7 iBM ■uy;;. ...:"• ■Hi":: :!:h"Sk«;"J :.:«b: ::;:: r: :;;.!:."5:ki; J S!hPPS1|S=2*H| »* ... • ^ A* ^ \.^ /i»\ v^ • v^&ak;* ^v w a **I2M5** a v ^Cft WAV* - ^^ :• «p ^ 7%- * o. **?V. 9 A tf t0 ■ •" vfc ^^ V ** , »-° 9 * ^ > 0* .•*•% "> V v -!.•«- O. ^ GIRL AND WOMAN GIRL AND WOMAN A BOOK FOR MOTHERS AND DAUGHTERS BY CAROLINE WORMELEY LATIMER, M.D., M.A. FORMERLY INSTRUCTOR IN BIOLOGY WOMAN'S COLLEGE OF BALTIMORE WITH AN INTRODUCTION BY HOWARD A. KELLY, M.D. PROFESSOR OF GYNECOLOGICAL SURGERY JOHNS HOPKINS UNIVERSITY NEW YORK AND LONDON" D. APPLETON AND COMPANY 1910 «<* Copyright, 1909, by D. APPLETON AND COMPANY Published November, 1909 • ©CU251835 TO THE MEMORY OF I. E. A. THE FRIEND WHOSE SYMPATHY, COUNSEL, AND ENCOURAGEMENT HAVE BEEN MY LIFE'S BEST INFLUENCE, WHILE HIS BELIEF IN THE POSSIBILITIES WITHIN MY REACH REMAINS MY STRONGEST STIMULUS TO EXERTION. PREFACE We have recently awakened to the fact that the most important period in life as regards the forma- tion of character, instead of being the first decade as always supposed, is really the years between child- hood and maturity. But although the attention of parents and guardians is now focussed upon this sea- son as one of supreme importance, especially as re- gards girls, the sources of information concerning it are few and far between. Aside from Dr. Stan- ley Hall's monumental work, the size and extent of which somewhat restrict its field of usefulness, all information upon the subject of girlhood is sparsely scattered over a wide territory of periodical litera- ture, much of it being contained in psychological and pedagogical journals or similar places remote from the main-traveled road familiar to the general reader. Moreover, these articles are commonly written by specialists in language which requires some interpre- tation. To make this mass of scattered and semi-technical information available to the public at large, it re- quired to be reviewed and sifted, in order that the main facts, as well as the more important of the views viii PREFACE and ideas suggested by them, could be presented in a simple and compact form, easy of assimilation by those most nearly concerned. The preception of this want has led to the preparation of this little volume, which, it is hoped, may place the valuable results ob- tained through the labors of thoughtful minds at the service of many who lack time or opportunity to seek them along the bye-paths of specialized lit- erature. No pains have been spared to make the investigation complete and to seek authority at the fountain head. It is with great pleasure that I avail myself of this opportunity to acknowledge the kindness shown me by friends in the course of my work. To Pro- fessor W. H. Howell of the Johns Hopkins Medical School I am indebted for council and suggestion con- cerning the first four chapters and to Dr. Elizabeth Hurdon, Assistant in Gynecology in the same Uni- versity for criticism of the fifth chapter. But most especially my thanks are due to Dr. Howard A. Kelly for the interest he has taken in my work and for his kindness in allowing my little book to enter the world under his protection. The service he has rendered me in this instance is but one of many helpful actions, each of which forms a rivet in a friendship which is one of my most valued posses- sions. Caroline Wormeley Latimer, M.D. Baltimore, June 22, 1909. INTRODUCTION I am glad that Dr. Latimer has undertaken to write this much needed work addressed to women at large, and conveying a mass of useful information in language free from technicalities. I am of opinion that such instruction as is here given, with proper reserve as to special functions, is wiser than that conveyed in many of the popular cheap books touch- ing upon these hitherto forbidden subjects. A few centuries have wrought great changes in our views upon the training of women. But three hundred years ago the ordering of a girl's life was a matter of interest to nobody and the world at large agreed with Thomas Fuller of that time that " Daugh- ters are silent strings sending no sound to posterity and losing their identity in their husbands." But this view-point is altogether changed, and the thought- ful, conscientious parent to-day holds a daughter's education, in the widest sense, as no less important than a son's. It is only of recent years, however, that we have begun to recognize in girlhood a distinct period in life with characteristic demands and neces- sities. How much we have neglected this critical age may be gathered from a glance over Poole's Index x INTRODUCTION of Periodical Literature for the last ten years, where the titles of papers dealing with either childhood or womanhood fill several pages, while those devoted to girlhood as a separate and distinct stage in life occupy only a few lines. During the last year or two of the decade, however, the articles on girlhood steadily increase in number, a significant change, which is due to the fact that the psychologists have recently devoted much attention to adolescence, and the in- terest thus aroused has extended to the public. Psychological research has made it plain that no period in a woman's life is so important to herself or so full of interest to her natural guardians as the transition years of development from childhood to womanhood, and it has also shown that her evolu- tion, instead of being extremely brief, as was sup- posed, is really a process of slow and gradual unfold- ing of both body and mind, occupying all the years between twelve and twenty-one. Another fact lately made evident is that the impressibility of this period of life is greater than any other, for the mind is more susceptible to influence, and the moral nature more plastic than at any subsequent time, while the indi- vidual sense of right and wrong becomes clearer than at an earlier age. For these reasons the principles in- stilled into a girl's mind at this critical stage of her life's journey are of paramount importance. There are two supreme objects to be kept in view at this INTRODUCTION xi period: first, that she shall pass through its changes in a natural, happy, and healthful manner; and sec- ond, that her training shall be such as to fit her for the serious burdens of the years that are to follow when she must shoulder the cares and responsibilities of life. The burning question with those interested in securing her health and happiness is the best means of arriving at the desired end, and here there are still some differences of opinion. In the days of our grandmothers custom decreed the formal separation of the sexes almost from baby- hood, and all pursuits, work, and pleasures advanced along different lines, planned to fit the boy to cope with the world and fight his own battles, while the girl, who was no warrior, received no definite train- ing and lived restrained within the narrow limits of her natural physical activities. A generation ago we awakened to the discovery that physical freedom and activity are as good and as necessary for a little girl as for a little boy, and that the principles of elementary education which produced the best results with boys succeeded equally well with girls. This il- luminating idea at once deferred the separation of the sexes until adolescence, but as it was then still enforced bodily freedom for a girl ended in most cases with childhood, while her mental training was much less thorough than that of her brother. To-day we hold that a system which condemns xii INTRODUCTION outdoor life and activities as unwomanly, and sac- rifices sound learning for mere drawing-room ac- complishments is fundamentally wrong. We have, therefore, changed our tactics and proceeded to give girls the same advantages as boys, both physically and mentally. The one point now at issue is this : Is a girl best fitted for life by precisely the same training as a boy, or is some modification desirable in con- formity with the elementary difference of sex? I think that those who say : " Let there be no difference whatever," fail to give sufficient weight to the issues involved and overlook the fact that when boys and girls reach puberty the fundamental dif- ference between them, hitherto latent, asserts itself openly and emphatically and cannot henceforth be ignored without serious consequences to the proper development and sound health of both body and mind in the girl. The establishment of puberty in itself is always a strain upon the physical and mental forces, often severe enough to affect the general health or the central nervous system. For both sexes puberty is a period requiring especial care and watchfulness and when it is over, and the fundamental differences between the sexes are fully established, the function of menstruation with its cyclical changes and their de- mands upon the nervous system continues to call for consideration in young women. Few girls or women can treat this function with entire disregard, except at INTRODUCTION xiii their peril. I do not say that the menstrual periods ought seriously to interrupt the routine of daily life in a healthy girl, and any manifest invalidism may be accepted as evidence of depressed health. But un- due exertion, prolonged and repeated, at such times almost inevitably results in an exhaustion of the nerv- ous system, manifested, sooner or later, by excessive periodical suffering or by some more general dis- turbance. To illustrate this fact take the athletic sports now so general for girls. A boy who plays on his team at school or college is under no necessity for heeding the times and seasons of his games, being as fit to play one day as another, but almost every girl, under like conditions, must consider a regularly recurring inter- val when her nervous force is so taxed by the demands of her economy that the excessive effort demanded by the game places her at a disadvantage for the moment, beside exposing her to the risk of lasting ill effects, even so great as life-long invalidism. Some strong vigorous girls do sometimes play tennis, basket-ball, and hockey at such times with impunity, but no girl can risk the strain of a match game without danger of suffering from it sooner or later, not only because of the extreme bodily effort, but because of the nervous tension arising from the excitement of competition together with the emotional disturbance inevitably at- tending- success or defeat. xiv INTRODUCTION Excessive nervous strain is, in fact, the key to the whole situation and we find that the sex limit im- posed by means of it is as definite on the intellectual side of life as it is in the sphere of the body. The present system of education for women, with all its improvements, has the defects of its qualities in its ever insistent emulation and competition with their resultant tension and excitement. An ambitious girl with examinations awaiting her during the menstrual period is exposed to risks similar to those of the ath- letic field and is under the same disadvantages as com- pared with her brother. But while there are many who realize the dangers of physical over-exertion dur- ing menstruation, few seem alive to the, perhaps, greater risks of mental high pressure at such times and at an age when the emotional nature is most ex- citable. To my mind these observations teach us that a woman's physical well-being, under existing social conditions, depends largely upon her willingness to ac- quiesce in those moderate and proper restrictions im- posed by nature upon her sex. I have used examina- tions and athletic sports simply as a means to illus- trate my position, which is : first, that a woman must avoid excessive effort of body or mind during the menstrual periods and that if she neglects this salutary precaution her health will suffer in the long run; second, that this fact, of necessity, prevents her from INTRODUCTION xv standing on a perfect equality with a man engaged in the same occupations. Just what precautions are called for must be determined according to the con- ditions in each individual case ; this question is fully discussed in one of Dr. Latimer's chapters. We may draw one general conclusion, however, which is that while experience has shown that girls are in every way better for the removal of artificial restrictions upon their activities, it is also plain that any attempt to treat the restrictions imposed by Nature as though they did not exist, results, as a rule, in harm to body and mind. Some of the partisans of exact uniformity in the training of the sexes who are unwilling to admit any necessity for caution whatever, point with conviction to a certain proportion of women who are able to disregard the menstrual function without suffering for doing so. But this argument overlooks the chief difficulty, which is that the mischief done by the neglect of a periodical conservation of the forces does not usually show itself immediately and may take the form of some disturbance of a general character. In- discreet and prolonged exertion during the periods, during a series of years, may be a factor of im- portance in the production of nervous prostration, though the causal link in the chain may have long since disappeared. But, in my opinion, the greatest harm done by an xvi INTRODUCTION education which teaches a girl to regard her sphere in life as identical with that of a boy is that by sugges- tion or implication it encourages her to despise the duties belonging to her sex by right of Nature, there- by striking at the roots of her real happiness. It is not that a woman is in any sense whatever inferior to a man, but that her sphere is a different and a com- plementary one. A man and a woman each does many things that the other cannot do, but in their re- spective spheres how distinct, how different they are! The very best our civilization has yet offered has been the higher education of our daughters. But the the- ory that public offices and public works are as much the business of a woman as of a man, holding pub- lic claims as more honorable and more worthy of at- tention than those of the home, is injurious alike to women and to the public they desire to serve. Philanthropic occupations are of paramount im- portance under certain conditions, and the woman who does not marry often finds in them her vocation and her salvation from the narrow, gossiping ex- istence once the lot of the old maid. These activities, however, must ever be of secondary importance to the married woman. The woman who devotes herself exclusively to outside interests, I believe, contributes less to life and gets less from it than she whose ac- tivities lie mainly or wholly in the sphere of the home. There exist certain conservatives who, while they INTRODUCTION xvii fully appreciate the limitations imposed by the differ- ence of sex and the importance of the claims upon women in her own peculiar sphere, are sometimes apt to do our girls an injustice from an entirely op- posite point of view. These people incline to the notion that if a girl marries she not only does not need, but may be actually hurt by more than an elementary education; while, on the other hand, they admit that, should she remain single, it is well that her mind should be cultivated extensively in order to open up numerous avenues of interest and activity. If this idea were rational, the difficulties consequent upon it would be serious indeed, since girls cannot be di- vided at birth into queens and workers like bee larvae. Fortunately, the difficulty, when squarely faced, dis- appears. Data thus far collected touching higher ed- ucation for women show that learning in itself does not interfere, but rather adds to a girl's usefulness as a wife or mother, nor does college wisdom, as Matthew Arnold expressed it, " affect her chances " of matrimony. And it is surely but a shallow con- ception of the marriage state which holds that there is no room in it for knowledge and a diversity of in- terests. A healthier, saner view is that which holds that whatever develops a girl's faculties and broadens her outlook upon life makes her better fitted for her work in the world, whether that work is ultimately carried on in the single or the married state, and that xviii INTRODUCTION the more cultivation, the more information, the wider the interests a woman brings to bear upon her inter- course with her husband and her children the more en- nobling and elevating are their mutual relationships. Finally, I desire to repeat, that the sum of what I have been saying is this: In their practical, daily, human relations the sexes are never precisely alike except during the earliest years of childhood. For the first ten years of life a boy and a girl may be looked upon and treated as identical, though even then the foreshadowing of the coming changes are al- ways visible to keen eyes. But with the approach of puberty the fundamental differences, everywhere stamped upon the sexes in nature, become sharply de- fined and the breach thus made widens with the suc- ceeding years until maturity finds the man and the woman two distinct entities, complementary in all their future relations. It is the office of the wise physician, as well as of the philanthropist and of the educator, not to minimize but to recognize these dif- ferences and to lead young women wisely into the paths designed for them. The book before us is a notable effort in this direction. Howard A. Kelly, M.D. Baltimore, June, 1909. CONTENTS CHAPTER I.— Physical Disturbances of Girlhood II.— Mental Disturbances of Girlhood III.— Moral Disturbances of Girlhood . IV. — Reproduction V.— Menstruation VI. — Sexual Knowledge VII.— Bodily Functions— Exercise— Sleep Vin.— Personal Hygiene IX. — Daily Life During School Days X. — Daily Life on Leaving School . . XL— Minor Ailments ....•„. PAGE 1 24 55 n 100 138 158 201 234 263 290 GIRL AND WOMAN CHAPTER I PHYSICAL DISTURBANCES OF GIRLHOOD General considerations — Changes in the bones and mus- cles — Curvature of the spine — Changes in the heart and arteries — Blushing — Anemia ■ — Chlorosis — Changes in the lungs and thorax — Changes in the skin — Eruptions — Changes in Digestion — Appetite — Teeth — ■ Changes in the organs of special sense — Voice — Smell — Hearing — Vision — Changes in the nervous system — Chorea — Stammering — Sick headache — Neurasthenia — Epilepsy — Conclusion. The period of a girl's passage from childhood to womanhood is characterized by changes of the most radical and far-reaching description. Up to this time her development, both of body and mind, has been steady and uniform, following definite lines and not subject to sudden checks or advances. Now she reaches a point when a hitherto dormant force awak- ens within her, in response to which she enters upon a phase of what has been called tumultuous grozvth. The impulse to activity, now making itself felt for 2 GIRL AND WOMAN the first time, proceeds from the great elemental in- stinct, sex, which is henceforward to be one of the most powerful agencies in her life. The central fea- ture of this period is, therefore, the development of the reproductive organs and of the functions con- nected with them, but associated with these primary changes are secondary ones, both mental and physical, which extend their influence in all directions. Al- most every organ and system in the body begins to grow with startling rapidity though at different rates of speed, so that relative proportions are everywhere changed, sometimes permanently, in other cases for the time being. The mind, and even more the emo- tions, show evidence of change to a marked degree, the character develops, the moral sense begins to act in- dependently, the perceptions become more acute, the susceptibilities more active, until finally, in the space of a few brief years, the child has disappeared and a woman, in whom, perhaps, not a trace of the child remains, occupies her place. It is needless to say that this period of life is one of supreme importance in a woman's life. Not only her immediate well-being but her well-being in the future depend upon the manner in which she passes through it. The phase of development in itself, how- ever, is perfectly natural, and the changes incident to it are only such as lead naturally to a normal woman- hood. PHYSICAL DISTURBANCES 3 Next to the sexual changes, which will be discussed elsewhere, the most striking feature is a sudden and rapid increase in height and weight, that begins about thirteen. The difference in height taking place in the course of a few months may be so great as to make it seems as if we had to do with a different girl; a tremendous interval all at once appears between her and the brothers and sisters next to her in the family, and she outgrows her wardrobe so fast that it is almost impossible to keep her in clothes. This rapid growth in height comes to an end (on an average) about fif- teen and the final stature is then nearly, if not quite complete. It is true that a girl may, and not infre- quently does, continue to grow for several years longer, but the process is comparatively slow and the addition to her height inconsiderable. This increase In height is accompanied by an in- crease in weight, but not commonly a proportionate one, the advance in height being the more rapid of the two. With girls this disproportion between height and weight is not so marked as with boys, be- cause in a girl, the development of the figure and of the hips, with all the attendant curves, does a great deal to conceal the apparent loss of tissue. There is a great deal of difference, however, between individual girls in this respect, some of them showing but slight signs of womanly development until the period of rapid growth is over, when they begin to fill out rap- 4 GIRL AND WOMAN idly; while with others, the womanly changes pro- ceed side by side with the increase in stature. The basis for all this rapid growth is profound changes in the bones and muscles. The rapidity of these changes, as we have just said, is not proportion- ate, and the disproportion between them is responsible for much of the awkwardness and clumsiness of move- ment so characteristic of the age. When the long bones grow more rapidly than the muscles attached to them we have the familiar " growing pains," while when the muscles grow faster than the bones there is extreme mobility of the joints. The various con- tortions of the limbs and of the fingers and toes, to which girls of thirteen and fourteen are so much addicted, are possible at this time by reason of this mobility, which disappears in the course of a few years. The power of muscular co-ordination also de- velops greatly, so that this is the time when manual training in all pursuits or trades requiring dexterity and delicacy of touch ought to begin. If it is not undertaken until later, when the mobility has dimin- ished, the same degree of skill can never be attained, but it cannot be carried very far earlier, for the neces- sary power of co-ordination between brain and muscle is not yet developed. A danger belonging especially to this period of growth is curvature of the spine. All the bones of the body are first formed in cartilage and gradually PHYSICAL DISTURBANCES 5 converted into true bone by the deposit of lime salts, a process not entirely complete before the twenty-fifth year. While the bones are still largely cartilaginous, they are soft enough to yield easily to pressure, a fact which is made use of by certain races to produce dis- tortions which they consider beautiful. The most fa- miliar example of this practice is the foot-binding of China, and another is the distortion of the shape of the head admired by certain of the North American Indians, who produce it by tying bits of board to a young child's skull. In early girlhood the spinal col- umn is still not fully hardened, and is therefore easily affected by pressure. When the period of rapid growth begins, the increase in height is often so sud- den that a girl finds it hard to hold herself erect and is apt to assume slouching, ungainly positions, all the more because she feels herself awkward and uncom- fortable. Any attitude which throws the spinal col. umn out of its normal line, such as standing with the weight of the body thrown altogether on one foot, or keeping one leg crossed over the other without re- versing the position, is likely to cause a curvature of the spine. The sitting posture is apt to result in spi- nal curvature when the head rests always on the same hand while reading, or the body is inclined to the right side while writing, both of which attitudes are constantly assumed by school girls. Occupations or trades which require the continual use of the right 6 GIRL AND WOMAN hand and arm, such, for instance, as dressmaking, have the same result,, if girls begin to work at them while still quite young. Rightsided lateral curvature at about the level of the arm is the result of this par- ticular error of position. It is the most common of all in the different curvatures, no doubt because there are so many occupations which oblige the in- cessant use of the right arm and hand; but there are other curvatures associated with other faulty atti- tudes. The best preventive of this state of things is abundance of active physical exercise in the open air, as well as the daily use of systematic exercises, either at home or in a gymnasium. If a curvature has al- ready begun, a great deal can be done to correct it by special gymnastic work under trained supervision, without resort to mechanical appliances. Next to the changes in bone and muscles those in the heart and arteries are most significant. In child- hood the heart is relatively small and the arteries large, but at maturity this state of things has been reversed, the difference being caused by increased growth on the part of the heart in the years between twelve and twenty-five. Not that the arteries cease to grow, but they do so more slowly than before, while the heart grows faster. With the growth of the heart it acquires, of course, additional strength, and as the arteries are but little larger, the pres- sure of the blood within them is increased; this in- PHYSICAL DISTURBANCES 7 creased pressure resulting in great activity of both mind and body, which finds physical expression in a craving for movement and muscular action of any kind, which it is cruelty to repress. The whole circulatory system is in a state of great excitability which manifests itself in many different ways. Coldness of the hands- and feet from feeble- ness of the circulation in the extremities, is quite fre- quent and occasionally, though more rarely, there are sudden flushes or chills over the whole body. An- other disturbance of the circulation especially frequent in youth because of the peculiar conditions of the period is blushing. The stimulus in the act of blush- ing is, of course, a mental one, being the conscious- ness of self aroused by some external impression, but the impulse thus aroused, transmitted through the nervous system to the superficial blood vessels, re- sults in a rush of blood to the face. Exactly why the face should be the locality affected by the impulse has not been satisfactorily explained. We do know, however, that blushing is not necessarily confined to the face or even to the neck, having been observed, in certain cases, to spread over the whole body. Youth, as we shall presently see, is a period of in- tense self-consciousness, and this fact, together with the disturbed condition of the circulation at that time of life, explains why blushing is so much more com- mon at that time than later in life. 8 GIRL AND WOMAN It sometimes happens that the changes in the blood vessels affect the veins as well as the arteries, and when this is the case there may be varicose veins of the lower extremities, although it is a rare occurrence. Bleeding from the nose, which is quite common in girlhood, is partly due to the disturbed state of the cir- culation and partly to poverty of the blood itself. It is not surprising that such significant changes in the heart and arteries should sometimes be ac- companied by disturbance of the heart's action. As a matter of fact, irregularity and palpitation, with shortness of breath and a feeble or intermittent pulse, are not at all uncommon in young girls. Whenever these symptoms occur a doctor ought to be consulted and his advice followed implicitly. In the large ma- jority of cases there is no disease of the heart, but only a physician can determine whether it is absent; moreover a girl who shows such symptoms requires more hours of rest in the recumbent position than she would under ordinary conditions, and it is for a doc- tor to decide how many they should be, and also what amount of physical exercise is advisable, too little being nearly as bad as too much. Changes in the composition of the blood itself are not uncommon in girlhood. The most frequent of these is anemia, or simple poverty of the blood, caused by deficiency in the number of red cells of the blood or in their capacity to nourish the tissues. This PHYSICAL DISTURBANCES 9 condition is marked by pallor, with great languor and disinclination to exertion, both mental and phys- ical, quite out of keeping with the usual activity of the age. Whenever a girl who has hitherto been bright and active, both physically and mentally, begins to feel her school work too much for her, and play such an effort that she would rather sit still and read she is probably anemic, especially if she is losing color. But anemia is sometimes present without pallor. Headache is a common accompaniment of anemia as well as a tendency to hemorrhage, shown usually in bleeding from the nose. Sometimes the blood is seen to be a lighter red than it should be. Simple anemia usually yields readily to treatment, especially iron and cod-liver oil. Another condition associated with changes in the blood and belonging almost exclusively to this period in life, is chlorosis, more commonly known as green-sickness. It is so closely connected, however, with irregularities of menstruation, which are one of its chief symptoms, that it seems better to consider it with that subject. The vital capacity of the lungs, that is to say, their capacity for holding air, increases very much in early girlhood. There seems to be some difference of opin- ion as to the exact period between twelve and six- teen when the increase is most decided, but all ob- servers agree that it is greater during these years than at any other period of life. This increase in io GIRL AND WOMAN vital capacity is accompanied, as we should naturally suppose, by an increase in the size and weight of the lungs, and as the heart is rapidly becoming larger, it is plain the circumference of the chest must enlarge in order to accommodate the growth of the organs within it. As a matter of fact, the ribs do grow rap- idly and at the same time harden rapidly from deposit of lime salts. They do not become completely ossi- fied, however, before twenty, and up to that time their shape can be easily modified by pressure, es- pecially during the years just following childhood, when they are still largely cartilaginous. This fact has a most important bearing upon the question of girls' clothing. Any considerable constriction around the ribs will result in a change of their shape, more or less marked according to the degree of pressure and the age at which it occurs. It also interferes with the development of the lungs and makes them more liable to tuberculosis. Tight lacing at this period is productive of much more harm than it is later, for the whole shape of the thorax may be altered by it. There can be no doubt that the digestive organs un- dergo important changes during girlhood, but the nature of these changes is not clearly understood and it would not be profitable to discuss them here. In- digestion is not so common in youth as it is in later life, and when it does occur is usually of temporary duration, provoked by imprudence of diet. But this PHYSICAL DISTURBANCES II period of life is characterized by striking peculiarities of the appetite, which in youth is normally a hearty one to meet the demands made by rapid growth; sometimes, especially with girls who live in cities, it is entirely lost, sometimes it is capricious, and occasion- ally actually perverted. This disturbance of appetite arises probably from radical changes in the nutrition of the body which we do not yet understand. Foods formerly disliked now become attractive, and on the other hand, those hitherto preferred are now distaste- ful. A craving for sweets is quite common, and still more one for acids; indeed the latter taste is almost always present at some period of girlhood. These cravings are the expression of some need associated with new processes of growth and necessities of nutri- tion. One fancy in particular, which is not by any means uncommon, we know can be explained by the necessity for lime salts in the growth of the skeleton. Bone formation is effected by the deposit of lime salts in the pre-formed cartilage, the material for it being supplied in the food. The formation of bone tissue goes on all through childhood, but with the sudden increase of growth in the bones in early youth the demand for material becomes suddenly much larger, and with it arises a craving for articles that contain lime salts, even though they are quite unsuited for food. This explains the fancy displayed by some young girls for eating chalk, slate pencils, plaster 12 GIRL AND WOMAN from the walls, and similar articles. An excellent description of this particular fancy, as well as some of the other physiological features of girlhood, has been given us by Oliver Wendell Holmes in one of his humorous poems : — " Now six young damsels slight and frail Next claimed this kind young doctor's cares. They all were getting thin and pale And short of breath on mounting stairs; They all made rhymes about sighs and skies And loathed their puddings and buttered rolls, And dieted — much to their friends' surprise — On pickles and pencils and chalk and coals." In course of time, when the changes taking place in the digestive organs during girlhood are better understood than they are to-day, we shall probably understand other caprices and cravings. The more serious forms of actually perverted appetite, in which there is a craving for dirt and other absolutely re- pulsive articles, are associated with some mental dis- turbance. In the future they also will probably be understood, but at present they are among the curios- ities of medicine. The second set of teeth have appeared before the beginning of the period we are now considering, but the last four molars, commonly known as wisdom teeth, make their appearance between fourteen and twenty-five. The size of the jaw in human beings PHYSICAL DISTURBANCES 13 has become so reduced under the use of cooked food and other influences of civilization that not infre- quently there is difficulty in finding room for these belated intruders, and when this happens they may give trouble and require attention from a dentist. Certain changes in the skin are peculiar to girlhood. The sensibility of it is sometimes greatly increased and at others diminished. When it is lessened the usual perception of pain may be almost lost, and this is the reason why girls will occasionally find amuse- ment in pricking themselves with pins, in a manner startling to older persons. The tactile corpuscles at the ends of the fingers, concerned with the sense of touch, become more highly developed at this time and the perceptions connected with them more acute. This increase of tactile perception is one of the reasons why manual training is so much more effective at this age. Eruptions, especially on the face, are very common in girlhood; so much so, in fact, that hardly any girl wholly escapes them. Their cause is not altogether clear, but probably they are associated to some extent with the changes in the circulation, and there is no doubt they are often connected with constitutional disturbances such as anemia or indigestion. It may be because they are so extremely common that such eruptions do not always receive the attention they deserve. There is a popular impression that they ought not to be interfered with and will right them- 14 GIRL AND WOMAN selves if only they are let alone, which is so far true that when they are slight or intermittent, they may be safely left to time. But any eruption that is even moderately severe, or that persists for months at a time, should have attention from a skin specialist, if possible; or at any rate from a physician. It is true that they almost always disappear eventually without treatment, but the interval before their spontaneous' disappearance may extend over years and in the mean- time the surface of the skin is more or less perma- nently injured and. the clearness of the complexion lost, to say nothing of the mortification and distress of mind endured by a sensitive girl. The fact that skin troubles are often caused by some constitutional difficulty is quite generally recognized, but unfortu- nately it is associated with another popular error, namely, that the cure of the local disorder will be followed by some grave crisis in the constitutional dif- ficulty. A common saying in regard to them is that, " Whatever it is, is better out than in." This idea is altogether without foundation. If there is a consti- tutional cause, the skin trouble will not get well, of course, until it is cured, but the necessity for finding out and removing the underlying difficulty is only an additional reason for professional advice. There are two excellent and perfectly harmless rem- edies for these eruptions at everyone's command. The first of these is regulation of the bowels. Almost all PHYSICAL DISTURBANCES 15 skin troubles are associated with constipation and a marked improvement nearly always follows its re- lief. The other remedy is to wash the face every night with water as hot as can be borne and a good soap, such, for instance, as white castile. Most skin troubles and acne, in particular, which is by far the most common of them, are caused by a torpid condi- tion of the glands in the skin with deficiency of secre- tion, and nothing does so much to relieve this diffi- culty as stimulation with heat, moisture, and a good soap. The organs of special sense undergo certain 'trans- formations at the same time as the more general changes. The voice with girls, does not undergo the marked variations that are present with boys, because a girl's larynx does not grow so large, hence the period of change in her is not accompanied by the grotesque sounds which characterize it in him. But about the age of fifteen the girl's childish voice disappears, yield- ing quietly and without any distinct epoch of transi- tion, to the woman's voice with its higher pitch and undefinable quality of sex. The sense of smell passes through distinct altera- tions of sensibility. Children are extremely insensi- tive to odor of any kind; a perfume must be very heavy or very penetrating to give them pleasure, while on the other hand, a bad smell must be very strong to disgust them. But with girlhood the perception of 16 GIRL AND WOMAN odors becomes much keener and the capacity for en- joyment or disgust is enlarged. Delicate perfumes are more agreeable than heavy ones, and peculiarities which formerly were not perceptible now give ex- quisite enjoyment. Evil odors, on the other hand, to which children are wholly indifferent, become over- poweringly disagreeable. This fact is sometimes amusingly illustrated by the change of opinion that takes place about this time in life as to the attraction of a visit to the monkey house at a Zoological Gar- den. The little girl, who delighted in it up to the age of fourteen or thereabout, will suddenly discover that the atmosphere is intolerable, a fact of which, up to this time, she was happily unconscious. This in- crease of perception is often considered a mere affec- tation and girls have to bear more or less ridicule in regard to it; but it is really one of the phases of normal development, and a girl has no more power over it than over the change in her voice, or her bones, or her muscles, though the self-conscious- ness of the period may sometimes foster it. Hearing undergoes little or no change as far as acuteness in the perception of sound is concerned, but as an avenue for enjoyment it develops greatly. In childhood there is usually a complete indifference to music, unless there is a distinct talent for it, and when no such talent exists the same indifference will return in maturity. But during the period of youth, PHYSICAL DISTURBANCES 17 even girls who are naturally unmusical find pleasure in melody, especially of their own creation. The de- sire to perform upon some kind of instrument, nota- bly the banjo, is almost universal. Probably, how- ever, the development of tactile perception and muscu- lar co-ordination has something to do with the nascent wish to be a performer. The use of the voice, from a musical standpoint also begins to be a source of pleasure at this epoch. Mere animal spirits, no doubt, have something to do with enjoyment of its use in melody, but a real de- velopment of aural perception is evident from the fact that the harsh discordant sounds which in child- hood were unnoticed or even agreeable, now become increasingly unpleasant. This is a point of difference between boys and girls, for boys continue to carry their love of uncouth sounds, such as college yells and war-whoops, into early manhood. The normal changes in vision at this period are not marked. The perception of color becomes more acute and more intense, and with it appears the love of exceedingly bright colors, which is so characteristic of youth. As time goes on, however, crudity of taste is outgrown, being sometimes succeeded by exquisite delicacy of color-feeling. The judgment of form also becomes more accurate, and the perception of beauty more developed. Abnormal changes in the eyesight occasioned by over-strain are sometimes quite marked, 18 GIRL AND WOMAN and much permanent harm to eyesight results from them, but it seems better to discuss these in connection with the eye. Disturbances of the nervous system may find ex- pression through either the mind or the body ; whereas disturbances of other organs or systems must express themselves through the body exclusively. The most common disturbance of the nervous system in girls is chorea, or what is known in old-fashioned parlance as St. Vitus' Dance. It is a disorder characterized by irregular and involuntary muscular movements, the cause of which is not yet clearly understood. All that we do know with certainty is that there is no actual disease of the nervous system. It is not surprising that the condition is regarded with great dread, for its peculiarities are most alarming as well as most morti- fying. There is really, however, no reason for appre- hension. With the exception of a few rare cases of a peculiar nature, the disease runs its course and re- covery takes place spontaneously. It usually makes its appearance in bright intelligent girls rather than stupid ones, and it is especially frequent in ambitious girls who are stimulated beyond their physical en- durance at school. One physician of experience has even gone so far as to speak of it as " school-made." The first symptoms of it are usually nothing more than restlessness and inability to sit still in one posi- tion, sometimes accompanied by disturbed sleep and PHYSICAL DISTURBANCES 19 causeless attacks of crying. The characteristic jerk- ing movements begin a little later. Often they are first noticed at table and a girl is supposed to be awkward or careless because she drops articles that are handed to her. In severe cases all the muscles of the body are affected and movements of every kind become jerking and eccentric. A doctor ought al- ways, of course, to be consulted in regard to chorea, for there are various means by which he can relieve and shorten it; but the disease, as I said before, is one that almost always gets well spontaneously. Another nervous affection which sometimes makes its first appearance in youth, though not so often as in childhood, is stammering. It is caused by a want of co-ordination between the muscles of speech and the brain impulse which stimulates them to action. While not serious in itself, it ought to have extreme care, because if not cured immediately, it may easily become permanent. That particular form of headache, accompanied by nausea and vomiting, which is commonly known as sick headache and technically as migraine, almost al- ways makes its appearance in youth. It is occasion- ally, though rarely, seen in childhood, but hardly ever begins after twenty. The disorder is undoubtedly a nerve storm of some kind, though we do not know the explanation of it. It is often associated with some constitutional disease, especially gout, and it is quite a 20 GIRL AND WOMAN different thing from the headache which accompanies an attack of acute indigestion with gastric symptoms. Genuine migraine is almost always inherited, either directly or collaterally. The pain is usually on but one side of the head and is accompanied by various dis- turbances of the nervous system, such as temporary loss of sight, giddiness, a sense of blinding light, and other symptoms, some of which are present in one case and some in another. Neurasthenia, or nervous prostration, is not com- mon in girlhood, though the foundations of it are often laid at that time by over-pressure either in education or in social life. The form peculiar to girlhood, when it does occur at that time, is character- ized by excessive fatigue following exertion quite in- sufficient to account for it. Whenever nervous pros- tration does occur in a young girl it must be taken as a sign that her nervous system is not fully up to par and requires more care than under ordinary circumstances. Her life in future must be so arranged as to give her every facility for taking the necessary precautions. Excitement or exertion that in a normal girl might do no harm, are too great a risk in the case of one who has shown signs of neurasthenia, even though she has entirely recovered. A liberal allowance of sleep also is a necessity and it must not be curtailed for any reason whatever. The same thing is true in regard to other nervous ailments, as in the case of PHYSICAL DISTURBANCES 21 girls who suffer from neuritis or from prolonged neu^ ralgia. A word must be said in regard to that worst of all nervous disorders, epilepsy, though fortunately it is not common. When it does exist, it most commonly makes its appearance between thirteen and eighteen. It differs from the other conditions we have discussed, because in it there are areas of actual disease in the brain, though it seems to be doubtful how far these are the result of the epilepsy or its cause. It is strong- ly hereditary, or rather the nervous imperfection that gives rise to it, is hereditary, but in the immediate ancestors the defect may have shown itself as insanity, intemperance, or some other abnormality of the ner- vous system. Whenever signs of it appear, of even the mildest description, the case should be put under the care of a specialist at once. How far the condi- tion is susceptible of cure is not yet determined, but we do know that we have more reason to be hopeful in regard to recovery than we formerly had, and also that the condition can be kept from growing worse by timely treatment. It is only necessary to have a clear understanding of the physical side of girlhood to realize that it is a period calling for incessant care and attention. Only now, however, has this understanding been reached; the necessities of girls at this age up to the present time, being too little regarded. Mothers, who 22 GIRL AND WOMAN watch over every minute of a young child's existence with jealous care, often become indifferent when she reaches girlhood. It is not surprising that such marked bodily changes should sometimes be accom- panied by disturbances of health; there is more reason for surprise that these disturbances are not more fre- quent and more serious. Many of them disappear spontaneously and others yield readily to medical treatment. But the advice of any intelligent sensible physician will take the shape largely of directions as to the healthful conduct of life rather than the pre- scription of medicines, and just as a typhoid patient owes his life mainly to the nurse upon whom the hourly care of his case depends, so does a young girl owe her healthy womanhood to nothing so much as the mother whose intelligent care and sympathy con- trol her daily life during her passage from child to woman. I give here, in conclusion, the account of a case in my own experience which illustrates what can be done by sanity and patience, even when the disturbance of health is more serious than is often the case. A girl who had had a normal healthy childhood, began, when she was about thirteen, to display great languor and disinclination to exertion whether in study or play. At first this was set down to indolence, but her mother shortly became convinced that some change incident to her age was the underlying cause, though nothing PHYSICAL DISTURBANCES 23 was apparent beyond a certain degree of anemia. In the course of a few months she developed the symp- toms characteristic of heart disturbance, namely, ra- pidity of action, palpitation, and shortness of breath, soon followed by an attack of chorea so severe that she could not walk and had to be carried each day into the open air. She was under the care of a good physician, but she lived at such a distance from him that he could see her only at long intervals, and her mother carried out his instructions, which were mainly directed to rest, sleep, fresh air and nourishment. Under this regimen the child improved slowly, until at the end of eighteen months from the first attack she was able to go back to school, after which the symp- toms gradually disappeared altogether, and she is now a vigorous, healthy young woman, who spent four years in college without any strain upon her health whatever. Yet this was a case of unusual severity with a wider range of disturbance than is often seen. CHAPTER II MENTAL DISTURBANCES OF GIRLHOOD Development of brain — Self consciousness — Egotism — Altruism — Self-confidence — Timidity — Interest in per- sonal appearance — Love of society — Love of solitude — ■ Reticence — Girlish friendships — Early love affairs — Attachments to older women — Hero-worship — Religious excitement — Spiritual awakening — Religious doubt — Conversion — Religious activity — Pledges — Morbid re- ligious feeling — Nostalgia — Hysteria — Insanity. The brain increases very little in size after the eighth year, and the brain cells are almost as large and as numerous by that time as they ever will be. But the function of the brain, that is to say the capa- city for thought, depends, not upon the size or number of the cells, but upon the number and arrangement of certain long fibers, called nerve processes, which ex- tend from one cell to another and establish paths of connection by which ideas travel from one part of the brain to another. The extent and variety of these connections are what determine brain capacity, for upon them depends the number of ideas and their association with one another, as well as rapidity of thought. During childhood the number of nerve proc- 24 MENTAL DISTURBANCES 25 esses is small and the paths for ideas few and simple, but when the growth of the brain in respect to size is complete, they begin to develop in every direction. The growth of mental power, however, depends not only upon the development and association of nerve cells and nerve processes but upon their education by which new regions of thought are opened and paths of least resistance cultivated and it is during youth that such training is most easily and effectually carried on. This is the time when education does its best work by strengthening structures already formed and by rousing dormant elements to fu- ture growth and organization. If the nerve ele- ments of the brain are by nature deficient, cultivation cannot do much for them but, on the other hand, no matter how rich in possibilities they may be, much latent ability will be lost in the absence of the training and stimulation bestowed by formal educa- tion. The process of cell development begins at about the same time as the period of physical growth. Up to that time the higher mental processes, such as intellect, imagination/ and originality of thought exist only in a latent state, but with the establishment of brain con- nections in every direction they come rapidly into ac- tivity. The development of the different mental faculties, however, is extremely unequal, emotion and imagination advancing more quickly than intellect and 26 GIRL AND WOMAN reason, so that during the early years of mental growth there is great mental instability and excess of the emotions. Emotional life is, indeed, the most prominent feature of early girlhood, a fact which must never be forgotten in studying the mental pecu- liarities of the period, for, in most cases, it contains their explanation. These mental disturbances begin at about the same time as the physical ones, described in the previous chapter, but they continue longer, and, speaking generally, it may be said that while the bodily changes occupy the years between twelve and sixteen, the mental ones cover the period between twelve and twenty-one, being most intense from fifteen to eighteen. The most characteristic feature in the mental de- velopment of girlhood is self -consciousness, or, to put it more exactly, the consciousness of self; which is the basis of all the mental changes of the period. During childhood there is little or no consciousness of the in- dividual. The little girl is cared for by others, her judgments and opinions are taken from others, and she not only acquiesces in this state of things, but has no conception of any other. The most characteristic feature of childhood is imitation. But with the dawn of mental development and the birth of new ideas, begins the growth of individual life and the capacity to reason, judge, and analyze. Life has hitherto been limited by the girl's own surroundings, MENTAL DISTURBANCES 27 which she has accepted without question; now she be- gins to ask herself the meaning of things around her, and then, going a step farther, she looks out into the world and ponders over her own relation to it, realiz- ing that a place in it is her birthright and speculating upon its possibilities. While, all the time, underneath this mental awakening lies the mysterious influence of sex just coming into existence, unrecognized by her but nevertheless entering into all her thoughts and emotions. It is not strange, surely, that this phase of her life should be one of storm and stress during which she is subject to excess of emotion. The fundamental self-consciousness of the period expresses itself in a variety of ways, sometimes in ap- parent contradiction to each other. Egotism is pres- ent, whichever way we turn, for nothing in the world is so interesting to a girl at this time in life as herself; yet this is the moment when the altruistic instinct, in other words the feeling for others, first makes itself felt. It seems as though the perception of an indi- vidual place in the world belonging to herself brought with it the perception of the place occupied by others, so that the selfish and the altruistic instinct exist side by side in a manner which is never possible again, for by the time maturity is reached one or the other will have gained ascendancy and will maintain the domin- ant note throughout the future life. Another seem- ing contradiction is the presence of self-confidence and 28 GIRL AND WOMAN self-distrust in the same person, one mood succeeding the other with instant transition. But this is only the natural outcome of lack of self-knowledge. A girl at this age does not know herself and self-confidence without self -understanding is easily upset. . The effect of the self -consciousness on manner is largely a question of temperament. Girls who are naturally timid are awkward, shy and sensitive to such a degree that they sometimes seem paralyzed in the presence of strangers, while others, by nature self- possessed, are confident even to the point of boldness. But shyness does not always show itself in difficulty of speech. On the contrary, extreme shyness may be at the bottom of loud, rapid talking on all-chosen sub- jects, while at other times, speech, although fluent, is so forced and nervous as to be almost incoherent. Both the talkative and the tongue-tied forms of shy- ness proceed from the same thing, namely, the percep- tion in the girl's mind that she does not know exactly what she ought to say or do, and therefore she either abandons the attempt and takes refuge in silence or makes an agonized effort resulting in incoherent chat- ter. Boldness, or in its extreme form, impudence, is an indication of confidence in the ability to do and say the right thing and a determination to let the capacity be seen. It is not so common as shyness, and when it is present, there has generally been some defect in MENTAL DISTURBANCES 29 early training. Not that defective training neces- sarily results in boldness of manner, but when ex- treme self-assurance is a natural trait, an error in early education will bring it to flagrant proportions in early youth. Intense interest in personal appearance is a very common manifestation of self-consciousness, and often develops suddenly when there has been no sign of it before. Up to this time clothes have been taken as a matter of course, very much as if they were fur or feathers ; now they become one of the vital interests in life. Trifling questions of fashion, color or fit, are a real source of unhappiness; the exaggerated impor- tance attached to them gives the impression that noth- ing else in the world can be of any consequence what- ever, and that the girls expect to stand or fall in life by their clothes. The form of fastidiousness takes dif- ferent directions according to temperament. Some girls wish to have their dress and appointments as striking as possible, in order to attract attention; oth- ers manifest an almost morbid desire that everything about them shall be so exactly what it should be that it will attract no notice whatever, whether approval or censure. This difference is really, at bottom, one of character, arising from a natural confidence or a natural timidity. Increased attention to personal neatness is another feature of this particular phase. Often it is in 30 GIRL AND WOMAN marked contrast to the previous condition of affairs. Many girls up to thirteen or fourteen, are as careless and indifferent to their toilet as their brothers, and will not give due attention to its details without super- vision. Very few girls, indeed, can be trusted with the care of their own toilet before they are fifteen. Then, of a sudden, there is a transformation, personal nicety and adornment becoming matters of absorbing interest and importance. Dainty and fanciful toilet appointments, such as ivory or silver-backed brushes or elaborate manicure sets, become objects of pride or envy, and the beautifying of bedrooms occupies much time and attention. All these new interests, whether of dress, of person, or of appointments, are signs of the new consciousness of independent personality, and also of the perception that its attraction to the other sex is beginning to be appreciated. Miss Austen has touched upon this phase of girlhood with delightful humor in the description of her heroine, Catherine Morland : " At ten years old . . . she was noisy and wild, hated confinement and cleanliness, and loved nothing in the world so well as rolling down the green slope at the back of the house. At fifteen appear- ances were mending; she began to curl her hair and long for balls ; her complexion improved, her features softened, her eyes gained more animation, and her figure more consequence. Her love of dirt gave way MENTAL DISTURBANCES 31 to an inclination for finery, and she grew clean as she grew smart." The social sense almost always undergoes some change. Some girls have a craving for society; oth- ers for solitude. The little girl who dreaded the companionship of other children and could not bear to go away from home will suddenly develop an inor- dinate taste for social intercourse. She will go any- where and everywhere she is invited, and makes plans for incessant company at home. This development of the social sense and of the gregarious instinct shows itself in the fancy for societies and clubs, so common among school girls, while in boys it appears in a dis- position to " go in gangs." At the other extreme of this phase is the taste for solitude. A girl who was formerly content and happy in the society of other children, now seizes every op- portunity to read or walk alone, or slip away by her- self and sit lost in her own thoughts. The satisfac- tion in being alone, however, does not always proceed from aversion to companionship in itself. The med- ley of new thoughts, impressions and emotions crowded into a girl's mind at this time sometimes be- comes so oppressive that she longs for isolation until she has established some sort of relation between her- self, and her new mental processes. It is rather the custom to ascribe this kind of conduct to secretiveness, which I cannot help thinking shows a misunderstand- 32 GIRL AND WOMAN ing of its nature. Secretiveness implies a deliberate in- tention to conceal, but the reticence of this period is usually entirely without conscious intention. The girl does not scheme to conceal what is passing in her mind, but her thoughts at this time are as full of mystery to herself as to others, and if she does not speak of them openly it is because she does not - un- derstand herself and has no means of expression at her command. It is at this point in development that parents often make a grave mistake. Not infrequently a nlother, to whom all her daughter's plans, hopes, and aspira- tions have always been known, suddenly finds herself shut out, not by intention on the girl's part, but by force of changes within, which she lacks power to express. It is not surprising that a mother should ex- perience a moment's hurt feeling when she first real- izes that the child whose every thought has hitherto been known to her is now more or less a mystery, but good sense ought to convince her that the new order of things is only what is natural and right. This is the time when a girl, to use a coloquial phrase, is doing her own thinking, and it is for her own good that she should do it spontaneously, without being forced to attempt an analysis of her mental processes for the information of another, no matter how near and dear the other may be. At this stage of mental growth the power of insight is far in advance of the power MENTAL DISTURBANCES 33 of expression. A girl feels and perceives much more than she can put into words or even into connected thought. By-and-by when the reasoning powers are more developed and the mental processes are in equili- brium, all her half-formulated ideas, aspirations, and wonderings will take form and find expression; but until this time comes it is a great mistake to intrude upon her reserve. Properly treated, the period is only a temporary one. If a girl finds that her confi- dence is not forced and is sensible of that silent com- prehension and sympathy which demands no recogni- tion, she will give her confidence again fully and freely as she did before; but interference with the process of self-evolution just at this period will certainly impair confidence for the future. Turning to emotional changes of a deeper charac- ter, we find that those of affection are most common. With little children the family circle represents the entire world and the affections developed within it are founded upon dependence and trust, but with the ad- vent of youth, other types of affection make their appearance, all of which contain more or less of the altruistic instinct, combined in each instance with some other sentiment or sentiments. The simplest of the various forms of youthful affection is that of friend- ship between two girls of about the same age, at- tachments which are often of great intensity for the moment. 34 GIRL AND WOMAN Sometimes parents are disposed to disapprove of such friendships on the ground that they are too en- grossing and that other claims or duties are neglected. No doubt this danger does exist. Youth; as someone has said, is the age of folly, and occasionally a girl will carry such an attachment to absurd lengths, neglecting her acquaintance, her studies, even her family, for this one intimacy, going out only in the beloved one's company, entering into no pleasures or interests which cannot be shared with her, and dress- ing either exactly like her, or in accordance with her taste. This kind of thing, if kept up for any length of time, is, of course, detrimental to a rounded de- velopment, but as a matter of fact the passion burns itself out, like other intense emotions, in a few months, and either becomes an extinct volcano or else settles down into a common-place, every-day regard. If it is kept within moderate bounds while it lasts it is not a bad thing, provided it satisfies two requirements, namely, that both parties shall be innocent-minded, conscientious girls and that duties or ties which have a moral claim shall not be neglected for it. Under undue repression the emotional disturbance at the bot- tom of it will certainly find some other means of ex- pression and a girlish friendship is certainly more desirable than a premature love affair. Not that early love affairs between boy and girl, under natural and blameless conditions, are by any MENTAL DISTURBANCES 35 means so objectionable as they are sometimes thought to be. They have been looked upon askance because, until recently, the opinion of the French psychologist, Ribot, that sex instinct is the only influence concerned in them has been accepted without question. But later psychologists incline to the belief that sex in- stinct is only one of several factors involved, and not by any means the most powerful. The altruistic in- stinct is certainly an element in all the other affections that develop during youth, and there seems every rea- son to believe it is so here. In fact, the opinion now coming to be accepted in regard to early love affairs is that they are composed of the same elements as friend- ships between girls, namely the altruistic and gregar- ious instincts, with the addition of sex instinct in small proportion. External influence, such as imita- tion and suggestion, has a part in their causation, the latter being sometimes a most harmful agent. But quite as powerful as either of these and in many in- stances much more so, is the effect produced by read- ing romantic love stories, in which the element of passion is given undue prominence, such for example as the serial tales in the cheap weekly papers. But although these early attachments are far more childlike and platonic in their nature than has been supposed, there is no doubt they are undesirable for young girls, even though the harm done by them is mainly indirect. Such an attachment may and some- 36 GIRL AND WOMAN times does have a certain good effect by stimulating a girl to pay attention to her manners and deportment, but these advantages are outbalanced by their evils, such as neglect of study, possible jealousy and deceit, and above all, by the unwholesome excitement which in the common phrase, turns a girl's head. Yet it is by no means judicious to treat such affairs with sum- mary repression, for it is only too likely to induce de- ceit. In fact, repression is never a wise means of treatment for emotional excesses. The excitement of girlhood must find some means of expression, and if the chosen outlet is thwarted, it will either continue its course by underhand means, or if the girl, from conscientious motives lends herself to repression, her health of body or mind will almost surely suffer. The period, as I said before, is one of storm and stress, and the girl who passes through the years be- tween twelve and twenty without emotional disturb- ance of some kind is exceptional. Probably the best means of dealing with youthful attachments is to give them as much judicious neglect as is consistent with keeping them under quiet ob- servation. Separation has a most excellent effect, be- cause the growth of the mental powers at this age is so rapid that even a brief interval of time will create changes so marked as to make both parties feel quite differently when they meet again. Early love affairs, however, are one of the things in which an ounce of MENTAL DISTURBANCES 37 prevention is worth a pound of cure. There can be no doubt, as I have said before, that they are fostered by unsuitable suggestions during the later years of childhood, which do an immense amount of harm that is not sufficiently appreciated, for even when it has no immediate bad effect, it prepares the way for later influences of a harmful nature. Many people^ who think twice before suggesting a love affair to a young girl, think it is pretty to do so in her babyhood, and amusing to watch the effect of allusions to little sweethearts of six and seven years old. But the child- ish mind which is accustomed to such allusions has had its soil well prepared for the same influences in later years, and enters into a girlish attachment far more lightly and easily than would be the case if childhood had been free from suggestion. The results of investigation into early love affairs are as yet too small to warrant positive conclusions, but as far as they go, it seems that their tendency is toward a natural death, and therefore there are rarely any permanent bad results, though there is always rea- son for watchfulness and caution, especially at the close of an attachment, for the excitement occasioned by it often results in a craving for renewal. Out of one hundred cases investigated in one High School, only two ended in marriage and one of these applied for a divorce, a result which our knowledge of the mental conditions belonging to the age would lead us 38 GIRL AND WOMAN to expect, since the fact that the emotions are so much more developed than the reason makes it highly un- likely that any choice made at this age could be based on any real appreciation of character, or stand the test of time. Another type of affection, confined usually to the years between twelve and seventeen, is the passion- ate and romantic friendship between a young girl and a woman some years older than herself. These at- tachments are often contemptuously treated by parents and guardians, on the ground that they are unnatural and therefore likely to be harmful to the younger party, an unfortunate idea, for they are often most exquisite in their nature and beneficial in their effects. The nature of their influence depends upon the charac- ter of the older woman. If it is a fine one, her in- fluence, which for the time being is unbounded, will be one of the best things life can bestow. The self- consciousness of the age and the growth of the in- dividual life often make a girl impatient of home influences, even when her affection for them is un- changed. In the new phase of existence upon which she is now entering, all her own ideas and impressions are new to her and even her own personality, now realized for the first time, strikes her with surprise. It is not strange that a gulf seems fixed between her and the formulas which governed her childhood, nor that in this period of transition, when everything on MENTAL DISTURBANCES 39 her mental horizon is changing around her like a kaleidoscope, she should feel that her necessities are better understood by an outsider, who from her point of view, is not hampered by preconceived opin- ions. For one peculiarity of the emotional period is that every girl believes her experience to be unique while it lasts. Careful study of many cases shows that they are all alike as far as the main char- acteristics are concerned, but it is only in later life that this fact can be perceived by the chief figure. It is quite natural, therefore, that a girl should believe her- self best understood by a stranger, and wise parents will accept the situation as one of the necessities of growth. Everything depends, however, upon the character of the older party in the friendship. If she does not grasp the* situation and use her influence with tact and discretion,- the. younger may lose her self-reliance and individuality, even though the influence is other- wise good and sincere. And" if the older woman is really undeserving of confidence, much graver injury to character will result. The influence of a really bad woman, upon a young and plastic mind, at a time when impressions are most easily received, may ruin a whole life; and even, when the defects are confined to weak- ness, selfishness, or vulgarity, a great deal of harm is possible. A girl may' regain her freedom of judg- ment and, after a time, see clearly how mistaken she 40 GIRL AND WOMAN was in her youthful confidence and affection, but even if her principles escape unharmed, a certain amount of injury to taste is almost unavoidable. If parents have reason to think the influence undesirable, but not actually objectionable, the friendship had better be dissolved as gently and indirectly as possible. For it must be remembered that the girl's affection is sin- cere and intense, and that, for the moment, she is not capable of understanding the objections, though she will do so eventually. Hence direct and determined opposition will not only cause her great suffering, but for the time being, impair her confidence in her par- ents. Yet if the parents are assured that the older woman is really one who has lost general respect, the friendship had better be broken without loss of time, at any cost of trouble or heart-burning. Closely akin to this type of affection is that known as hero-worship, which is really devotion to the ideal. One of the writers on adolescent affection says with great clearness of observation, that " in certain phases of adolescent emotion, affection seems to exist in a diffused state and attach itself to some real or im- aginary individual, whom the alembics of youthful fancy transforms into the highest ideal." It is the peculiarity of this form of affection that an imaginary object answers the purpose as well as a real one; in- deed, it seems with girls, at any rate, as if an im- aginary one were preferred. All that is needed is MENTAL DISTURBANCES 41 some heroic action or some inspiring quality of heart or head to serve as a focus for the diffused emotion. An inquiry into the nature of the ideals in a num- ber of these cases has shown them to be rarely un- worthy ; indeed, it throws a pleasant light upon youth- ful human nature, to find that the objects of hero- worship are almost always noble and refined. This being the case, the only harm that can possibly arise from an attack of it, is absorption to such a degree that legitimate claims and duties are neglected, while, on the other side the stimulus given to character in process of formation by devotion to a high ideal, real or imaginary, is a great gain. Next to affection, the commonest form of emotional disturbance in youth, and also the most powerful, is religious excitement. Inquiry into this phase shows that toward the end of actual childhood, that is to say, between eight and twelve, there is a period when the mind becomes conscious that henceforward the con- duct of life must be ruled from within and not from without, and with this perception comes a certain amount of mental disturbance which may be either religious or moral. This phase lasts but a short time and is over by the time the period of rapid physical growth begins. It belongs, therefore, entirely to child- hood and would hardly call for mention here, were it not the prelude to more developed excitement a few years later. 42 GIRL AND WOMAN The latter disturbance usually appears in girls be- tween thirteen and sixteen, the most common age be- ing about fifteen. The latent spiritual feeling which it represents has been developing for a long time un- known to the subject of it, until it is suddenly roused into activity by some external influence, such as a sermon, a conversation with a friend or a stranger, or, in some cases, a passage in a book. Whatever form it may assume, it is the spark falling upon a train prepared for it, for the spiritual influence which has been stirring within needs only the right stimulus to become overwhelming, a fact which explains why an impulse that often seems quite inadequate, can arouse feelings of such intensity. In other instances the awakening takes place quietly and spontaneously without any excitement whatever, and the subject is unable to say why the consciousness of religious emo- tion should suddenly appear, though the fact that it has done so is plain, and the circumstances attending it make such an impression that they are never for- gotten. Whatever the outward form of expression may be, there is hardly any girl who passes through the transi- tion between childhood and womanhood without an awakening to religious life of some description. The reason for this is probably that all children are nat- urally religious and most of them are religiously taught ; the idea of religion, therefore, is firmly im- MENTAL DISTURBANCES 43 planted in their minds and accepted as a matter of course. But with the growth of emotion and of in- dependent thought, it suddenly presents itself as a principle which must be thought out in company with other new perceptions and ideas. It has been rather the custom to associate the religious sensibility of youth with the excitement attending the establishment of the function of sex; but those who have studied the subject most recently incline to the belief that, with girls at any rate, the connection between the two states is nothing more than must exist between any two emotional conditions at a period when there is great mental unstability. The spiritual awakening having once taken place, it is followed by a period of disturbance which may as- sume one of several forms. One of these, which some persons consider the most frequent, is that of religious doubt, the objects of skepticism being usually dogmas or creeds, as for example, the inspiration of the Bible, the existence of God, the divinity of Christ, the doc- trines of immortality and atonement. Sometimes the disbelief begins with some one of God's attributes, as His mercy, justice or love, and then having started with one in particular, advances gradually from one attribute to another until it is complete. Some persons have assumed that the fact of doubt appearing so frequently with the first stages of in- dependent thought is evidence that the doubting attri- 44 GIRL AND WOMAN bute in religion is a natural one, but this is a great mistake. It is an even greater error to consider such doubts a manifestation of atheism and treat the sub- ject of them as a willful unbeliever. The explanation of the phase is to be found, as in most disturbances of the period, in the birth of self-consciousness and the growth of independent thought, which arouse a crav- ing for absolute truth, the girl not realizing that much of what she would like to know can only be under- stood through the experience of life, or, it may be, can never be known at all. The capacity to accept uncertainty on important abstract questions comes only with maturity; youth is confident of its own ability to understand all mysteries and all knowledge, and cannot believe that an answer to earnest inquiry is ever impossible. As soon as the mind awakens to religious inquiry, the beliefs hitherto accepted without question, sud- denly present themselves for fresh and independent judgment. They are tried in the balance of indi- vidual opinion, but before any decision can be reached, there is almost always a period of suspense and fer- ment. As the years go on and the intellect develops sufficiently to balance the emotions, judgment is formed, and in the majority of cases the girl returns to her former articles of belief, generally in a recon- structed form. There are always a few cases, how- ever, which decide for positive unbelief in one form or MENTAL DISTURBANCES 45 another, but the unbelief often disappears in its turn, with the experience of years. When the excitement following spiritual awaken- ing is not accompanied by doubt, it usually takes the form of a sense of imperfection, accompanied by rest- lessness, anxiety, depression, and doubt of God's for- giveness or the genuine character of its own re- pentance. This is the condition known as the " con- viction of sin " in which the consciousness of imper- fection is always the central feature, while the feelings accompanying it vary according to individual tem- perament and education. The state of religious distress continues for a longer or shorter period and then yields to a sense of forgive- ness and peace, brought about by both conscious and unconscious causes. This is the state of mind known as conversion. It is sometimes accompanied by great excitement, which under special conditions and mis- management may become hysterical ; in other instances the chief feature of it is a yielding up of the will fol- lowed by joy and peace. The cases in which the spir- itual awakening is spontaneous and peaceful, without any period of ferment or distress, do not experience any process of active conversion. Whatever form the spiritual disturbance assumes, it is almost always followed by great religious activity of one kind or another. Some girls are possessed with a consuming desire for attendance upon religious 46 GIRL AND WOMAN services, or for hearing sermons by emotional preach- ers ; others are consumed with a burning zeal for do- ing good to others or testifying to their belief in and out of season, while still another class spends hours in private devotion, sometimes to the neglect of other duties. Whatever form the activity may take, it is hardly ever in moderation. It is often a nice question for parents who are watching a daughter pass through this period of re- ligious ferment, how far the emotion of the moment ought to be encouraged to express itself formally in the shape of an open profession or a pledge. The wish for such action is the natural outcome of intense excitement seeking definite expression and most girls are ardently desirous of some such step, whether it take the form of the rite of confirmation, of adult bap- tism, or a formal " joining the church." The objec- tion to such a step lies, of course, in the possibility that when the excitement of the transition from girl to woman is over and the calmness of maturity is reached, it may be the subject of regret, since it holds her committed to opinions which may not then be ap- proved by her judgment. On the other hand it may be argued that it is wise to secure a definite committal at this time, just because it may be impossible later on. The question must, of course, be decided for itself in every case ; but one thing is quite certain, namely, that those in authority are never justified in taking ad- MENTAL DISTURBANCES 47 vantage of the excisable and unstable condition of the mind at this period to exert pressure toward a pledge of any kind, nor in stimulating religious feeling be- yond its spontaneous limit. In the first place the sus- ceptible condition of the nervous system at this time may make forced pressure actually dangerous, and the result may be hysteria or neurasthenia. This is the dangerous side of revivals. But equally injurious and much more common, is the forcing an artifi- cial state of mind, in which the girl imagines that she feels more than is really the case. Then, when her reason develops and she realizes where she actually stands, she will be antagonized toward religious be- lief altogether. Many a young mind has been warped by this kind of treatment. It sometimes happens that religious disturbance, whether it is doubt, depression, or anxiety, passes be- yond any reasonable boundaries. In such a case a girl cannot sleep, she loses her appetite, and lives under a dark cloud of gloom and self-reproach. The belief in having committed the unpardonable sin, which in old times caused such fearful misery, was one man- ifestation of this condition, that fortunately is now rarely seen. Such cases are almost always due to physical weakness; indeed it is hardly too much to say that they are always so, whether the failure is one of general health or some special disturbance of the nervous system. 48 GIRL AND WOMAN A perfect description of such a case is that of John Bunyan's religious experiences, as given by himself in " Grace Abounding " ; the interpretation of his feel- ings on a physical basis having been supplied, in re- cent years, by a well-known psychologist. 1 Religious consolation and advice in such a case is worse than useless unless it is accompanied by physical care, but it is not always well to exclude discussion on religious subjects altogether, for the patient then begins to think that those around her are out of sym- pathy with her condition and state of mind, and nothing is so important as that her confidence should be preserved. Usually these cases are perfectly un- mistakable, but if there is any uncertainty whether the doubt or depression passes over the normal line, the point can be settled by observing the effect of an assurance that no anxiety or care need be felt, given by someone in whom full confidence is reposed. If the mind is normal, there will be relief, at any rate for a time, but if the condition is a morbid one, the assurance will have no effect. One abnormal condition practically confined to girl- hood, is the extreme form of homesickness, profes- sionally known as nostalgia. The ordinary type of homesickness, which hardly any of us has escaped, is not important enough to come under this head. But occasionally, — usually when there is a defective nerv- 1 " The Case of John Bunyan," by Josiah Royce. MENTAL DISTURBANCES 49 011s system, — separation from home and accustomed surroundings is followed by a distress so acute and so profound that the victim cannot eat nor sleep, and unless it is relieved, the health fails altogether. One striking peculiarity of the condition, which is wanting in the common form of homesickness, is that the crav- ing seems to be for the home itself and for the accus- tomed environment, not for the persons belonging to it, and the companionship of relatives at a distance, or even the establishment of the conditions of home, gives no relief. An interesting case of nostalgia in its typical form is that of the two sisters, Charlotte and Emily Bronte, who in early girlhood left their lonely home in the moorlands to study in Brussels. Charlotte, by a great effort of will, managed to remain away for the ap- pointed time, though she was never well or even mod- erately happy ; but Emily, whose temperament was ex- tremely morbid, was so seriously ill that it was neces- sary to send her home again. Genuine cases of nostalgia are rare, but they do sometimes occur, especially in boarding schools. Generally if a girl can be carried through a few weeks by means of her own will and the sympathy of those in charge of her, she will recover; but if the condi- tion persists and her general health begins to fail, there is nothing for it but to send her home. Hysteria is a nervous condition not peculiar to 50 GIRL AND WOMAN youth, but much more frequent then than at any other time. Exactly what the nature of it is we do not know. So far as appearances are concerned it is characterized by involuntary imitation of the symp- toms of some kind of disease, and this imitation, which would be impossible to any voluntary effort, even that of the cleverest mimic, is carried on perfectly through the subconscious mind. The term " hysteria " is some- times applied to cases of deliberate imposture, and also (from carelessness) to almost any condition which is not at once understood and seems to the by- standers unreasonable. But every year shows more plainly that the various manifestations of hysteria are due to some actual disease, though we do not as yet know what that disease is. The typical severe forms of hysteria, with convul- sive seizures, epileptic symptoms, and other violent manifestations, are extremely rare in this country. Among French women, whose nervous temperament is very unstable, they are not uncommon. The milder forms, such as we see here, usually appear as uncon- trollable fits of crying or laughing, or both together, a choking sensation in the throat, and great lack of self- control. In more severe cases there is imitation of symptoms which have been read of, or overheard in the conversation of others. It is strongly hereditary, about seventy per cent of cases being inherited, though, like other nervous affections, the nervous defect may MENTAL DISTURBANCES 51 have shown itself under another form in the previous generation. Perhaps the most important thing to be remembered in everyday life about hysteria is that we are not justi- fied in using the word in the same sense as imaginary, and dismissing an ailment as hysterical because we do not understand it and therefore do not more than half believe in it. Even if it is characterized by imitation of symptoms belonging to diseases which are known not to be present, the underlying hysterical condition is none the less present and real. The careless and unwarranted use of the word " hysterical " is respon- sible for a great deal of cruelty. The most serious of all mental disturbances, of course, is insanity. In the very early years of girl- hood, it is rare, but a little later, that is to say, from eighteen to twenty-one, it is not uncommon, a fact which is not surprising when we remember the excita- bility of the brain at this period. The element of in- heritance enters into it strongly, in fact, insanity of youth is the most hereditary of all insanities, probably because youth is the time when all inherited qualities are especially liable to appear. Still another influence which favors the appearance of insanity in youth is the excitement attending the establishment of the sex- ual function. Insanity in girlhood may take either of the two great forms which characterize it in later life, namely, 52 GIRL AND WOMAN mania or melancholia. In both cases there are de- lusions of persecution, the imaginary persecutor being usually a friend or a relative. Sometimes the patient thinks she will be robbed or put into prison unjustly, or have her home burned. In other cases there is simple depression, without any definite idea. Illu- sions, that is to say, false impressions connected with the senses, such as imaginary odors, visions or sounds, are not so common as in older insanity. In other cases no definite idea exists and there is simple melancholia without assignable reason, or else bursts of excitement with hysterical symptoms. Sometimes a patient who has apparently been uncon- scious of all that was passing around her, will show afterwards that she was aware of every word, and that her condition must have been largely feigned. It would not be profitable to discuss the various manifestations of youthful insanity at length, but there are a few peculiarities of it which it may be desirable to mention. The idea of suicide is often present, but it rarely takes active expression as it does in later life. In fact, it seems as if the impulse to self-de- struction in youthful insanity is usually hysterical, be- ing intended to deceive the bystanders and excite their sympathies. It is not, as in older persons, a real desire to take life. There is more or less disturbance of menstruation, usually of the nature of suppression, and the mental condition is always worse at the time MENTAL DISTURBANCES 53 of the periods, or shortly before they appear. Friends and relatives are apt to think that the mental condi- tion is the result of the suppression, but the truth is that both are manifestations of some general dis- turbance belonging to the period of life. The prospect of recovery from youthful insanity is good, much bet- ter than in later life; in fact it is more hopeful than in any other form of mental derangement. Eighty per cent of recoveries are given by one authority. There may be several relapses, however, before recov- ery finally sets in. The treatment of all such cases belongs, of course, to the physician, and any case showing symptoms of insanity ought to be placed in his hands without delay. The matter of prevention, however, lies largely in the hands of relatives, and a good deal can be done in this line. Whenever an insane inheritance is known or suspected, a special watch must be kept over a girl during girlhood and the few years preceding it. Men- tal excitement and over-pressure in study must be avoided with the utmost care, but on the other hand constant occupation of a congenial kind is a necessity, for nothing is so likely to favor a latent tendency to mental derangement as introspection and self-analy- sis, which always arises when the thoughts have noth- ing to keep them occupied. Disturbances of men- struation in girls with such an inheritance should re- ceive more attention than would be necessary in girls 54 GIRL AND WOMAN without it, and any symptoms of hysteria or undue excitement, either with the periods or at other times, must receive prompt attention. Above all there must be abundance of sleep and nothing should be allowed to interfere with the night's rest. Insomnia, if it should appear, must never be neglected. In all actions and events of life it must be remembered that cases where an insane inheritance exists cannot take liber- ties with health, and that slight risks in the way of excitement, pressure or fatigue, which a normal girl, for sufficient reason, might assume, ought never to be allowed in a case where there is reason to fear insan- ity. CHAPTER III MORAL DISTURBANCES OF GIRLHOOD Association of mental and moral disturbance — Sense of personal freedom — Exaggerated conscience — Abolition of moral sense — Bad temper — Untruthfulness — Dis- honesty — Kleptomania — Debt — Use of bad language — Failure of will power — Review of principal points in disturbances of girlhood. There is no real difference between the mental and moral disturbances of girlhood, or rather, to speak more exactly, moral disturbances are actually mental changes which find expression through the moral na- ture. For the sake of convenience, however, it seems best to consider them separately. The development of self-consciousness, which underlies the mental changes of girlhood, finds expression morally in a desire for personal freedom, before unknown. To a child right conduct is represented by obedience. A normal, healthy little girl does not trouble herself as to ab- stract questions of right or wrong and feels no moral responsibility beyond the fulfillment of duties laid down for her by her parents. But when she reaches the age when the brain cells begin to establish con- nections in every direction, the process of thinking 55 56 GIRL AND WOMAN for herself, which leads, on the emotional side, to re- ligious excitement, shows itself on the side of the reason by activity of the moral sense and sometimes by eccentricity of conduct. I do not propose to discuss the graver moral de- linquencies which come under the head of law-break- ing, for their presence shows that the offender is suf- fering from the pernicious effects of defective train- ing and poor environment, or else that she has in- herited criminal tendencies; and in either case she belongs to the specialist in child reformation. What we need to consider here are the peculiarities that ap- pear in almost all girls at some point between twelve and twenty-one, and then disappear with the estab- lishment of maturity and the subsidence of emotional disturbance. These peculiarities of conduct may be for better or for worse, that is to say, they may take the form of a morbid exaggeration of what is right or of a departure from it. In a girl who has inherited good moral instincts and received a careful training based upon principle, the new sense of personal freedom and individual responsibility sometimes shows itself in a morbid conscientiousness, assuming one form or an- other according to temperament and circumstance. An exaggerated altruism, or love of others, is a fre- quent manifestation. Under its influence a girl will imagine herself called upon to make some fanatical MORAL DISTURBANCES 57 self-sacrifice. Sometimes the impulse takes the form of renunciation and under the stimulus of this morbid craving for self-immolation, she will give up every claim that she considers worldly or accept the most unwholesome and unattractive duties and surround- ings, which ten years later, when her moral equilib- rium is reached, she would make every effort to change for the better; or, if that should be impossible, to es- cape from altogether. This impulse towards self-sac- rifice is one element in the condition of self-surrender which combined with religious excitement creates the condition known as conversion. Sometimes the perverted moral sense takes the form of thinking all pleasure wrong, because it distracts the mind from serious things, or even simply because it is pleasant. In other instances there is a craving for exertion, which prompts the subject of it to un- dertake many new and sometimes unnecessary duties, such as teaching in Sunday School, helping in boys' clubs, or mothers' meetings, or sewing circles. But however proper the undertaking may be in itself, the conscience is never satisfied that all possible exertion has been made or that the results are all that they should be. Another form of expression is that in which a girl cannot be satisfied if she has done wrong without confessing the fault to someone, sometimes because confession is good for the soul, and in other cases be- 58 GIRL AND WOMAN cause she cannot be satisfied without the assurance of pardon. Not infrequently when she does confess the fault she exaggerates its importance to an extent that is absurd, like the little Sister of Charity in Miss Wool- son's tale who accused herself of murderous rage because she chastised the cat with a palm branch when it had broken her flower pot. Another variety of exaggerated conscience is that which invents an im- aginary ethical situation and then argues as to the question of right and wrong involved in it. Still an- other phase is literal verbal accuracy, in which a girl is miserable because she has said she heard carriage wheels, when they may have been the wheels of a cart, or that she thought a thing was so, when she had better have said she believed it. It is very important not to stimulate this morbid condition. There is no danger that a conscience of this description will become lax; the great thing to be feared is that it will be finical, and every effort must be made to induce the victim to take a sane view of things. Physical causes are often concerned in this moral unhappiness, just as they are in religious de- pression, and for both the cure lies in a healthy life with abundance of sleep. At the other extreme from this exaggeration of the moral sense are the cases where the moral sense for the time being is diminished or even lost. The most frequent form of moral weakness in adolescence is bad MORAL DISTURBANCES 59 temper, whether it takes the form of violent anger, of sulkiness, of revengefulness, or of general irrita- bility. Here again physical causes play a considerable part, for often the nervous system just at this age is so excitable and over-charged that the most trivial things, such as a teasing glance, or a well-meant but ill-judged word will cause an explosion. It is wrong to judge a girl too severely for conduct of this kind, since she is not responsible for the emotional condi- tion peculiar to her age; but it is very necessary to make her realize the dangers of yielding to it, for the habit of bad temper is one easily formed and hard to break. It is a good plan to watch a case in which irritability of any kind seems to be developing, so as to find out how far it is affected by physical fatigue. If it is worse in the afternoon, when the fatigue of the day is beginning to be felt, if it is increased by exer- tion or excitement, and especially if it is increased at the monthly periods, it may be safely set down to bodily weakness. The treatment must lie in adjusting physical conditions, in removing or forestalling causes of offense, and, above all, in enlisting the girl's efforts in her own service and teaching her to control herself. Explain to her how great will be the injury to her future if the habit of bad temper is formed, and show her how easy it is, comparatively, to control herself, if she makes the effort in the very beginning before she has begun to yield to the angry influence. 60 GIRL AND WOMAN Untruthfulness is another common fault of youth, sometimes appearing in a girl who has hitherto been truth itself. It assumes various forms, not all of which can be characterized as deceit, though they are certainly departures from truth. The commonest, as well as the most interesting of the latter, is that in which the imagination overpowers the sense of reality. It is the same mental condition as that in which young children declare they have met with lions and tigers, or set fire to houses, or, perhaps, in cases where the mind is naturally commonplace, describe imaginary in- cidents in which the circumstances are of everyday nature but have had no existence. The only difference in the delusions of later years is that the imagination is more developed and the consciousness of self more intense. These imaginative states are generally excited by some character in romance or history, around which the imagination plays, and they often contain a strong element of hero-worship. A girl will imagine herself to be some individual of whom she has heard or read, as, for instance, Mary, Queen of Scots; Elaine; Peggy Stewart ; or it may be, a Red Cross Nurse. The illu- sion, whatever it may be, will pervade all her thoughts and actions while it lasts, and she will endure consider- able discomfort or make great exertion in order to sustain it with dignity. Fiametta, in Mrs. Harker's charming story, " A Romance of the Nursery " ; when MORAL DISTURBANCES 61 she impersonated Ellen in " Home Influence," — " walking with drooping head and downcast eyes, the antimacassar draped gracefully about her cheeks to represent her flowing ringlets " is an excellent ex- ample. The most remarkable thing about these affairs is the relation of the girl herself to her delusion. She knows perfectly well, of course, that the idea in pos- session of her is the work of her own imagination, but this knowledge remains in a subconscious state un- til it is called into active existence by a deliberate ef- fort or a sudden shock. In the absence of any ex- ternal stimulus, she lends herself to the delusion and is for the time being the creature of her own imagina- tion. It is unwise to treat these affairs too seriously, for there is no deceit in them in the real sense of the word. The girl does not " practice to deceive," and therefore to tell her that she is lending herself to a lie and is to blame in the same sense, if not in the same degree, as if she were guilty of a deliberate imposture is doing her a great injustice and may end by seriously confus- ing her ideas of right and wrong. Nor is it right, so it seems to me, to treat these innocent fancies with contempt or derision. The advice, sometimes given, to laugh at them cannot be judicious, for it will cer- tainly cause pain and may result in their being car- ried on secretly, which is peculiarly unfortunate for 6 62 GIRL AND WOMAN it is evidence that the girl's trust in her authorities has been shaken. The whole thing ought to be regarded as a perfectly natural phase in girlish development. At this time in life, the mind is opening every day to new sources of knowledge and the girl is continually making ac- quaintance with interesting personalities in history and romance, or, it may be, in the. accounts of actual events. At the same time the self -consciousness be- longing to the period is constantly on the alert to seize occasions for its gratification. Is it surprising that, under these conditions, the imagination, always ex- citable at this age, even in girls who are naturally commonplace, should seize upon some romantic or heroic character now heard of for the first time, and invest herself with its personality and atmosphere? It may sometimes be necessary to take measures to keep an impulsive girl from making herself ridicu- lous before strangers who do not understand her but otherwise it is surely best to let the situation entirely alone. The girl who passes through the early years of youth without any experience of the kind is really less normal in her development than the girl for whom it exists and what is more she is less fortu- nate. The phase while it lasts will give her many happy hours, and when it has passed away, which it does spontaneously, it. will leave her in possession of delightful memories. MORAL DISTURBANCES 63 Another variety of untruthfulness, quite different from the last, is that which comes from fear. Prob- ably American girls, who are brought up from in- fancy to independence, are less likely to fall into this form of error than their contemporaries in other lands ; still, there are timid girls everywhere who may be tempted to lie to escape punishment. Another mo- tive, which I believe to be more common, is dread of ridicule. This point has received less attention, as a cause of falsehood than it deserves. In girlhood the thoughts, ambitions, and imaginations are exquisitely sensitive, and like all young and tender growths they are easily crushed by rough usage. Moreover the feelings are much quicker than they are in later life, and, although a young girl has still to learn their full depths, she feels acutely upon matters that seem trivial in the extreme to her elders. No other age is so re- sponsive to sympathy or so hurt and repelled by con- tempt or ridicule. The dread of being " made fun of " on a subject near and dear to her will cause a girl to seek protection from wounded feeling in false- hood as soon or sooner than the fear of blame or punishment. In fact ridicule is never a useful or safe means of dealing with girlhood. The sense of humor is almost entirely absent in children and very crude and unde- veloped in youth, which always takes itself with the utmost seriousness. A sneer, a laugh, or even a look 64 GIRL AND WOMAN of good-natured amusement is enough to give deep offense, or to check the sources of innocent pleasure and take away many happy hours, to say nothing of the possibility of destroying confidence and stimulat- ing deceit. Still another class of untruths is that arising from vanity and affectation. " Showing off " is one of the common defects of the age, arising naturally from its ever-present self-consciousness, and girls affected by it are apt, in order to impress others, particularly those younger than themselves, to say anything that will serve their purpose in this respect, no matter whether it is true or false. They will repeat compliments paid them upon their appearance by boys or young men, or praises of their proficiency in study coming from their teachers, which are wholly, or in part their own inven- tion. In other cases they boast of personal posses- sions which they do not own, or of accomplishments which they cannot produce when occasion offers. If they have early love affairs they are prone to deceive their admirers as to the existence of previous attach- ments, leading them to suppose there were no others, or else boasting of their number and importance. No doubt there is a certain amount of self-deception in this form of untruthfulness, though much less than in the imagination of personality, but the worst thing about them is the ugly element of self-seeking and vanity, which makes it necessary to treat them with MORAL DISTURBANCES 65 more or less severity. Exposure in such cases often does good. If a girl who has been indulging in this form of falsehood is confronted unexpectedly with the truth in the presence of the person she is trying to impose upon, it is a most useful lesson. But what- ever form of treatment is adopted, it is essential that the culprit should understand she is blamed for the wrong motives behind her falsehood quite as much as for the falsehood itself. Lies told with deliberate intention, in order to gain some advantage or to injure someone else, are usually associated with intrinsic meanness of character or with motives of revenge. They are met with under vari- ous conditions. A girl may declare herself possessed of qualities or attainments which she knows she does not own, not, as in the case just mentioned, from the instinct of self-importance, but because she wishes to gain a coveted amusement or distinction; or she may justify herself at the expense of an innocent compan- ion; or circulate a story which she knows to be un- true in order to injure someone against whom she has a grudge. In such cases the moral delinquency lies, not so much in the falsehood, as in the feelings of envy, hatred, and malice by which it is prompted. It is of no use to blame the offender for deceit and pass over the underlying faults of disposition. It would seem as if a really bad disposition must exist whenever the last two kinds of untruthfulness 66 GIRL AND WOMAN are present, but happily experience shows that is not by any means always the case. At this period the moral sense seems not infrequently to be abolished for the time being, by reason of backwardness of de- velopment in the rational faculties upon which the ethical sense depends. The intellectual qualities of mind, as we have already seen, including reason, judg- ment, and self-restraint, always develop more slowly and reach maturity later than the emotional ones, and if, as must sometimes happen, the difference between their growth should be greater than customary, the in- dividual is left at the mercy of the emotions until reason asserts herself and will-power is developed. Of course, it occasionally happens that the moral equilib- rium is never attained, and then we have the moral delinquents who become habitual criminals or not, ac- cording to character and environment. But these are the exceptions, which, as I said before, belong to the consideration of specialists. Under normal conditions the lapse of moral sense at this period is a transient phase which does not give rise to any grave misde- meanors and disappears spontaneously as reason as- serts itself. This explanation of moral delinquency in youth is every day becoming more appreciated by those inter- ested in the training of girls and boys, and it is for this reason that such persons strive so earnestly to establish reformatories where those who offend MORAL DISTURBANCES 67 against the law during this state of moral feebleness, or who cannot be controlled by their friends, may be sent for a few years until their moral nature has reached its proper development. To treat such cases as criminal is the height of injustice and unkindness, to say nothing of its being the surest way of turning the unfortunates into habitual offenders. Dishonesty in girls or young women is generally found among those who are in want of necessities, or of what might be called lawful indulgences. The craving for pleasure is one of the characteristics of youth, the appreciation of it being keener at that time than it was before or will ever be again. But with the putting away of childish things the simple pleas- ures, which formerly furnished all that heart could desire, suddenly lose their savor, and as the mind opens and knowledge increases all kinds of new pos- sibilities in the way of enjoyment suggest themselves. When legitimate means of indulging these longings are wanting, it is not strange that the temptation to find ways and means should sometimes be too much for the unstable moral sense of the period. Theft of such a kind cannot be classed with the worst forms of dishonesty, and when it is committed for actual neces- sities, such as food, we must naturally feel that the fault lies with a state of society in which such things can exist. Among the well-to-do, theft, when it does occur, 68 GIRL AND WOMAN arises from a temporary loss of moral sense, though, of course, there are occasionally cases, in which the want of moral perception is an inherent defect. But such cases are very rare. One particular form of theft confined almost entirely to young girls, is that known as kleptomania. It appears almost always be- tween thirteen and twenty, though it is occasionally seen in older women. There is a great deal of dis- cussion as to whether this condition is one of the forms of temporary loss of moral sense, or a delib- erate crime against the law, for which the offender is fully responsible. It is hard to regard it in the light of deliberate theft, for the motive, in most cases, is lacking, the girl taking articles she does not in the least need or even desire, or which she could have by expressing a wish for them. Again, the things taken are sometimes so unsuitable that they can be of no possible use or pleasure in themselves, and yet no attempt is made to dispose of them. An- other argument against its being deliberate is that the impulse seems to be irresistible, even when it is al- most sure to be quickly found out. Take, for in- stance, the case of a young girl who ordered a most expensive set of furs from a well-known shop and had them charged to a friend of her mother's, who, there was every reason to believe, would discover the fact without loss of time. As by far the greater number of cases of kleptomania happen in early MORAL DISTURBANCES 69 girlhood and recover with maturity, it seems probable that it is really one of the temporary moral dis- turbances. To deal with a case of theft requires the utmost tact and discretion, whether it is a direct yielding to temptation or the effect of kleptomania. Each case must be treated according to the temperament and cir- cumstances of the offender. It is most essential that she should feel what she has done to be wrong, and at the same time it would be a great injustice to treat her as a thief. Perhaps what is most important is that she should appreciate that the offense is one for which she could be prosecuted, and realize how near she stands to a penalty which others, less fortunate, may have to pay under similar circumstances. If a sufficient impression can be made in this way it will probably keep her straight, until she has developed sufficient moral force for her own protection. Another form of dishonesty frequent in girlhood is debt on account of extravagance. The debts con- tracted by young girls are not serious and must, of course, be paid by some one responsible for them, but the moral defect is greater than it may appear at first, because it lays the foundation for a habit of debt later on. No doubt it arises, like other moral dis- turbances of the period, from the temporary loss of moral perception, but it is really more serious than most of the others, for they pass away spontaneously 70 GIRL AND WOMAN with growth; but a habit of debt will be kept up later in life. In fact the moral sense once disturbed in this particular does not seem able to recover as it does in other cases. The use of bad language is supposed to be a fault belonging especially to boys ; nevertheless girls are by no means exempt from it at this particular age. Sometimes a girl who has never shown the slightest disposition to such a thing before will suddenly ap- pear to be under a perfect obsession, compelling her to say all the profane or obscene words she has ever heard and a great many which it seems impossible she ever could have heard. An outbreak of profanity of this kind is quite a different thing from the swearing prompted by a fit of anger or exasperation, indeed, girls do not seem to experience this particular tempta- tion as boys and men do, for in their case, a good fit of crying takes the place of a storm of bad words. Probably the explanation of bad language in girls is to be found in the impulse to " show off," arising from self-consciousness. The craving for attention and notice is sometimes so strong at this age that to do what is shocking is almost as great a temptation as to do what is admired, and bad language, of course, affords an easy means to the end in view. This particular phase of moral disturbance is the only one in which contempt is useful as a cure. To show horror and distress is exactly what the offender MORAL DISTURBANCES 71 desires^ though she may not have formulated the thought, and therefore it is the thing of all others to be avoided. If the offense is treated with silent con- tempt, or with a few words showing disgust and sur- prise at such childishness and bad taste, there will be no temptation to repeat it. It sometimes happens that the period of life which we are now discussing is disturbed at some point by a failure of will power, or rather by a lack of its development, which affects the conduct passively in- stead of actively. There does not seem to be suffi- cient vigor of either mind or body to excite deter- minate wrongdoing, neither is there enough to act as a protection against it, and the results, of course, are faults of omission rather than commission. It is in such cases as this that we find incorrigible lazi- ness. A girl goes to school if she is sent, for she has not enough energy to set up an active resistance or to play truant; but when she gets there she sits with her eyes fixed on her book and her mind fixed on noth- ing at all. Another manifestation of the condition is excessive disorderliness and want of cleanliness both of person and surroundings. Just at the age when a girl becomes old enough to have charge of her own toilet and is usually much occupied with its various phases, such a one as we are now discussing must either be supervised like a child or be as unpresentable as a child left to its own devices. Still another form 72, GIRL AND WOMAN of the condition is a dreaminess and general want of responsibility which make the subject of it entirely untrustworthy. Here again the question of physical causes must be considered. A depreciated state of the general health and a low vitality are frequently at the bottom of this condition. Often the discovery and cure of anemia, or of a disturbed action of the heart, will be followed by such a sudden change to vigor and activity that there seems to be a difference of individuality. Faults arising from this cause should never be set down arbitrarily as proceeding from willfulness and super- fluity of naughtiness. A will thus weakened is an in- firmity which ought to excite compassion, and needs to be protected and cared for until it is strong enough to stand alone, which it will do when the period of transition is over. The treatment must be governed by circumstances. Such a girl may be perfectly obedient, but nothing is gained by that. It is impos- sible to regulate life at this age entirely by obedience. The great point is to find out what will stimulate the will and develop the sense of personal responsibility, and that is a task that will often tax the most acute perceptions. Sometimes, in fact not infrequently, strangers are more successful in awakening energy than relatives or friends, and it may be a good pjan to send such a girl away from home for a time to a good boarding school or some other place where there will MORAL DISTURBANCES 73 be a change of interest as well as the necessity for assuming more personal responsibility, and of keeping up appearances with strangers. The most serious of the moral disturbances of girl- hood, of course, are those connected with sex, though persons best acquainted with the subject seem now agreed that ignorance is a far more powerful agent in such cases than sexual temptation. The two chapters devoted to the various matters associated with sex, seem to be a more appropriate place for the discussion of these matters, therefore they are now only men- tioned in passing. If we take a brief review of the various disturb- ances of girlhood, it is plain that their presence is not in itself a cause for anxiety. The physical changes natural to the age, especially the development of com- plex associations in the brain, with its consequent evo- lution from a lower to a higher function, must in- evitably be accompanied by disturbances of one kind or another, the nature of which in any particular case depends upon a variety of influences, such as in- heritance, environment, education, and the most subtle of all, — temperament. It is in the management of the period that occasion for anxiety lies. Not that there is anything in that management which cannot be carried out successfully and easily, provided the forces to be reckoned with are clearly understood. The difficulty lies in the fact 74 GIRL AND WOMAN that the nature of these forces has not, until recently, been investigated. The object of these three chapters has been to present such information in regard to them as it has been possible to obtain from sources now open, and before concluding, it seems well to em- phasize such of the points considered as suggest special food for thought. All the disturbances of girlhood can be accounted for if only we remember that consciousness of self and realization of personal freedom are the two great influences of the period. The regulation of these two forces is the one great essential in the management of youth, but in order to carry this out successfully the difference in development between the emotions and the reason must always be borne in mind. As I have said more than once, all the emotional qualities are in excess during the early years of girlhood and the imagination has a vividness which it will never have again, but the rational qualities develop with compara- tive slowness. These fundamental facts, once clearly understood and kept constantly in mind furnish a solu- tion for most, if not all the problems of girlhood. Few parents, or those in the position of parents, realize how important the period of girlhood is, nor how tactful their own conduct must be while their children are passing through it. The task before them is to combine watchfulness and care with the personal freedom that youth requires for its full development, MORAL DISTURBANCES 75 and it is not an easy one. Naturally it is hard for parents to see a child make grave mistakes and in- volve herself in unhappiness because she will not con- sent to profit by their experience of life. Yet this is just what a wise parent will try to do. I do not mean, of course, that girls should be allowed to do what will injure their characters, or involve them in perma- nent suffering; still less that they should act so that they are condemned by the outside world. In the larger affairs of life, whose consequences are far- reaching, they need to be controlled, more or less as they were in childhood. But in the smaller affairs of everyday life, they had much better be left to their own devices, even though these will surely lead them into trouble. Only by their own experience can they learn what is worth knowing, and only by bearing the consequences of their own mistakes will they find out how to protect themselves in the future, even if they burn their fingers — as they undoubtedly will — in the fiery furnace of experience. Nothing, moreover, inspires confidence between youth and those in authority over it so quickly as the absence of interference, and nothing calms and regu- lates the agitation of the period so entirely as the pres- ence of confidence and the knowledge of sympathy. As someone has said, " What youth wants most is room." And if it recognizes that space to grow in its own way is willingly granted, not grudgingly con- 76 GIRL AND WOMAN ceded, the great difficulty in the situation is overcome. Above all, the reserve of youth should be respected. I have tried to show that it is not the result of delib- erate concealment, but a lack of self -comprehension and of power of expression. Youth is naturally in- articulate and must remain mute as to its own mental processes until such time as its faculties are fully and evenly developed. Fathers and mothers who can re- frain from interference, respect reticence, and sym- pathize with ill-regulated emotion during girlhood, will reap a rich reward in that life-long friendship with their daughter, which is one of life's most precious possessions. CHAPTER IV REPRODUCTION Nature of reproduction — Difference of the process in the lower and the higher forms of life — Manner of reproduc- tion in ameba — In hematococcus — In heteromita — In vaucheria — In polygordius — In crayfish — In the fish — In the bird — In the mammal — In the human being. All the various functions of the body are estab- lished at birth with one exception, namely, that of reproduction, which is not developed in any living thing, whether animal or vegetable, until it reaches maturity. The establishment of the function in the human being is accompanied, especially in girls, by changes affecting both mind and body, which have been described in the previous chapters. The anat- omy and physiology of the reproductive organs, how- ever, as well as the nature of the reproductive process itself are still to be considered. For a girl to grow up uninformed of these facts and of the natural laws connected with them is doing her a great injustice, because she then enters life unprepared for some of its most serious problems and may have to pay heavily in health or happiness for her ignorance. Our present custom of surrounding all matters of sex and of re- 7 J7 78 GIRL AND WOMAN production with an atmosphere of mystery is a most unfortunate policy and we have reason to rejoice at the perception, now growing up on all sides, that the open, direct treatment of such subjects is a duty par- ents owe to their children. There seems to be a gen- eral agreement among those interested in the question of sex from the educational standpoint that the best way to make the subject clear to young minds and to place it before them in a right light is to explain the evolution of the process of reproduction as it appears in the different forms of life from the lowest to the highest, illustrating the different stages by the descrip- tion of types showing special characteristics. This is the method I propose to follow here, though it is impossible in the space at command to do more than present the most distinctive forms. Every living thing is able to reproduce itself. It is, indeed, the power of reproducing its kind that dis- tinguishes life from what is inanimate. Inanimate ob- jects can increase in size by the addition of more of their own substance, but only living things can multi- ply their kind by the production of a new individual in their own likeness. The manner of reproduction differs greatly in different forms of life, but whatever the variations may be, they are always in accordance with the position in the scale of life. In the lower forms, reproduction is more or less simple; in the higher more or less complex. It is more intricate in REPRODUCTION 79 a dog than in a bird; in a frog or a fish than in a lobster; in a worm than in a jelly-fish, and the same differences exist in vegetable life, though they are not so constantly before us. The reproduction of a rose is a much more complicated process than that of a seaweed. One of the lowest and simplest of all living things is the ameba, an animal organism so small that it can only be seen through the microscope. It consists of one single cell, composed of a transparent jelly- like substance called protoplasm, which contains a central spot, known as the nucleus, the whole being- surrounded by a wall formed of the cell substance. But this cell, tiny as it is, is able to carry on within itself all the processes necessary to life — it moves, it breathes, it digests, and finally, it reproduces itself, all in the most elementary manner. The process of its reproduction is as follows : First, the nucleus divides into halves and the two halves immediately move away from each other; next the ameba stretches itself out in such a manner that it becomes extremely thin just be- tween the two nuclei and, finally, it separates at this spot. No sooner has the separation taken place, than the cell wall closes again on each side so that there are two cells, each exactly like the parent cell except that it is a little smaller and each ready to begin life on its own account as a separate individual. This process of cell division is the first step in all reproduction, the 80 GIRL AND WOMAN division of the nucleus being the essential point in the process; and it always takes place in the manner just described, the nucleus dividing first and the cell sub- stance afterwards. The behavior of the cell wall, which is not necessary to reproduction, varies in dif- ferent forms of life. The next stage in reproduction is well illustrated by a one-celled vegetable organism called the hematococ- cus. It is slightly higher in the scale of life than the ameba and its mode of reproducing itself is, therefore, a little more advanced. The first division of the cell substance into halves takes place exactly as in the ameba, except that the cell wall, which is harder in the hematococcus, remains unbroken, the division of the cell substance taking place within it. But the process does not stop at a single division, as in the ameba; as soon as the two new cells are formed, they each divide again, so that there are four daughter cells within the wall of the mother cell. The cell wall then breaks up and goes to pieces, while the new cells separate and move a little apart from each other. Each of them then develops a new cell wall of its own, having at one point in it a pair of little filaments, called flagella, by means of which it moves about. We next come to the stage where the presence of two individuals is necessary to reproduction, although the part which they take in it is of the simplest descrip- tion. A good example of this type is another little REPRODUCTION 81 one-celled organism, called heteromita, which is suf- ficiently advanced to have a front and a hind end. At times the heteromita swims freely about in the water where it lives; at others it attaches itself to some ob- ject which it encounters, such as a bit of stick or a piece of straw, and remains stationary. When it is ready for reproduction, one of the swimming forms approaches a stationary form and attaches itself to the latter in such a way that the hind ends of the two come into contact, after which the two cells mingle with each other, just as two drops of mucilage on a plate might do. This fusion of two individual cells is called conjugation. Out of the mass of protoplasm formed by their union a new cell is formed, which, after undergoing various stages in development, be- comes a full grown heteromita exactly like the parents. The next step in the evolution of reproduction is a most significant one, namely, the first appearance of sex. In the heteromita the presence of two individ- uals was necessary to the production of a new one, but they were exactly alike; now we reach a point where they are different from each other, one representing the male and the other the female. Another sign of advance is that only a part of the cell takes part in reproduction instead of the whole. The best example of the type for our present pur- pose is a vegetable form called vancheria, which is the highest of the one-celled organisms, or rather, it is an 82 GIRL AND WOMAN intermediate stage between the one-celled and the many-celled forms. Vaucheria is large enough to be seen with the naked eye, though the process of repro- duction cannot be observed without a microscope. It consists of long green filaments which lie closely packed together forming a slimy mass on the surface of stagnant water. Along the filaments many nuclei are scattered at intervals, but there is no sign of cell walls between them, so that the plant cannot be said to be either one-celled or many-celled. When reproduc- tion is about to take place, which happens only at cer- tain seasons of the year, little buds appear at inter- vals along the sides of the filaments, each bud con- taining a nucleus which has separated from a larger one near by. The buds are arranged in pairs, one of each pair being a little longer than the other. As soon as they are distinctly formed, the shorter bud swells up into a round blunt point, after which a cell wall forms around it, so that it is shut off from the rest of the filament and converted into a separate cell containing its own nucleus. This cell is called the ovary and rep- resents the female. While the short bud has been swelling, the long one has grown still longer and after it reaches a certain length, the tip divides into a separate cell as in the shorter bud. The new cell thus formed is called the spermary and represents the male. The spermary now bends over upon itself until it is nearly double and its tip approaches closely to the REPRODUCTION 83 ovary. Next the cell wall of the ovary breaks down at one point and a little bit of protoplasm comes out and disappears. After this the remainder of the protoplasm within the ovary separates itself from the cell wall and becomes what is called a " naked cell," that is to say a cell having a nucleus but no wall. This naked cell is the ovum or egg. In the meantime the spermary has multiplied by cell division inside the cell wall, until there are a great number of tiny cells, each of which has developed a pair of flagella as in the hematococcus. These tiny cells are sperm cells. The walls of the spermary now break down and the sperm cells escape, moving away by means of their flagella. Some of them approach the ovary and pass through the opening in its wall, after which one of the number attaches itself to the ovum and the two fuse together as in the case of the heteromita. The sperm cell and the ovum are the two essential elements in reproduction wherever it may be, the sperm cell being the male and the ovum the female element. Motion is the special characteristic of the sperm cell, for its function is to search for the ovum, which is always passive. For this reason the sperm cells are provided with flagella. The union of the sperm cell and the ovum is called fertilisation and it takes place in all forms of reproduction. The essen- tial point in it is the union of the two nuclei, one from the male and the other from the female cell. The 84 GIRL AND WOMAN process of reproduction in vaucheria, simple as it is, does not differ in anything essential from the same process in the higher forms of life and the terms em- ployed in the description just given are those employed at every stage in the scale of life. We now reach the many-celled organisms, that is to say living things composed of numbers of cells, modi- fied in many different ways to perform different func- tions. With every advance in the scale of life the cells become more numerous and more distinctly adapted to special forms or functions. All the va- rious tissues, parts, and organs of every living thing consist of cells which have undergone whatever kind of development and modification was necessary to fit them for their particular office. The specialization of cells becomes more and more complicated with each advance in the scale of life until we reach the human being, where it attains its highest development. In all many-celled organisms, whether high or low in the scale, one particular set of cells is set apart and adapted for the purpose of reproduction, the male and female being separate individuals. A good example of the lowest many-celled organ- isms is a tiny worm an inch or so in length, called polygordius, which lives in the sand at the bottom of the sea. The interior of its body, as in all worms, is divided into segments and in all of the segments, ex- cept a few at the extreme ends, are heaps of cells REPRODUCTION 85 devoted to the function of reproduction. In the male worm, when the season for reproduction comes round, these special cells divide and re-divide over and over again, the new cells thus formed taking on the special characteristics of sperm cells. In the female worm the cells instead of dividing increase in size and at the same time develop the characteristics of ova. By this process of multiplication in one case and enlarge- ment in the other the interior of each segment becomes filled with sperm cells or ova, according to the sex of the individual worm. When the ova have reached a certain size, the body of the worm splits at some point in each segment and the ova escape, remaining just where they happen to fall. The sperm cells also es- cape from the body of the male worm, though it is not known whether they do so in exactly the same manner as in the female. As soon as the sperm cells are free, they begin, as usual, to move in the direction of the ova by means of their flagella. Every sperm cell that meets an ovum fuses with it, after which the new cell formed by their union divides into two and the development of a new worm begins. At the next stage of reproduction, represented for our present purpose by the crayfish, the reproductive organs are still more specialized. In the male cray- fish they form a definite organ called the testis, which is filled with sperm cells and represents a further de- velopment of the spermary in vaucheria. The testis 86 GIRL AND WOMAN lies about the middle of the body cavity in the median line and from each side of it proceeds a tube called the spermiduct which leads to the exterior and opens on one of the legs. In the female crayfish the repro- ductive cells form an ovary containing ova and com- municating with the exterior by means of a passage called the oviduct which opens in a manner similar to that of the spermiduct. When reproduction is about to take place the bodies of the male and female cray- fish come into close contact, after which the sperm cells pass out through the spermiduct and are deposited on the body of the female at a point near to the open- ing of the oviduct. Shortly after this occurs the ova escape from the ovary and pass out through the ovi- duct. As soon as they reach the outside they encoun- ter a sticky substance secreted by a gland in the vicin- ity, which fastens them to the body of the female and keeps them stationary until the sperm cells have a chance to reach them and fertilization can take place. As soon as the ova are fertilized, they drop off the female and remain where they fall while undergoing further development. We now reach the important class of vertebrates, which is comparatively high in the scale of life, an advance shown, as regards reproduction, by the fact that fertilization takes place within the body of the female. In the fish which will answer very well for the purpose of illustration, the reproductive organs REPRODUCTION 87 are much the same as they are in the crayfish except that the male has two testes while the female has but one ovary. The ovary has two oviducts, however, one on each side; but instead of leading directly to the exterior, they unite so as to form a single tube opening on the outside. Each testis has a spermiduct which dilates near its outer end so as to form a pouch in which the sperm cells collect and the pouches termi- nate in tubes leading to the exterior. When repro- duction takes place the male fish comes into contact with the female and the sperm cells collected in the pouches of the spermiduct pass out of the body of the male into the lower part of the oviduct, where the ova are fertilized. Soon after fertilization takes place the ova pass out of the oviduct and are deposited in the grass and weeds. In the course of its passage out- ward each fertilized ovum is surrounded with a horny substance that serves as a protection during its devel- opment. This substance is secreted by a gland called the shell-gland situated in the widest part of the ovi- duct. The process of reproduction in the frog is much the same as it is in the fish, but the eggs of the frog are covered with a slimy jelly-like substance that forms a protective covering and also provides food for the developing ovum. The presence of protection and of nourishment for the ovum during the period in which it is undergoing the further stage of its 88 GIRL AND WOMAN development shows a distinct advance in the repro- ductive process. With birds we come to a still higher stage in repro- duction though the advance is more apparent in the condition of the ovum during its development than in the reproductive process itself. • The organs of repro- duction in the bird are not essentially different from what they are in the fish or the frog. The female bird has only one ovary which lies in the abdominal cavity on the left side of the spinal column. The oviduct leading from it is dilated at the end next to the ovary and there is another still larger dilation near the other extremity. It does not open directly on the exterior, but into a passage called the cloaca where the organs concerned in excretion also discharge their contents. The ovary in the bird is filled with ova in different stages of development embedded in a mass of tissue. A mature ovum, when it is ready to escape from the ovary, consists of a light yellow body enclosed in a delicate membrane and having at one point a slightly darkened spot or disc. The yellow substance is known to us as the yolk of the egg and the disc is what old cooks call " the chicken." Cell-division and de- velopment take place only in the disc, the yolk serving solely for nourishment. When the ovum escapes from the ovary it passes into the dilated portion of the oviduct. Here it is fer- tilized by the sperm cells and passes on downward. REPRODUCTION 89 The white of the egg, which surrounds the yolk, is secreted by glands situated in the walls of the oviduct and surrounds the ovum as it passes through it. An- other set of glands a little further down the oviduct secrete the substance that forms the shell. When first deposited around the egg the shell is quite soft and slimy, but when the ovum reaches the lower dila- tion of the oviduct it remains there for twelve to eighteen hours during which time the shell becomes quite hard. After this the fully formed egg, sur- rounded by its shell, is expelled from the dilated por- tion of the oviduct by violent contractions of the walls and passes out through the cloaca to the outside. In other words it is laid. But, if nothing more were to happen the egg of the bird would never develop any farther. It cannot take care of itself, or rather do without any care at all, like the eggs of the lower animals. With the bird we reach the stage in development known as warm- blooded, which means that the temperature of the ani- mal's body remains always the same in health and does not change according to the surrounding atmosphere as in frogs, fish, and other so-called cold-blooded ani- mals. It is necessary to the development of the ova of warm-blooded animals that they should be kept at the temperature of the mother's body until they are able to" take care of themselves. In birds the neces- sary warmth is furnished by means of the process 90 GIRL AND WOMAN known as sitting, during which the mother keeps the eggs close to her body and consequently always at the same temperature with it until they are ready to come out of the shell. This period in the chicken lasts for twenty to twenty-one days at the end of which time the little chick is quite formed and, as Mr. Foster says in his book upon the subject, " steps out into the world." Here is a distinct advance upon the process of re- production in cold-blooded animals. The ovum de- pends upon the mother for protection during its period of development, which is not the case in any of the lower animals. Moreover, it is provided with nour- ishment during its development as well as protected from external injury by the shell. These last two points are present in the higher of the cold-blooded animals, but in a less mature degree. We now come to the highest class in the scale of life, the class known as mammals, or mammalia, to which man, on his animal side, belongs. With mam- mals the ovum is not only fertilized within the body of the mother, but develops within it as well until it is fit for an independent existence. Moreover, after its separation from the mother it is nourished by her until the first stage of its life is over. The name mammal, derived from the Latin mamma, a breast, is taken from the organs by means of which this func- tion is performed. REPRODUCTION 91 In the dog, which affords a good example of the typical features of the mammalia, the female has two ovaries each with its oviduct, situated as usual in the abdominal cavity, one on each side of the spinal col- umn. The upper ends of the oviducts consist of a number of long processes forming a fringe which lies close against the ovary without actually opening into it. At their lower ends the oviducts open into an organ called the uterus, where the ovum, after fertili- zation, is received and nourished during its further development. The uterus in its fully developed form is present only in the mammalia, though there are sug- gestions of it in some of the lower animals. The lower dilation in the oviduct of the bird is, no doubt, a stage in its evolution and is sometimes, incorrectly, spoken of as the uterus. In the dog and some other mammalia the uterus has two long horns, in each of which several ova can develop at the same time. This arrangement is present in all animals where the young are born in families, such as puppies, kittens, or rab- bits. But in those mammals, such as the horse and the cow, where one ovum develops at a time, the uterus has a rounded or a pear-shaped form. Whatever may be the shape of the upper portion of the uterus its lower end is always elongated and some- what resembles the neck of a bottle, from which fact it has received the name of the cervix, or neck. The cervix opens into a passage leading to the exterior, 92 GIRL AND WOMAN called the vagina. In all animals up to this point the reproductive organs have opened into a cloaca common to them and to the organs of excretion, as in the bird. The presence of a passage devoted exclusively to the reproductive organs is another evidence of higher de- velopment. The male dog has two testes, which instead of lying inside the body as heretofore, are contained in a pouch of skin outside it. They are filled with a great many tiny tubules called the seminal vesicles which contain the sperm cells. Connected with the testes by a very complicated arrangement is a hollow organ, the penis, by means of which the sperm cells are conveyed into the vagina of the female when the time for reproduc- tion arrives. At intervals, which differ in different animals, and in the dog are about six months, the ovaries and the uterus become congested and swollen, after which the thick outer covering that surrounds them breaks down at places and such of the ova as are ready to be fertil- ized escape. They are then caught by the fine proc- esses at the end of the oviduct and pass into its inte- rior. This process is known as ovulation. The walls of the oviduct are lined with thread-like filaments called cilia, which sweep the ova along the passage in the direction of the uterus. At the same time the sperm cells move up from the vagina by means of their flagella and when one of them meets an ovum fertiliza- REPRODUCTION 93 tion takes place. After the ovum is fertilized it con- tinues to move downward until it enters the uterus, where it finds the mucous membrane that forms the uterine lining so swollen and softened that it has no difficulty in forming an attachment to it, after which it continues its development. In the dog, as I said, several ova (commonly six to eight) develop at the same time, but the process of fertilization is the same in all mammalia, whether it is single or multiple. As the mammalian ovum is not provided with any means of nourishment such as the chick possesses in the yolk and white of the egg, some other form of sustenance is necessary. For a little while after the ovum becomes attached to the wall of the uterus it is nourished by the blood vessels in the uterine mucous membrane, but in a short time blood vessels begin to form in the ovum itself and a connection is established between them and the blood vessels in the uterus by means of an organ called the placenta, which is pres- ent only in mammals. The placenta is a flat round mass composed of soft, spongy tissue and full of blood vessels communicating on one side with those in the uterus and on the other with the vessels developing in the ovum. By means of this arrangement the embryo, as the ovum at this stage of its development is called, derives nourishment from its mother until it is ready to separate from her. The period of time during which the developing embryo remains in the 94 GIRL AND WOMAN uterus is called pregnancy. Its duration differs in dif- ferent animals; in the dog it is sixty days. At the end of it violent contractions of the uterus come on, as in the case of the bird, and the young animal is forced out of the uterus through the vagina to the ex- terior ; in other words it is born. This process of ex- pulsion from the uterus is called delivery. After the animal has been expelled from the uterus the placenta also is expelled and the connection between the two is severed. But the young animal is feeble and helpless, wholly unable to help itself or care for itself as the little chick can do, and therefore entirely dependent upon its mother for protection and nourishment. The means for its nourishment are provided by glands called the mammary glands, which secrete milk just as other glands in the body secrete saliva or the digestive fer- ments. There is one peculiarity, however, about the mammary glands, which is that instead of being more or less active at all times, as in other cases, they only begin to secrete when a young mammal is born and their secretion is needed. As soon as the little animal is old enough to eat ordinary food and the demand upon the mammary glands is over the secretion ceases. I have not yet described the process of development in the ovum after fertilization because there is not sufficient resemblance between the process in cold;, blooded and warm-blooded animals (after the first REPRODUCTION 95 stage of cell division is over) to make it worth while to take up the matter before reaching this point. In all mammals, however, the process is the same and the only difference between them and birds is that the nourishment furnished by the yolk in birds is supplied in mammals by the placenta. The outlines of the process in mammalia are as fol- lows: The ovum, as soon as it is fertilized, begins a process known as segmentation, that is to say of re- peated cell division. The one-celled ovum divides into two, the two new cells into four, the four into eight, the eight into sixteen and so on until, finally, there is a mass of cells too numerous to count. After segmentation has reached a certain point the cells separate themselves into distinct masses and those con- tained in each mass assume special characteristics. The masses then proceed to develop in different posi- tions and upon different planes, the various parts of the body being all evolved in this way. The study of the different stages in the development of either the mammal or the chick is one of the most fascinating branches of scientific investigation and has been fol- lowed with great minuteness, but it is far too complex to be described here, even in the most superficial man- ner. All that can be said is that every organ or tissue of the body, whether of the human being, the dog, the bird, or any other animal is formed by the multiplica- tion and specialization of cells, the special character- 96 GIRL AND WOMAN istics of each kind appearing at a definite point in its de- velopment. What is, perhaps, the most wonderful thing in the whole remarkable process is that, no mat- ter whether the organism is low or high in the scale of life, no matter whether it is a human being or an ameba or anything between, the first step is always the same, that is the division of one cell into two. In the ameba this single division is all; in the human being it constitutes merely the first step in a most compli- cated process occupying a period of months; but the fundamental stage is the same in both, as well as in every form of life between them. The process of reproduction in the human being is the same in all essentials as it is in the dog or any other mammal, though it has, of course, certain individual peculiarities. The ovaries in women are two thick oval bodies, about the size of bantams' eggs, situated in the extreme lower part of the abdomen. Ovulation takes place in the human being in the same manner as in the dog, but at intervals of four weeks. At these intervals the ovaries*become swollen and con- gested in consequence of changes taking place in the ova with which they are filled. If an ovum is ready for fertilization it approaches the surface of the ovary and the thick outer capsule breaks down at that point, after which it is caught by the fringed border of the oviduct, passes into the interior, and proceeds down- ward. If the ovum does not meet with any sperm REPRODUCTION 97 cells as it passes down, it dies and disappears, but if the sperm cells are introduced into the vagina at that time, one of them will probably encounter the ovum in the upper part of the oviduct and fertilization will take place. But as only one ovum is cast off at each ovula- tion, fertilization is not so sure to take place in the human being as in the lower mammals where several ova are thrown off at a time. The fertilized ovum continues to descend until it ar- rives in the uterus, where it becomes attached to the wall and is nourished by the placenta in the manner al- ready described, the only difference in the human be- ing being that nine months are required for the de- velopment of the embryo. At the end of that time it is expelled by muscular contractions as in the dog, but here there is an important difference, for whereas in animals these contractions are accompanied by only a slight amount of pain, in the human being they are attended by very severe suffering. After the uterus is emptied of its contents, it gradually returns to its former size, which has, of course, been greatly en- larged by the developing embryo. This process re- quires four weeks for its accomplishment and it is of the utmost importance to a woman's future health that it should not be interfered with by over-exertion of any kind. The great peculiarity of the reproductive process in human beings, which distinguishes it from the process 98 GIRL AND WOMAN in any other of the mammalia, is that it is accompan- ied by the function known as menstruation. This condition is peculiar to human beings though it exists in a modified form in certain monkeys. Its mechan- ism is as follows : In ovulation the swelling and con- gestion of the uterus and ovaries is very well marked and under its influence the smaller blood vessels in the mucous membrane lining the uterus break down, causing a flow of blood which passes out of the vagina, becoming mixed with more or less mucous secreted by the vaginal glands as it passes through. This hemor- rhage, as a rule, accompanies every ovulation as long as the ovum is not fertilized, recurring at intervals of four weeks until reproductive activity is over, which usually happens between forty and fifty years of age. If fertilization takes place, however, ovulation and menstruation cease until after delivery, and in many cases they are also absent as long as the child is de- pendent upon its mother for nourishment and the mammary glands are secreting. The cause of menstruation is not yet understood. All that we do know in regard to it at present is that it is in some way connected with ovulation and that it usually, though not invariably takes place at the same time. Menstruation exerts a marked influence upon the lives of girls and women and its relation to health is of such importance that it is important they should understand all the facts in regard to it. Much harm REPRODUCTION 99 has been done in the past by ignorance of the real facts concerning it and even more by profane and old wives' fables circulated in regard to it. In order, therefore, that the facts may be fully understood in their right relations, the next chapter is devoted ex- clusively to the subject. CHAPTER V MENSTRUATION Age of first menstruation — Influences affecting its appear- ance — Length of interval between periods — Duration of periods — Amount — Care of health during menstruation — Dysmenorrhea — Amenorrhea — Menorrhagia. I Menstruation is the name given to the discharge of mucous and blood that takes place from the uterus at regular intervals during the reproductive period of a woman's life. We do not yet understand its cause. All that we do know about it at present, as was said in the last chapter, is that it is closely associated with the process of ovulation and usually, though not in- variably, takes place at the same time. The appearance of menstruation shows that the re- productive organs have reached maturity and begun the exercise of their function. There is no fixed age for its establishment, or rather for the establishment of ovulation, which it represents, since they both de- pend upon the development of the reproductive system, and this is influenced by various causes. Climate and race are among these influences, the women of warm ioo MENSTRUATION 101 southern countries coming to maturity, as a rule, ear- lier than those in the colder northern climates. In the United States the average age for menstruation is a little over fourteen, but there are many cases in which it is earlier or later than this. It is a matter of common observation that menstruation is apt to ap- pear at about the same time in different members of the same family, and that it generally begins at the same age in mothers and daughters. Consequently, whenever it has been unusually early or late in one generation, it may be expected to be so in the next. But of all the conditions that influence the age of first menstruation, stimulation of the nervous system and the state of the general health are the most power- ful. Any circumstance in a girl's life that stimulates the mind or the emotions is likely to favor early' men- struation. City girls generally menstruate earlier than country girls, because they live under conditions of higher pressure and are exposed to the forcing ef- fects of constant notice, social intercourse, and all the pressure of an over-full life. The age of first men- struation is also influenced by the condition of the gen- eral health, that is to say, it is apt to be delayed in cases where the health is below the proper standard. In girls of the poorer classes, who are habitually over- worked and underfed, it almost always appears later than in those in more comfortable circumstances. Owing to the presence or absence of these various 102 GIRL AND WOMAN influences, the appearance of menstruation varies over a limit of some years, and while the average age is about fourteen years, it may appear as early as eleven or as late as eighteen, without any reason for anxiety. Over-early menstruation is a matter for regret, however, because the periodical loss to the blood-mak- ing system is a drain upon the strength, and even more because it shows a premature physical development; but there is no reason for fancying that it indicates the presence of disease in the organs concerned. On the contrary, the early establishment of menstruation shows that the reproductive powers are unusually strong and vigorous. Delay in first menstruation usually proceeds from depreciation of the general health, resulting in retarded development of every kind, the condition making itself known by pallor, loss of flesh, and all the customary signs of impaired health. That the menstrual func- tion should not appear under these circumstances is no reason for uneasiness ; on the contrary, it is a thing for which to be thankful, because it saves the vital powers from a tax upon their resources which they are not in a condition to support. The absence of the function may, however, be taken as evidence that the general health requires attention. There are a few rare cases where menstruation fails to appear at the customary age, because the reproduc- tive organs are imperfectly developed. When this MENSTRUATION 103 happens, the general health shows no sign of depre- ciation, in fact, it may be actually robust, but the usual indications of approaching physical maturity are ab- sent. When menstruation does not appear at the age at which it might reasonably be expected, the family doctor ought to be consulted, but there is no occasion for seeking the advice of a specialist (unless the doctor recommends doing so) and on no account whatever should medicine be given to stimulate the How. It cannot possibly do good and it may do a great deal of harm. There is only one condition in which the failure of the menstrual function to appear at the usual age need cause anxiety and this is when the non-appear- ance is due to the presence of mechanical obstruction. This condition is of extreme rarity, but when it does exist it is easily recognized and should never be neglected. It may be suspected when attacks of pain in the abdomen accompanied by headache and, per- haps, bleeding at the nose, appear at about the time menstruation might be expected and recur at intervals corresponding, in a rough way, to the periods. The physical signs of puberty are also present. A special- ist ought to be consulted without delay, for neglect may result in serious consequences and the treatment should be carried out only by a specialist. The period of life at which ovulation and men- struation begin is called puberty. It is the most im- 104 GIRL AND WOMAN portant phase in the development of girlhood and re- quires the utmost care, both physically and mentally. The daily life at this time should be as regular and healthy as possible. Food ought to be abundant and nourishing but simple, and it is a great mistake to al- low the use of tea or coffee or any other stimulant habitually. As many hours of the day as possible should be passed in the open air. A girl at this age (from twelve to fifteen) usually spends her morn- ings in school, but her afternoons ought not to have any claim upon them which interferes with her being out of doors until dark. If she goes to a school that has two sessions, she must spend all the time between them, not occupied with dinner, out of doors, as well as any daylight that remains after the second session closes. Her work at school must be carefully watched, and if she shows signs of more than passing fatigue, it must be lessened, no matter whether her standing in class is injured or not. This .question is fully considered in the discussion of education, for it is one of great importance. Above all things, there must be abundance of sleep. This is a point upon which a girl's necessities are not always appreciated. Everyone agrees that a child ought to be in bed by nine o'clock at the latest, but unfortunately there is a com- mon impression that about the time a little girl enters what are called her " teens," she is getting old enough to do with less sleep and may, therefore, go to bed MENSTRUATION 105 later. But this is exactly the time when she is begin- ning to grow most rapidly and her physical necessities as regards every kind of nutrition are greater than at any other time in her life. Her mind is developing in all directions, and most significant of all, her sexual system is just reaching maturity and her nervous sys- tem is more or less disorganized in consequence. In fact, it is only necessary to consider these things to perceive that this is no time to curtail her allowance of sleep any more than her allowance of food. Her nervous system, in particular requires frequent periods of repose, because if it is unduly stimulated, there is risk of over-early maturity, and nothing protects the nervous system so effectively as abundance of healthy sleep. Amusement and pleasure are not only desirable, but really necessary at this time in life, when the mind and body are charged with activity ; but they ought to be of a kind suited to their undeveloped condition. Enter- tainments that keep a girl up until midnight and later must not be allowed except on the rarest occasions. To put the matter in a few words, the more the life of a girl during the period of puberty resembles the life of the child before the period began, the better for body and mind. She cannot of course, live exactly as- she did in her childhood, for her mind is developing fast and her position in the world around her is chang- ing rapidly; but the kindest and wisest thing that can 106 GIRL AND WOMAN be done for her is to encourage her to do so as far as possible. The general health at puberty is sometimes good ; in other cases more or less upset. The strain upon the physical powers caused by the establishment of the re- productive functions is more in some instances than can be borne without some degree of failure. This temporary weakness of the bodily powers takes vari- ous forms, according to individual constitution. The only thing which can be done is to exercise patience and good sense. All the different means of improv- ing the general health, including medical advice, should be tried, and this being done, it is safe to trust that everything will come right in the end. From time immemorial the interval between the menstrual periods, that is to say, between the periods of ovulation, has been accepted as twenty-eight days, or one lunar month. This apparent connection be- tween the return of the function and the changes of the moon has caused the belief among uncivilized peo- ple that it is under the moon's influence. In a few rare cases the regular interval is more or less than four weeks, but these are most unusual. In one analysis of a thousand cases of menstruation in healthy women, it has been found that the interval was twenty- eight days in 942 cases, while out of the remaining 58 the interval was twenty-one days in more than half. In other words, the twenty-eight-day type existed in MENSTRUATION 107 over nine-tenths of the cases, and of the variations upon it, the twenty-one-day type was by far the most frequent. Four weeks then, may be accepted as the regular interval. If another type is established in the begin- ning and continues regularly without disturbance of health, it is normal in that particular instance ; but such exceptions are very rare. In this respect, as in the age of first menstruation, family peculiarities assert them- selves strongly, and any variation from the established custom in one generation will probably appear in the next. During the first years of menstruation, the interval between the periods is apt to be irregular, because the development of the organs is not complete nor is the function fully established. Sometimes these early ir- regularities are considerable. For example, after the first period, there may be no return of the function for six months, or even a year. Permanent regularity is sometimes established in the course of a few months; in other cases it takes two or three years; in a few instances the function is perfectly regular from the beginning. After regularity is once established there ought not to be more than a few days' variation in one direction or the other. But trivial irregularities of a day or two are not at all uncommon and there is no reason whatever for uneasiness on their account. Their cause is not understood, but it probably lies in io8 GIRL AND WOMAN some influence of the central nervous system. With some women these irregularities occur constantly all through menstrual life; with others, the function re- turns regularly almost to the hour as long as it con- tinues. Some of the books written on the subject for the general public lay far too much stress upon the necessity of absolute regularity to health, which is a pity, because it is apt to excite needless anxiety in re- gard to trivial variations. In married women menstruation ceases, as described in the last chapter, whenever an ovum is fertilized, and does not return until after delivery. The duration of the menstrual period differs in dif- ferent women, that is to say, each woman has her own individual standard which may be several days longer or shorter than that of another woman. The time may be as short as twenty-four hours and as long as seven days. But both of these types are extreme and exist in only a few cases. The usual time is from two to six days, four to five days being the most common type. Whatever duration is established in each indi- vidual instance is the proper thing for that particular girl. Irregularity in the length of the period is of more consequence than irregularity in the intervals between them, and merits more attention. The amount of the menstrual discharge also varies greatly in different women, what is normal for one be- ing excessive for another, or deficient for a third. MENSTRUATION 109 One fact, however, which is the same in all cases, is that the greater part of the flow is during the first two days, so that there is not so much difference as might be imagined between cases lasting three or four, and those lasting six or seven days. To estimate the exact amount of menstruation is very difficult; in fact it is impossible to do so with absolute accuracy, but the common way of estimating by the number of protec- tives used, rough as it is, answers the purpose fairly well. Speaking generally, it may be said that if more than two in twenty-four hours are really needed, the flow is too free ; but there are many exceptions to this standard with women in perfect health. The import- ant point, however, is not so much the actual amount as the presence of increase or decrease from estab- lished custom in any individual case, and this fact is easily determined by the usual mode of estimating. If the number of protectives employed is more than is customary for one or two successive periods, the rea- son for the change should be investigated. In young girls it will almost always be found in some disturb- ance of the general health. Care of the general health at the menstrual period during girlhood is most important, especially while the function is becoming established, but this does not mean that it is necessary for a healthy girl to upset the usual routine of her life. Theoretically, of course, a girl ought not to know any difference, as far as her no GIRL AND WOMAN sensations are concerned, between the menstrual periods and the intervals between them, but practi- cally such a state of things is uncommon, especially among Americans. The rush and pressure of our modern life, with all its varied demands upon the in- telligence and the senses, has made our nervous sys- tems more sensitive than they ought to be, even when the general health is good, and as a result, the process of ovulation is generally accompanied by more or less nervous excitement, which expresses itself in pain and discomfort associated with menstruation. The amount and the nature of the disturbance vary with different persons, and even with the same person at different times, but not many women escape alto- gether. The proportion of cases entirely free from suffering or discomfort has been recently investigated by a German woman, Miss Tobler, who found that out of one thousand women and girls whom she ques- tioned on the subject, only sixteen per cent were alto- gether free from discomfort of any kind. The disturbance accompanying menstruation may be local, that is, situated in the region of the uterus and ovaries, or it may be reflex, that is, reflected to some other part of the body. It may vary from the most trivial discomfort to acute suffering. In what might be considered an average case, there is more or less pain in the lower abdomen, extending down the limbs, with languor and nervous irritability, and, pos- MENSTRUATION in sibly, some headache. Usually the disturbance begins a little before menstruation appears and passes off as the flow, which is apt to be scanty at first, becomes more free. Sometimes, instead of local pain, there is severe headache and marked excitement or else de- pression. In a normal case these symptoms are not severe enough to incapacitate a girl ; indeed, if they are, the case is not normal. Care is required at the periods mainly from motives of prevention, for, as all the dis- comforts attending the function are due to disturbance of the central nervous system, it is the nervous system which requires relief from strain at these times, and if period after period passes without any measures be- ing taken for rest and relief, the nerves will almost certainly become unduly sensitive, after which the suffering at the periods is very severe. A girl her- self is not, of course, sufficiently informed at the 1 time menstruation begins to comprehend the necessity for care, nor the best means of taking it; it is her mother upon whom this responsibility must rest. But sometimes it happens that, with the best intentions, a mother may err from a lack of the requisite knowl- edge. She may advise too little care, because she is honestly persuaded that it is best to take as little no- tice of the matter as possible; but more often, she will go to the other extreme and pay too much attention to it.