|ijt ■jji l» ^IfflRfla U ill A N Inaugural Phyfiological Differtation ON THE CATAMENIA: TO WHICH ARE SUBJOINED, Obfervations on Amenorrhoea. Submitted to the Examination of the Rev. JOHN EWING, S. T. P. Provost, THE TRUSTEES AND MEDICAL PROFESSORS OP THl UNIVERSITY OF PENNSYLVANIA, For the Degree of Doctor of Medicine* By JAMES WESTWOOD WALLACE, of Virginia,. Member of the Royal Medical Society of Edinburgh. PHILADELPHIA: PRINTED BY T. DOBSON, AT THE STONE-HOUSE,; NO. 41, SOUTH SECOND-STREiiV MDCCXCHI. V. : \\ 7 To BENJAMIN RUSH, M. D. Profejjor of the Inflitutes and Clinical Medicine, in the Univerfity of Pennfylvania, WHOSE charader is not lefs efteemed for literary accomplifhments, than morality and benevolence, and to whom this Univerfity is much indebted for his vafl: fund of fads and many ingenious and new fpeculations, This Diflertation, Is gratefully infcribed, By his Friend, THE AUTHOR. GUSTAVUS RICHARD BROWN, M. D. Sir, SINCE the pradice of Dedication is meant to dcfignate efteem and friendihip, permit me to infcribe the following Differtation to you; if it merits your approbation, alone, I fhall feel myfelf amply compenfated. Confider it as the fruit of a ftudy commenced under your aufpices, r And believe me to be, Your Friend, THE AUTHOR. To JOHN THOMSON MASON. S I R, IMPRESSED with the raoft lively fenfe of Gratitude to your deceafed father, whofe memory I revere, I cannot in filence overlook the fon of my patron and friend ; permit me, then, as an acknowledgement for the particular care and attention fhewn me at an early period, to dedicate this Differtation to you, And believe me, Your Friend, THE AUTHOR. INAUGURAL DISSERTATION. I. HT^HE uterus is fituated in the hypogastric -*- region, is a hollow vifcus, and is defign-* ed to receive the firft rudiments of the fcetus, which it retains until its parts are completely evolved, and is fitted to make its firft appear- ance on the theatre of the world. The nerves of the uterus are principally derived from the intercoftal ; its arteries from the hypogaftric and fpermatic. Thefe arteries are fo ramified through the fubftance of the womb, which is of a lax, fpongy confiftence, that they form a very confiderable part of its fubftance. When the fubftance of the uterus is divided after a lucky injedion of the uterine arteries, it ap- pears to be nearly all vafcular. When we me- ditate on this ftrudure, furprife at the great quantity evacuated at fome times may ceafe, and we may difcover aftonifhment that the A difchargc ( 2 ) difcharge is not more often immoderate, when we refled that it proceeds from the open mouths of perhaps a half million of veflels. This organization fo curious and interefting is evidently neceflary to enable the fyftem to effeduate that phenomenon called the menfes. II. From the mouths of the uterine arteries that difcharge of blood called the catamenia is poured fourth. This flux appears defigned for the fupport of that condition of the uterus which enables it to retain and fupport the im- pregnated ovum. III. The menfes is a difcharge of pure arterial blood from the uterine arteries. They appear at puberty, and return at ftated periods, and ceafe in advanced life. Though the various morbid affedions to which the fex is liable, in- terrupt the courfe and vary the quantity, they are generally abfent during pregnancy and lac- tation : They are confidered as peculiar to the human female. * IV. Con- * Some have afterted that a certain ipecies of monkey men- ftruate, bat this is doubtful. ( 3 ) IV. Constitution, climate, and modes of living, alter very considerably the period at which this healthy evacuation firft makes its appearance. As this period is eftablifhed at puberty, the eruption will be earlier or more late, as the human ftrudure is fooner evolved under the warm breezes of a mild, or retarded by the cold of a northerly climate. The menfes appear later in thofe of a rigid fibre, are more painful and tedious, than in others of a more lax habit, and whofe conftitutions are lefs bordering on torpor of the nervous, and rigi- dity of the mufcular fyftems. V. In countries near the torrid zone the cata- menia appear as early as the eighth or ninth years. In the Icy regions they are retained to the 20th and 25th years. In this temperate climate they generally manifeft themfelves about the 13th or 14th years. VL As ( 4 ) VI. As the menfes indicate the maturity of the fyften7, and as the maturity cf this is neceflary to generation, and as premature venery is high- ly injurious to the conftitution, the laws of molt nations have determined at what age fe- males are marriageable. This is much influ- enced by climate, &c. In Perfia, India, and other countries contiguous to the torrid zone, marriages are celebrated at the eighth or ninth year. Marriages in this country are never celebrated until the female attains to fourteen, and the male to fixteen, years of age. VII. The firft travellers over the northern coun- tries, whofe obfervations have been publifhed, affirm that the females of thofe northern coun- tries do not menftruate. But the moil rerpeda- ble authority has fince fhewn, that the females of Lapland and Kamfchatka, and all the di- minutive race of the Efquimaux, diffufed over fuch immenfe trad* of land near the frigid zone, obey this univerfal law of the human fe- male ( -s ) male ceconomy. Though the menfes in thefe countries appear late, continue a fhort fpace of time, and return after long intervals, and although they flow from certain women only during the fummer, while there is an abun- dance of aliment; yet among thefe nations they are no lefs necefTary to conception and the health of the fyftem, than among the in- habitants of more temperate climates, and any deviation from the laws of the climate pro- duces fimilar affedions to thofe which occur to females nearer the torrid zone. A variety frequently occurs in the different Situations of the fame country. Haller mentions a percep- tible difference in the women inhabiting a high- er or lower fituation of the fame kingdom. He obferved the appearance of the catamenia in certain low and warm diftrids as early as the eighth year of age; but in more mountainous and northern diftrids as late as the twentieth and twenty-fifth years. In thefe United States a variety is obfervable agreeable to the variety of country and modes of living. Though they appear generally about the 13th or 14th year in this country, I have feen one inftance of their occuring as early as the ninth year. Van Swieten has obferved that the females of Holland menftruate more copioufly than other women ( 6 ) women inhabiting the fame latitude. This he afcribes to the ufe of the foot-ftove fo common among them ; indeed I conceive this pradice can have much influence on the difcharge. Modes of living no doubt influence the time of appearance, the quantity, and the duration of the catamenia. The ufe of warm cham- bers and foft beds often increafe the evacua- tion : Contrary circumftances produce contra- ry effeds. VIII. The earlier the evacuation begins the fbon- er does it difcontinue, and vice verfa. Females inhabiting very fouthern latitudes attain to ma- turity at the ninth year, are mothers at four- teen, or fooner, paft child-bearing at twenty- five, and exhibit ftrong marks of old age at thirty. It has been obferved that in very northern climates, women bear children at the advanced age of fixty. * In the United States of America the menfes generally ceafe on or about the 45th year, at which time the wo- men generally ceafe to breed. IX. The * Dr. Monro's Lectures on Phyfiology. ( 7 ) IX. The appearance of the menfes is ufually announced by the following fymptoms. The ftrongeft marks of puberty now manifeft themfelves, the manners alter, the voice be- comes changed, the mammas fwelled and tur- gid, and the pubes now fhew the firft marks of covering. To thefe fucceed heat and red- nefs of the genital fyftem, fometimes to a de- gree bordering on nymphomania. The fyftem now becomes affeded with languor and lafli- tude, vertigo and head-ach, and various pains are alfo felt in the hypogaftric and lumbar re- gions: The eyes now become languid and dull, a blue colour appears below the orbits : A ferous difcharge now breaks forth from the uterus which relieves the afflided fair, X. These fymptoms only appear when the menfes are about to become eftablifhed. Ma- ny month** and even years are confirmed be- fore this is effeded. Thefe fymptoms, com- monly precurfors to the event, occur month- . 4 ly, ( * ) ly, though generally with fome alleviation in proportion as the ferum becomes more tinged with blood. The difcharge becomes, at length, pure arterial blood. The eyes now acquire their wonted brilliancy, the lips become tinged with an agreeable red, the cheeks bloomy, gaiety and chearfulnefs fucceed to languor and defponden- cy ; and now the fair one, refplendent with joy, through all nature diffufes her charms. XL The evacuation may be divided into three ftages, the beginning, height and decline. It commences firft ferous ; this gradually becomes more coloured, until pure arterial blood comes forth. In the dedine the blood becomes mix- ed with ferum, which gradually increafes un- til pure ferum is again evacuated. * This fe- rous difcharge, diminifhes gradually, until a final ftop is put to the evacuation. The fyf- tem, at this time, often becomes affeded with various diforders, as vertigo, difpepfia, apo- plexy and fyncope. XII. The * This is not the cafe with all wor/.en—fome evacuate pure arterial blood to the Iaft. ( 9 ) XII. The menftrual period when once eftablifh- ed, becomes uniform, unlefs interrupted by pregnancy, ladation, or difeafe; though it is various, as has been before mentioned, from climate and modes of life. The difcharge ufu- ally returns onee in twertty-feven or thirty days, and rarely continues longer than five or or fix, and feldom fhorter than two days. A deviation; lefs frequently takes place in the time of recurrence, than in the quantity, or time of continuance. XIII. It is difficult to afcertain, precifely, the quantity evacuated at one menftrual period, as it is impoflible to come at an adual meafure- ment. Experiments to afcertain the quantity have been propofed, and indeed really made with a fponge ; but as part of the blood may be abforbed, as the orifice is flopped up by the fponge, it mufi be but an inaccurate experi- ment. The ufual quantity for a healthy fe-^ male of a moderately lax fibre is from three to B fix ( io ) fix ounces. Luxurious living, warm cham- bers, and a fedentary life, very much alter the quantity. XIV. It may not be improper in this place to enu- merate the opinions that have been entertain- ed of the nature of the catamenia. They have been fuppofed of fo deleterious a nature, as to extinguifh the life of a male, and de- ftroy the germination of plants. This certain- ly is giving the evacuation more poifonous power than any thing in nature poffenes. Haller mentions that gardeners would not al- low their wives or daughters to approach a plant, if recently fet, if their catamenia were flowing. The Italians harboured a notion that the breath of a woman during that period would kill filk worms. La Motte retains the idea of thefe women being deleterious, but with fome limitation ; he only fufpeds thofe with red hair—He relates a ftory of a fervant maid whofe hair was red, fpoiling a calk of wine and half a hog, by having accefs to the former during her menftruation, and fairing the latter at the fame peri@d, which foon pu- trified. Indeed, I think La Mottes red head- ed ( « ) ed fervant man, would have been equally de- ftrudive to his wine and pork. The impro- bability of thefe tales deftroys entirely their credit. XV. The idea of menftrual blood being poifon- ous appears to have arifen from laws and in- ftitutions of the Oriental nations. The par- ticular fource of this error firft arofe among the Jews: they were fond of cleanlinefs, and converted their cuftoms into religious ceremo- nies—Their Legiflator enjoined purifications as a part of religion. After the mod ordina- ry and necefiary duties of life, they were com- pelled to have recourfe to purifications. Thefe purifications were thought particularly necef- fary to menftruating females. If a male touched the bed on which the female lay, he was thought impure for fome time. The poor female was after this period unclean for feven days. It is not to be wondered at, that fuch opinions prevailed among the vulgar after a ftrid adherence to the above cuftoms. The ( I* j XVI. Th e menfes are apt to become acrid by long retention in the folds of the vagina; and if copulation is performed in this fituation, the male often cbntrads a difeafe fimilar to Go- norrhoea, but this generally ceafes fpontaneouf- ly in a few days. Perhaps this difcharge from the^ male urethra might have given- rife to the rigor of the Jewifh cuftoms refpeding the fair fex, But now, when fcience and civiliza* tion have banifjied fuperffttion and bigotry, the greateft ornaments of the human race, are no longer considered .as mere convenient utenfils, the former ridiculous cuftoms are done away, and women perform their domeftk and focial pleafures without any fufpicion of harbouring a natural poifon^ XVII. The eaufe of the menftrual fltix has given rife to many fpeeulations among Medical Phi- lofophera. Some of them have been engaged refpeding minute inquiries into the proximate caufe of menftruation ; but the refults of their inveftiga- ( ,»3 ) inveftigations afford nothing fatisfa&ory on the fubjed, and all I can do will be to enu- merate fome of thofe which appear moft plaufible. xyiu. It has been faid that the fides are daufed, the growth of vegetables accelerated, and the human fyftem much influenced by the moon, as in mania, epilepfy, &c. The moon alfo has been fuppofed to be the caiife of the menfes, as they appear at the interval of a lunar month. But this laft hypothefis is built on a tottering bafis. As the influence of the moon is extended to all the animal creation, why is it exerted on the human female alone, and not extended to the inferior order of animals ? If the catamenia are the efFed of lunar influence, why do they oc- cur at puberty, and ceafe in advanced life? Would not the moon exeit its influence on all the females inhabiting the fame lattitude, the fame country, the fame city, the fame hof- pital, and all the fifterhood, inhabiting the fame convent, at one time, and would not the catamenia return at exadly ftated periods ? Fi^ 2 nally, ( 14 ) natty, would not all women become pregnant nearly on the fame day of the month ? XIX. Fermentation has been fuppofed the caufe of the menfes ; but the idea of fermen- tation going on in the living animal blood has been entirely done away by the learned and ingenious Dr^ Guftavus Richard Brown of Maryland, in a differtation publifhed at Edin- burgh, de oitu animalium caloris. XX. The experiments of Spallanzanifully evince that fermentation does not go on even in the Stomach ; and when this is admitted, it cannot be fuppofed that any can take place in the ute- rine arteries. The idea of fermentation in the living body is inconfiftent with the laws of the animal economy, and indeed with reafon. What power can ad by inducing fermentation once a month ? If fermentation is the caufe of the evacuation, I will afk, what flops the procefs when once commenced ? This error firft arofe among the Chymifts. XXI. On ( 15 ) XXL On the other hand, the mechanic fed have fuppofed it occafioned by the depending fitua- tion of the uterus. To this opinion let it fuf- fice to fay, that fome women confined to bed for many years menftruate freely and copiouf- ly. I know one inftance of a woman, in the Royal Infirmary of Edinburgh, who menftru- ated freely though fhe had been confined to bed nine years. She was much fubjed to me- norrhagia. XXII. Universal plethora has been fuppofed the caufe of the phenomenon. But when we confider the lax cellular texture of the lungs more eafily admitting of a determination than any other part of the body, we might more reafonably exped hemoptyfis than catamenia. Nay, when the fyftem has been reduced much below its natural plethoric ftate by hemorr- hage even the morning of an expeded erup- tion, ftill the menfes flow. XXJII. Another ( I a ) XXIII. Another modern opinion is, that of a partial plethora of the uterine vefTels. For this opinion there are many advocates. If uterine plethora produces catamenia, why do they appear at puberty, and ceafe in advaflced life ? Wounds of the inferior extremities, from which considerable hemorrhages proceed, fel- dom prevent the flux, though they are inflided immediately before the evacuation is to come forward. XXIV. It has been conjedured,and with confidence aiTerted, that the uterine veins are of a firmer texture than the arteries, and this texture, by retaining the venous blood, produced plethora in the arteries. In my humble opinion, it muft be difficult indeed to afcertain the compara- tive difference between vefTels in a lifelefs and collapfed ftate ; though by the afliftance of microfcopes fome difference might be fufped- ed, the conclufion drawn cannot bejuft; for great is the difference between animate and in- animate ( 17 ) animate matter. A fubftance, endowed with life, exhibits various phenomena peculiar to itfelf, and vice verfa. XXV. Another modern theory is, that the blood difcharged, is not fimple blood, but a fecreted fluid. Shew one fecretion that returns at ftated times, and I will admit the menfes to be of the fame nature. The urine is difcharged at certain times, yet the fecretion of it incef- fantly goes on. Bile becomes, at particular times, more abundant than ufual, ftill the fe- cretion is carried on, during a healthy ftate, with uniformity. Paflions of the mind, and irritating fubftances, produce a preternatural flow of tears, yet the fecretory fundion is uni- formly continued to preferve the humidity of the eye. XXVI. How can any glandular fundion be per- formed only at ftated times, while the ftruc- ture of the gland remains entire, and the fup- ply of blood is uniformly the fame ? An at- tempt to prove the menfes a fecretion, only C removes ( is ) removes the truth the farther off, and in- volves the fubjed in additional obfcurity. XXVII. After delivering the various opinions on the fubjed of catamenia, I cannot conceal my aftonifhment, that the caufe of menftruation fhould yet remain an objed worthy of invef- tigation. Let us, for a moment, fuppofe it proven to demonftration, that it depended on lunar influence, on a ferment, on a pofition of the uterus, on general or on partial pletho- ra, and, laftly, on a true fecretion. Permit me to afk, what pradical advantage could fol- low ? As the labours of the learned have been fruitlefs, fuccefs on this point cannot be ex- peded : And, if we judge of the future by the paft, the caufe of menftruation will ever remain hidden in the recefles of obfcurity. XXVIII. t In all probability all we fhall ever know on the fubjed, is, that it is pure arterial blood, which proceeds from the mouths of thofe uterine arteries wThich open into the cavity of the ( *9 ) the uterus. This fad is fupported by the combined teftimony of the moft celebrated anatomifts Europe and America afford. This ftrudure being difcovered by no theoretic au- thor, anxious to make it the bafis on which he might rear an elegant fuperftrudure, but delivered in the form of a fimple truth, has obtained the credit of all phyfiologifts. In- deed it has been proven by injedion *—-inver- tions of the uterus alfo demonftrates this fad, as the blood can then be feen to proceed from the open mouths of the uterine vefTels. XXIX. Every medical man muft acknowledge that the menfes are indifpenfably neceiTary to the health of the female, and the propagation of the human fpecies. Though the difcharge is in fo many refpeds inconvenient, as being fubjed to excefs and deficiency, either of which will deftroy both the health of the fyf- tem and the power of procreation. When we contemplate on thefe inconveniencies to which the human female is alone fubjed, in a philo- fophic * 7T,- Fyfe's private Dcinonftratie-ns on Auitomy, Edin- U:roh. fophic view, we might be led to conclude that they are but imperfedly finifhed animals. In a fuperftitious light, we might fuppofe the difcharge meant as a curfe on the fex for the tali of man. XXX. We come now to a part of the fubjed which Phyficians have more generally agreed on—the ufes of menjlruation. XXXI. The menfes are defigned, principally, to preferve and keep up a ftate of tonic unifon between the uterus and ovaria, to give to the uterus that condition which capacitates it to retain the impregnated ovum ; to carry a fuf- ficient quantity of blood for the fupport and evolution of the fcetus in utero ; and to fup- port the health and welfare of the female ceco- nomy»* The difcharge may ferve other pur- pofes, but they are merely fecondary. XXXII. Conception never appears before the menfes, and never after they have ceafed— this ( 21 ) this a ftrong mark of the wifdom in all natu- ral inftitutions ; for, during both periods, the fyftem is incapable of affording, a fufficient degree of nourifhment for both mother and foetus. XXXIII. Rarely, or never, is coition prolific im- mediately before menftruation ; and the true and final caufe of the evacuation is, doubtlefs, to effeduate pregnancy. Few would become pregnant were the intervals fhorter. Sapient nature has fo organized the human female ceconomy, that women, unlefs affeded by dif- eafe, may become pregnant almoft at any time. XXXIV. Coition, immediately fucceeding the dif- charge, is often fruitful; but the time, of all others the moft critical, is a day or two after the flood has ceafed—a fpace of feveral weeks is neceffary to form the adhefion of the ovum to the uterus—were the menfes to occur at fhorter intervals, the ovum would frequently be loft. XXXV. ( « ) XXXV. Those females afflided with menorrhagia, fluor albus, or amenorrhcea, are generally un- fruitful—and this ftate of the fyftem, fo incon- fiftent with the female ceconomy, is the only caufe of fterility which the art of medicine can remedy. Obftrudions of the fallopean tubes; imperfedions of the ovaria, and va- rious other morbid affedions of the internal parts, are not to be difcovered by human faga- city, and, if difcovered, admit of no cure. Ninety-nine of an hundred cafes of fterility proceed from irregularities of the menfes; and, in ninety-nine cafes of an hundred, we may promife a cure of barrennefs, when it proceeds from thefe caufes *. XXXVI. Those women wrho are fubjed to an he- morrhage vicarious to the menfes, are fterile, though the evacuation be monthly ; for, fince the blood does not pafs through the uterine vefTels, * Dr Gregory's Lectures on the Pra&ice of Medicine, Edinburgh. ( 23 ) vefTels, they lofe their adivity and tone. Do not the ovaria fympathife with the uterus and partake of its morbid affedions ? Can conception ever take place when the ovaria and uterus are not in perfed unifon with each other? XXXVII. Some females of robuft conftitutions, and ri