour, of Obstetrics, 1885, vol. xviii. Seven valuable articles.
PERIODICITY 505 There are now, happily, signs of a reaction against the re- cent excessively surgical tendency, which has been too domi- nant, toward a large view of the whole life of woman. Special- ists are beginning to realize that they must broaden their view from the pathology of her organs, till lately so often doomed, if she once consulted them, to the entire problem of regimen, and know at least as much about woman as about her pelvic diseases. Indeed, not a few experts are beginning to recog- nize that this larger field is relatively unknown to them, and that they must begin the study of the new or higher gynecology with something like a Socratic confession of ignorance. As long as they hold any exclusive theory which consigns to either ovaries, uterus, tubes, or central nervous system, the exclusive dominance, or assume that either the psyche or soma is always primal or causal, little progress can be made. Each of the modern views is partially correct and must always be consid- ered as a possible aspect of each case.
To understand a woman's body and soul is a larger problem than to understand a man's. It is true of her more than of him, that to know a part we must know the whole; first, because her nature is more generic and less specific, and, second, be- cause reproduction, the deepest secret of animate nature, plays a larger role in her life. Illness constitutes a greater element of her existence and is in a sense more a part of her. Each woman is a more adequate representative of her sex than a man is of his, so that to know one well more involves knowing all; hence experts and specialists, apparatus and particular processes, while often helpful, are more liable to be an insult to the deeper laws of her being. Our medical science, our psychology, and our philosophy are still inadequate to answer the questions her nature propounds. If the male doctor could occasionally be a woman, as Plato thought he should be sickly to more sympathetically understand those with whom he deals, this would avail much, but might reveal more new problems than answers to old ones, for, despite the great and real recent advances, it is not unlikely that modern woman, with her pro- gressive complexity and sensitiveness, is evolving new symp- toms and disorders yet faster. Perhaps it is this that has kept gynecologists so bound down to pressing needs as they arise that they have had little time to generalize on the facts within 5o6 THE PSYCHOLOGY OF ADOLESCENCE their ken, and little strength to rebase their practises upon larger views of woman's nature. Perhaps our medical schools, now happily becoming endowed, have not hitherto been able to do their duty in the lines of research that are so inviting here. American woman is herself unique enough to furnish many special problems tliat almost cry out for investigation. Her status is changing more rapidly here than elsewhere, and the future of our race depends on whether for good or for ill, but this we can not clearly see till medicine broadens, here at least where need is greatest, to include anthropology, and all study of woman's diseases is made on a broad background of biology and heredity.
No one who has once abandoned himself to the fascination and suggestiveness that all parts of this field are now acquiring can fail to hope that a new and higher synthesis is impending which will not coordinate menstruation with pregnancy, and adolescence with senescence, but will bring together the results of the changes in the quantity, pressure, and alkalinity of the blood, in pulse rate, in the rhythm of output of carbonic acid and urea, temperature, nerve tension in brain, medulla, cord, and pelvic plexus and ovaries; homologize the loss of the endo- metrium and its regeneration with the moulting and subse- quent reproduction of new organs; correlate normal with mor- bid changes; and show the true relation of these processes to pubertal growth on the one hand and to sexual desire on the other, as well as to fecundity. It is also apparent that the key that is to unlock the secret of all these relations is to be found in the biogenetic field. That the challenge that this condition now issues to science will soon be taken up more successfully and its difficulties overcome, we must hope. It is certain that any marked advance here will mark an epoch in our knowledge of both man's body and soul, and, what is more vital, will help us to bring the future mothers of our race to a better discharge of their functions.
Meanwhile we must hold fast to the basal fact that this process must be absolutely normal and complete in all its details or the mental and physical well-being of woman is jeopardized, and that a healthful performance of this function is essential to a well-balanced mind. If every organ has an independent nervous mechanism, these must be combined with reciprocal PERIODICITY 507 interaction from a rhythmically pulsating center as real as that which controls respiration or heart-beat. Ophthalmology has vastly widened its scope in recent years by entering the school and doing a great preventive work for the young. Gynecology should profit by this example. Woman's sphere has vastly widened of late, yet she is not equipped for the boundless field opening before her, but is handicapped by need- less fashion and inveterate habits of antihygienic life. Vital as the distinction may be for diagnosis, it is often impossible to tell whether the mental symptoms are caused by defective menstruation or vice versa. The whole problem of the relation of the mind and body is here involved.
It is frequently assumed that among individuals of the same race and environment an early beginning goes with a late cessation of menstruation, and in individual cases this is dem- onstrated, as is the fact that a retardation of the development of this function goes with early senescence. In general, the former at least must be regarded as exceptional. Commonly, if it is accelerated prematurely it is followed by early involution, as women in hot climates are often old at thirty. In the main it is probable that those who mature late age late. It would certainly seem as if the interests of racial advancement re- quired at least a progressively later ripening, if not a later decay, and that most effective propagation be kept near the acme of maturity. The duration of this best age for offspring may not increase or decrease concomitantly with that of men- struation, but may fall within its limits by a variable interval.^ In fine, puberty for a girl is like floating down a broaden- ing river into an open sea. Landmarks recede, the water deepens and changes in its nature, there are new and strange forms of life, the currents are more complex, and the phe- nomena of tides make new conditions and new dangers. The bark is frail, liable to be tossed by storms of feeling, at the mercy of wind and wave, and if without chart and compass and simple rules of navigation, aimless drifting in the darkness of ignorance, amidst both rocks and shoals, may make of the * The curves on p. 508 will aid us in stating the many unsolved problems here. The lower line represents the age of first menstruation; line 2, the age capable of producing viable children; line 3, the age of most effective heredity. The three THE PSYCHOLOGY OF ADOLESCENCE weak or unadvised wrecks or castaways. The change itself is exciting, and half knowledge or popular and perhaps prurescent fallacies only augment instead of allaying the strain. Four or five days a month for some thirty years the girl's system will be depleted, and there will be lassitude with peculiar susceptibility to physical or mental shock, and complex problems of regimen that even with the best instruction must receive a large residu- ary personal solution. Shall she withdraw, and make or ac- cept excuses which seem to her a kind of implicit confession which is so hard even to those nearest her? Does she show or curves are schematic representations of the fertile age, of which a pictures early maturity and decay with deficient effectiveness; b represents later maturity and prolonged fertility; c a late short period of very effective productivity. The short lines just above each curve represent children 7, 9, and 4 in number, progressivity being their upward direction. Thus the first and last child of a are decadent; the second and sixth, which are horizontal, just maintain the status of the parent; the third and fifth add a little, and the fourth adds most, while the four children of c are all progressive. Frequency is greatest in a and least in c, which excels also in regularity of interval. While such a curve might be constructed for any fertile mother who had already reached the menopause, or, better yet, for a fertile grandmother, in point of fact we can not construct any part of such a general curve AgelO AgelO from any other given part of it. We do not know whether those who begin to menstruate late attain full fertility sooner or later or within the same interval as those who begin early. Perhaps curve b should be very steep at first and reach line 2 almost as soon as does curve a, instead of crossing it at a greater interval than it rises from line i. Perhaps curve c is not the one that ascends highest, and per- haps it, and not 3, is most prolonged at its greatest altitude. Curve a may really fall later than does c. Statistics of viability of offspring suggest quite an interval between lines i and 2, and we have every reason to believe that the period of pre- nubility and adolescence should be prolonged above the latter, but above line 3 we have no clue save that of vague popular impression or abstract theory. Whether, and, if so, how long, the curve becomes horizontal on top, or whether those that reach the highest level do so latest and decline earliest, as is often commonly assumed among the educated classes, or whether nature decrees that, to do the very best that birth can do for offspring, preparation must be begun early rather than late, we are ignorant.
PERIODICITY 509 can she conceal her state at least from strangers, or will they suspect, or must she make an effort to be natural? Shall she accept corsets, long and heavy skirts, the rush, crush, and bustle of social obligations? Shall she seek the information or ad- vice she feels the need of, and how and of whom? There is almost always some pain, reflex or direct, and this is a nervous handicap which may tend to feverish instability. After a few periods and a little knowledge she often learns to be more or less anxious about either regularity, duration, or quantity, or all, and practises little expedients, stumbling onward in the pathway of self-knowledge. In the dim depths of her soul she vaguely feels how paramount this function is, especially in its initial stage of incipiency, at least for her good looks, spirits, and ease of daily duties, but at the same time she infers from observation of others, and perhaps from the very paucity of information given her, that the less concession made to this instinctive sense of its importance, or to her feelings or her sense of waning vigor, the better. The change in her own psychic state naturally suggests that the periods are all-condi- tioning, but the sentiment of her environment is to ignore them as unimportant if not shameful. She may have experienced a nervous shock at the first flow, or suffered, as experts tell us so many still do, from applying cold water as if to stanch a wound, or been the victim of unusual exposure or activity at the critical time; or, as our returns show, she not infrequently tides herself over by unwonted coffee, tea, or even vinegar or tablets of vari- ous kinds, that often acquire unsuspected vogue in school cir- cles, where such expedients occasionally are almost comparable to the errors of incompetent obstetricians later, which Engel- mann says furnish the gynecologist half his patients, or the fad of operation when, for a period just closing, experts were " blinded by the glitter of the surgeon's knife." Everywhere, whether in the profession or among adolescents, the greater a non- or half-understood subject like this is felt to be, the more rankly fads and extreme and special theories and practises arise and flourish for a season. This phenomenon of iides quaerefjs intellectus is nowhere so well illustrated as in every aspect of sex, and is itself a most tempting psychological theme.
But my point here is one I have nowhere seen stated, viz., that menstruation now forces a most challenging set of ques- 5IO THE PSYCHOLOGY OF ADOLESCENCE tions, conscious and unconscious, upon the girl's mind, that of themselves constitute a great strain and demand for some time a good share of all her power of mentation. Because her puberty is shorter and its manifestation more ostensive and the function now born more central for her life than for the boy, this psychic incubation is more important if she would emerge into full womanhood unscathed. Perhaps to this we must add another unnoticed factor, viz., fully assimilated knowledge that immediately becomes a part of life is strength, but that which is undigested and not transformed into carrying power, but is a burden to be carried in memory, is an added cause of tension and fatigue. It devitalizes, augments worry, and if there is no introspection may be permanently de-educational. Because girls accept with more patience than boys learning that is merely conventional, they are especially exposed at this period of conformity to harm by pedagogic fooleries that have only a factitious school value, and to be victimized by spurious mental interests just when real ones would steady them, in their time of greatest danger from emotional instability. Vital and nor- mal intellectual work and zest has a power already manifestly hygienic, but with possibilities in this direction needing, and therefore certain of, great further development. That con- cessions are progressively, if unconsciously, made with the increasing feminization of American schools is seen, happily for the girls but unhappily for the boys, in both the matter, method, and quantity of work.
Savagery has great advantage even over modern educa- tional life in that it everywhere recognizes the need of seclusion. The tepee, or booth, or grot, so commonly set apart for men- struant girls, often purposely built so low that they can not stand but are forced to sit or lie down, suggests so far sound ideas of health, although other requirements are often deleterious. In many ancient civilizations withdrawal was divinely ordained and enforced by penalties. False as was the idea of unclean- ness or contamination, in practise it wrought good. While of all influences right muscular exercise can best smooth out this wave, even it must cease for a time at the onset of puberty when the organism first enacts the minimized pantomime of parturition, as children rehearse in play with toys and dolls the serious business of life. This system at least did not turn out PERIODICITY 5*1 either the hectic or the faded fraud that once was proud of semi- invahdism as a deHcacy that was thought to be interesting, and later cultivated the Grecian bend, which is its instinctive pos- ture, and now is content with a nervous sprightliness and vivac- ity as if restlessness were brilliancy.^ Instead of shame of this function girls should be taught the greatest reverence for it, and should help it to normality by reg- ularly stepping aside at stated times for a few years till it is well established and normal. To higher beings that looked down upon human life as we do upon flowers, these would be the most interesting and beautiful hours of blossoming. With more self-knowledge woman will have most self-respect at this time. Savagery reveres this state and it gives to woman a mystic awe. That after the almost universal pubescent initial seclusion practised among primitive people it is so commonly ignored, is perhaps one cause of tribal arrest or decline. Civ- ilization differentiates the sexes in nearly every respect. The time may come when we must even change the divisions of the year for woman, leaving to man his week and giving to her the same number of Sabbaths per year, but in groups of four successive days per month. But Sabbaths they should remain — days, superior to others, devoted to leisure, to higher over- thoughts, religious sentiments and suggestive of a lost paradise, the idea of a more precise expression of her nature and needs at this time than the weekly cycle man accepted for his norm from his God and has imposed on woman. When woman asserts her true physiological rights she will begin here, and will glory in what, in an age of ignorance and sense, man made her think to be her shame. The pathos about the leaders of woman's so- called emancipation is that they, even more than those they would persuade, accept man's estimate of this state, disapprove, minimize, and perhaps would eliminate if they could the very best thing in their nature. In so doing it is the feminists, who ' See Engelmann: The Health of the American Girl, Trans, of So. Surgical and Gynecological Association, 1890. Hatfield: Dynamics of School Puberty, Jour, of Am. Med. Ass'n, November, 1899. L. Meyer: Der Menstruations Pro- cess, Stuttgart, 1890. R. H. Smith: Preventive Gynecology, Am. Jour, of Obstetrics, May, 1900. Schaeffer: Einfiuss der Psychosen auf den Menstruations Vorgang, Allg. Zeitsch. f. Psychiatric, 1893, p. 976 et seq. Axel-Key: Die Pu- bertats Entwickelung, Verhandl. d. Internal, med. Cong., Berlin, 1890, p. 67.
512 THE PSYCHOLOGY OF ADOLESCENCE