April
1895.]
JOUBERT ON THE INFLUENCE OF TROPICAL CLIMATE, ETC.
?rtgiual iommttitipftuus. \/ THE SUPPOSED INFLUENCE OF TROPICAL CLIMATE ON MENSTRUATION.* Bv Surgn.-Lieut.-Col. C. H. Joubert, m.b., f.r.c.s, i.m.s.
There always seems to have been an impression in the mind of the medical profession that residence in tropical climates causes menstruation to appear at an earlier age than in temperate climates. Most text-books merely repeat the statement without comment. Playfair, however, in the 7th Edition of his " Science and Practice of Midwifery," says that the influence of climate has been unduly exaggerated, and it is my object in this short paper to bring forward some facts in support of this statement. In collecting information on the subject we are met at once by the difficulty that we have to rely upon the statements of women themselves as to the date, or age rather, at which they commenced to menstruate, and their statements are merely founded upon memory. The age fixed, therefore, must always be approximate only, not absolutely But when we take the statements of correct. a large number, we may fairly assume that we get somewhere near the truth." Some years ago, I commenced recording at the Eden Hospital for Women, Calcutta, the personal statement of every woman admitted as to the age at which she commenced to menstruate. During the same period I also made notes of the same fact in a good many cases of patients in my private practice. The period covered by these observations is for about four years up to the middle of 1894. Some of my records were made use of by my friend and pupil, Dr. Kader Natli Dass, for some statistics supplied " bv him, which have appeared in Davidson's Hygiene and Diseases of Warm Climates." In my table the Europeans are all from my private patients who, I passed their youth and personally ascertained, The adolescence in Europe. Europeans, countryborn, are chiefly hospital cases, amongst whom may be a few Europe-born persons, but not sufficient to affect the percentage materially. In collecting the numbers from the hospital records doubtful cases were
excluded.
On examining the table at the end of this paper, it will be at once noticed that there is very little difference in the percentages for the various ages between the Europeans and the country-born Europeans, who have lived all their lives under the influence of a tropical climate, so little differwhether ence that the question at once arises as to there has been any influence at all. In the next class, that of Eurasians, a difference is at once noticeable, the type approaching that but of natives between the ages of 12 to 14 years, direction of the European the in diveroing again between the ages of 14 to 16 years.
type *
Read at the Indiau Medical Congress,
uecemner
iw*.
In the class of pure natives,
129
Hindoos and
Mahommedans, but chiefly the former, the greatest percentage of dates of first menstruation occurs
between the 12th and 14th year, amounting to G5'7 of the whole class. The number of Jewesses observed is small, but it will be observed that the menstrual type resembles that of the European and country-born European. If the figures in my table be allowed to be approximately correct, the only conclusion we can come to, is that residence in a tropical climate during youth and adolesence has not the marked effect in causing early menstruation which was formerly attributed to it, and we must seek for some other cause influencing the native races of India and to a lesser degree the Eurasian of mix-
ed native and European parentage. Failing the influence of climate, we may enquire into the social customs of the different races, and here I think we touch the true cause of precocious menstruation. European women are rarely married before their 18th year, and more often much later. It is the earnest endeavour also of all European parents to keep their children ignorant on the subject of sexual matters till they are grown up. Many English women marry in perfect ignorance of what marriage means and with only a very hazy idea on the subject of child-bearing. We need not discuss whether this is right or wrong, but it O7 certainly is very wise and proper that children should be kept ignorant of the facts of sexual relations. There can be no question whatever as to the difference in the amount of knowledge upon this point possessed between the majority of European children and all Oriental children. Now, what are the social customs of the races of India which constitute this difference ? First and foremost I would place the absolute want of privacy in the inner mode of life of an Indian native household. There is of course, very rigid seclusion of the female inmates and children from the outer world in general, but there is, what I may term, an absolute want of domestic privacy. I have for many years past seen a good deal of the inner life of native houses during professional visits. What has always struck me very forcibly is the utter want of restraint with which the ailments and most private concerns of women sick, suffering from female complaints or the conditions peculiar to child-birth and pregnancy are discussed by the whole family in the presence of children who are just old enough to understand the subject of conversation. Indeed, times without number, when I have had to examine a pregnant or lyingin-woman, I have had to ask for the children and youths of both sexes, who crowd in to see what is going on, to be sent away. Never once have I found that it has struck any grown-up member of the household that the presence of the children was improper, and that they would see and hear things that they had better not know. Indeed, I ?
1
?
?
17
_
*30
INDIAN MEDICAL GAZETTE.
have often been told that it is unkind of want the children to be sent away and
to their
[April
1895.
third year after marriage, when she is finally sent to her father-in-law's house to perform the duties natural curiosity restrained. In the large joint of a wife and daughter in her new home. Daring families so common out here, child-birth in the this period menstruation has commonly commenced, house is of common occurrence, and I do not and the girl may have reached her 13th or 14th year. think I am going too far when I say that I doubt The commencement of menstruation is usually if there are any little boys or girls, in native made the occasion of a festival in the family. It houses in this country who have reached the age is considered a sin for intercourse to take place of 10 years who do not have a very fair know- before the appearance of menstruation, but it is a ledge of what the sexual relations and child-bear- matter of fact that, during the two or three years ing really mean. I hope my Indian friends will that the girl passes in her own father's home after not misunderstand me. I am merely stating marriage, the husband is allowed to pay frequent what I believe to be a fact from what I have visits to his wife and to pass the night with her. observed of their domestic habits. It appears, however, that frequently the bride is Now, what can be the result of all this, but sent to the husband's house after the 8th day, undue sexual precocity as regards knowledge. there to remain permanently. But this might not be sufficient to account for Now, is it surprising, with all this amount of precocious menstruation, so we may go further sexual excitement, combined with knowledge, and inquire into what effect the marriage cus- that the result is the early appearance of the toms in this country have. menses, when you compare with this the different A Hindu friend and confrere of mine has life between the ages of 13 and 10 years of supplied me with some interesting notes on European and many Eurasian children? Then Hindu marriage customs. The Hindu shastras certainly the Europeans are hard at work with (religious laws) order that a girl shall be married their lessons or their innocent games, and nothingbefore she has passed her 10th year, the non- is more remote from their lives and knowledge than observance of the law being a sin. If, however, the relations of the sexes, whereas the native female a suitable husband cannot be obtained, the shastras child lives in an atmosphere of sexual excitement, permit the postponement of the marriage of the and apparently often is exposed to the possibility of girl till one can be found. The Kulin Brahmans sexual intercourse?authorised perhaps by native in Bengai take advantage of this permission, as customs, but illegal according to the present laws, suitable husbands for their girls are not easy to and improper certainly from a moral point of view. find, and they often postpone the marriage of Native Christians and other natives belonging their girls till quite late. Want of means to meet to the Brahmo Somaj marry their girls late. I the heavy marriage expenses often in other castes have not been able to procure any statistics as to and also the former, but Dr. Bolye Chunder Sen in his causes postponement of the ceremony, the fear of the child being left a widow at an early paper on the "Nubile Age of Females in India" age. But in any case, except the Kulins, it is published the facts connected with 65 members of rarely postponed beyond the 12th year. As the Brahmo community. Of these 44*6 per cent, menstruated for the first time between 13 and 14 regards the details of the marriage, I am informed, and 400 per cent, between 14 and 15 years of ao-e. that the following are the usual customs : After With reference to the effect of sexual interthe religious ceremony performed after sunset, course the bridegroom and his child-bride are ritually previous to menstruation, Dr. Jogendra tied together bv knotting a corner of his scarf to Nath Ghose has given me the facts relating to 40 such cases. In these cases the first menses a corner of her sari, and they are conducted to a room where they pass the night in company with appeared in the 10th year in 2 cases: in the 11th the women of the household and other female year in more than half; in the 12th year in rather less than half; in the 13th year in one case only. relatives and friends. The next day the bride We have still to consider the facts as regards is carried to her father-in-law's house, and on the second night the husband and wife are not Eurasians noted in my table. It will be noticed allowed to see each other. The third night, that for the ages of 12 to 13, 13 to 14 and 14 to however, is the night of the phulsujya or flower- 15 the percentages are 22*0, 31*8 and 22*0, bed," and the young pair are allowed to sleep respectively, occupying an intermediate position together, but still, however, under the eye of the between the pure Europeans and the pure natives. The figures apply chiefly to hospital cases, women of the household, and this goes on till the 8th night. Since the passing of the Age of Consent Eurasians of the poorer classes living in Calcutta. Act, however, the third night is often the only one Their habits are more those of natives than of Eurospent theoretically alone. It is not difficult to peans, and they live in large families with the same imagine the amount of sexual excitement produced complete absence of domestic privacy. Their in the girl by these customs, even if actual congress children are of necessity early acquainted with does not take place. the facts of sexual life. Early marriage is very On the 9th day the bride is taken back to her common among them, though probably rarely father's house to remain there till the second or before the first menstruation. me
April
v
1895.]
NOTT ON A SPECIAL SANITARY SERVICE FOR THE MUFASAL.
If the records at the Eden Hospital are kept up for a number of years on the lines I have inaugurated, I think that in time a sufficiently large number of facts will be recorded to put this question at rest. The conclusion I have come to is that it is not the residence in a tropical climate which determines early menstruation but precocious knowledge and too early sexual excitement. '1YXOJ,
?qnaa .xaj o
?jaqran^j !>?
1895.]
JOUBERT ON THE INFLUENCE OF TROPICAL CLIMATE, ETC.
?rtgiual iommttitipftuus. \/ THE SUPPOSED INFLUENCE OF TROPICAL CLIMATE ON MENSTRUATION.* Bv Surgn.-Lieut.-Col. C. H. Joubert, m.b., f.r.c.s, i.m.s.
There always seems to have been an impression in the mind of the medical profession that residence in tropical climates causes menstruation to appear at an earlier age than in temperate climates. Most text-books merely repeat the statement without comment. Playfair, however, in the 7th Edition of his " Science and Practice of Midwifery," says that the influence of climate has been unduly exaggerated, and it is my object in this short paper to bring forward some facts in support of this statement. In collecting information on the subject we are met at once by the difficulty that we have to rely upon the statements of women themselves as to the date, or age rather, at which they commenced to menstruate, and their statements are merely founded upon memory. The age fixed, therefore, must always be approximate only, not absolutely But when we take the statements of correct. a large number, we may fairly assume that we get somewhere near the truth." Some years ago, I commenced recording at the Eden Hospital for Women, Calcutta, the personal statement of every woman admitted as to the age at which she commenced to menstruate. During the same period I also made notes of the same fact in a good many cases of patients in my private practice. The period covered by these observations is for about four years up to the middle of 1894. Some of my records were made use of by my friend and pupil, Dr. Kader Natli Dass, for some statistics supplied " bv him, which have appeared in Davidson's Hygiene and Diseases of Warm Climates." In my table the Europeans are all from my private patients who, I passed their youth and personally ascertained, The adolescence in Europe. Europeans, countryborn, are chiefly hospital cases, amongst whom may be a few Europe-born persons, but not sufficient to affect the percentage materially. In collecting the numbers from the hospital records doubtful cases were
excluded.
On examining the table at the end of this paper, it will be at once noticed that there is very little difference in the percentages for the various ages between the Europeans and the country-born Europeans, who have lived all their lives under the influence of a tropical climate, so little differwhether ence that the question at once arises as to there has been any influence at all. In the next class, that of Eurasians, a difference is at once noticeable, the type approaching that but of natives between the ages of 12 to 14 years, direction of the European the in diveroing again between the ages of 14 to 16 years.
type *
Read at the Indiau Medical Congress,
uecemner
iw*.
In the class of pure natives,
129
Hindoos and
Mahommedans, but chiefly the former, the greatest percentage of dates of first menstruation occurs
between the 12th and 14th year, amounting to G5'7 of the whole class. The number of Jewesses observed is small, but it will be observed that the menstrual type resembles that of the European and country-born European. If the figures in my table be allowed to be approximately correct, the only conclusion we can come to, is that residence in a tropical climate during youth and adolesence has not the marked effect in causing early menstruation which was formerly attributed to it, and we must seek for some other cause influencing the native races of India and to a lesser degree the Eurasian of mix-
ed native and European parentage. Failing the influence of climate, we may enquire into the social customs of the different races, and here I think we touch the true cause of precocious menstruation. European women are rarely married before their 18th year, and more often much later. It is the earnest endeavour also of all European parents to keep their children ignorant on the subject of sexual matters till they are grown up. Many English women marry in perfect ignorance of what marriage means and with only a very hazy idea on the subject of child-bearing. We need not discuss whether this is right or wrong, but it O7 certainly is very wise and proper that children should be kept ignorant of the facts of sexual relations. There can be no question whatever as to the difference in the amount of knowledge upon this point possessed between the majority of European children and all Oriental children. Now, what are the social customs of the races of India which constitute this difference ? First and foremost I would place the absolute want of privacy in the inner mode of life of an Indian native household. There is of course, very rigid seclusion of the female inmates and children from the outer world in general, but there is, what I may term, an absolute want of domestic privacy. I have for many years past seen a good deal of the inner life of native houses during professional visits. What has always struck me very forcibly is the utter want of restraint with which the ailments and most private concerns of women sick, suffering from female complaints or the conditions peculiar to child-birth and pregnancy are discussed by the whole family in the presence of children who are just old enough to understand the subject of conversation. Indeed, times without number, when I have had to examine a pregnant or lyingin-woman, I have had to ask for the children and youths of both sexes, who crowd in to see what is going on, to be sent away. Never once have I found that it has struck any grown-up member of the household that the presence of the children was improper, and that they would see and hear things that they had better not know. Indeed, I ?
1
?
?
17
_
*30
INDIAN MEDICAL GAZETTE.
have often been told that it is unkind of want the children to be sent away and
to their
[April
1895.
third year after marriage, when she is finally sent to her father-in-law's house to perform the duties natural curiosity restrained. In the large joint of a wife and daughter in her new home. Daring families so common out here, child-birth in the this period menstruation has commonly commenced, house is of common occurrence, and I do not and the girl may have reached her 13th or 14th year. think I am going too far when I say that I doubt The commencement of menstruation is usually if there are any little boys or girls, in native made the occasion of a festival in the family. It houses in this country who have reached the age is considered a sin for intercourse to take place of 10 years who do not have a very fair know- before the appearance of menstruation, but it is a ledge of what the sexual relations and child-bear- matter of fact that, during the two or three years ing really mean. I hope my Indian friends will that the girl passes in her own father's home after not misunderstand me. I am merely stating marriage, the husband is allowed to pay frequent what I believe to be a fact from what I have visits to his wife and to pass the night with her. observed of their domestic habits. It appears, however, that frequently the bride is Now, what can be the result of all this, but sent to the husband's house after the 8th day, undue sexual precocity as regards knowledge. there to remain permanently. But this might not be sufficient to account for Now, is it surprising, with all this amount of precocious menstruation, so we may go further sexual excitement, combined with knowledge, and inquire into what effect the marriage cus- that the result is the early appearance of the toms in this country have. menses, when you compare with this the different A Hindu friend and confrere of mine has life between the ages of 13 and 10 years of supplied me with some interesting notes on European and many Eurasian children? Then Hindu marriage customs. The Hindu shastras certainly the Europeans are hard at work with (religious laws) order that a girl shall be married their lessons or their innocent games, and nothingbefore she has passed her 10th year, the non- is more remote from their lives and knowledge than observance of the law being a sin. If, however, the relations of the sexes, whereas the native female a suitable husband cannot be obtained, the shastras child lives in an atmosphere of sexual excitement, permit the postponement of the marriage of the and apparently often is exposed to the possibility of girl till one can be found. The Kulin Brahmans sexual intercourse?authorised perhaps by native in Bengai take advantage of this permission, as customs, but illegal according to the present laws, suitable husbands for their girls are not easy to and improper certainly from a moral point of view. find, and they often postpone the marriage of Native Christians and other natives belonging their girls till quite late. Want of means to meet to the Brahmo Somaj marry their girls late. I the heavy marriage expenses often in other castes have not been able to procure any statistics as to and also the former, but Dr. Bolye Chunder Sen in his causes postponement of the ceremony, the fear of the child being left a widow at an early paper on the "Nubile Age of Females in India" age. But in any case, except the Kulins, it is published the facts connected with 65 members of rarely postponed beyond the 12th year. As the Brahmo community. Of these 44*6 per cent, menstruated for the first time between 13 and 14 regards the details of the marriage, I am informed, and 400 per cent, between 14 and 15 years of ao-e. that the following are the usual customs : After With reference to the effect of sexual interthe religious ceremony performed after sunset, course the bridegroom and his child-bride are ritually previous to menstruation, Dr. Jogendra tied together bv knotting a corner of his scarf to Nath Ghose has given me the facts relating to 40 such cases. In these cases the first menses a corner of her sari, and they are conducted to a room where they pass the night in company with appeared in the 10th year in 2 cases: in the 11th the women of the household and other female year in more than half; in the 12th year in rather less than half; in the 13th year in one case only. relatives and friends. The next day the bride We have still to consider the facts as regards is carried to her father-in-law's house, and on the second night the husband and wife are not Eurasians noted in my table. It will be noticed allowed to see each other. The third night, that for the ages of 12 to 13, 13 to 14 and 14 to however, is the night of the phulsujya or flower- 15 the percentages are 22*0, 31*8 and 22*0, bed," and the young pair are allowed to sleep respectively, occupying an intermediate position together, but still, however, under the eye of the between the pure Europeans and the pure natives. The figures apply chiefly to hospital cases, women of the household, and this goes on till the 8th night. Since the passing of the Age of Consent Eurasians of the poorer classes living in Calcutta. Act, however, the third night is often the only one Their habits are more those of natives than of Eurospent theoretically alone. It is not difficult to peans, and they live in large families with the same imagine the amount of sexual excitement produced complete absence of domestic privacy. Their in the girl by these customs, even if actual congress children are of necessity early acquainted with does not take place. the facts of sexual life. Early marriage is very On the 9th day the bride is taken back to her common among them, though probably rarely father's house to remain there till the second or before the first menstruation. me
April
v
1895.]
NOTT ON A SPECIAL SANITARY SERVICE FOR THE MUFASAL.
If the records at the Eden Hospital are kept up for a number of years on the lines I have inaugurated, I think that in time a sufficiently large number of facts will be recorded to put this question at rest. The conclusion I have come to is that it is not the residence in a tropical climate which determines early menstruation but precocious knowledge and too early sexual excitement. '1YXOJ,
?qnaa .xaj o
?jaqran^j !>?
