Part 5

The growing girl must not, as has hitherto been the case, be kept in a state of ignorance (which is indeed in most cases apparent merely) regarding the sexual processes of her own body, she must no longer, when she asks to be informed concerning these matters, be put off with conventional lies and prevarication. But her enlightenment must not be effected in such a manner as to lead to excitement and excessive stimulation, to the awakening of slumbering feelings, and to the conversion of fantasy into a devouring flame. Sexual enlightenment must not be made an excuse for the unchaining of sensibility. When about to be married, a woman should certainly be instructed regarding her sexual duties and rights, and enter as one well informed into the act in which she is to play a leading part. But she ought not, with the excessive valuation of herself attained in recent times, to regard the man as her enemy, as one whom she is always justified in fighting and always ready to fight with the equal weapons of sexual transgression. It cannot be doubted that the ideal of “pure marriage” at an early age is one greatly to be prized as the foundation of a powerful future generation; but the real nature of the male must not be overlooked, nor must his sexual honor be put to too difficult a test. We regard as reasonable the modern demand of woman that in marriage her individuality should not be buried, and that space should be given for the development of her personality; but every sober-minded person will reject the “moral demand” for “ideal passion” in accordance with “entire mutual freedom” in the sexual relation between man and wife, and will regard such free love as social insanity and as a barbaric retrogression toward the rude sexual habits of savage peoples. Further, in view of the continually increasing intensity of the struggle for existence and in view of the difficulties of the task of rearing children, we cannot fail to recognize that it is not right for women to be overburdened with the task of reproduction, and that she does not live simply and solely for the bearing of children—but those rush to the other extreme who undervalue motherhood and the duties of maternity, who speak scornfully of the woman who is “a mother, and a mother only,” who despise women whom they regard merely as “means for the production of children,” and who employ all possible methods to free women from the pressing claims of nature and of society.

In all social circumstances, and in all times the great principle of sexual morality must dominate the sexual life of woman. As the ethical characteristics of the three great epochs in that sexual life we recognize the purity of the maiden, the faithfulness of the wife, and the love of the mother. But within the limits imposed by these demands it is still possible to satisfy the modern claim for a free development of the personality, and to accommodate the circumstances of the sexual life to the individual vital needs and vital claims of the present day.

I. THE SEXUAL EPOCH OF THE MENARCHE.

(PUBERTY.)

The term _menarche_ (μήν, a month, ἀρχή, the beginning) was introduced by me into medical literature to denote the period of life in which, as a sign of puberty, menstruation first makes its appearance.

The age at which this occurs is subject to variations depending upon race, occupation, hereditary tendencies, and climate; but in Germany and Austria the average age at puberty is 14 or 15, the extreme limits being 12 to 19.

Until about the age of 13, the physical differentiation of the sexes, except for the anatomical peculiarities of the genital organs, is in our climates a trifling one. But at puberty the important changes occur by which the sexes are so strikingly differentiated. Whereas in the growing boy all physical change takes the form of increasing strength and energy, in the development of the girl, we note the appearances of the rounded outlines so characteristic of womanhood. At the same time the voice alters, becoming less sharp, with a softer quality, and yet a fuller tone; and we may observe that young brunettes have commonly a contralto voice, young blondes, more often a soprano. The intellectual changes undergone by the girl at puberty are no less extensive and characteristic than the physical changes. In brief, the undifferentiated, neuter girl is transformed into a young woman, endowed with all the attributes, mental and bodily, characteristic of femininity.

As regards the age at which the menarche usually occurs, and the manner in which its occurrence is anticipated or retarded by the various influences already mentioned, the following propositions may be put forward, based on the available statistics and observations:

1. Climate is an important factor. In the torrid zone, menstruation appears at a very early age, on the average from 11 to 14; in the temperate zone, it appears later, on the average from the age of 13 to 16; in the frigid zone, later still, on the average from the age of 15 to 18. The mean temperature of the atmosphere appears to have a direct influence on the age at which menstruation begins, the hotter the climate, the earlier being the menarche. The height of the place of residence above the sea level and its distance from the coast also have a certain influence.

2. Race and constitution have a distinct influence upon the age at which menstruation makes its appearance. In women of the Semitic races the menarche occurs earlier than in women of the Aryan races. The average age at which menstruation begins is in Jewish girls, from 14 to 15; in Magyar girls from 15 to 16; in German girls from 16 to 16½; and in Slavonic girls from 16 to 17.

In general the menarche is earlier in girls of a sanguine, lively temperament and a powerful constitution than in girls of a phlegmatic temperament and a weakly constitution; further, other things being equal, menstruation appears earlier in brunettes, girls with black hair, thick skin, dark eyes, and a dark complexion, than it appears in blondes, girls with light hair, thin skin, blue eyes, and a fair complexion.

3. The age at which menstruation begins is also affected by the conditions of life and the social circumstances. In the higher circles of society, in the upper, well-to-do classes, menstruation appears earlier than among women of the laboring classes, who are compelled to strive for their daily bread. Amongst upper-class girls the menarche occurs at the age of 14 in one-fourth of their number, whereas among lower-class girls barely one-sixth begin to menstruate at the age of 14.

In large towns, again, menstruation appears earlier than in small towns, whilst in the open country the menarche is still further delayed. In the women of Paris the average age at the menarche is 14 years and 6 months, in the women of smaller French towns it is 14 years and 9 months, in French countrywomen it is 14 years and 10 months.

How far the mode of nutrition is concerned in the production of these results is not yet determined.

4. The time of the menarche appears to be influenced by inheritance to this extent, that the daughters of women who began to menstruate early begin themselves to menstruate at an early age, whereas in other families we observe that both mothers and daughters began to menstruate late. But this relation is by no means a constant one.

_Ploss_ has collected observations made in various countries and towns regarding the age at which menstruation begins, and the mean results of these observations are given below.

The average age at which menstruation began was:

In Swedish Lapland 18 years, 0 months, 0 days. In Christiania 16 years, 9 months, 25 days. In Copenhagen 16 years, 9 months, 12 days. In Munich 16 years, 5 months, 12 days. In Göttingen 16 years, 2 months, 2 days. In Vienna 15 years, 8 months, 15 days. In Berlin 15 years, 7 months, 6 days. In Stockholm 15 years, 6 months, 22 days. In Manchester 15 years, 6 months, 0 days. In Warsaw 15 years, 1 month, 23 days. In London, between 15 years, 1 month, 4 days. and 14 years, 9 months, 9 days. In Paris, between 15 years, 7 months, 18 days. and 14 years, 5 months, 17 days. In Madeira 14 years, 3 months, 0 days. In Montpellier 14 years, 2 months, 0 days. In Corfu 14 years, 0 months, 0 days. In Marseilles 13 years, 11 months, 11 days. In Calcutta 12 years, 6 months, 0 days. In Egypt 10 years, 0 months, 0 days.

The collective results of the investigations of French authors regarding the average age at which menstruation first appears are given in the following table:

I. IN TEMPERATE CLIMATES:

_Observer._ _Place._ _No. of _Average Age._ Cases._

De Soye Paris 1,000 15 years, 0 months. Dubois Paris 600 15 years, 3 months. Raciborski Paris 200 14 years, 5 months. M. Despines Paris 85 14 years, 11 months. Arau Paris 100 15 years, 4 months. Courty Montpellier 600 14 years, 3 months. Puech Nîmes 941 14 years, 2 months. M. Despines Toulon 43 14 years, 1 month. M. Despines Marseilles 25 14 years, 1 month. Puech Toulon 144 14 years, 1 month. Grey London 1,498 15 years, 6 months. Lee & Murphy London 1,719 15 years, 6 month Torisiano Corfu 33 14 years, 6 months. Lebrun Warsaw 100 15 years, 1 month.

from these observations we obtain an average of 15 years.

II. IN COLD CLIMATES:

_Observer._ _Place._ _No. of _Average Age._ Cases._

Ravn Copenhagen 3,840 16 years, 9 months. Frugel Christiania 157 16 years, 6 months. Dubois Russia 600 16 years, 8 months. Faye Norway 100 15 years, 6 months. Lundborg Esquimaux 16 15 years, 6 months. Wistrand Stockholm 100 15 years, 7 months.

from these observations we obtain an average of 16 years and 3 months.

III. IN HOT CLIMATES:

_Observer._ _Place._ _No. of _Average Age._ Cases._

Goodeve Calcutta 239 12 years, 5 months. Lith Deccan 217 13 years, 5 months. Robertson Calcutta 540 12 years, 6 months. Webb Calcutta 39 12 years, 5 months. Dubois Asia 600 12 years, 11 months.

from these observations we obtain an average of 12 years and 7 months.

In 6,550 cases collected by _Krieger_ menstruation first appeared:

At the age of:

9 years in 1 instance. 10 years in 7 instances. 11 years in 43 instances. 12 years in 184 instances. 13 years in 605 instances. 14 years in 1193 instances. 15 years in 1240 instances. 16 years in 1026 instances. 17 years in 758 instances. 18 years in 582 instances. 19 years in 425 instances. 20 years in 281 instances. 21 years in 111 instances. 22 years in 55 instances. 23 years in 15 instances. 24 years in 15 instances. 25 years in 1 instance. 26 years in 4 instances. 27 years in 2 instances. 28 years in 1 instance. 29 years in 1 instance.

From these figures it appears that in the 6,550 cases under consideration, the age 15 was that at which the first appearance of menstruation was most frequently observed, namely in 1,240 instances, or 18.9 per cent. The age 14 comes next, with 1,193 instances, or 18.2 per cent. The case in this series in which menstruation appeared earliest, namely in the ninth year, was observed by _Mayer_, the girl being a blonde of average height, good family, and German descent; the case in which menstruation appeared latest, namely in the twenty-ninth year, was that of a woman living in Berlin, who was sickly and chlorotic up to the time of her marriage, and in whom menstruation did not appear until some years after that event.

As regards climatic influences, all the data at our disposal prove that the hotter the climate the earlier the menarche. According to _Marc d’Espine_ the age at puberty varies in an almost geometrical ratio with the mean annual temperature.

The dependence of the menarche upon climatic influences is clearly shown by the statistical data collected from various regions of the world. We append the general compilation of _Gebhard_ dealing with this question.

A. EUROPE.

For Europe the data furnished by _Ploss_ are grouped by _Gebhard_ in the following manner.

1. _Northern Europe._

The average age at which menstruation first appears, according to the older statistics, is in Swedish Lapland 18, in Norway, 16.12. In Copenhagen it is 16.75, in St. Petersburg 14.5.

More recent statistics for Finland are furnished by _Engström_. Among 3,500 women of pure Finnish descent, he found that menstruation began:

At the age of:

8 years in 2 instances. 9 years in 2 instances. 10 years in 4 instances. 11 years in 41 instances. 12 years in 178 instances. 13 years in 458 instances. 14 years in 715 instances. 15 years in 778 instances. 16 years in 614 instances. 17 years in 369 instances. 18 years in 195 instances. 19 years in 91 instances. 20 years in 31 instances. 21 years in 8 instances. 22 years in 10 instances. 23 years in 2 instances. 24 years in 1 instance. 25 years in 0 instance. 26 years in 1 instance.

Thus, in nearly half of all Finnish women, menstruation begins with the completion of the fourteenth and fifteenth years. The statistics include women of all classes of society.

At the Pirogoff Congress _Grusdeff_ furnished particulars of the first onset of menstruation in Russia among 10,000 women. Menstruation began:

At the age of:

9 years in 1 instance. 10 years in 4 instances. 11 years in 31 instances. 12 years in 244 instances. 13 years in 864 instances. 14 years in 1641 instances. 15 years in 1795 instances. 16 years in 2012 instances. 17 years in 1692 instances. 18 years in 910 instances. 19 years in 498 instances. 20 years in 183 instances. 21 years in 65 instances. 22 years in 19 instances. 23 years in 5 instances. 24 years in 3 instances. 32 years in 1 instance.

In women of German race living in Russia puberty was earliest, occurring at the average age of 15.16 years; in Finnish women it was latest, occurring at the average age of 16.17 years.

2. _Middle Europe._

In Germany, according to the tables of _Krieger_ and _L. Mayer_, who have recorded 11,500 cases in all, menstruation begins most commonly (in 18.931 per cent. of the cases) at the age of 15; the next most frequent age is 14 (18.213 per cent. of the cases).

For Berlin, in a number of cases collected from the lower classes of society, we find the average age for the first appearance of menstruation to be 16.18 years.

Notwithstanding the more northerly situation of Berlin, the average age at puberty is somewhat less than in Munich, situated 4½ degrees to the southward, for the reason that the retardation dependent upon altitude makes itself manifest in the latter town, which is situate about 500 metres (1,640 feet) higher above the sea level. Whereas in Berlin 18 per cent. of all cases begin to menstruate at the age of 14, and 19 per cent. at the age of 15, in Munich the two leading years are 15 with a percentage of 17½, and 16 with a percentage of 18¾.

In Great Britain, according to _Krieger_, the average age at which menstruation begins is 15 years, 1 month, and 5 days. For Manchester the age given is 15 years, 6 months, and 23 days. In France, according to the calculation of _Brierre de Boismont_, the most frequent age for the first onset of menstruation is 16. In Paris the average age is 14 years, 6 months, and 14 days. Bohemia, Upper and Lower Austria, and Moravia have an average age of 16 years and 2 to 3 months.

3. _Southern Europe._

In Southern Europe the influence of the higher mean temperature manifests itself. The average age at which Spanish girls begin to menstruate is 12. In Northern and Middle Italy the most frequent age is 14; in Southern Italy, 13. In Lyons the average age at which menstruation begins is 14 years, 5 months, and 29 days; in Marseilles and Toulon it is 13 years and 10 months. For Hungary, _Doktor_ gives the statistics of 9,600 cases. In 22⅓ per cent. menstruation began at the age of 15; in 20½ per cent. at the age of 16, and in 10 per cent. at the age of 17. The earliest age among these cases was 8 years; the latest, 33 years. (The latter must no doubt be regarded as pathological.)

B. ASIA.

In Palestine puberty most commonly occurs at the age of 13; in Turkey even as early as 10. _Rouvier_ calculated the average of 742 cases observed in Syria to be the age of 12. As regards Persian women, the data vary between the age of 14 for the northern part of the country and the age of 9 or 10 for the southern. According to _Joubert’s_ data in 46.4 per cent. of the indigens of India, menstruation begins at the age of 12 or 13. Similar figures are given for Ceylon and for Siam. In Japan menstruation most frequently begins at the age of 14, sometimes as early as 13; mothers of 15 are by no means rarities in this country, but for menstruation to begin before the age of 12 is considered a very exceptional occurrence. According to a table dealing with 584 women of Tokio menstruation began:

At the age of:

11 years in 2 instances. 12 years in 2 instances. 13 years in 26 instances. 14 years in 78 instances. 15 years in 224 instances. 16 years in 228 instances. 17 years in 68 instances. 18 years in 44 instances. 19 years in 10 instances. 20 years in 2 instances.

The data available regarding China are so exceedingly variable that little importance can be attached to them.

C. AFRICA, OCEANIA, AND AMERICA.

The average age at which menstruation begins in the negro women of Africa is from 10 to 13. In Algeria puberty occurs at 9 or 10 years. Among the Australian indigens, menstruation commonly begins as early as 8 years, and at the very latest at the age of 12 years. The data available concerning the indigens of the Oceanic Archipelago are extremely variable and inexact, but we cannot go far astray in stating the age of puberty among these to be from 10 to 13. In tropical South America girls begin to menstruate from the age of 9 to 14 years. The Indian women of North America begin to menstruate at the ages of 12, 13, 14, or even as late as 18 or 20. In the Arctic zone of North America and in Greenland the onset of menstruation is delayed till 17 and even till 23 years.

As regards the position in life and the upbringing years it has been shown by numerous observers that among the well-to-do classes, whose mode of living is luxurious, and whose social circumstances allow free play to the imagination, menstruation begins at an earlier age than among the working classes, whose life is one of want and privation. According to the statistical data of _Mayer’s_ regarding 6,000 women, menstruation began:

_In women of the upper _In women of the lower classes._ classes._ At the age of 13 years 11.73 per cent. 7.06 per cent. At the age of 14 years 23.90 per cent. 13.33 per cent. At the age of 15 years 22.83 per cent. 14.56 per cent. At the age of 16 years 14.10 per cent. 16.53 per cent. At the age of 17 years 9.60 per cent. 13.33 per cent.

From this table we learn that in nearly one-fourth of the girls of the upper classes puberty occurs at the age of 14, whilst in girls of the lower classes barely one-sixth begin to menstruate at this age. The average age at the first menstruation in girls belonging to the upper classes is seen to be 14.69 years, but in girls belonging to the lower classes, 16.00 years. According to other observers the average age at the first menstruation is:

_Brierre de _Tilt._ _Krieger._ _Ravn._ Boismont._ (_London._) (_Berlin._) (_Copenhagen._) (_Paris._) Amongst gentle folk 13y. 8m. 13y. 5½m. 14y. 1m. 14y. 3m. and the rich Amongst the 14y. 5m. 14y. 3½m. 15y. 5m. 15y. 5½m. well-to-do middle classes Amongst the lower 14y. 10m. 16y. 8m. 16y. 5½m. classes

Comparative observations on women living in towns and women living in the country show also that in the former, menstruation begins on the average at an earlier age. According to _Brierre de Boismont_, the average age at the first menstruation is:

In Paris 14 years, 6 months. In small towns 14 years, 9 months. In country districts 14 years, 10 months.

Similarly it was found by _Ravn_ that menstruation first occurred:

In Copenhagen at the average age of 15 years, 7 months. In industrial towns 15 years, 4 months. In country districts 16 years, 5 months.

_Mayer_ states that the average age at which the first menstruation occurs is:

In townswomen 15.98 years. In countrywomen 15.20 years.

In Italy, according to _Calderini_, in a thousand instances, menstruation begins at the age of 14 in 280, at the age of 15 in 219, at the age of 13 in 205, at the age of 12 in 116, at the age of 16 in 89, at the age of 17 in 55, at the age of 18 in 14, at the age of 11 in 7, at the age of 10 in 6, and at the age of 20 in 6 instances. In girls attending town schools, the first menstruation most commonly occurs in the months of June and August; but in girls attending country schools most commonly in the spring months.

A certain hereditary predisposition is so far determinant in the matter of the early or late onset of the first menstruation, that from a knowledge of the age at which menstruation began in the mother, we are able with great probability to predict the age at which it will begin in the daughter. Among fifty cases which I investigated with this point in view, I found forty-one in which the daughters of mothers who had begun to menstruate early began themselves to menstruate early, usually indeed in about the same year of life; or conversely that when the mother had begun to menstruate late, late onset of menstruation was usually to be observed in the daughter also. _Tilt_ relates a case in which a woman began to menstruate at the age of fourteen, and her daughter and granddaughter both began to menstruate at the same age. _Courty_ observed a mother who began to menstruate at the age of eleven, and whose eight daughters all began to menstruate at the same age.

Gynecologists agree in stating that girls of sanguine temperament and powerful constitution begin to menstruate earlier than weakly and phlegmatic individuals. _Tilt_ describes a peculiar ovarian temperament, in which menstruation begins early; such women have as a rule striking nervous sensibilities, with a dark complexion and glistening, longing eyes, always surrounded by dark rings.

The opinion is general that in girls with black hair, dark eyes, thick skin, and dark complexion, menstruation begins earlier than in blondes with blue eyes and delicate white skin. _Brierre de Boismont_ states in this connection that not fair hair only, but also chestnut-tinted locks, indicate a late onset of menstruation. _L. Mayer_ found that:

_Of blondes._ _Of brunettes._

17.20 per cent. 18.84 per cent. began to menstruate at the age of 14 16.89 per cent. 18.02 per cent. began to menstruate at the age of 15 15.14 per cent. 16.59 per cent. began to menstruate at the age of 16