The sexual life of woman in its physiological, pathological and hygienic aspects

by E. Heinrich Kisch

Schrader, through his researches on metabolism during menstruation in relation to the condition of the bodily functions during this process, has established that immediately before menstruation the elimination of nitrogen in the fæces and the urine is at its lowest, a fact which indicates that at this period of the menstrual cycle the disintegration of albumen in the body is notably diminished.

Von Ott found in thirteen cases out of fourteen that at the beginning of the catamenial discharge or just before a considerable fall in blood-pressure occurred, and that throughout the flow the pressure almost always remained below the mean, no rise taking place till menstruation was finished; this fall in blood-pressure during menstruation was more considerable than could be accounted for by the moderate hæmorrhage. The same author, in conjunction with Schichareff, examined fifty-seven healthy women in respect of heat-radiation, muscular power, respiratory capacity, expiratory and inspiratory power, and tendon-reflexes. He found that the energy of the functions of the female body increased before the beginning of menstruation, but declined with or immediately before the appearance of the catamenial discharge. He exhibited this rhythmical variation in the vital processes by means of the following curve, in which the line A B represents these physiological variations, whilst on the abscissa line c e, the days of observation are recorded, and the interval m n represents the menstrual period. The degree of intensity of the united functions is indicated by the numbers 0–100 on the ordinate.

Fig. [6].

Still another point of view from which the influences affecting the female organism as a whole may be regarded has very recently become apparent in consequence of the doctrine of Brown-Séquard relating to the internal secretions of ductless glands. As regards the female reproductive glands, which in consequence of their structure must be referred to the group of ductless glands, and yet owing to their secretory function must be classed among secreting glands (so that the nature of the ovary is that of a secreting gland without an excretory duct), it would appear that these glands are not concerned only with the specific female reproductive functions of menstruation and ovulation, but that they also exercise a powerful influence on the nutritive processes, on metabolism and hæmatopoiesis, and on growth and development in their mental as well as their physical relations.

It is supposed that these glands under normal conditions enrich the blood with certain substances, which in part assist in hæmatopoiesis, and in part by regulating the vascular tone in the various organs are concerned in the normal processes of assimilation and general metabolism. According to Etienne and Demange, ovariin possesses an oxidising power similar to that possessed by spermin. Thus it becomes easy to understand how disturbances in the functions of the ovaries give rise to disturbances in the processes of general metabolism and of assimilation. Some go even further, though in doing so they leave the ground of assured fact, suggesting that the ovary in certain circumstances produces toxins, or that the normal ovary possesses an antitoxic function, and speaking of an occasional ovarian auto-intoxication of the body or of a menstrual intoxication. Thus, chlorosis is by some regarded as a disturbance of hæmatopoiesis, dependent on an abnormal condition of the female reproductive organs during the period of development, and referable to a disturbance of the internal secretion of the ovaries (Charrin, von Noorden, Salmon, Etienne, and Demange). And it is now generally assumed, the assumption being based on the observations recently made concerning the organo-therapeutic employment of the chemical constituents of the ovary, that many of the disorders, and especially those connected with the vasomotor system, common during the climacteric period, are dependent on the deficiency of the products of the internal secretion of the ovary that accompanies the cessation of the menses.

Recent experimental investigations on this subject have shown that the interconnection between the female genital organs and the organism as a whole, between the functions of the reproductive organs and the functions of other organs, does not depend on nervous influences only, but that in this interconnection the blood vascular system and the lymphatic vascular system also play their parts. Goltz has proved by actual experiment that the nervous influence on menstruation and ovulation is not the only determinant. In a bitch, he divided the spinal cord at the level of the first lumbar vertebra, and observed, as soon as the animal had recovered from the operation, the appearance of the usual signs of heat; the bitch was impregnated, and gave birth to one living and two dead puppies; lactation and sucking took place as in a normal animal. When the bitch was killed and the body examined it was found that no reunion had taken place in the severed spinal cord. The experiments of Halban gave similar results. He found that in apes, if the ovaries are removed from their normal situation and successfully transplanted to some region remote from the genital organs, the animals remain capable of menstruating. But if the ovaries, which have been transplanted beneath the skin or beneath the peritoneum, are subsequently entirely removed, menstruation, which has continued regularly after the first operation, ceases altogether after the second. It follows from these experiments that the cessation of the menstrual process may be considered to be brought about through the intermediation of the lymphatic or blood-vascular system, by the absence of a kind of internal secretion.

Loewy and Richter have further proved by experiment that in spayed bitches the consumption of nitrogen is less by about 20 per cent. and the entire gaseous interchange less by about 9 per cent., as compared with what takes place in normal animals, and that this change in respiratory metabolism lasts for a long time after the oöphorectomy, for as much as nine to twelve months. If dried ovaries are given to such animals in their food, the gaseous interchange rises to the former level and even higher.

The undulatory movement of the vital processes in woman is apparently in some way dependent on ovulation, though the nature of the connection has not hitherto been fully elucidated. This view is confirmed by the fact that no such rhythmic variation in the bodily functions can be detected either in girls under thirteen years of age, or in women from fifty-eight to eighty years of age in whom menstrual activity has entirely disappeared. The menstrual rhythm begins at puberty and ends when ovulation ceases.

A further contribution to the doctrine of the undulatory movement of the vital processes in woman is to be found in my own observations that pathological symptoms which have become manifest before and at the time of the first onset of menstruation, and have given but little trouble throughout the period of developed and regular sexual activity, are apt when menstruation ceases to recrudesce, and to become as prominent as they were at the commencement of the sexual life. Women who at the time of puberty suffered from cardiac troubles, from digestive disturbances, or from various forms of nervous irritation, and in whom as they grew up these disorders passed more or less into abeyance, are apt at the climacteric period to exhibit, as I have frequently been able to observe, a violent return of these symptoms, in the form, as the case may be, of tachycardia, of dyspeptic troubles, or of psychoneuroses. In this connection we may mention an observation of Potain’s, who distinguishes a peculiar form of chlorosis, occurring in individuals of delicate constitution, which, though apparently cured, reappears at the menopause.