grammatical feminine endings of words, and the sharper quality of the feminine endings may be well studied in the French language. This sexual vocal difference is by no means peculiar to Man: in most animals the female has a shriller and weaker voice than the male, as the hen, bitch, and mare, for ex- ample; and Buffon observed that the she-ass has a clearer and more piercing voice than the male. Darwin, discussing the loud voices of male animals at the breeding-season, came to the conclusion that the most probable view is that " the frequent use of the voice, under the strong excitement of love, jealousy, and rage, continued during many generations, may at last have produced an inherited effect on the vocal organs." * It is scarcely possible yet to speak more definitely as to the cause of this secondary sexual character, or its utility. We must be satisfied to regard it as one of the methods by which the mutual attraction of the sexes is ensured. That the deeper voice of a man and the gentler but higher-pitched voice in woman, have their effect in heightening the pleasure of the sexes in each other's person is a well recognisable fact The Thoracic Viscera. — The heart at an early age is as large in the female as in the male, or even larger. According to Boyd's tables, it is still abso- lutely larger in girls between the ages of fourteen and twenty, but from that age on it keeps about two ounces smaller; the maximum weight is only attained at a mature age. According to F. W. Beneke, the child has a relatively large arterial system, but at puberty this relation is changed; "the larger the heart relatively to the vessels the higher the blood pressure, and the earlier this becomes the case the earlier, stronger, and more complete is the development of puberty." 2 According 1 Descent of Man, Part II., Chap, xviii.
2 F. W. Beneke, Die anat. Grundlagen der Constitntionsanomalien des Menschen, Marburg, 1878.
Google THE VISCERA. 239 to Vierordt's tables, the male heart from birth on- wards increases its original weight fully thirteen times, the female heart less than twelve times. Hypertrophy of the heart is about twice as common in men as in women, while atrophy is somewhat more frequent in women.
The right lung, according to Boyd, is absolutely larger in the female child at birth, but between the ages of twenty and thirty the male lung has become by as much as a third of its weight heavier than the female. 1 It is not easy to ascertain the normal weights of the lungs and heart, as these are so frequently in- creased or diminished through disease. It seems probable, however, that there is a tendency in early life for the heart and lungs in the female child to develop faster than in the male. If so, it may be another case of precocity resulting in diminished final attainment, for there is reason to think that in women these organs are relatively somewhat smaller than in men. This result is in harmony with what we know of the size of the thorax in women, and of their marked inferiority in vital capacity and in muscular efforts.
The Abdominal Viscera. — The stomach appears to be relatively larger in women than in men. Thus, according to Boyd's tables, it is the same size in both sexes at birth; between the ages of 14 and 20 it is still of equal size in both sexes, or indeed somewhat heavier in girls, although the total average weight of the boys is five pounds more than of the girls. At the age of 20 to 30 it is still nearly the same size in men and women, although the preponderance of men in total weight has by this time become much greater.
It is stated by Burdach and other old writers that the intestinal canal is longer in women than in men.
1 Boyd's "Table of Weights of the Human Body and Internal Organs," founded on the results of 2600 post-mortems, Philosophical Transactions, 1 861.
Google 240 MAN AND WOMAN.
Women are said by Burdach and others to digest more rapidly than men. Delaunay found on making inquiries from the matrons of orphan asylums that little girls become hungry much oftener than little boys, and he also found that in almshouses for the aged where there are three regulation meals a day, the old women often put aside a portion of their meals to eat during the interval. The need for food at frequent intervals is common among the young.
At the same time women eat less than men. In prisons and hospitals, according to Burdach, women take nearly one-fifth less food than men. A London vegetarian restaurant-keeper said that the average price a man pays for a vegetarian dinner is tenpence, while the women only average sixpence. It would probably be easy to add proofs of the small appetite of women, but it must be added that when women work, are under good conditions, and not forced to economise, the sexual difference is by no means marked.
It has often been said that gluttony is more common in women than in men. Delaunay, who has a curious discussion on the frequency of gluttony in various classes of the com- munity, 1 came to this conclusion as the unanimous result of his inquiries; he found it was most marked during menstruation and pregnancy. Brillat Savarin thought that women are in- stinctively gourmandeS) the reason being that they know it is favourable to beauty. I should be inclined to say that women are friandes rather than gourmandes, loving special foods, chiefly sweets? sometimes acids; such a conclusion is quite in accordance with the facts given by Delaunay. And it may be added that if women were as much addicted as men are to the use of tobacco their friandise would probably no longer be observable. The taste for tobacco and the taste for sweets seem usually to be mutually exclusive.
The liver is relatively very large at birth, and according to Vierordt it is proportionately somewhat larger in women. 2 Boyd's figures tend on the whole to show the same result According to Gegenbaur, however, the liver represents 28 per cent of the weight of the body in men, and only 26 per cent in women. Wiesener's figures show that it varies very greatly through life, and at birth is larger in the female. On the whole, it is difficult to speak definitely 1 Atudes de Biol Comp. y "Physiologic," pp. 16-25.
2 H. Vierordt, "Das Massenwachsthum der Korperorgane des Menschen," Arch./. Anai, u. Phys., 1890.
Google THE VISCERA. 24 1 regarding so variable an organ, but it seems probable that if there is any sexual difference at all it is in favour of women.
The spleen, according to Boyd's tables, is, on the average, absolutely larger in the female, if prematurely stillborn, if stillborn at full time, or if born alive. Up to three months it is the same size in both sexes, and after that it is of about equal size in both sexes pro- portionately to body-weight The maximum weight of the spleen in proportion to the body, according to Gaston and Valine, who have specially studied the organ, it may be mentioned, is attained at the age of eight; 1 it is therefore essentially an organ of child- hood. Blosfeld of Kasan and Gocke of Munich have both found the spleen (according to Vierordt) abso- lutely larger in women by about 12 grs.; Vierordt himself does not find much sexual difference.
The kidneys in infancy are relatively very large. In early life, according to Boyd's tables, they are in absolute figures slightly smaller in the female, the difference increasing in the adult. Sappey has found the average length, breadth, and thickness equal in the sexes, and therefore relatively greater in women. While the absolute weight is somewhat less in women, proportionately to body-weight there seems to be little sexual difference.
The bladder is relatively small in infancy, and its shape is at this time inclined to be fusiform; in men it is ovoid, and in women ellipsoid, or rounder. It is also relatively larger in women, with a tendency to lateral expansion, and more dilatable; the majority of cases of enormous distension of the bladder have been found in women. It may perhaps be said, therefore, that the bladder is more highly evolved in women than in men.
There has been considerable controversy as to the relative size of the male and female bladders. Cruveilhier stated that 1 Revue Mensuelle des Maladies de VEnfance t September 1892.
16 Google 242 MAN AND WOMAN.
it is larger in women. Sappey, as well as Hoffmann, on the other hand, claim a vesical predominance for men, and con- clude that when in women the viscus is large it is simply due to unnatural habits of distension, the result of social causes. Charpy, who attributed much importance to sexual differences of size in the bladder, found that it was anatomically smaller in women, but of greater physiological capacity. Heitzmann and Winckel (who has made a special study of the female bladder) find it larger in women. Hart and Barbour find that, relatively to body-weight, it is more capacious in women. This result is doubtless correct.
The question of the dilatability of the bladder has lately been carefully studied by Genouville (" fetude Comparative des Organes de Miction dans les deux Sexes," Archives de Tocologie et de Gynicologie^ Mai 1893). This investigator, examining the bodies of 25 men and 25 women after death, found that on an average Male bladder without pressure contained 88 gr. Female „ „ „ 58 gr.
Male bladder with,,,, 238 gr.
So that while without pressure the female bladder only contains about two-thirds of the amount contained in the male, with pressure the proportion is almost reversed; the male bladder with a pressure of o™* 20 height of water contained nearly three times what it contained before, the female bladder nearly six times what it contained before. (It must be remembered that the results without pressure do not correspond to what is normally found during life, the pressure of the muscular tonicity of the sphincter in life, as Hache has pointed out, making a greater difference between the dead and living bladder in women than in men.) Duchastelet in the living subject also found that the tolerance of the female bladder on injecting water is much greater than of the male. And Duchastelet also found, like Mosso and Pellacani, that the desire to urinate always makes itself felt at the same pressure; the threshold of desire is not determined by the amount of urine, but by the energy with which the bladder walls contract on that amount, and this thresh- old is constant in any one individual. Genouville considers that habit may possibly have something to do with the greater dilatability of the bladder in women, but that it is certain that the female bladder is predisposed to this, and possesses a native dilatability. It is less heavy and muscular than that of men. The child's is even less dilatable than that of men. The anatomical capacity of the bladder (*>., after death), Genouville concludes with Charpy, is greater in men; the physiological capacity is greater in women.
Google THE VISCERA. 243 On the whole, this glance at the viscera seems to show that the thoracic organs somewhat predominate in men and the abdominal in women. Our know- ledge is imperfect and the fallacies are so considerable that we can scarcely hope to attain very accurate information. Such results as we see, however, are in harmony with what we have already found as to the sexual differences in the thoracic and abdominal cavities. They are in harmony, also, with the opinions of the older writers, who attributed abdominal pre- dominance to women. The muscular energy which is so marked a characteristic of men depends largely on the strength of the heart and lungs.
It is not possible to say much at present of the viscera as organs of emotion, although there is reason to believe that the organic basis of emotion is largely to be traced here. A very ancient and widespread psychology has placed the seat of the manly virtues of courage and endurance in the breast, and the womanly virtues of love and pity in the belly. Cceur- de-lion is emphatically a manly title of honour; the liver was formerly regarded as the organ of love, and the Hebrew and other races, even as far off as the Pacific, have found the seat of compassion in their bowels.
Google CHAPTER XL THE FUNCTIONAL PERIODICITY OF WOMEN.
THE PHENOMENA OF MENSTRUATION — ORIGIN— THE THEORY THAT WOMEN ARE NATURAL INVALIDS — THE CYCLIC LIFE OF WOMEN — ITS RECENT DISCOVERY — ILLUS- TRATED BY THE OBSERVATION OF VARIOUS FUNCTIONS — THE HEART, THE EYE, ETC. — THE SPECIAL PHYSICAL AND PSYCHIC PHENOMENA OF THE MONTHLY CLIMAX — THESE ARE INTENSIFIED IN ILL-HEALTH — THE LEGAL, SCIENTIFIC, AND SOCIAL IMPORTANCE OF WOMEN'S PERIODICITY OF FUNCTION.
The fact that from the evolution of puberty onwards during the years of sexual life, with periods of inter- mission caused by impregnation, women are subjected to a monthly loss of blood has incidentally come before us several times. The amount of blood lost every lunar month may be said to be between 100 and 200 grammes; the period of flow lasts from three to five days, and on an average recurs on every twenty-eighth day; and the age at which it first appears is usually between fourteen and sixteen, though it may be earlier. 1 The origin of this periodic flux is quite unknown; it exists in all human races, 1 Dr. Whitehead's tables show that out of several thousand girls the largest number of menstruations occurred at the age of sixteen — i.e., 24 per cent., as against 19 per cent, at 15 years, and 12 per cent, at 17 years. Sullies, at Konigsberg, also found that the mean age is sixteen, tall, weak, and fair girls menstruating earlier than short, strong, and dark girls. For a full discussion of this point see Ploss and Bartels, Google THE FUNCTIONAL PERIODICITY OF WOMEN. 245 and some traces of it may be found among the higher mammals, such as the mare and cow, as Aristotle remarked, as well as in the sow and bitch; while among the apes in their wild condition there is a well-marked menstrual discharge. In the higher apes, when they do not suffer from captivity, the flow is sometimes quite as copious as in women; in some varieties the genitals become swollen and brilliantly pigmented, so that tomato-like, vermilion- tinted masses render their condition conspicuous. 1 On the whole, however, it may be said that menstrua- tion in its fully-developed form is a human character. Not only is the flow more copious generally as the animal approaches Man, but among the lower human races it is less pronounced than among the higher races; American Indian women, for instance, as Dr. Holder has found, usually only menstruate for two days.
The curious resemblance to the lunar cycle was long ago noticed. More recently Darwin suggested that the connection between physiological periodicity and the moon was directly formed at a very remote period of zoological evolution, and that the periodicity then impressed on the organism has survived until the present day. Ascidians living near low or high water-mark would have their nutrition profoundly modified by their position, and the fortnightly cycles they pass through would lead to a general tendency to periodicity. 2 He did not, however, so far as I am aware, directly connect this particular function with the tides, and there is perhaps a difficulty on account of the comparatively recent period during which the function has evolved. 8 1 Some of these facts were ascertained by the late Dr. Wiltshire; see his valuable lectures on "Comparative Physiology of Menstruation," Brit. Med. Journal, 1883.
2 Descent of Man y Part I., Chap. vi.
8 The non-appearance of any corresponding periodic cycle in men is less of a difficulty, for, as we shall see (Chap. X V. ), men have a greater tendency than women to vary from primitive conditions. Apart from Google 246 MAN AND WOMAN.
The fact that women are thus, as it were, period- ically wounded in the most sensitive spot in their organism, and subjected to a monthly loss of blood, is familiar, and has been used, legitimately or illegiti- mately, as we have indeed already seen, to explain numerous phenomena. It has even been suggested that to the weakening influence of this cause we must attribute the early arrest of development of girls in height, muscles, larynx, etc In support of this position, Dr. Fothergill, for example, has stated that, in his experience, a prolonged menstrual period is more common in small than in well-developed girls, and that sometimes when this heavy expenditure has been checked growth has continued. 1 On the whole, however, there does not seem any real ground for this supposition; among all mammals, as well as among many other kinds of animals fairly high in the morphological scale, the male is more highly developed than the female, frequently to a very much greater extent than in Man. There are also so many advantages gained by the precocious and slighter development of women that we cannot legitimately regard the character of feminine devel- opment as merely the fortuitous and pathological result of a periodic function.
It is not difficult to see how the menstrual function has given origin to the erroneous notion that women are natural invalids. Thus Galiani, in his Dialogue sur Us Femmes^ describes woman as " un animal naturellement faible et malade." " At first she is an invalid," he remarks, " as all animals are until they have attained their full growth; then come the symptoms so well known in every race of man, and which make her an invalid for six days during every month on an average, which makes at least a fifth part of her life; then come pregnancies and lactations which, properly considered, are two troublesome this there is some reason to believe that men do actually pass through a rudimentary menstrual cycle, affecting the whole organism. I am collecting evidence on this point, and hope some day to be able to put it into shape. 1 J. Fothergill, West Riding Rtports % vol. vi.
Google THE FUNCTIONAL PERIODICITY OF WOMEN. 247 disorders. Women, therefore, only have intervals of health in the course of a continual disease. In character they show the influence of this almost habitual condition: they are caress- ing and engaging as invalids usually are, although, like invalids, brusque and capricious at times; quickly irritated, they are promptly appeased. They seek for distraction; a mere nothing amuses them, like invalids. Their imagination is always in play: fear, hope, joy, despair, desire, disgust, succeed each other rapidly in their heads, and disappear with equal rapidity...And then we — yes, we seek to cure them by causing them perhaps a new disease." Michelet, the historian, in his book LAmour (1859), expounds the same idea that women are invalids; "woman is for ever suffering," he says, " from the cicatrisation of an interior wound which is the cause of a whole drama. So that in reality for 15 to 20 days out of 28 [in any case, an extremely exaggerated estimate, it may be remarked] — one may almost say always— woman is not only invalided but wounded. She suffers incessantly the eternal wound of love." Quite recently a woman has sought to revive the idea that women are normally in a pathological condition, owing to this function, the cause of which she finds, in some unexplained way, in the brutality of men. It is scarcely necessary to point out that a pathological condition can scarcely be called normal. A function which affects half the human race cannot be dismissed as a mere symptom of ill-health.
Other writers have gone to the opposite extreme, and have asserted that this function, normally and even generally, has no effect whatever on the health or general physical condition of women. Thus Miss Frances Power Cobbe has made this assertion in reply to Michelet. Mrs. Fawcett, again, has more recently made a similar assertion in replying to Mr. Frederic Harrison: — " He says, ' all women/ with very few exceptions, are ' subject to functional interruption absolutely incompatible with the highest forms of continuous pressure/ This asser- tion I venture most emphatically to deny. The actual period of childbirth apart, the ordinarily healthy woman is as fit for work every day of her life as the ordinarily healthy man." Mrs. Fawcett appears to attribute this to a marvellous im- provement in the health of women, brought about in recent years by attention to hygiene {Fortnightly Review ', September 1891). Unfortunately there is ample evidence to show that this rose- coloured view is scarcely justified, although no one doubts that it is fairly true concerning a certain proportion of women. The question is, as we shall see: What proportion of women are "ordinarily healthy"?
While this periodic loss of blood has always 248 MAN AND WOMAN.
attracted attention, and has furnished a more or less hazardous basis for various poetic and scientific suppositions, it is only within recent years that it has come to be recognised that menstruation is not an isolated phenomenon. It is but the outward mani- festation of the climax of a monthly physiological cycle which influences throughout the month the whole of a woman's physical and psychic organism. Whatever organic activity we investigate daily with any precision we find traces of this rhythm. While a man may be said, at all events relatively, to live on a plane, a woman always lives on the upward or down- ward slope of a curve. This is a fact of the very first importance in the study of physiological or psycho- logical phenomena in women. Unless we always bear it in mind we cannot attain to any true know- ledge of the physical, mental, or moral life of women.
Our knowledge of the physiological and psychological period- icity of women is chiefly owing to Goodman, " The Cyclical Theory of Menstruation," American Journal of Obstetrics, 1878, p. 673; Dr. Mary Putnam Jacobi, The Question of Rest for Women during Menstruation, New York, 1877; Stephenson, American Journal of Obstetrics, 1882, p. 287; Reinl, Volkmann's Sammlung, No. 243; Professor Ott (of St Petersburg), "Des Lois de la Pe'riodicite' de la Fonction Physiologique dans l'Organisme Fe'minin," Nouvelles Archives d } Obstitrique, Paris, 25th September 1890. There are several interesting chapters discussing "The Monthly Rhythm" in Dr. H. Campbell's Differences in the Nervous Organisation of Man and Woman, 1 89 1. I have not been able to see all these papers.
In order to give a fairly correct general view of the monthly physiological curve in women I here repro- duce a diagram, prepared by Professor Ott, which sums up a very large number of daily observations carried on during 68 monthly cycles on about 60 healthy women. The observations concerned temperature, muscular force, vital capacity, and reflex action. While this curve represents the average result, the period of maximum excitability (usually attained, it will be seen, nearly three days before the onset of Google THE FUNCTIONAL PERIODICITY OF WOMEN. 249 menstruation) may sometimes be delayed until the appearance of the flow. The line A. B. represents Google 250 MAN AND WOMAN.
the diagram); the degree of intensity of the functions investigated is represented along the line E. C.; the actual period of menstruation (somewhat more pro- longed than we usually find it in this country) corre- sponds to the shaded portion of the diagram.
The heart and the tension of the vascular system have most frequently been observed with reference to this monthly periodicity. Cullen long ago main- tained that the pulse-rate rises at the approach of the periods. Dr. Fancourt Barnes observed the increase of vascular tension in the pulse at the wrist, as measured by the sphygmograph. Stephenson found a monthly cycle as regards arterial tension and pulse- rate. Dr. Mary Jacobi concluded, as the result of her investigations with the sphygmograph, that " in women exists a rhythmic wave of plenitude and tension of the arterial system, at all events perceptible in the radial artery, which begins at a minimum point, from one to four days after the cessation of menstruation, and gradually rises to a maximum, either seven or eight days before menstruation, or at any day nearer than this, or even during the first day of the flow." 1 This process involves an active engorgement of the thyroid, parotid, tonsils, and other organs also, during the period of the flow. The temperature is also at its highest point a few days before actual menstrua- tion, as has been shown by Jacobi, Ott, and others. The curve in the excretion of urea and urine I have re- ferred to already (p. 2 1 5). The highest points of activity in the sexual organs also correspond to the general maximum, and in most healthy women the sexual emotions are strongest at the maximum before the period, and at the lesser maximum after it That the intellectual vigour is also greatest at the same points is somewhat less easy to prove, but is extremely probable. That the mental energy, as well as the muscular strength and dexterity, even in the strongest, 1 The Question of Rest ', etc., pp. 148-161.
THE FUNCTIONAL PERIODICITY OF WOMEN. 25 1 healthiest, and most determined women, are usually somewhat impaired during the menstrual period itself is a fact that is familiar to most women; I am not, however, aware of any data showing a maximum during the intermenstrual period.
There can be little doubt that a daily examination of any of the senses would show a monthly rhythm. I am, however, only acquainted with one series of observations on this point, those of Finkelstein of St. Petersburg, carried out on the eye, under the super- intendence of Professor Mierzejewskl Finkelstein studied the functional activity of the eye during menstruation in twenty healthy women, aged between nineteen and thirty-three. He found that during the period there is a concentric narrowing of the field of vision, beginning one, two, or three days beforehand, reaching the greatest intensity on the third or fourth day of menstruation, and gradually disappearing on the seventh or eighth day after its appearance. The narrowing is more pronounced in those women in whom menstruation is associated with malaise y headache, cardiac palpitation, and other nervous symptoms, as well as in those who lose large quantities of blood. Not only the field of vision for white but also the visual fields for green, red, yellow, and blue undergo a regular diminution. Per- version of perception of green (which is seen as yellow) is observed fairly often (in 20 per cent cases). Central vision is but slightly impaired, and rapidly returns to the normal standard after the period, and refraction remains intact 1 There can be little doubt that observation of the other sense organs would yield ' similar proof of monthly periodicity.
As soon as the climax of vital activity is reached, or a day or two afterwards, the menstrual flow begins. Even in perfectly healthy women this affects the whole organism to a more or less marked degree. The 1 Summarised in Ophthalmic Review », 1887, pp. 323-326.
252 MAN AND WOMAN.
pulse is usually found to be slow and of high tension. There is a general feeling of tension in the pelvic or- gans; the breasts also are slightly enlarged, and may consequently be somewhat tender and painful. The same congestive tendency shows itself in the enlarged thyroid. The temperature, even under strictly physio- logical conditions, may rise 0.5 Fahr. The surface blood-vessels tend to be fuller than usual, so that there may be flushing of the face. There is increased nerv- ous tension and greater muscular excitability; reflex action is quicker, and there may be slight twitchings of the legs; also yawning and stiffness in the neck, and sleep is heavier than usual. There is loss of appetite and a certain amount of digestive and intestinal disturbance with a tendency to flatulence. Urination also is both more frequent and more copious than usual. There is a fall of urea and an increase of uric acid, whence, according to Haig, the high tension of pulse and the tendency to mental depression. 1 There is a tendency to pigmentation, though far slighter than among monkeys; the pigmented circle around the nipple usually becomes somewhat darker, the complexion is changed, losing its clearness, and a dark ring may sometimes be perceptible around the eyes; these pigmentary changes are more especially observed in brunettes, and, like many other disturb- ances of menstruation, during pregnancy they become still more marked. In many women the breath and also the skin exhale an odour (quite distinct from that due to the discharge) of a peculiar aromatic and not unpleasant character. The voice also may undergo some change; there is a tendency to hoarseness, and singers sometimes lose the brilliancy of their high notes, so that at this period (as is generally recognised on the Continent) it is not desirable for public singers to appear. 2 2 Dr. Robert Barnes has specially drawn attention to some of the points in the above picture. {Brit. Med. Journal, 2nd March 1889. ) In Google THE FUNCTIONAL PERIODICITY OF WOMEN. 253 With reference to the influence of normal menstruation on the voice, Mr. Lennox Browne, the well-known specialist, writes to me as follows: — " With regard to singers, I believe that the pitch of the voice is often lowered at the menstrual epoch, although I have not found this to be universally admitted by patients to whom I have spoken on the subject. Many have told me that they have a disposition to sing flat, and in two cases in my recollection the patients, who suffered from dys- menorrhea, told me that they sang sharp, of which they were conscious — probably from information, for of course you know that those who sing sharp are not generally sensible of the defect It is, however, generally agreed that the timbre and tone-quality is impaired, the voice being decidedly thinner and poorer during the epoch.