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Physical Properties of the Menstrual Fluid.

379

held between the blades of a sponge-holder, all the secretion from about the os and cervix uteri. This must be done immediately after the instrument shall have been properly adjusted, and will be found necessary in order that the fluid may be free from admixture with that exuding from the surrounding surfaces. In consequence of the irksomeness of the procedure, however, the patient will seldom be able to remain in the required posture longer than until from ten to twenty grains have accumulated. This quantity, although too small for the purposes of chemical analysis, will nevertheless be sufficiently large for determining its sensible properties, as well as for microscopic investigation." P. 21.

Now, without saying anything, for the present, as to the decency of the proceeding here described, we shall only remark, that Mr. Whitehead believes, from his experiments, that the true menstrual secretion very nearly approximates to, if it be not identical with, the blood circulating in the capillary vessels, and that "the properties which are said to characterize common menstrual blood-namely, its want of power to clot, attributed to the absence of fibrin, its acid reaction, and its peculiar colour and consistence-are altogether acquired, and variously modified, by admixture with the vaginal mucus after the fluid has escaped from the uterine vessels ;" the true menstrual fluid readily coagulating, and invariably exhibiting an alkaline reaction, as ordinary blood is found to do. It is obvious, therefore, if this view of the case be correct, that the menstrual discharge is to be regarded rather as a simple exudation than as a proper secretion.

That the change of the true into the common or crude menstrual fluid is owing to the action of the acid mucus of the vagina is attempted to be proved by some experiments:

"If blood that has been drawn from the basilic or some other vein, or collected from a scarified surface, be allowed to flow into a cup containing pure or diluted acetic acid,—the same acid which exists in a free state in the vaginal mucus, in the proportion of one part of pure acid to sixty parts of blood, and if the acid be properly diffused through the blood; the latter will remain uncoagulated, and become of a darker colour if the blood be arterial, but lighter if venous, and no traces of uncombined fibrin can then be found in it." P. 25.

That the menstrual discharge proceeds from the internal surface of the uterus has been taken for granted in the preceding observations, and indeed is a fact that is now generally recognised in physiological science. "I have witnessed," says Mr. Whitehead, "in numerous instances the menstrual blood issuing from the os uteri; the labia, cervix, and all the vaginal surface being perfectly normal, and furnishing no such product. Some of these observations were made upon females affected with procidentia uteri; but, in the majority, the information was obtained by means of the speculum." He had an opportunity, about two years ago, of confirming these observations by a post-mortem examination. A young girl died from the effects of a menorrhagic attack: the hæmorrhage had ceased only 24 hours before death.

"An early post-mortem examination discovered no organic lesion in any part of the body, which was everywhere drained of blood. The uterus was rather larger than natural; its parietes were less firm, but nearly of the usual thickness. Its interior contained a clot of blood which occupied the entire cavity. This clot, which was an exact mould of the uterine cavity, measured, from its lower extremity which terminated at the os tincæ, to the part situated at the fundus uteri, two inches and a quarter; and between its two horns, one inch and three quar

ters. Each horn had a rounded extremity, was semi-transparent and fibrinous, and terminated at the corresponding Fallopian orifice. The Fallopian tubes were perfectly empty, and of the natural dimensions. The right ovarium was a little larger than the left, and presented several distinct cicatrices in different stages of reparation. One of these was recent, depressed, puckered, and appeared at first sight to have an opening in its centre; but it was afterwards found to be impervious. The cavity over which this was situated was occupied by a firm, reddish coagulum, traversed by yellow striæ, having an irregularly concentrical arrangement. Immediately beneath the next most distinct cicatrix was a firm yellow body, smaller in size than the preceding, and less striated. Another paler formation of a similar kind, but still smaller and more deeply seated, and marked by a faint indentation of the surface above it, was observed in the same ovary. There were also two vesicles of different sizes containing a thinnish glairy fluid, one of which was near the surface.

"The left ovarium presented on one of its sides a large bluish vesicle, projecting its peritoneal covering considerably above the surrounding surface; this was the size of a small hazel nut, and contained apparently nothing but serum. Two smaller vesicles more deeply seated, and two well-marked yellow bodies of different dimensions having corresponding cicatrices, were also observed in the

same ovary.

"The labia and cervix uteri were perfectly healthy. The-inner surface of the uterus presented numerous openings scattered over every part of it, obvious to the naked view, some being sufficiently large to admit a good-sized bristle, or the end of a lachrymal probe. The largest and most numerous were at each side of the fundus near the horns of the uterus, and at the contracted part of its body near the commencement of the cervix. The openings had a valvular arrangement, a great number passing downwards towards the cervix, while those at the upper part of the organ appeared to pass towards the Fallopian orifices." P. 35.

The appearances, discovered in this case, are fairly regarded by our author as confirmatory of the opinion that menstruation is in short nothing more than "a simple exsudation of blood from the arterial capillaries in communication with the valvular orifices naturally existing upon the inner surface of the uterus."

But, if the true or proper catamenia invariably proceed from the inner surface of the womb, it is to be borne in mind that a sanguineous discharge, having the very same appearance, and possessed of the same physical properties, and returning, moreover, at regular monthly intervals, may proceed altogether and exclusively from the labia and outer portion of the cervix of the uterus, and this too whether the cavity of that organ be occupied with the product of conception or not. It is to this state of things that our author applies the term of spurious menstruation. And now comes the important (most important, certainly, if confirmed by subsequent enquiries) ætiological position, which he labours to maintain; viz. that "it (the discharge in question) is invariably associated with a morbid condition of the parts external to the cavity of the uterus, generally of its cervix and labia; sometimes of a portion of the vaginal mucous surface." Several facts are adduced in the way of proof: we shall presently have occasion to allude more particularly to them.

It has been already stated, that pregnancy may co-exist with this spurious form of menstruation. Not unfrequently, however, it is a mere sham or mock pregnancy that is present under such circumstances. This state is thus described by Mr. Whitehead :

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Spurious Menstruation.

381

Spurious menstruation occurring in the absence of pregnancy is accompanied with enlargement of the abdomen and of the mammary glands, nausea and occasional vomiting, alternate rigors and flushes of heat, languor, loss of rest, precarious appetite, and other symptoms tending to encourage a suspicion of the existence of pregnancy. The abdomen is sometimes enormously and painfully distended, as if caused by accumulation of flatus, and then suddenly subsides, but seldom to the dimensions of the unimpregnated state; there is constant aching of the loins, hips, and hypogastrium; a sense of bearing-down, and inability to retain the urine the ordinary length of time. Pressure of the distended parts upon the large arterial trunks produces a sensible throbbing over the whole region, which, together with the visceral movements consequent upon the shifting of the confined flatus from one portion to another of the lower bowel, strengthens the belief in the existence of a foetus in utero; and it is often a very difficult matter to convince the patient, under such circumstances, that she is not with child." P. 37.

Three examples are related in illustration of these remarks; but we must candidly confess that, while we admit that they certainly attest the importance of examining the state of the uterus with the speculum in some obstinate and doubtful cases, we are by no means quite satisfied that the monthly-recurring sanguineous discharge in all of them was not the genuine catamenia, and merely an exsudation of blood from the ulcerated surface of the cervix uteri; as is alleged by our author, in consequence of his finding upon ocular inspection that the os uteri appeared to be closed and linear. That the reader however may judge for himself, we shall give the report of one case entire, especially as its details will serve to illustrate some other points, which will subsequently come under our notice.

"Sarah Neale, a married woman, twenty-six years of age, was admitted a patient of the Manchester Lying-in Hospital in January, 1846. She had borne two living children at the full term of gestation, and subsequently, one still-born at the end of the seventh month. At the time of her admission she stated herself to be in the seventh month of her fourth pregnancy; and sought relief at this period for an abundant leucorrhoeal discharge which had existed ever since her miscarriage, and which she believed to be the result of a gonorrhoeal affection, contracted from her husband, when between five and six months advanced in that pregnancy. To this cause she referred her premature delivery. Although nearly seven months advanced, she had felt the foetal movements only very slightly and at long intervals; and she had menstruated regularly every month during the whole period, the discharge being precisely the same both as to its appearance, the number of days during which it continued, and the attendant symptoms, as when not pregnant. She complained of unusual weight and fulness of the abdomen, a fixed pain of the right hypogastrium, constant aching of the loins, and a sense of bearing down. The vaginal discharge which, in the absence of menstruation, was a yellowish matter, communicating a deep stain to the linen, exhibited a faint acid reaction, but was sometimes decidedly alkaline. The abdomen was of medium size, somewhat larger on the right than on the left side, and the skin appeared a good deal loaded with adipose deposit. The mammary glands were enlarged, and the areola and follicles more than ordinarily distinct. A tumour, which appeared to be the uterus, was sufficiently palpable above the pubis; but no fœtal impulse was communicated, on careful manipulation, to the hand; nor could the placental soufle or the beat of the fœtal heart be detected. To the touch, the uterus, although somewhat enlarged, was loose and floating; its cervix hard and hypertrophied, and the labia expanded and irregular. Examined with the speculum, the os uteri was found perfectly linear, and closed; the whole circumference of the labia was one mass of granulations

NEW SERIES, NO. XII.—VI.

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of a purplish colour, covered with pus, and exuding a little blood from several points, caused probably by temporary pressure of the instrument. The adjacent vaginal reflection was thickened and varicose. My opinion was at once given that pregnancy did not exist, which, however, the patient was unwilling to believe.

During the following menstrual crisis I examined the parts again with the speculum. The ulcerated surface was covered with blood, which, being carefully removed by means of lint, the parts were brought more distinctly to view. The os uteri was still completely closed, and gave no escape to any fluid; but the diseased parts were again covered with a sanguinolent exudation, and this was repeated as often as the product was cleared away; the uterine orifice still remaining closed and free from discharge as before. A course of alterative medicine, with repeated small bleedings by leeches from the hypogastrium, and, subsequently, the application of nitrate of silver to the ulcerated surfaces, effected a complete cure. The abdomen gradually subsided, the pain and bearing-down disappeared, and the menstrual function was restored to its normal state." P. 39.

It will be observed that the "normal state" here mentioned alludes not to any alteration in the physical properties, or in the periodic recurrence of the discharge, but simply and altogether to its seat or origin, as discovered by the use of the speculum.

CHAP. II.-Conditions which principally influence Menstruation at its com

mencement.

The following table is given by Mr. Whitehead, to shew the age at which this function was established in 4000 individuals.

66

Total 4000

Average age of the first menstrual crisis, fifteen years and nearly seven months." P. 46.

In treating of the influence of the habit or diathesis of the system on menstruation, a good deal of space is most unnecessarily occupied with common-place remarks on the general physiological subject of temperaments; and, not satisfied with this discussion, our author actually proceeds to discuss the origin and ætiology of Scrofula. That his reasoning is occasionally apt to be rather loose and illogical on some of the questions he undertakes to solve is pretty apparent from the story, which is recorded

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Conditions influencing Menstruation.

383

"to show in what manner Scrofula may be induced by the action of mercury, independently of previous disease."

Mr. Whitehead is certainly not warranted, according to general experience, in attributing the development of scrofulous disease so frequently as he seems inclined to do to a venereal taint of the system. No sooner is this subject broached than forthwith he proceeds to narrate cases of syphilitic disease in infants being followed, at a subsequent period, by the appearance of scrofulous cachexy. If space permitted, it would be easy to shew the inconsequential nature of several of the assertions. He is probably more correct, when he impugns the accuracy of many of the statements, that have been published by Commissioners and others, touching the injurious effects of factory labour upon the health of young females.

"It has been asserted for instance-and the assertion is quoted in every European country as referring to an absolute fact that factory employment has a particular tendency to induce premature development of the sexual organs, and that a precocious womanhood is more frequently witnessed among the manufacturing population than among other classes of people. Until lately, I also entertained a similar belief, based, it must be confessed, upon the authority of others whose statements I now believe to have been advanced at random, or founded, at best, upon a very few isolated cases, altogether inadequate to a general conclusion. A more extended inquiry into the subject has convinced me of this popular fallacy. The subjoined facts will show that, in this respect, mill employment has an effect the very opposite of that which it is generally believed to have.

"Of the 4000 individuals before quoted, 2127 were employed in mills, warehouses, and places connected with the various processes of manufacturing, at the period of puberty and for a length of time previous to its advent. Their collective ages amounted to 33,296, affording an average of fifteen years, and nearly eight months; of whom 511, or 24.02 per cent. suffered under disease consequent upon undue retardation of the functional changes at the commencement.

"The remainder, 1873 in number, included all that were otherwise circumstanced; as domestic and farm servants, hawkers, sempstresses, and shopwomen; together with a number of educated females not necessarily engaged in any pursuit, except school exercises. The sum of their ages was 28,982, giving fifteen years and about five months as the average age of puberty; and 375, or 20.02 per cent. experienced functional difficulty in form of amenorrhoea at the onset. P. 81.

Mr. Whitehead declares, as the result of extensive observation, that the high temperature maintained in mills is far less injurious to health than has been represented by many writers. Nay, he does not hesitate to affirm that, were it not for the hurtful effects of exposure to a cooler, and often a cold, temperature upon leaving the mills," he feels persuaded that a more efficient or more valuable auxiliary could scarcely be employed in these latitudes, in the treatment of some strumous affections than this artificial climate is capable of affording."

According to our author's observations, young females, the daughters of persons in easy circumstances, and who are therefore not engaged in any other occupation save the usual educational exercises, arrive at the epoch of puberty, as indicated by the advent of the catamenia, somewhat earlier than those who are labouring at some manual work. In the former, the change took place at about the age of 14 years and a half, “being more than a year earlier than the general average; and they suffered under

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