1st. Experimental excitation, by means of galvanismor mechanical irritation, causes different results when applied to spinal nerves, to different parts of the spinal cord, or to different parts of the brain. Galvanism applied to a spinal nerve, determines, it has been said, dilatation of blood-vessels, and increased secretion in glands. But galvanism applied to the spinal cord in the neck, causes contraction of blood-vessels. Mechanical irritation of other parts of the spinal cord, on the other hand, causes vaso-motor paralysis and dilatation of blood-vessels. This is especially true of that part lying in the loins, and which contains a peculiar nervous centre, that stands in special relation to the uterus and ovaries, and is involved in many of their diseases, either as a cause or effect. Systematic galvanic irritation of the brain has been little attempted, until in some very recent experiments; but its effects are already known to be most various, according to the part to which it is applied. The brain is not a single organ, but rather a collection of organs, differing from one another in function even more than in situation, and among them only some are really concerned in the production of thought.2d. In the medulla oblongata exists a nervous centre called the vaso-motor centre, because of its close relations with the vaso-motor nerves. Stimulation of this centre causes contraction of the blood-vessels. Severing the same part causes paralysis of the vaso-motor nerves and dilatation of the blood-vessels. The conditions of the brain that have been most clearly shown to influence the circulation, are those that can be proved to take an effect on this vaso-motor centre. If, as is probable, different forms of cerebral action induce or depend on different cerebral conditions, or involve different sectionsof the cranial masses, this effect would necessarily be different, and the influence on the circulation vary accordingly.3d. No experimental proof has hitherto been obtained that stimulation of the cerebral organs lying above the vaso-motor centre, and which include those possessing the function of thought, ever paralyzes this centre; but, as it is only by such paralysis that cerebral conditions can induce dilatation of blood-vessels, it must follow that noexperimental proofat present exists that stimulation of the brain ever does cause such dilatation—that is, ever does become a cause of hæmorrhage. Theclinicalfacts for such a supposition are those in which the occurrence of an emotion is followed by flushing of the face, acceleration of the pulse, hot or cold perspirations, phenomena all indicative of dilatation of the blood-vessels, with temporary paralysis of their nerves and of their vaso-motor centre. It is not proved, however, that the emotions capable of causing these effects really result from a stimulation of the brain. On the contrary, they are generally accompanied by diminished activity of that cerebral function that most certainly does depend on such stimulation—the function, namely, of thought.
1st. Experimental excitation, by means of galvanismor mechanical irritation, causes different results when applied to spinal nerves, to different parts of the spinal cord, or to different parts of the brain. Galvanism applied to a spinal nerve, determines, it has been said, dilatation of blood-vessels, and increased secretion in glands. But galvanism applied to the spinal cord in the neck, causes contraction of blood-vessels. Mechanical irritation of other parts of the spinal cord, on the other hand, causes vaso-motor paralysis and dilatation of blood-vessels. This is especially true of that part lying in the loins, and which contains a peculiar nervous centre, that stands in special relation to the uterus and ovaries, and is involved in many of their diseases, either as a cause or effect. Systematic galvanic irritation of the brain has been little attempted, until in some very recent experiments; but its effects are already known to be most various, according to the part to which it is applied. The brain is not a single organ, but rather a collection of organs, differing from one another in function even more than in situation, and among them only some are really concerned in the production of thought.
2d. In the medulla oblongata exists a nervous centre called the vaso-motor centre, because of its close relations with the vaso-motor nerves. Stimulation of this centre causes contraction of the blood-vessels. Severing the same part causes paralysis of the vaso-motor nerves and dilatation of the blood-vessels. The conditions of the brain that have been most clearly shown to influence the circulation, are those that can be proved to take an effect on this vaso-motor centre. If, as is probable, different forms of cerebral action induce or depend on different cerebral conditions, or involve different sectionsof the cranial masses, this effect would necessarily be different, and the influence on the circulation vary accordingly.
3d. No experimental proof has hitherto been obtained that stimulation of the cerebral organs lying above the vaso-motor centre, and which include those possessing the function of thought, ever paralyzes this centre; but, as it is only by such paralysis that cerebral conditions can induce dilatation of blood-vessels, it must follow that noexperimental proofat present exists that stimulation of the brain ever does cause such dilatation—that is, ever does become a cause of hæmorrhage. Theclinicalfacts for such a supposition are those in which the occurrence of an emotion is followed by flushing of the face, acceleration of the pulse, hot or cold perspirations, phenomena all indicative of dilatation of the blood-vessels, with temporary paralysis of their nerves and of their vaso-motor centre. It is not proved, however, that the emotions capable of causing these effects really result from a stimulation of the brain. On the contrary, they are generally accompanied by diminished activity of that cerebral function that most certainly does depend on such stimulation—the function, namely, of thought.
Now, since the power of thought and the power of the vaso-motor centre are equally paralyzed under these circumstances, it is more probable that the phenomena which most nearly resemble those of stimulation of the brain are either confined to some special part of it, whose activity is in antagonism to the rest, or else are really phenomena of exhaustion, and therefore come under another category. But if these do not, no facts exist to prove that stimulation of the intellectual functions of the brain is in itself capable of producing vaso-motor paralysis—that is, of becoming a cause of hæmorrhage; or, in other words, stimulation of the brain cannot be likened in its effect to galvanic stimulation of a spinal nerve. But if stimulation of the brain does not paralyze, it must increase the tonicity of the vaso-motor centre, and hence the force and regularity of the circulation. Up to a certain point, these characters do indeed increase, with increase of pressure in the cerebral blood-vessels. They increase also during intellectual operations, unattended by emotion, in which a similar increase of pressure must take place, on account of the afflux of blood to the cerebral hemispheres, when these are aroused to activity.
These facts already indicate a radical difference between the nature of the cerebral actions involved in emotion and in thought. From them also we should infer in all cases where vaso-motor paralysis was apparently traceable to excess of cerebral activity, eitherthat exhaustion had already occurred, or that the activity was not intellectual but emotional. In the first case, we should be immediately brought to our fourth possible condition for uterine hæmorrhage, dependent on modifications of the cerebro-spinal system. It is admitted, as the result of many experiments and pathological observations that need not here be quoted, that exhaustion of certain parts of the brain and spinal cord may induce vaso-motor paralysis, and that, if a cause for hæmorrhage is already in operation, a passive flow of blood may be indefinitely increased. Such a course is the menstrual crisis, without which even the vaso-motor paralysis is usually unable todetermine uterine hæmorrhage.[40]In connection with it, physical exercise, pushed to the point of exhausting the spinal cord, and the peculiar centre in its lumbar portion, or mental effort so excessive and prolonged as to exhaust the brain, and the general vaso-motor centre, might become causes of menorrhagia.
It is evident, however, that if such exhaustion had been produced previous to the menstrual epoch, the effect would be precisely the same as if the morbific causes operated only at the time of menstruation. From this point of view the precaution suggested by Dr. Clarke, of intermitting intellectual effort during the menstrual period, would be inadequate whenever it was not superfluous. But in Dr. Clarke's theory this period has a peculiar influence in rendering morbific conditions that at other times are innocuous. This, in virtue of the law already quoted, that the evolution of force at one centre of the nervous system is incompatible with an evolution of equal intensity at another, since it diminishes the sum of resources distributed to the nervous system as a whole. Hence, relatively to the amount of power left in the brain, the same exertion becomes very much more fatiguing, and may easily lead to exhaustion with all its consequences.
Nothing seems more simple than this proposition when thus stated. But all physiological problems are complicated by the element of quantity—circumstance which almost indefinitely limits our power of making absolute assertions. The comparison already made between theprocess of digestion and that of menstruation should suffice to show that there is no absolute incompatibility between the evolution of nerve force at the ganglionic centres and at the cerebro-spinal. For if so the process of digestion would necessitate such absolute torpor of the brain and spinal cord as certainly would be quite incompatible with the exigencies of civilized life. There is a certain alternation between the periods of activity of the two systems, but this varies in infinite gradation; from the digestive torpor of the savage, analogous to that of ruminating animals, up to the unconscious digestion of healthy men of temperate habits and marked intellectual and physical activity, to whom all hours of the day are nearly equally suitable for exertion. As previously said, up to a certain point, the incompatibility diminishes with every increase in the development of the cerebral system.
But again, the evolution of nerve force required by ovulation should not normally be comparable in intensity with that effected in cerebral or spinal action. Whenever it is so the activity of the ganglionic system must be in excess, or that of the cerebro-spinal system must be deficient. It is true that among the women of highly civilized societies, one or both of these conditions very frequently exist, but it is then as truly abnormal as is the dyspepsia and spleen—equally prevalent.
Although, for certain purposes, it is necessary to consider the ganglionic and cerebro-spinal system together, as parts of a single apparatus, it is important also to remember the boundaries that lie between them. It is much easier, by intense muscular exertion, that necessitates evolution of force in the spinal cord, to render the brain incapable of function, than to do so by intenseaction of the ganglionic nerves, whose connection with the brain, though real, is much less direct. Were it not so, life would be much more precarious than it is, and advance in civilization impossible; because the necessarily incessant activity of the nerves involved in nutritive processes would too largely impair the action of the brain. The effect on the brain of a really irresistible and predominant activity of the nerves involved in the reproductive organs, is to be studied in the lower animals, and in phenomena that, fortunately, are rarely to be observed in healthy individuals of the human race. Still less can such confessedly morbid predominance be considered as a peculiar liability of the female sex in this race. A singular tendency exists in many quarters, and is strongly manifested in Dr. Clarke's book, to assume that considerations pertaining to sex and to the functions of reproduction exercise such an enormous influence upon one sex, and none at all upon the other. Since the discovery in 1827 of the ovule or female reproductive cell, there can be no question of the complete physiological equivalence and analogy between the essential organs of reproduction in the two sexes. The period of their development, the influence of such development on the entire nutrition of the body, the irregularities of nutritive or of cerebro-spinal action, that may be caused by irregularities in such development, are also completely analogous. It is only the organ of gestation that is peculiar to the female—the organ of maternity—the function that, although resulting from sex, transcends sex and belongs to the race. In a double sense is the uterus secondary to the ovaries.[41]For its physiological action, both in menstruation and in pregnancy, is the direct consequence of ovarian functions, and closely dependent upon them; and the period of its prominent activity does not come until after the action of the ovaries has been completely established; that is, the period of maternity is, or should be, consecutive to the period of adolescence, and the work of gestation only entered upon when the work of ovulation has long been thoroughly accomplished.
The analogies have been much overstrained that exist between the menstrual epoch of an adolescent girl and the pregnancy of an adult woman. They are illustrations of a general physiological law that in some cases might be called a caprice of nature, in virtue of which the rudiments of a process that is to be effected at a future epoch are sketched out during an epoch already existing. The afflux of blood to the uterus during the rupture of the ovisac, cannot be shown to be useful by any effort of teleological physiologists. It predicts, however, the afflux that will be necessary at a future pregnancy, in precisely the same way as the growth of the lungs in the fœtus predicts the future necessity for respiration, or the formation of ovules in the ovaries of the newborn girl, predicts the future necessity of a reproductive apparatus. But to impose on the girl the precautions necessary to the mother, is one way to enfeeble and prematurely age her. In the same way is the child enfeebled by premature considerations in regard to sex that do not yet exist, and the adult woman so often treated as old as soon as she has borne children, which should be a proof not of age, but of maturity.
From the preceding considerations we may, we think, conclude:
1st. That unless the brain and spinal cordhad been already exhausted or on the point of exhaustion previous to the menstrualcrisis, this alone would be insufficient to exhaust them.2d. That the degree of exhaustion in the cerebro-spinal system, necessary to determine vaso-motor paralysis, is very great, and much transcends that likely to be induced by the mental exertion required in the ordinary curriculum of a girl's school.3d. That therefore, when vaso-motor paralysis, as indicated by uterine hæmorrhage, has occurred apparently in consequence of such mental exertion, it is really due to some other conditions existing with this.
1st. That unless the brain and spinal cordhad been already exhausted or on the point of exhaustion previous to the menstrualcrisis, this alone would be insufficient to exhaust them.
2d. That the degree of exhaustion in the cerebro-spinal system, necessary to determine vaso-motor paralysis, is very great, and much transcends that likely to be induced by the mental exertion required in the ordinary curriculum of a girl's school.
3d. That therefore, when vaso-motor paralysis, as indicated by uterine hæmorrhage, has occurred apparently in consequence of such mental exertion, it is really due to some other conditions existing with this.
Of these we have already insisted upon two—sedentary position and deficiency of physical exercise.
Authors have less frequently analyzed the effects of another circumstance so often accompanying the intellectual exertions of school life, namely, the morbid emotional excitement that is incident either to the period of adolescence or to the injudicious educationalrégime. To precisely appreciate these effects, it will be necessary to push a little further the analysis already commenced, of the mode of activity exhibited by different portions of the brain during the evolution of thought or of emotion.
Among all the obscurities that overhang this subject, a few facts are, nevertheless, demonstrated. The first that concerns us is the existence of the vaso-motor centre, whose situation and functions have been already described. The second is the localization of the function of thought in the circumvolutions of gray matter on the surface of the cerebral hemispheres—fact that we have already assumed to be sufficiently demonstrated. The third class of facts include those, also insisted upon, thatindicate a peculiar influence of the emotions upon the circulation and the vaso-motor nerves. In some cases these are stimulated, and the blood-vessels spasmodically contract, the cheek pales, the hands and feet grow cold, chills creep down the back—even nausea may occur from interference with the circulation of the brain; or else the cheek flushes, the temples throb, the heart beats more rapidly, when, from temporary paralysis of these same nerves, the blood-vessels are suddenly dilated.
These phenomena indicate that either the anatomical seat or the mode of generation of emotion, is in closer connection with the cerebral vaso-motor centre than is the seat of ideas.
From this positive stand-point we may be permitted to cautiously venture a little further, in the direction of a theory for the precise localization of the organs of emotion.
It is well known that at the base of the brain are collected certain masses of nervous matter, that constitute nervous centres or cerebral ganglia, that are in very intimate connection, on the one hand, with nerves of special sense, as the optic[42]and olfactory,[43]on the other with nerves of general sensation and motion.[44]To this intricate part of the brain, these centres, converge the nerve-fibres collected in the spinal cord and medulla oblongata, and from them radiate other fibres that pursue a divergent course, and finally terminate in the gray matter of the cerebral hemispheres. Thus, the brute impressions brought from the periphery of the body, are conveyed to special foci of concentration, thence to be transmitted to the gray matter at the surface of the brain, and become material for thought. Conversely,impulses generated in the nerve-cells devoted to the elaboration of thought, pass through these same intermediate stations before they acquire sufficient consistency to affect the motor-nerves, and, through them, the muscular osseous apparatus of the body. Before a sensory impression can become a thought, or a voluntary impulse express itself by motion, each must be converged toward these centres, whence it afterwards radiates, along divergent fibres, directed now above, to the surface of the brain, now below, on a longer course, to the surface of the body.
Luys has suggested, therefore, that these intermediate stations of cerebral organs constitute peculiar centres in which crude nervous impressions sustain a primary elaboration before passing to the surface of the brain. Further, that the generation of emotions, which differs in so many respects from that of ideas, is especially connected with these centres as distinguished from the cerebral hemispheres lying above them. This idea is based on the following facts:
1st. The nervous masses in question are well developed in animals in whom the cerebral hemispheres, or organs of intellection, are comparatively rudimentary; and in these same animals, while little or no capacity for abstract reasoning exists, the instincts and feelings attain individuality and intensity.2d. The emotions stand in much closer relation to sensation and movement, than do the operations of thought. The latter, indeed, necessitate immobility, and, if sufficiently intense, diminish the power of sensation; they seem to indicate a concentration of nervous action upon organs unconnected with motility or sensibility. On the contrary, movements of some kind are the first result of emotions, of which each is expressedby a characteristic gesture, and these increase in violence with the intensity of the feeling. A powerful emotion, as well as an absorbing thought, may, it is true, annihilate or transform sensation; but this is explicable by the fact that the strongest emotions are excited by ideas. Hence, on the hypothesis, the impression radiating downwards to the emotional centres from the cerebral hemispheres, would counteract a sensory impression radiating upwards from them, by a literal interference analogous to that observed in opposing waves of sound. But as the direction of the impression generating emotion coincides with that of the motor impulses, the latter would not be counteracted, but reinforced.3d. Conversely, sensations of various kinds, transmitted to these centres from different parts of the body, are as effective as ideas in generating or modifying emotional conditions—often, indeed, much more so. The hypochondria of the ancients, the dyspeptic melancholia of the moderns, the infinite varieties of hysterical sensibility, are all well-known illustrations of this undisputed fact. The elastic consciousness of well-being that emboldens the volition of certain individuals, as distinguished from the timid apprehensiveness that constantly depresses the powers of others, is connected, not with any view of external conditions appreciable by the intellect, but with a vast multitude of vague bodily sensations, of which each alone fails to make a distinct impression upon consciousness.4th. An impression made on one part of the sympathetic system is easily communicated to another, and to the ganglionic masses of the visceral plexuses, already described. Hence the rapid effect of many emotions upon the processes of digestion; hence the epigastricresponse to the emotion of fear, which led Bichat to localize this feeling in the solar plexus lying behind the stomach. In a precisely similar manner may the effect of emotion be distributed to the ganglionic nerves of the kidneys, uterus, and ovaries, leading to the flow of urine that terminates a paroxysm of hysteria, often suppressing menstruation, by contraction of uterine blood vessels, or causing an excess of menstrual hæmorrhage, from an excessive excitement of the ovarian nerves during the menstrual crisis. None of these effects are observed after a simple act of thinking, unattended by emotion.5th. Probably on account of such an influence upon the vaso-motor nerves, the blood vessels, and, consequently, the processes of nutrition, the evolution of emotions is attended with much greater fatigue than is that of thought. The fatigue that may follow a prolonged intellectual operation is, moreover, distinctly localized in the head, and exists in various degrees, from simple inability for further attention, to decided sensation of weariness, or even pain. But the fatigue experienced after excessive emotion, especially if this be of a depressing character and accompanied by tears (which imply vaso-motor paralysis in the lachrymal glands), is generalized all over the body, and is, moreover, very much more often followed by headache, or by symptoms of cerebral congestion or anemia, than is the act of thinking, except in persons morbidly predisposed. When nervous exhaustion is observed after prolonged mental effort, one of two other conditions, or both, has nearly always co-existed, namely, deficiency of physical exercise, or presence of active emotion, as, ardent ambitions or harassing anxieties. In a few cases, the mental effort itself, by the afflux of blood determined to thebrain, or the excessive activity imposed upon its elements, becomes an efficient cause of disease. But in these cases there is either an original imperfection in the organization of the nerve tissues, or the mental effort has been of that exceptionally intense nature of which none but a few minds are capable. Finally, in these cases, the resulting disease is seated in the brain or spinal column.
1st. The nervous masses in question are well developed in animals in whom the cerebral hemispheres, or organs of intellection, are comparatively rudimentary; and in these same animals, while little or no capacity for abstract reasoning exists, the instincts and feelings attain individuality and intensity.
2d. The emotions stand in much closer relation to sensation and movement, than do the operations of thought. The latter, indeed, necessitate immobility, and, if sufficiently intense, diminish the power of sensation; they seem to indicate a concentration of nervous action upon organs unconnected with motility or sensibility. On the contrary, movements of some kind are the first result of emotions, of which each is expressedby a characteristic gesture, and these increase in violence with the intensity of the feeling. A powerful emotion, as well as an absorbing thought, may, it is true, annihilate or transform sensation; but this is explicable by the fact that the strongest emotions are excited by ideas. Hence, on the hypothesis, the impression radiating downwards to the emotional centres from the cerebral hemispheres, would counteract a sensory impression radiating upwards from them, by a literal interference analogous to that observed in opposing waves of sound. But as the direction of the impression generating emotion coincides with that of the motor impulses, the latter would not be counteracted, but reinforced.
3d. Conversely, sensations of various kinds, transmitted to these centres from different parts of the body, are as effective as ideas in generating or modifying emotional conditions—often, indeed, much more so. The hypochondria of the ancients, the dyspeptic melancholia of the moderns, the infinite varieties of hysterical sensibility, are all well-known illustrations of this undisputed fact. The elastic consciousness of well-being that emboldens the volition of certain individuals, as distinguished from the timid apprehensiveness that constantly depresses the powers of others, is connected, not with any view of external conditions appreciable by the intellect, but with a vast multitude of vague bodily sensations, of which each alone fails to make a distinct impression upon consciousness.
4th. An impression made on one part of the sympathetic system is easily communicated to another, and to the ganglionic masses of the visceral plexuses, already described. Hence the rapid effect of many emotions upon the processes of digestion; hence the epigastricresponse to the emotion of fear, which led Bichat to localize this feeling in the solar plexus lying behind the stomach. In a precisely similar manner may the effect of emotion be distributed to the ganglionic nerves of the kidneys, uterus, and ovaries, leading to the flow of urine that terminates a paroxysm of hysteria, often suppressing menstruation, by contraction of uterine blood vessels, or causing an excess of menstrual hæmorrhage, from an excessive excitement of the ovarian nerves during the menstrual crisis. None of these effects are observed after a simple act of thinking, unattended by emotion.
5th. Probably on account of such an influence upon the vaso-motor nerves, the blood vessels, and, consequently, the processes of nutrition, the evolution of emotions is attended with much greater fatigue than is that of thought. The fatigue that may follow a prolonged intellectual operation is, moreover, distinctly localized in the head, and exists in various degrees, from simple inability for further attention, to decided sensation of weariness, or even pain. But the fatigue experienced after excessive emotion, especially if this be of a depressing character and accompanied by tears (which imply vaso-motor paralysis in the lachrymal glands), is generalized all over the body, and is, moreover, very much more often followed by headache, or by symptoms of cerebral congestion or anemia, than is the act of thinking, except in persons morbidly predisposed. When nervous exhaustion is observed after prolonged mental effort, one of two other conditions, or both, has nearly always co-existed, namely, deficiency of physical exercise, or presence of active emotion, as, ardent ambitions or harassing anxieties. In a few cases, the mental effort itself, by the afflux of blood determined to thebrain, or the excessive activity imposed upon its elements, becomes an efficient cause of disease. But in these cases there is either an original imperfection in the organization of the nerve tissues, or the mental effort has been of that exceptionally intense nature of which none but a few minds are capable. Finally, in these cases, the resulting disease is seated in the brain or spinal column.
This latter remark is of great importance for our purpose; for it tends to show that diseases produced elsewhere within the range of the ganglionic system of nerves—as the menstrual hæmorrhage, that we are especially considering—must be due to some other nervous act than that of thought.
From the foregoing considerations, we believe, may be again inferred, first, that the radical difference which exists between the cerebral operations that result in thought, and those that accompany the evolution of emotion, probably depends upon the fact, that in the former central nervous action remains more or less localized on the surface of the cerebral hemispheres, while, in the latter, the great ganglia lying at the base of the brain, and hence nearer the vaso-motor centre, are called into play; second, that the effects of such action are more rapidly generalized throughout the nervous system, and, by causing the dilatation of the blood-vessels in the manner described, exhaust the central nervous system in a twofold manner, by a disturbance of its circulation, and by a direct depression of its nutrition, when the modifications of the circulation exaggerate the nutrition elsewhere. Repeated excitement and consecutive paralysis of the vaso-motor nerves, therefore, serve as the most efficient means of draining off the force of the cerebro-spinal nervous system. Andit has been seen, that a depression of its power is followed by an exaggerated and irregular activity of the ganglionic system, to which are due most of the phenomena observed in hysteria and in ordinarily nervous women. These are in many respects different from those observed in men suffering from so-called nervous debility, for the reason, that in them the ganglionic system of nerves is less prominent, and its irregularities of action therefore less marked, when the control exercised by the cerebro-spinal system has been diminished. If the vaso-motor centre of the brain is only influenced when the ganglia at the base are called into activity, and if their activity coincides with emotion, and not with thought, whose organ is much more remote, in the cerebral hemispheres, it should follow that emotion, and not thought, should most easily influence the vaso-motor centre, and be followed by peculiar modifications of the ganglionic system and of the circulation. This supposition is confirmed by the occurrence of many vaso-motor phenomena that commonly follow emotion, but are rarely observed after even prolonged thought. It is not, therefore, stimulation of the intellect, but excitement of the feelings, that can be shown from physiological data to have an injurious effect upon the vaso-motor nerves of the uterus, or the ganglionic nerves of the ovaries, or, in other words, can be concerned in the production of uterine hæmorrhage. To be just, however, it must be admitted, that still another view is possible. For it might be affirmed: first, that in women communication of impressions between different parts of the nervous system was so rapid, that the limitation of activity to a particular part of the brain was impossible; in other words, that the distinction between thought and emotion waseffaced, because any action set up at the surface of the cerebral hemispheres, invariably called the emotional centres into play; or, second, it might be said, that the original organization of the cerebral tissues in women was so imperfect, that a slight amount of activity was sufficient to exhaust them, and hence become a cause of hæmorrhage by the mechanism previously described.
Neither of these assertions is made by Dr. Clarke, but it is certain that one or both of them might be made in regard to a large number of women. To these, however, severe intellectual exertion would be injurious, not only if performed during the week of menstruation, but if performed at all. Nervous excitement during the inter-menstrual period, is quite as likely to be followed by pain or excessive hæmorrhage at the next menstruation, as if it had been sustained at the critical epoch itself. Nature generally provides for a portion of this contingency, by rendering such women little capable of mental exertion, and little ambitious for it. But, though they be kept in the most complete intellectual quiescence, the condition of these unfortunates is scarcely improved. Withdrawn from the serene and powerful movement of intellectual life, they are left to all the agitations of their ganglionic nerves; impressions, unfelt by others, raise storms of feeling in them, that actually ravage their nervous system; efforts that but slightly fatigue stronger organizations, are completely exhausting to theirs; health, indeed, is only possible to them while they may be sheltered from exposure, saved from exertion, and carefully screened from excitement and shock.
The method, therefore, suggested by Dr. Clarke for enabling young girls to master Latin and Greek without sacrifice of their health, seems to us to be addressed tothe wrong element in the group of supposed causes. In the cases related by Dr. Clarke, there is nothing to show that the menorrhagia was occasioned by study during the week of menstruation, rather than during the three weeks that preceded it. Nor that even then, the true cause of disease was to be found in the intellectual exertion of mastering the school text-books, rather than in the moral excitement due to competition, haste, and cramming, or the close confinement necessitated by prolonged school hours, and unhealthy sedentary habits out of school.
The complexity of causation in such instances may be well illustrated by the following case, that I select on account of its great resemblance to the type described by Dr. Clarke.
A young girl of sixteen consulted me on account of menstrual hæmorrhage so excessive as to induce complete exhaustion, bordering upon syncope. She had menstruated for two years—during the first, in quite a normal manner—but during the second, had become subject to these menorrhagic accidents, since residence at boarding-school. It would have been easy to decide that the disturbance was directly due to the severity of the mental efforts exacted by therégimeof the school. But on further inquiry it appeared: first, that the mother of the girl had always been subject to menorrhagia, and it is well known that this often occurs exclusively as the result of hereditary predisposition. Second, that just before the entrance to school, and the disturbance of menstruation, the girl had been living in a malarial district, and had suffered from malarial infection, which is again a frequent cause of menorrhagia. Third, that the studies pursued at school were unusually rudimentary for a girl of sixteen, and indeed, below thenatural capacity of her intelligence, had this been properly trained. But the hours of study were so ill-arranged, that the pupils were kept over their books, or at the piano, nearly all day, and even in the intervals allowed for recreation, no exercise was enforced. It was therefore frequently neglected, and the girl, with hereditary predisposition to menorrhagia, increased by malarial infection, and also by certain rheumatic tendencies, was allowed to expend upon elementary text-books an amount of time, attention, and nervous energy, that would have been deemed excessive for the most valuable intellectual pursuits.
All physicians are aware of the frequent dependence of menorrhagia upon anemia, not only acquired, but congenital. The existence of anemia, or of an imperfect elaboration of the blood and vascular system, previous to the occurrence of the first menstruation, is a possible condition of menstrual disorder that must always be very carefully eliminated before any other cause be assigned. It is, moreover, extremely frequent. Others exist, but are more rare—as peculiar congenital predisposition to hæmorrhages, with or without true hemophilia[45].
With such causes (anemia, rheumatism, malarial infection, hereditary predisposition), the observance of rest during the menstrual week would be quite ineffectual so long as therégimeof the other three weeks remain uselessly unhygienic. If the menstrual crisis finds the uterine blood-vessels already deprived of tonicity through nervous exhaustion or other cause, hæmorrhage is as likely to occur as if that tonicity were only exhausted at the epoch of menstruation. In the cases described by Dr. Clarke, the cure was effected, when at all, not by an intermittence of study, which does not seem to have been tried, but by its complete cessation, together with that of all the conditions by which it was accompanied.
Again, therefore, it may be said, that wherever such intermittence is not superfluous, it would be inadequate for the purpose for which it is designed.
But this conclusion may seem to be much more severe, and, to those interested in the education of girls, much more disagreeable than that formulated by Dr. Clarke. We firmly believe, however, that truth never can be disagreeable when it is really understood in all its bearings and all its consequences, and conversely, that any proposition framed with a view to supposed desirableness rather than veracity, is almost certain to lead in the end to consequences quite undesirable. We will not, therefore, try to decide whether it may be more agreeable to believe that the health of adolescent girls requires general and permanent supervision, or that all responsibility may be discharged by confining them to a sofa and a novel for one week out of every four; to believe that a certain number of women, as of men, are always unfit for intellectual exertion, or that all women are inevitably rendered so unfit during one quarter of their lives at times unknown to outsiders, and which, therefore, may be at any time; to believe that the increased delicacy of women in civilized societies depends on a cultivated predominance of their ganglionic nervous system and emotional functions, or on the excessive stimulus of the cerebro-spinal system and on intellectual cultivation.
More useful than such discussion is the consideration of the methods that might be proposed, instead of that suggested by Dr. Clarke in the third proposition we have formulated from his book. Dr. Clarke's method is to provide regular intermittences in the education of girls, “conceding to Nature her moderate but inexorable demand for rest, during one week out of four.” The method that we believe to be suggested by the foregoing considerations would be more complex, but, we think, at once more effectual and less inconvenient. It may be stated in the following formula: “Secure the predominance of the cerebro-spinal system over the activity of the ganglionic.” Since the activity of the cerebro-spinal system may be roughly[46]divided into a twofold direction, intellectual and muscular, this predominance is to be secured by assiduous cultivation of the intellect as compared with the emotions, and of the muscles of the limbs as compared with the muscular fibre of the blood-vessels. In other words, the evil effects of school competition, and of the emotional excitement natural to adolescence, are to be combated by a larger, wider, slower, and more complete intellectual education than at present falls to the lot of either boys or girls. And the dangers incident to the development of new activity in the ganglionic nervous system by the functions of the ovaries, the dangers of irregular circulation, vaso-motor spasm and paralysis, are to be averted by systematic physical exercise, that shall stimulate the spinal nerves, quicken the external circulation, and favor the development of muscles at the moment that their activity threatens to be overpowered.
The effect of systematic training on the spinal nervous system, and on the bones and muscles dependent upon it, has been often enough described. Far less attention has been given to the equally positive development that can be secured for the brain, under the influence of prolonged and systematic exercise of its functions. An immense increase of functional capacity is possible, even without marked anatomical alteration; but even this is observed under circumstances that seem to indicate that it is rather the effect than the cause of changes in function. Retzius (Muller's Archives, 1845, p. 89[47]) observes that the female cranium varies in size much more than the male: “Female crania of the higher and middle classes are in general much smaller relatively than is the case among the peasants, a fact which probably depends on the different mode of life and occupation. The skull of the Norway female peasants is as large and strong as that of the men.” Welcker himself makes a somewhat analogous observation in regard to the crania of different races, the differences between the sexes being more marked in proportion to the civilization of the race—that is, to the degree of specialization of education, and mental occupation. He gives the following table:
CRANIAL CAPACITY.WOMAN.MAN.Asiatic Caucasian11.27.European11.17.Mongols11.13.Malays11.08.Americans11.08.Negroes11.07.
Besides the prominent fact upon which Welcker insists, this table indicates two others. First, that the anatomical difference in the higher races is too little to explain the general difference in intellectual achievement really observed between the two sexes of these races. Second, that the difference is not in precise proportion to the maximum intelligence attained by the race, but to the social inferiority and subjection of the women; for the Asiatics (Hindoos) stand highest on the scale, the Europeans only second; and the excess of the first over the second, in regard to the point in question, is greater than the excess of the Europeans over the other races named.
The general fact that, beyond certain well-defined limits, the activity of the cerebro-spinal system and its relative predominance over the ganglionic, is to be determined dynamically rather than anatomically, is insisted upon by Laycock (Med. Times and Gaz., 1862). This writer observes that the large, slowly-nourished brain of a lymphatic man, frequently evolves much less intellectual force than does the smaller, perhaps more compact, brain of another, in whom the circulation is more active, and the nutrition probably more elaborate.
These facts, and many others that might be quoted, are pertinent to our subject, on account of the influence exercised over the ganglionic centres by the development and functional activity of those of thought. Stimulation of the cerebral hemispheres is one of the most powerful means of counteracting paralysis of the vaso-motor centre, with all its consequences. Habitual activity of these centres—implying, psychologically, habitual activity of thought, physiologically, a more active local circulation—is therefore the best method at our disposal for permanentlycounteracting tendencies to irregular action in this centre, in the emotional ganglia lying in its vicinity, and in the vaso-motor nerves dependent upon it.
A method of such general supervision does not in itself forbid the co-education of girls and boys; for from this more general point of view, the health of the latter during adolescence really requires precisely the same precautions as that of the former. Attention is less frequently drawn to the precautions required in the case of boys, mainly because such precautions are more frequently observed in regard to them. But besides, girls arrive at the period of adolescence already enervated by the senseless training of their childhood, on which distinctions of sex have been obtruded long before they are established by nature. Finally, since peculiarities relating to the sexual organs are inherited, if at all, from the parent of the same sex,[48]the germs of uterine diseases acquired by mothers too frequently exist in daughters, ready to be developed at the earliest opportunity.
As a matter of fact, therefore, the existing generation of girls, especially in New England, too often possess a delicacy of organization greater than that of their brothers, and demanding a special supervision and watchfulness, best bestowed when they are educated apart. For the reasons already detailed at length, we think that such supervision does not necessitate periodical intermittence of study, except in special cases, that constitute a decided minority among the whole. It does necessitate, however, the more difficult task of providing for adequate rest and exercise during every day of the month. It necessitates a more rational system of study, a moreprofound training, a more intelligent view of the real character of intellectual life, and of the exercises required to develop it. It necessitates a concentration of intellectual effort into four or six hours out of the twenty-four, instead of a useless diffusion of intellectual peddling over ten or twelve. It necessitates an extension of the term of years allowed for education, and the giving up the fashionable notion that a girl is to be “finished” at seventeen or eighteen, while her brother continues to pursue his studies until twenty-two or twenty-five. It necessitates, finally, the most careful individual adjustment to each different case; and to all its peculiarities, mental, moral, and physical—quite as frequently, therefore, necessitates the education of girls apart from one another as apart from boys.
But this necessity is not permanent. Dr. Clarke himself admits that if the one precaution upon which he insists be observed during the first years of adolescence, it will become unnecessary when the constitution is formed. But neither Dr. Clarke nor his reviewers seem to see that this admission annihilates the only objection made by him to the co-education of the sexes. For that is especially demanded as the only means by which women may be enabled to enjoy a technically superior education, as distinguished from the primary and secondary, and such education does not begin until eighteen. A university education is too expensive to be duplicated in any state; it moreover represents the collective intellectual force of society, and as such cannot rationally be cut in two. Indeed, as such, cannot logically exclude women from men's schools, which are thereby left as imperfect and incomplete as would be the new universities to be constructed exclusively for women. During the neutral period ofchildhood, girls and boys should be educated together, because, as sex does not, properly speaking, exist, it is absurd to base any distinctions upon it, and the attempt, like all absurdities, is liable to lead to really disastrous consequences. During the period of adolescence or of the formation of sex, it is well to establish a separate education, during which the character of each may be defined and consolidated. This separation is needed by the moral and the physical training rather than by the intellectual. Were it, as is usually assumed, necessary for boys to exercise and for girls to sit still, the need of separation would be much less than it is, for the boys could be sent to the gymnasium while the girls remained in the school room. But systematic exercise is even more necessary for the latter than for the former, because they are likely to take it spontaneously. These exercises must differ in kind and in intensity from those performed by boys, and for this and other reasons, are best pursued alone.
The moral differentiation of the sexes requires separate education, for analogous reasons. Moral differences, though less marked than physical, are more so than intellectual, and any system of education that might be supposed to efface these, would be an injury to society, that requires, not uniformity, but increasing complexity, by means of increasing variety of character among its members. Thus the education of adolescent girls should include certain training in the care of children, and other duties that either permanently, or for the time being, must fall to them and not to boys. But a more important moral reason for separate education consists in the desirability of prolonging as late as possible, the first unconsciousness of sex. At this age the stimulus derivedfrom co-education, acting upon imperfect organizations, is liable to be other than intellectual—liable to excite emotions equally ridiculous and painful from their pre-maturity, and therefore to increase the very danger most to be averted from this period of life—the excessive development of the emotional functions and organs of the nervous system.
But, by the age of eighteen, the reasons against the co-education of the sexes have ceased to exist, and imperative reasons in its favor have come into play. The first we have already indicated. Unless the education of girls be continued beyond the conventional retiring-point of eighteen, and unless they be permitted access to the State Universities, they cannot participate in the highest intellectual education of the race. This cannot be carried on by private teachers, in isolated classes, under uncontrolled authorities. It must be public, national, supreme—for it represents the collective intellectual force of the nation; it is the work of society, and fits for society; and the social influences presiding over its instruction are as important as is the technical knowledge conveyed in its system. Only the best minds should be employed in its service, and in any State these are not sufficiently numerous for the wants of indefinitely multiplied schools.
But, further, if girls may be educated, and better educated, apart from boys, it is scarcely possible to give women an intellectual training apart from men, certainly in the present generation. What may be lost to men by exclusion from the intellectual companionship of women, may perhaps be beyond the scope of our present subject to inquire. But the loss sustained by women, who, shut up in female academies, attempt, or pretend to makethe attempt, to obtain a “college education,” is conspicuous beyond possibility of cavil. The same peculiarities that render women, as a rule, less original, are justly said to make them more receptive, more malleable, more exquisitely adjustable to the least variation of external circumstance, or difference in the intellectual calibre of their associates or masters. Their own intellects are quickened to activity or repressed into torpor, by influences that would have little effect upon the less impressionable, more self-poised minds of men. These facts, upon which great emphasis has often been laid, should only lead to one inference, namely, that the education and intellectual capacity of women is likely to remain at the point, or advance to the degree at which men may consider it desirable for it to exist; if, therefore, certain conditions are seen to favor this advancement to an extraordinary degree, and others to retard it in a manner as extraordinary; if, in addition to results already achieved by the increased education of women, others far greater may be foreseen, when that education shall have become really equal to that now accessible to men; it becomes imperative to concede the conditions in question, unless some equally imperative counter indication can be shown to exist. Reasons of an entirely different order exist, we think, in the fact that at this age the sexes naturally seek each other's society, as much as they avoided it before. It is difficult to see why this tendency requires to be counteracted, except on some monastic principle that is an unconscious “survival” from the middle ages. Thwarting this tendency leads often to immorality in the one sex—to languor, and mental, moral, and physical debility in the other.
Dr. Clarke places his counter indication almost exclusively in the supposed necessity for a periodical intermittence in the intellectual work of women, that could not, therefore, be brought into harmony with that of men. But, as we have seen, Dr. Clarke himself admits that such necessity is scarcely imperative except under the age of eighteen or nineteen, and the period of study for which co-education is really desirable, indeed, necessary, does not begin until that age. Moreover, Dr. Clarke draws his examples, not from students who have been educated at mixed schools, but from those who have attended ordinary girls' boarding-schools; so that no proof is adduced of any special influence of co-education, unless the general statement that “co-education is intellectually a success, physically a failure,” can be considered as such proof, which we do not believe. Since, according to Dr. Clarke's own argument, the argument does not apply to the particular point of controversy upon which it has been made to bear with most force, it is superfluous to return to our own reasonings, whereby we believe to have shown that the dangers signalized, though they exist, menace the minority and not the majority; that they are then attributable, not to mental exertion, but to the coincidences of mental exertion as at present conducted; that they are to be averted, not by a single manœuvre, but by a general system of training, that should include, instead of excluding, special attention to intellectual development; that the results of such training would remain, after the consolidation of the physical health and the termination of the period of growth had rendered further training unnecessary; whereas, the peculiar precaution suggested by Dr. Clarke, would rather tend to create a habit of body that would persist throughout life, to immense inconvenience.
Mary Putnam Jacobi.
110 West Thirty-fourth street, New York.