After the discharge has become established it recurs periodically while in health; and its recurrence is so regular, that it can be calculated with great exactness. The usual period of its visitations is from twenty-seven to thirty days. As to the time of its continuance, this is various in different women; but it seldom continues longer than six days, or less than three, and does not cease suddenly, but in a gradual manner.
Its approach is generally preceded by certain feelings of oppression or deviation from the ordinary state of health, which warn the individual of what is to happen. There is, in particular, a sensation of fulness about the lower part of the belly, and a relaxation about the uterine system which can scarcely be overlooked by the most heedless. The appetite becomes delicate, the limbs tremble and feel weak, the face becomes pale, and there is a peculiar dark streak or shade under the eyes; sometimes great restlessness, slight fever, headache, heavy and dull pain in the small of the back and bottom of the belly, swelled and hardened breasts, &c. All of which are sometimes instantly relieved by a trifling discharge from the vagina, and this not necessarily colored. It must at the same time be admitted, that in some few constitutions these feelings are so inconsiderable as to be little attended to; so that the woman mixes in society as usual without any apparent inconvenience.
The period at which the menses make their appearance, is various; it is much influenced by constitution, climate and mode of life. As a general rule, it takes place at puberty, or at that period at which the female is capable of propagating her species; and this period varies as climate may differ. They constantly, however, keep pace with the development of the body; where this is rapid, they will appear proportionably earlier; where this process is slower, they will appear later: but whenever the menses appear as regular evacuations, they mark the period of puberty: thus, in hot countries, women commence to menstruate at eight or nine years of age, and are not unfrequently mothers at ten.[[1]]
In the more northern regions, as in Lapland, &c., this evacuation is generally delayed until the female has attained her eighteenth or nineteenth year: in the temperate latitudes the average period will be found from the fourteenth to the sixteenth year. A difference, will, nevertheless, be found in the women who may reside in cities, and in those who dwell in the country of each respective portion of the globe. It may also be observed, that in cold countries, women continue to menstruate for a longer period than in warm; and as a general rule, it will be found they are obnoxious to this discharge double the period that elapses before it commences. Thus, women who have not this discharge until eighteen, will be found to have it until beyond fifty; those who commence at fourteen or fifteen, will leave off at forty-five; those who begin so early as eight or nine, will have it cease at twenty-five or six.[[2]]
On the appearance of the menses, or monthly turns, nature seems to perfect her work, both as regards development and proportion: it is the period of the most perfect beauty of which the female is susceptible; it is the one at which the moral changes are not less remarkable than the physical; it is a moment, of all others, the most replete with consequences to the inexperienced and confiding female.
At this period a great variety of interesting and curious phenomena present themselves: the voice is found to change; the neck and throat to increase in size, and to become more symmetrical; the mammæ to swell; the nipple to protrude; the chest to expand; the eyes to acquire intelligence, and increase of brilliancy; in a word, a new being, almost, is created.
The quantity of fluid expended at a menstruous period differs in different individuals; with girls who precociously menstruate, the quantity is in general smaller, and the returns less regular. Climate exerts an influence upon the quantity discharged, as well as upon the periods at which this evacuation shall commence. Thus, in the equatorial and more northern regions, it is less than in the more temperate climates.
It is of importance for women to know that occasional irregularities are not always the consequences of disease. Constitutions vary as much in respect to the regular returns of this discharge, as they do with regard to their first appearance or final cessation. Those in whom the change occurs very early from vigor of constitution, require little to be done for them; but in weak and delicate habits, the non-appearance of this evacuation is too often considered as the cause, whereas it ought to be viewed as the effect, of the state of the habit unpropitious to its taking place. And, according to family practice, under this false impression, warm teas and forcing medicines are employed at the approach of this disease, which have often done much harm.
Nature is not so defective in her own judgment as to require auxiliaries. Care should be taken to improve the general state of the health, by attention to diet, moderate exercise, change of air, &c.
In some instances the menstrual discharge does not make its appearance before the age of seventeen or eighteen, and, nevertheless, health is not in the least affected. The mere want of evacuation at the ordinary time, therefore, is not to be considered as morbid, unless the system be evidently deranged thereby. In many cases, however, symptoms of disease appear which are evidently connected with the defect of the menses, and go off upon its discharge. The treatment, in such cases, must be regulated by the particular circumstances and constitution of the individual. There is no remedy adapted to every case of this kind; but an open state of the bowels, and a due regulation of the diet, together with moderate exercise, are useful in every instance of this complaint. Warm clothing, too, particularly about the lower extremities, is of most essential benefit. The occasional use of the warm bath is pleasant and beneficial, especially if the skin be dry and warm. As the health improves, the cold bath will prove an auxiliary, if, after using it, the patient feels a glow of heat and a greater degree of liveliness. When the means ordinarily employed have failed, marriage, or a change of climate, has produced the wished-for effect.