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First Blood: A Cultural Study of Menarche

Chapter 1

OF BLOOD AND BLEEDING

In the introduction, two very different instances of the same physiological event were presented. One was a public celebration of a private experience, the other a miserably lonely private discovery. The public ceremony was part of indigenous culture and the private recognition reflected the Anglo-Australian tradition of learned silence surrounding bodily processes beyond infancy and early childhood. In both cases, the common factor was bleeding. Therefore, before the voices of the interviewees are introduced I want to provide an overview of the major historical influences that shape ideas about blood, particularly the blood of menarche and menstruation. This will enable a wider understanding of statements made by interviewees from predominantly non-English-speaking backgrounds, whose experiences of menarche pre-date access to knowledge through electronic technology and social media.

Outside of the medical sciences, what do we know about blood and bleeding? This word blood, with its female connotations, arises from Nordic and Saxon through Old English, and relates to women’s domestic environment and their emotions. It is a word invoking the way in which we think of our bodies, from the earliest childhood horror of a bleeding cut to the adult dread of the bleeding disease, Ebola. Universally we learn that blood is part of life, invisible within the body boundaries, and that its visibility signifies injury or disease and perhaps even death. Menarche, therefore, is a paradox. It is uniquely a blood loss associated with health and an indicator of potential life, yet its meaning has in many ways been constructed in opposition to the reality.

Western understanding of blood and bleeding began in Classical Greece, with the most significant scholars of human physiology being the Hippocratics and Aristotle. The Hippocratics were a diverse group, most of whom practised medicine, although not necessarily of Hippocrates’ school or even within Hippocrates’ lifetime. They wrote over a lengthy time span, from the second half of the fifth century to the mid-fourth century BCE, contributing to a corpus of approximately 60 treatises, of which 10 are gynaecological.1 Their knowledge and understanding of the body and its processes was constructed without dissection but with certain extrapolations from animal carcasses. As a result the Hippocratics believed women’s bodies were made up of mammary-like glands, spongy and absorbent, capable of soaking up and retaining far more fluid than male bodies, and that this moistness characterised the principal difference between the sexes.2 They constructed ideas of women’s internal processes through observation of external mammary and menstrual signs; their theories of menstrual blood consistency, amount and duration were shaped by existing societal ideas of women.3

Menarche, according to the Hippocratics, confirmed the closing stages of puberty. Until then they considered girls to be similar to boys. Physiologically, the bodily changes in a young girl were thought to be caused by significantly increased blood made from food intake during the early adolescent growth spurt. When this ceased, and less activity was undertaken, it became an excess to be evacuated through the lower internal structures of uterus or womb. As a result, the menarcheal girl’s body was, as classicist Lesley Dean-Jones suggests, a newly completed system of blood-hydraulics, continuously generating and discharging blood throughout reproductive life; the attached social meaning was that menarche visibly signalled the end of childhood.4 One of the three writers of the Hippocratic gynaecological treatise ‘Diseases of Women’ theorised the moment of menarche began when the veins supplying the uterus widened sufficiently to enable blood to actually flow.5

As a result of that moment, the young girl began to bleed, metaphorically paralleling ritual Greek animal sacrifice, in which blood that clotted quickly indicated good health in the animal and augured well for the health of the community. The Hippocratics believed clotting in menstrual blood indicated good health also, and Dean-Jones argues a sacrificial connotation to the menarcheal girl, who might now renew the body civic as well as her own.6 Understandably, problems arose if a girl passed 14 without beginning to menstruate, and this was taken to mean an obstruction to the passages. The girl’s health was thought to become compromised by the ever-increasing dangerous waste sealed inside her body, which would rise to the area around the heart, causing change to sensation and progressing to symptoms akin to epilepsy and finally causing potential suicide.7 The treatment for this perilous situation is prescribed in a text from the Hippocratic On the Diseases of Virgins:

Relief from this complaint comes when nothing impedes the flow of blood. I order parthenoi to marry as quickly as possible if they suffer this. For if they become pregnant, they will become healthy.8

Classicist Helen King examines the social and cultural context in which the Hippocratics constructed their ideas about women’s bodies. King considers that the problem of a non-bleeding young girl might be more her resistance to social pressure to marry and reproduce rather than her symptoms.9 A slightly different perspective is taken by classicist Helen Demand, who suggests that the cultural construction of early marriage as the cure for symptoms might have served to reconcile the girl to premature defloration at a time when fear and apprehension were attributes valued in brides by men.10 So although we understand the treatment to be within the parameters of social expectation we cannot know how the girl, as subject, responded. Her menarche, an intensely private event, would become a shared endeavour achieved belatedly through male intervention, by physician or husband, with her defloration and marriage accelerating the transition from the young, single but marriageable parthenos, to adult woman or gynê, which a first birth completed. Yet another diagnosis was that of blood trapped in immature, narrow blood vessels. The treatment for this was applications of warmth to dilate the vessels and bring about menarche.11 Assisting girls to bleed was significant in Classical Greek society. Men might shed blood in battle but girls bled to become women in menarche, menstruation, defloration and childbirth.12

Contrasting with the Hippocratics, Aristotle wrote as a sole author in the latter part of the fourth century BCE, adding to and adapting his biological theories over the years. He believed the physiological difference between men and women was female menstruation, and reasoned the monthly flow caused the body temperature in women to be cooler than in men. However, Aristotle, whose template of the human was male, qualified what he means by ‘women’:

Everything reaches its perfection sooner in females than in males – e.g. puberty, maturity, old age – because females are weaker and colder in their nature; and we should look upon the female state as being as it were a deformity, though one which occurs in the ordinary state of nature.13

Aristotle believed puberty began at 14, when menarche initiated the transition from girl to woman without confirming readiness for the adult role.14 He observes that female puberty was signalled by voice change, as in the male, and by breast development.15 Both semen and menstrual blood were thought to be residue from purified nourishment, but discharged menstrual blood was useless according to Aristotle, because it was fluid.16 In matters of reproduction Aristotle believed both men and women embodied the ‘principle’ of generation. The heat of the male body ‘concocted’ semen to contain the principle of ‘form’ or ‘soul’, the essence of a particular body.17 Females lacked the heat to ‘concoct’ and their colder bodies and narrower blood vessels prevented them from storing any over-supply of nourishment. Menstruation, therefore, was the excess and was inclined to occur with the waning moon at the colder time of the month.18 At conception, the female provided the material from menstrual fluid contained in the uterus, which semen acted upon in a similar manner to rennet setting warm milk, giving rise to the belief that menstrual fluid and milk were essentially identical. Once ‘set’, foetal growth was dependent on maternal blood from the uterine wall via the umbilical cord.19

Although medical practitioners were socially placed to be influential observers of women, that is, to help shape social practice regarding women, classicist M.K. Hopkins emphasises that their patients were more likely to come from upper socio-economic groups of their communities – those who could afford their fees.20 One such physician was Soranus, who had studied in Alexandria and practised in Rome in the early second century CE. He is remembered for his writings, including on gynaecology, and his methods of treatment were still being used into the 16th century due to continuing translation and compilation of his texts. Soranus’ ideas of women’s bodies and of menarche are interesting, not only because he learned through human dissection but because they allow comparison with the earlier Hippocratics.21 His observation of menarche is that it occurs ‘at the time of puberty’, rather than as its completion, as the Hippocratics believed. The age of menarche is ‘around the fourteenth year’, indicating recognition of individual variation, and the same principle is applied to the menstrual cycle, allowing a slight difference between women in cyclical timing but with regularity within the variation. Soranus refutes the notion that a waning moon influenced the start of menstruation and observed the amount of blood loss was affected by seasonal change, body weight and physical activity with a maximum of two cotyles, about 450 mls, also considered normal by the Hippocratics. Anaemia would seem a likely outcome until we remember that women were pregnant or lactating from a very early age, hence not bleeding, for a great part of their menstrual lives. Soranus believed in preparation of girls, at about 13, in advance of defloration. He recommended a form of pelvic rocking through passive swinging, together with walking, being massaged and bathed daily and being mentally occupied. For Soranus a relaxed mind and body encouraged an unproblematic menarche and puberty and he writes, ‘even if the body be changed for the better, all abruptness disturbs it through discomfort’. His ideas about the purpose of menarche-menstruation are not dissimilar from the excretory notions of the Hippocratics and Aristotle. He defines the purpose of the uterus as threefold: menstruation, conception and pregnancy. Soranus reasons menstrual blood ‘is useful for childbearing only’ as it becomes food for the embryo, otherwise it is excreted as ‘excessive matter’, beginning with menarche at about 14, signalling ‘this age then is really the natural one indicating the time for defloration’.22 In this, Soranus warns against the hazards of childbirth that premature defloration could cause. He strongly believed that menarche and defloration should occur together but that menarche should precede marriage.23

As we have seen, the age of menarche assumed great social significance in Classical Greece and Rome. Hopkins studied the average age of Roman girls at menarche citing the hypothesis of M. Durry, who extrapolated from work in North Africa that pre-pubescent marriage occurred among the Romans, that puberty was irrelevant to fixing an age of marriage and that marriage was consummated before menarche. Hopkins counters that although Rome c.400 CE had commonalities with the modern Western family, Roman understanding of marriage was dissimilar from that of today.24

Soranus wrote that menarche occurred at about 14. Not unreasonably, Hopkins queries whether girls from all social strata have been represented, pointing out the trend towards earlier menarche among the upper socioeconomic group, with their smaller families and adequate nourishment, compared with manual workers. He notes that studies of 19th-century Europe reveal a menarcheal age difference of two years between the two groups. Yet later Roman marriage laws, from the time of Augustus to about 530 CE, made 12 the legal age of marriage for girls, providing another complication to the accepted age of menarche. Does this mean an earlier menarche had become generalised or that Rome condoned pre-menarcheal marriage? Hopkins points out that the men girls married were considerably older and not necessarily known to them. One example is the daughter of Emperor Claudius, Octavia, who married at 11, although according to Roman lawyer Julian, marriage under 12 constituted engagement, regardless of the formalities, until the legal age was reached. When we read of family alliances being made and dowries being specified, the socio-economic reasons for the early marriage of girls become clearer. Soranus’ warning about early defloration and his exercises aimed at making a premature experience less traumatic both suggest that consummated pre-menarcheal marriage was not unknown.25

At the time of the Classical Greeks and Romans, other ideas about women’s bodies, menarche and menstruation were being constructed in China and India. Once again, the writers of surviving data were practitioners of medicine and, as social scientist and historian Michel Foucault observes, the physician’s gaze varies according to shifts in parameters of bodily orientation in differing historical periods.26 The same may be said of differing cultures and beliefs about women’s bodies.

In an explanation and commentary on Chinese medicine, medical researcher Ted K. Kaptchuk explains that the Huang Di Nei Jing, or Inner Classic of the Yellow Emperor (known as Nei Jing), are the oldest Chinese medical texts and the equivalent of the Hippocratic corpus, compiled by unknown male writers between 300 and 100 BCE.27 Chinese understanding of physiology is based on fundamental substances which include qi, blood and jing. Underlying these fundamentals is the idea of yin and yang, complementary opposition. They are neither forces, nor material beings, but systems of thought in which all things are part of a continuously changing whole.28 Blood is a yin substance and the end-process of food transformed by qi, a yang substance, which is then transported through the body by heart qi. Blood has close relationships with heart, liver and spleen, but is indissoluble from qi which creates, moves and holds it in place. In medieval China, blood was thought to be carried through blood vessels and meridians, the pathways being considered of less importance than the function.29 Meridians are not blood vessels but conceptual conduits symbolising a physical reality, carrying qi and blood through the body, regulating yin and yang, and linking all vital substances and organs.30 According to Kaptchuk, qi is sometimes translated as vital energy, but energy in Chinese thought is not distinguishable from matter. Qi, therefore, could be considered as matter on the brink of becoming energy, or vice-versa.31 The third fundamental substance is jing, which Kaptchuk defines as the essence of all organic life and organic transformation. Understood as fluid, jing is the source of reproduction and development: firstly as the prenatal inheritance from parents, determining growth and development, and secondly as a postnatal source derived from ingested food, which, once purified, provides prenatal jing with vitality to balance growth with energy, a process that moves through seven-year stages.32

In ancient China the uterus, known literally as ‘palace of the child’, is considered to be a curious, or peculiar, organ – yang in form, because it disperses rather than stores, but yin in function, storing rather than dispersing. Its functionality is subsumed under primary organs or meridians. As a result, menarche and menstruation cannot occur without the governing function of other organs, the liver, spleen or kidneys together with a conception and penetrating meridian, both thought to arise in the uterus.33 Thus, the Nei Jing states that women’s bodies develop in seven-year stages and the significance attached to the second stage, at 14, is the arrival of the jing Dew of Heaven, or menarche. In her study on gender in China’s medical history, Charlotte Furth points out that the menarcheal age, given as 14, is the age in sui, that is, calculated from conception. Menarche, then, was socially anticipated at 13 – but what did ancient Chinese believe menstruation was?

Menstruation was seen by early medieval Chinese physicians as a diagnostic guide to women’s internal body processes and general physiological condition according to Sabine Wilms. Medical practitioners believed that ‘in women, one first regulates Blood, in men, one first regulates qi’.34 Menstrual blood told the story of reproductive health and process. It was believed to nourish the foetus in pregnancy, then travel and transform to milk in lactation. Any blockage in the channels of transport were cause for concern, consequently a regular and copious flow reflected blooming health and balance.35 In this, Wilms could be describing the Hippocratics; so could the influential physician Sun Simiao, c.561–662 CE, who wrote of girls:

From the age of fourteen [sui] on, their yin qi wells up and a hundred thought s run through their minds, damaging their organ systems within and ruining their beauty without. Their monthly courses flow out or are retained within, now early, now late, stagnating and congesting Blood and interrupting the functions of central pathways. The injuries from this cannot be enumerated in words.36

At the time Sun wrote, the practice of medicine as ‘impersonal, constant, and rule governed’37 was confined to court in the imperial capital, and by no means representative of the many states. There are echoes with Classical Greece in written perceptions of girls and women and in the medicalisation of the menarcheal and menstrual process within the urban setting. Although the court had its share of women healers, according to Furth, we have no access to accounts by women of their experiences.38 We do know, however, that during the Song dynasty female desire was problematic in regard to puberty. There was concern about the effects of shifting balances of bodily forces on delicate girls’ bodies not yet ready for birthing, as signified by blushing. The influence of fifth-century CE court physician Chu Cheng, whom Furth maintains was somewhat of an early eugenicist, resulted in social proscription of sexual knowledge for a decade post-puberty, followed by marriage without delay. The exception was among upper-class girls, who continued to marry at a young age.39 As a result, the bodies of young women who lived in communities such as the Imperial Court were protected by the growing medical interest in their physiological conditions, which included reproductive capabilities, beginning at menarche.

India is the site of Ayurveda, the other great tradition in historic constructions of women’s blood and bodies, a system of ancient medical teachings believed to have been introduced to India in the time of the Buddha, c.450 BCE. In his translation and notes on the text, medical historian and Sanskrit scholar Dominik Wujastyk considers Ayurveda to be significant in many ways, one being the evolution of a unified set of ideas and practices from the many in existence. Written in Sanskrit by scholarly men, these texts formed the fundamental learning texts for the formal study of medicine, and they remain so today, supported by the Indian government.40 Central to the Ayurvedic construct of the body is digestion, or transformation of food into a vital essence known as rasa, which has some similarity with the Chinese concept of jing. There are two different texts that describe the attributes of rasa. In Suśruta’s Compendium, rasa moves through the body and, in an oppositional process reminiscent of yin and yang, drinks from the cooling fluid principle of Soma. When rasa meets the fiery principle contained in the kidneys and spleen, the fluid becomes reddened and, in women, transforms into menstrual blood. Therefore, menstrual blood is of a fiery principle. Thus:

The pure water in people’s bodies is dyed (raňjita) by the clear, fiery principle which is present in the body. For this reason it is called blood (rakta). A woman’s blood, which issues from the same nutritive juice, is termed ‘menstrual blood’. It starts in the twelfth year.41

The authorities who wrote the alternative version have blood formed through the shared principle of the five elements: earth, water, fire, air and space, characterised by a raw odour, fluidity, red colour, pulsation and lightness respectively. According to Wujastyk this version is not elaborated in the text, which returns to blood creation by a process of transubstantiation from purified digestive material that has become rasa. Blood is the first of the body matters to be generated, transubstantiating to flesh, and continuing until the final essence, that of semen, over the course of a cycle that takes one lunar month. Having argued there is no female equivalent, Wujastyk’s translation later positions menstrual blood as an end product parallel to semen, giving evidence of some recognised inconsistency in the texts.42

The Ayurvedic fables are cautionary tales built around a demoness and child-killer, Lady Opulence. They are contained in Kaśyapa’s Compendium, c. first millennium BCE, which advises on diseases of women and children and are intended as explanations for miscarriage and infant or child death, based on the notion that disease is due to evil conduct. One example is:

If a woman has not started to menstruate by the time she is sixteen, if her arms are scrawny and she has no breasts, then she is said to be ‘Parched Lady Opulence’.

This seems like a harsh labelling for a girl who might already be suffering socially from her absent menarche. Kaśyapa calls such young girls destroyers of menstruation and pronounces them incurable.43 We are not told their fate and there is nothing more about menarche in the translated texts. I believe the significance of this fable lies in the girl’s age and physical description, possibly caused by existing famine or disease.

Returning to Europe, the medieval era in Italy brought forward the mysterious Trotula, who lived in Salerno, about the 11th or 12th century CE. The authoritative Latin text On the Diseases of Women is attributed to her, as is her position as first female professor of medicine at Salerno. But is it all myth? Medical historian Monica H. Green writes that there were three texts, two anonymous, probably from Salerno, and one (the second, On Treatments for Women) thought to have come be written by Trota, a woman midwife or healer. The three texts were compiled into one late in the 12th century and titled Trotula, meaning ‘little Trota’. According to Green, the texts are significant because they demonstrate developing the theories on women’s physiology and the spreading influence of Arabic medicine in Europe, as well as giving indications of how women understood themselves and their bodies within the medical framework of the time.44 Medical historian Charles Singer is scathing, relegating Trotula to the English nursery as Dame Trot and arguing that Trottus was a male doctor at Salerno whose collected works, of origins far earlier than the Middle Ages, were known as the Trotula. Singer maintains that the content of the work suggests a male author with a propensity for invasion of the private female space.45

Trotula’s woman is cold and moist, a combination of the Hippocratic and the Aristotelian, with reference made to the Hippocratics. Increasingly weak, she is a victim of repeated pregnancies and gynaecological disease. Her menarche, or ‘flowers’ as people referred to menstruation, occurred at about 13 years, and the timing is attributed to her body heat or coldness.46 However, Green asserts that since age given for medieval menarche is prescribed, it is historically unreliable, although she also refers to a 15th-century Dutch translation of Trotula which states ‘and it comes to some at their sixteenth years and to some at their ninth year’, indicating considerable variation existed.47 Trotula’s explanation for menstruation is that women lack the heat to dry out bodily fluid for excretion as sweat, in the manner of men. Their innate weakness prevents them labouring sufficiently hard to create enough heat, thus menstruation compensates, recurring regularly to empty out waste. Like the Hippocratics, Trotula regards a heavy blood flow as cleansing and synonymous with health but associates irregularity in flow with sickness.48

In late medieval England the influence of the Christian church brought about a shift in conceptualising the lives of young girls who, under medieval canon law, reached the age of consent at 12,49 the age when the Virgin Mary experienced her menarche.50 Symbolised as the Virgin Mother of Jesus Christ, representations of Mary in text and image depicted her as beautiful young woman and served to popularise the model of maidenhood as a virtue.51 Maidenhood was, according to historian Kim M. Phillips, the perfect age in a woman’s life, representing an idealised state of femininity, a concept widely popularised by a male elite, including members of the clergy, who generated representations of virginal perfection beginning at menarche when the young girl was neither child nor woman.52 This stage in her life-cycle could be from the age of between 12 to 15 until late-teens to mid-20s, when marriage in England was more likely to take place. However, Phillips acknowledges that marriage preceding canonical age took place among some of the upper classes and gentry, driven by socio-political or economic interests, albeit with the recognition of a lost phase of maidenhood.53 Phillips also raises two separate issues: she makes a brief reference to food shortage in the mid-14th century without associating it with a later onset of menarche, and she places the common and borough legal age of majority as mid-teen, which suggests the two may be linked. A third situation is the institution of service, through participation in cloistered life, by many girls from their mid-teens to mid-20s, which was recognised and accommodated in English culture.54 This state of maidenhood provoked certain tensions between maturation and the preservation of virginity until marriage, and is, Phillips considers, fundamental to the concept of feminine identity in late-medieval England. Legends evolved from the construction of the idealised courageous maiden defending her chastity against the attentions of the villainous pagan suitor. Examples of virgin martyrs proliferated. Their shared attributes were their menarcheal age, their beauty and their sexual appeal, and all had pledged their virginity to God at a time of their life that Phillips believes represents the female version of Aristotle’s ‘perfect manhood’.55

Literary use of names and terms enables us to trace other changes in social thought. We have an example of male attitude towards menarche in the 1600s in Milton’s Trinity manuscript, A Mask, in which Comus, the male suitor of the maiden Lady, refers to her ‘lees’. The interpreter, B.J. Sokol, uses the framework of the Lady’s menarche as the context for dialogue between the two. Comus is a metaphor for the pagan and the Lady is the non-acquiescent virgin. Comus speaks of ‘tilted lees’ and ‘settlings of a melancholy blood’ using the fermentation theory of menstruation and denigrating the Lady through inference that menstruation affects behaviour and detracts from desirability. He receives his come-uppance from the Lady, whose words he suggests have come from ‘some superior power’. Sokol argues this to be moral victory amid the turbulence of menarche, and one that shows Milton may have been influenced by shifting ideas about menstruation. At the time there was some revisionist medical thought that menarche and menstruation were sickening conditions only when illness already existed. Yet, as Dean-Jones has noted, Aristotle viewed menstruation as a normal part of a woman’s life without any thought of pollution to be taken into account. Sokol continues the thesis that menarche is both a serious and significant event transforming the girl-child to the marriageable virgin, and going so far as to suggest Milton’s masque might well have been a clandestine celebration of menarche in which the maiden, as a young, beautiful and sexually alluring virgin, is accepted into the community as ready and able to enter marriage and thus lose her virginity.56

By the close of the 1600s, women were asking what menstrual blood really was, as historian Cathy McClive has shown in her research into menstrual knowledge in early modern France. A midwifery text of the time, using the question-answer catechistic format, informed readers that it was a normal event beginning with menarche at 14 or 15, and known as the monthlies, ordinaries, flowers or menses. McClive shows that the importance of the text is diagnostic, enabling recognition of the cause of any blood breaking the body’s boundaries, but she also cautions that all blood loss was considered to be connected with menstruation.57 This is evidence of the continuing dominance of Classical Greek and Roman ideas in Western thought about women’s surplus blood being evacuated, and which carried through in medical thought until the 18th century.

During the 17th century in England, attitudes to menarche and menstruation were influenced by more complex beliefs about blood, life and death arising from Christian teachings and articulated by men in a culture of male dominance, according to historian Patricia Crawford.58 Cause and effect are argued in perceptions of women’s physiological inferiority situating them in positions of social inferiority. Crawford discusses the impact of the printing press in the 16th century, allowing the literate access to medical knowledge of menstruation, previously the realm of male medical practitioners, together with other forms of knowledge on the same topic, and using language as a key indicator to perceptions not necessarily held by women themselves.59 Two dominant thoughts about the purpose of menarche and menstruation were kept alive. One, the Aristotelian model of purification through evacuation led to naming menstruation ‘purgation’. The cause of the menarcheal or menstrual event was believed to be fermentation of the blood, which medical practitioners described as being similar in process to fermentation of wine or malt liquor in which scum, called flowers, is forced to the surface. The menstrual imitative with a characteristic odour and associated idea of impurity became known as ‘flowers’, although some believed the term entered common use as anticipation of a young woman’s later bearing of fruit. In this naming, the conceptual dichotomy is clear and Crawford observes that by the 18th century, questions were being raised about the fermentation-purification theory.

The second idea about menarche and menstruation in 17th-century England also shows the influence of Aristotle. The female body was still believed to be an inferior version of the male, lacking the ability to utilise the blood concocted from food. According to Crawford, the medical practitioner Galen, in second-century Rome, believed menstruation to be a plethora of unused blood-substance that, given suitable circumstances, might have nourished a foetus or been converted to lactation. However, by 1707, political and medical writer James Drake was arguing against menstruation being the emission of a plethora. There was little shift in thought about late menarche in the 1600s, both in England and France, where it was given disease status (named greensickness), and associated with the same symptoms as it had in Classical Greece. The cure depended on how the medical practitioner understood menstruation, and might include blood-letting from the foot – not the arm, as that would not draw blood to the uterus or womb. Another recognised reason for an absence of menarche in young girls was over-exercise, thought to leave no surplus blood to be excreted, as Soranus had described in the early second century, with the same advice to change customary activities offered.60

Crawford found traces of women’s voices living on in historical documents of the time, a rare presence. Certain facts are evident: the expectation of menstruation every four weeks; the aura of privacy and sometimes secrecy maintained by women toward menstruation; a dislike and avoidance of physical examination by ‘groping doctors’; a resistance to medical practitioners’ bloodletting for any absence of menstruation; and embarrassment over unexpected menarche or menstruation. In the main, women preferred to discuss concerns and cures among themselves or with midwives. It would be interesting to know if the women resisted blood-letting because they experienced a feeling of being less well as a consequence, in contrast with the medical belief in the treatment’s efficacy. It appears that women viewed menstruation within the context of their reproductive potential and there is no reason to suppose the young menarcheal girl differed. There was no particular recognition of the rite of passage, according to Crawford, although the hiatus provided by maidenhood might well be considered a liminal stage of life. Once fully adult through marriage and childbirth, menstruation became a normal part of life for 17th-century women. In contrast with this, men perceived an ambiguity of power and weakness in women, which allowed them to define women’s inferior place in society through menarche and menstruation.61

For historical demographers following trends in population studies, it not only indicates the age of marriage for girls but allows change to be followed in a wider context of famine, disease, warfare, attitudes, and values influenced by social movements such as acceptance of religious belief systems. For social historians the age of menarche helps explain socio-sexual conventions and relationships within a marriage framework. Medical practitioners may read it as indicative of a biological process with attendant risk. The curious reader will compare what is represented in the past with the known, and very different, present. Menarche at 13 we can understand. Marriage, under social duress, at 14 may seem premature unless we recognise it as a form of controlling sexual activity relative to particular cultures such as Classical Greek. The age of menarche continues to be a salient point in any society. The historian, Peter Laslett, associates rigorous social control with menarche, arguing that no community anywhere at any time, regardless of resources, can allow girls to reproduce at will. He suggests that the age of menarche, given as about 14 in medieval and early modern times, increased toward the 19th century.62 This is borne out in studies of 827 women by Dr Nicolai Edvard Ravn in Denmark in 1848, providing evidence that the average menarcheal age was 15 years and 8½ months. Ravn observed the differences in social classes between girls who were from urban and rural communities. The earlier menarche of upper-class urban girls was due, he believed, to the refinement and stimulation of education and nutrition. In the rural sector the daughter of a non-farmer, classified as clergyman or teacher for example, had a slightly earlier menarche than her urban counterpart, for possibly the same reasons with the added benefits of country life.63 Scholars in the field have been inclined to argue over variations in menarcheal ages. Social scientist Vern L. Bullough is critical of the claims of earlier menarche in Western Europe made by child health researcher J. M. Tanner, who asserted a difference of some four months per decade between 1830 and 1960. Not unreasonably, Bullough comments that the variants of genetics, diet, and skeletal maturation make it difficult to pinpoint a historically stable age of menarche.64 Another aspect of the debate is given by historical demographer J.B. Post, who believes Tanner’s menarche statistics to be the best available in the West for the 19th and 20th centuries, but cautions that the same method that provided evidence of the decline referred to above would have placed menarche in the mid-20s c.1650. Post argues that a suggested retardation of menarche, beginning in Europe about 1500, is not borne out in a 15th-century gynaecological text that refers to menarche at twelve, ‘purgations from the tyme of .xij’.65 He contends greater accuracy regarding age of menarche exists in writings intended for textbook use by medical practitioners informed by patients.66

In 18th-century England, male midwives were responsible for an increased focus on menarche and menstruation. The rise of the male midwife, according to medical historian Irvine Loudon, advanced the knowledge, if not the care, of women. However, it is the knowledge that we are concerned with here. As for the male midwives: by and large they had served an apprenticeship to barber-surgeons and then hung up their boards. Some took advantage of the new courses offered by the University of Edinburgh and in London, the latter being the learning place of William Smellie, notable for his manoeuvre used in breech (feet-first) deliveries. By the end of the 18th century the position of the male midwife was well established.67 Historian Alexandra Lord observes that the lines between male midwives and physicians blurred, making differentiation between their professional categories difficult. At the time, menstruation in Britain was widely considered to cause and define weakness in the bodies of women. Lord argues that it was an issue that drew medical theorists’ attention and presented the male midwife with an opportunity to move beyond childbirth to treat women who had problems with menstruation, or catamenia as it was known, and hence improve their general health. Rather than disregard the knowledge accrued from the ancients and medievalists, they chose to build upon it or disprove it. Three theories were discarded: that menstruation was a response to lunar forces, that it was a fermentation of the blood, and that it was an excretion of bodily excess.68

Menarche was a focus of close attention by these practitioners. Climatic effect was argued to influence age of onset; consequently girls living in warm to tropical climates had an earlier menarche than those living in temperate weather conditions. Lord argues an English aversion to premature menarche because transformation of the child’s body to pubescent excess was associated with perceptions of early sexuality and immorality, in an unwelcome process with connotations of uncleanliness. In contrast, girls who experienced a late menarche were spared the implicit suggestions of sexuality and immorality and were able to adopt the socially approved role of being ‘delicate’. Situations of menarcheal difficulty, diagnosed by scant bleeding, were almost certainly worsened by a diagnosis that correlated blood loss and narrowed uterine blood vessels. Echoes of the Hippocratics were present in the wide belief that childbirth was the cure. There may have been no recommended defloration by marriage, as the Hippocratics advised, but there was intervention by the practitioner, supposedly to release trapped excess blood thought to be potentially toxic. This invasion of the virginal body was not without medical critique, some arguing that a late menarche was natural for certain girls. Parents, particularly those of the upper class, also resisted the intervention, believing hymenal presence in their daughters was a necessary indication of virginity. The outcome of this focus on menarche and menstruation was a growing perception of fragility in the young female body and a continuing uncertainty about the cause and effect of menarche and menstruation among the practitioners.69

In 1896 W. E. Fothergill wrote his Manual of Midwifery as a teaching text intended for the University of Edinburgh, with greater theoretical knowledge necessitating two revisions before 1903. Fothergill makes the observation that menarche ushers in ‘a periodic disturbance marked by a discharge of blood from the mucous membrane of the uterus, mixed with cellular detritus and mucus from the whole of the genital tract’, indicating that dissection of uteri at various parts of the cycle had been undertaken with a resultant change in understanding of process. However, the most significant comment made by Fothergill links ovulation to menstruation:

Periodic sanguineous discharge occurs only in homo and some of the higher apes, whereas ovulation is a process essential to sexual reproduction throughout the organic world. The periodic ‘rut’ or ‘heat’ of many animals – a time of pelvic congestion, mucous discharge, and sexual appetite – is closely related with the ripening of ova. The relation of menstruation to ovulation is less clear.70

The following year J. K. Watson’s A Complete Handbook of Midwifery was published, giving further evidence of theoretical knowledge built on the foundation of Aristotle. We read of pre-menarcheal development of ‘the throat and chest’ as one of the ‘outward signs combined with certain internal changes we shall now discuss under the terms ovulation and menstruation’ but:

We do not yet know the precise relation which ovulation bears to menstruation. Some say the two are independent. Ovulation has been said to commence before menstruation. Ovisacs may, it has been averred, ripen and burst in childhood. A case has been recorded where a woman was delivered of a child before menstruation had set in, which would form an argument for their independence … menstruation usually commences between fourteen and fifteen, but it occurs earlier in warm climates, and also among the richer classes of society.71

How did this knowledge come about and what was its implication for menarcheal girls? To begin, an association between ovarian function and menstruation was first hypothesised by John B. Daveridge in 1793. His theory remained of little interest to medical knowledge before 1860.72 Nevertheless, in 1840, a zoologist, Felix A. Pouchet, had made a connection between animals and humans, asserting that ovulation occurred during oestrus, and that human menstruation and animal oestrus, both observable, corresponded.73 Further studies on Macacus Rhesus monkeys were taken up by Cambridge embryologist Walter Heape, who suggested menstruation was a degenerative process in preparation for oestrus.74 In 1874 obstetrician John Williams presented post-mortem findings on menstruating women to the Royal Society of London and in 1875 presented further findings on the link between ovulation and menstruation.75 Further to this, the medical historian Helen Blackman provides us with the context in which the work was carried out. It was a time of concern about British supremacy, and of alarm regarding eugenics in relation to changes in women’s social roles.76 Embryologist George Corner argues that from the 1890s agriculturalists, anthropologists, embryologists and obstetricians searched for answers to physiological problems that challenged the skills of gynaecologists, lacking in both understanding of the menstrual cycle and a sound basis of biological knowledge.77 Corner maintains, incorrectly, that in Britain the research subjects were animals.78 Meantime in Germany Robert Schroeder and Robert Meyer identified the general pattern of women’s cycles. Working with human material, they found that ovulation occurred mid-cycle and that menstruation did not parallel animal oestrus but followed the transformation of ovum to corpus luteum.79 It would be some years before work on higher primates revealed menstruation can occur without ovulation, as it does at menarche and for some time thereafter. The corpus luteum does indeed cause change to the endometrium, but menstrual bleeding is not because of this change but rather because the change ceases.80

The practical outcome of this knowledge was recognition of the time ovulation occurs in women. That knowledge was the basis for further studies in fertility control and the place of ovarian hormones in the cycle. Continuing research led to reproductive technology as we know it today. Corner commented in 1951 that the functional significance of menstruation remained unknown. The question as to why it was specific in such a developed form to only certain female primates and humans remained unanswered.81 Recently, veterinary scientist Colin Finn argued menstruation to be a relic of the prehistoric Müllerian duct in primitive vertebrates, which permitted internal fertilisation and survival of the embryo on land.82 Eventual merging together of the duct and embryo meant changes to the duct, evolving from embryonic demand for food and protection which resulted in its deep implantation. The uterine response was endometrial changes in anticipation of this invasion. When this failed to occur, the endometrium disintegrated in blood as menstruation.83 Against this we may read a description of menstruation by William Ledger from a recent edition of Dewhursts’s highly respected textbook on obstetrics and gynaecology:

Menstruation refers to the shedding of the superficial layers of the endometrium, with subsequent repair in preparation for regrowth from the basal layer. Menstruation is initiated by a fall in circulating concentration of progesterone that follows luteal regression – failure of ‘rescue’ of the corpus luteum by an implanted early pregnancy. Luteal progesterone synthesis is dependent on luteinising hormone from the pituitary gland. During luteolysis, progesterone secretion falls despite maintained serum concentrations of luteinising hormone, since the corpus luteum becomes less sensitive to gonotrophic support and becomes increasingly unable to maintain production of progesterone.

In the immediate pre-menstrual phase, progesterone withdrawal activates a complex series of intrauterine signals which include expression of chemotactic [response to chemical] factors, which draw leucocytes [white blood cells] into the uterus, and expression of … other compounds that act on the uterine vessels and smooth muscles. The ‘invasion’ of leucocytes and subsequent expression of inflammatory mediators has led to menstruation being likened to an inflammatory event. Increased production of one type of prostaglandin produces contraction of the middle uterine layer and constriction of the blood vessels seen at menstruation, while another variation of prostaglandin increases pain and swelling, and dilates the blood vessels, inducing another key inflammatory and chemotactic mediator. Pronounced vasoconstriction in turn leads to localised tissue hypoxia [lack of oxygen] increasing release of inflammatory mediators. The end result of this cascade of events is constriction of the spiral arterioles [small arteries] with contraction of the uterine muscles, leading to expulsion of the shed tissue.84

Another aspect is Ledger’s likening of menstruation to an inflammatory event. This builds on the theory of it being an ovarian event. Moreover, Ledger’s account is not incompatible with Finn’s hypothesis of the functional significance of menstruation. We can see the presence of blood, the main symbol of the healthy adult woman, has no association with the Classical or ancient belief in menstruation being a bodily excess or purgation. Clearly, this theory of menstruation has been influenced by the knowledge and understanding of endocrinology following the work of researchers a century ago. Has it altered any concepts about menarche? D. Keith Edmonds in Dewhurst’s textbook suggests an expansion in thought about the psychological development of the menarcheal girl, arguing a greater awareness of self-identity. The familiar secondary sex characteristics, breast development and axillary and pubic hair, are noted. The Aristotelian influence in evidence in Watson’s ‘throat and chest development’ has lost credence. Additional knowledge includes more attention to the growth spurt, which may be as much as eight centimetres in one year, occurring about two years before menarche. This is arrested by the production of oestrogen, which closes the growth points of the long bones so that final height is reached around 14 to 15 years. The onset of menarche is influenced by genetics and by hormones. A recently advanced theory, concerning transforming growth factors, includes that of the epidermis which links to an increase in body fat. There is also an association with external factors such as socio-economic background, nutrition and dietary habits and psychological profile, which might include anorexia nervosa or obesity. Early menstrual cycles are thought to remain non-ovulatory, possibly even for as much as 5–8 years, before regularity of cycle is established, and potential heavy blood loss is due to production of progesterone without ovulation.85 There is no mention of menarcheal girls being either ‘delicate’ or in a ‘perilous’ state of their lives.

Conclusion

The transition from child to woman, symbolised by menarche, has throughout history been a focus of the evolving thoughts, beliefs and actions of male medical practitioners, concerned to understand, to define and often also to control the menarcheal body. The meanings attributed to menstrual blood were a key feature of this control. In Classical Greek society menarche was constructed as commencement of the vital overflow of unused nourishment, made possible by widened blood vessels. Control was practised by the construction of a social age of onset, necessitating male intervention to correcting the health hazards of failure to bleed. The role of women in this control is uncertain, but the association in Classical Rome between menarche, dowry and marriage would suggest the practice had some support by women.

The onset of menarche in Ancient Chinese thought related to the function of other organs and served as a guide to the health of a young girl. In the Imperial Court in medieval China, menarche was associated with growing sexual desire, and early marriage followed among upper-class girls. Social control was apparent in the influence of a court physician, Chu Cheng, who prohibited sexual knowledge and marriage for a decade after menarche. In ancient India, Ayurvedic thought did not include any recommended form of social control relating to girls at menarche. In writings by men, menarche was constructed symbolically as the meeting of two principles, water and fire, and the male perspective was evident in the fabled interpretation of the demonic child-killer as an example of the fate awaiting girls who reach 16 without menstruating.

Christian religious and social elite in late medieval England constructed an ideal of nubile perfection, symbolised by the Virgin Mary, as a control of the body of the young menarcheal girl. This occurred at a time when canonical law defined the age of consent as 12, and indicates cooperation between the Church and girls and young women, which resulted in the cult of virgin martyrdom, with its long-lasting influence on the English construction of the ideal woman. An alternative construction of menarche is seen in the work of Milton, where it is depicted as the time of a young woman’s recognition of her sexual power through virgin non-acquiescence, and indicates an awareness of growing agency among young women. This was furthered in women’s documented dislike of, and resistance to, medical examinations and interventions based on the Aristotelian influence of purification through evacuation. Classical Greek thought continued to influence medical and social ideas about women’s bodies as inferior until the 18th century, as did the persistent medical construct of late-onset menarche as sickness.

From the late 19th century a widening scientific knowledge and understanding of women’s blood, menarche and menstruation continued to accumulate. Western medical thought remained dominant in shaping social attitudes and policies that influenced the ways in which young women would live. Today, remnants of older beliefs that have survived are heard in the testimony of some of the interviewees. The reader might ask where the ideas originated. This overview is intended to provide answers.

1    Lesley Dean-Jones, Women’s Bodies in Classical Greek Science (1994), Oxford University Press, Oxford 2001, pp. 7, 10. See also Luigi Arata, ‘Menses in the corpus Hippocraticum’, in Menstruation: a Cultural History, Andrew Shail and Gillian Howie (eds), Palgrove Macmillan, Basingstoke 2005, p. 13.

2    Dean-Jones (2001), p. 55.

3    Lesley Dean-Jones, ‘Menstrual bleeding according to the Hippocratics and Aristotle’, Transactions of the American Philological Association, vol. 119, 1989, p. 177–178.

4    Dean-Jones, (2001), pp. 46–55, 225, 229.

5    Arata in Shail and Howie (eds) (2005), p. 15.

6    Dean-Jones (1989), p. 191.

7    Dean-Jones (2001), pp. 19, 46–55.

8    Hippocrates, On the Diseases of Virgins (L8.466-71) cited in Helen King, Hippocrates’ Woman: Reading the Female Body in Ancient Greece, Routledge, London 1998, p. 78. See also Hippocrates, ‘Girls’, in Hippocrates, Vol. IX, trans. Paul Potter (ed.), Loeb Classical Library, Harvard University Press, Cambridge (US) 2010, pp. 259–263.

9    King (1998), p.79.

10  Nancy H. Demand, ‘Acculturation to Early Childhood’, in Birth, Death and Motherhood in Classical Greece, The Johns Hopkins University Press, Baltimore 1994, p. 103.

11  Dean Jones (2001), pp. 50–51; King (1998), p. 77.

12  King (1998), p. 84.

13  Aristotle, Generation of Animals XIII, trans. A. L. Peck (1942), Loeb Classical Library, William Heinemann Limited, London 1963, pp. 460–461.

14  Dean-Jones (2001), p. 53.

15  Aristotle, Generation, 726b, 727a, p. 95.

16  Aristotle, Generation, 725a, 739a, pp. 81, 187.

17  Aristotle, Generation, 731b, 738b, 765b, pp. 129, 185, 385.

18  Aristotle, Generation, 738a, p. 181.

19  Aristotle, Generation, 727b, 739b, 740a, pp. 101, 191, 193, 197.

20  M. K. Hopkins, ‘The age of Roman girls at marriage’, Population Studies, vol. 18, no. 3, 1965, p. 312.

21  Owsei Temkin, ‘Introduction’, in Soranus, Gynaecology, trans. Owsei Temkin (1956), The Johns Hopkins University Press, Baltimore 1991, pp. xxiii, xxv. See also Soranus, p. 15.

22  Soranus, trans. Temkin (1991), pp. 16–19, 21–22, 27, 31. For the Hippocratic menstrual blood loss ideal see Dean-Jones (1989), p. 180.

23  Hopkins (1965), p. 314.

24  Hopkins (1965), p. 309-310.

25  Hopkins (1965), pp. 312–316, 327.

26  Michel Foucault, The Birth of the Clinic: an Archaeology of Medical Perception, trans. A. M. Sheridan Smith, Vintage Books, New York, 1994, p. 54.

27  Ted J. Kaptchuk, Chinese Medicine: the Web that has no Weaver, (1983), Rider and Company, Essex 1987, p.23. Nei Jing was the foundation of later Chinese medical theories and commentaries, which evolved into those of the Han Dynasty (200 BCE–200 CE), the Ming Dynasty (1368–1645) and the Qing Dynasty (1644–1911).

28  Kaptchuck (1987), pp. 7–8.

29  Kaptchuk (1987), p. 41.

30  Kaptchuk (1987), pp. 7–8, 77–78. The term ‘meridian’ entered the English language from the French translation for the Chinese ‘jing-luo’, ‘jing’ meaning ‘to go through’ or ‘thread in a fabric’ and ‘Luo’ meaning ‘something that connects or attaches’ or ‘a net’. See p. 77. The term is not without its critics. Paul Unschuld, translator and commentator of the ancient Chinese medical texts, Huang Di nei jing su wen, argues ‘meridian’ is a term widely used in Western acupuncture writings and which fails to parallel the salient ‘jing’ concept. Unschuld believes Western use of the term is a construction removed from historical fact. See note 382 in ‘Notes’, p. 370, Paul U. Unschuld, Huang Di nei jing su wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text, University of California Press, Berkely and Los Angeles, 2003.

31  Kaptchuk (1987), p. 35.

32  Kaptchuk (1987), p. 43.

33  Kaptchuck (1987), pp.43, 336–337, ‘Appendix F: the Curious Organs’. See also Furth (1999), p. 45.

34  Chen Zeming, juan 6, 175, cited in Sabine Wilms, ‘The art and science of menstrual balancing in early medieval China’, in Menstruation: a Cultural History, Andrew Shail and Gillian Howie (eds), Palgrave Macmillan, Basingstoke 2005, p. 39. Chen Zeming (1190–1270) was a ‘fuke’ or what we would term gynaecologist, and author of All-inclusive Good Prescriptions for Women (Furen ta quan liang fang) compiled in 1237 and published in 1284. See also Charlotte Furth, A Flourishing Yin: Gender in China’s Medical History, 960–1665, University of California Press, Berkeley and Los Angeles, 1999, p. 70.

35  Wilms (2005), pp. 38–39.

36  Sun Simiao, Prescriptions Worth a Thousand (Beiji qianjin yaofang) quoted in Furth (1999), p. 71.

37  Unschuld (2003), p. 320.

38  Furth (1999), pp. 60–61, 67.

39  Furth (1999), pp. 53, 89–90.

40  Dominik Wujastyk, The Roots of Ayurveda, Penguin Books Limited (1998), London, 2003, pp. xv–xvi.

41  Suśruta’s Compendium, trans. Dominik Wujastyk in Wujastyk (2003), p. 110. Wujastyk has difficulty identifying the time of Suśruta’s work, arguing that the latest possible date for the text would be 600 CE, but also that possible reference was made to him through a grammatical rule in c. 250 BCE.

42  Wujastyk (2003), pp. xix. See also Suśruta in Wujastyk pp. 72–73, 111 f.n. 59. Suśruta is the oldest surviving manuscript today, written by scholars over a lengthy period commencing c 250 BCE with a final editing c sixth-century CE. See pp. 63–64.

43  Kaśyapa’s Compendium, trans. Wujastyk in Wujastyk (2003), pp. 165–166; 175–176. Kaśyapa’s Compendium remains fragmentary. It was written on palm leaves and the first of the surviving two texts was discovered in Katmandu in 1898. Because of the archaic language the writing is believed to be first millennium BCE. See pp. 165–166.

44  The Trotula: a Medieval Compendium of Women’s Medicine, trans. Monica H. Green (ed.), University of Pennsylvania Press, Philadelphia, 2001, p. xi–xiii.

45  Charles Singer, From Magic to Science, Dover, New York, 1958, p. 244. The nursery rhyme is as follows: ‘Dame Trot and her cat had a peaceable life when they were not troubled by other folks’ strife: when Dame had her dinner pussy would wait and was sure to receive a nice piece from her plate’. According to The Shorter Oxford English Dictionary, third edition (1944), C.T. Onions (ed.), Oxford 1959, p. 1627, pussy, as applied to girl or woman entered the English lexicon about 1583, so the provenance of the rhyme would be of interest to explore in the historical context.

46  Trotula, trans. Green (ed.) (2001), pp. 71, 73.

47  Trotula, trans. Green (ed.) (2001), note 85, p. 215. The quote is from Anna Delva, Vrouwengeneeskunde in Vlaanderen tijdens de late middeleeuwen, Brugge: Vlaamse Historische Studies, 1983, p. 162.

48  Trotula, trans. Green (ed.) (2001), pp. 71, 73, 75.

49  Kim M. Phillips, ‘Maidenhood as the perfect age of woman’s life’, in Young Medieval Women, Katherine J. Lewis, Noël James Menuge and Kim M. Phillips (eds), Sutton Publishing Limited, Gloucestershire, 1999, pp. 1, 4. Phillips refers to the term ‘maiden’ as being in use late 1300s to 1500 CE, pp. 1, 2, 4, 5, 16.

50  Charles T. Wood, ‘The doctor’s dilemma: sin, salvation and the menstrual cycle in medieval thought’, Speculum, vol. 56, no. 4, 1981, p. 722. Wood cites The Protevangelium of James, New Testament Apocrypha, Wilhelm Schneemelcher (ed.), R. McL. Wilson (tr.), as the source of this quotation. An internet search gave an alternative 1886 translation by Alexander Roberts, James Donaldson and Arthur C. Coxe. See The Infancy Gospel of James, 8:2, http://www.earlychristianwritings.com/text/infancyjames-roberts.html as verification. Janice Delaney, Mary Jane Upton and Emily Toth also include reference to the menarche of the Virgin Mary in The Curse: a Cultural History of the Menstruation, (1976,) University of Illinois Press, Urbana, 1988, p. 40.

51  Phillips in Lewis et al (1999), pp. 4, 12.

52  Phillips in Lewis et al (1999), p. 5, 16.

53  Phillips in Lewis et al (1999), pp. 4–5.

54  Phillips in Lewis et al (1999), pp. 4, 5, 8.

55  Phillips in Lewis et al (1999), pp. 5, 10, 11.

56  B.J. Sokol, ‘“Tilted lees”, dragons, haemony, menarche, spirit, and matter in Comus’, The Review of English Studies, vol. 41, no. 163, 1990, pp. 309, 310, 311, 312, 324. See also Dean-Jones (2001), p. 228.

57  Cathy McClive, ‘Menstrual knowledge and medical practice in early modern France c. 1555–1761’, in Menstruation: a Cultural History, Andrew Shail and Gillian Howie (eds), Palgrave Macmillan, Basingstoke, 2005, p. 76.

58  Patricia Crawford, ‘Attitudes to menstruation in seventeenth-century England’, Past and Present, vol. 91, no. 1, 1981, p. 47–48.

59  Crawford (1981), pp. 48–49.

60  Crawford (1981), pp. 50–51, 53–54. See also Soranus, Gynaecology, trans. Temkin (1991), p. 133.

61  Crawford (1981), pp. 67, 68, 69, 70, 71, 72.

62  Peter Laslett, ‘Age of menarche in Europe since the eighteenth century’, Journal of Interdisciplinary History, vol. 2, no. 2, 1971, p. 221, 223.

63  E. Maniche, ‘Age at menarche: Nicolai Edvard Ravn’s data on 3385 women in mid-19th century Denmark’, Annals of Human Biology, vol. 10, no. 1, 1983, pp. 79–81.

64  Vern L. Bullough, ‘Age at menarche: a misunderstanding’, Science, vol. 213, no. 4505, 1981, pp. 365–366. See also letters by J. M. Tanner and Peter T. Ellison, ‘Menarcheal age’, Science, vol. 214, no. 4521, 1981, p. 604.

65  The ‘j’ is the elongated ‘i’ used in manuscripts of the time: ‘xij’ is 12.

66  J.B. Post, ‘Ages at menarche and menopause: some medieval authorities, Population Studies, vol. 25, no. 1, 1971, pp. 83, 87. The citation is from MS Corpus Christi College 69, 119a, p. 87.

67  Irvine S. Loudon, ‘Childbirth’, in Companion Encyclopedia of the History of Medicine,Vol. 2, (1993), W.F. Bynum and Roy Porter (eds), Routledge, London 1997, pp. 1051–1053. Training, certification and practice of English midwives did not come under the Midwives Act until 1902. Until that time traditional practice was widely carried out and some practice by trained nurses. See Margaret Myles, Textbook for Midwives, Churchill Livingstone, Edinburgh 1975, p. xxiv.

68  Alexandra Lord, “The Great Arcana of the Deity’ menstruation and menstrual disorders in eighteenth-century British medical thought’, Bulletin of the History of Medicine, vol. 73, no. 1, 1999, pp. 39, 44.

69  Lord (1999), pp. 46, 49–51, 60.

70  W. E. Fothergill, Manual of midwifery for the use of Students and Practitioners, William F. Clay, Edinburgh 1903, p. 16.

71  J. K. Watson, A Complete Handbook of Midwifery for Midwives and Nurses, The Scientific Press Limited, London, 1904, pp. 21–23, 26.

72  George W. Corner, ‘Our knowledge of the menstrual cycle, 1910–1950’, The Lancet, 28 April 1951, p. 919. This was the fourth annual Addison Lecture given at Guy’s Hospital, London, 13 July 1950.

73  Helen Blackman, ‘Embryological and agricultural constructions of the menstrual cycle, 1890–1910, in Menstruation: a Cultural History, Andrew Shail and Gillian Howie (eds), Palgrave Macmillan, Basingstoke, 2005, p. 118.

74  Corner (1951), pp. 920–921.

75  Graily Hewitt, The Pathology, Diagnosis, and Treatment of the Diseases of Women, fourth edition, Longmans, Green, and Company, London, 1882, pp. 15–16, 19.

76  Blackman (2005), p. 118.

77  Corner (1951), p. 919.

78  Apart from Williams, Hewitt, as Professor of Midwifery and Diseases of Women at the University Hospital, London, documents immediate post-mortems on menstruating women. See Hewitt (1882), pp. 16–17.

79  Corner (1951), pp. 919–920.

80  Corner (1951), p. 921.

81  Corner (1951), p. 922.

82  The Müllerian duct, named after German scientist Johannes Peter Müller (1801–1858), referred to an embryonic paired duct system from which the epithelial lining of the female reproductive organs – uterine tube, uterus and vaginal vault – developed. The male gonadal development degenerated under the influence of the duct system. See Mark Hill, ‘Müllerian duct’, http://www.embryology.med.unsw.edu.au/notes/index/m.htm.

83  Colin A. Finn, ‘Why do women menstruate? Historical and evolutionary view’, European Journal of Obstetrics and Gynaecology and Reproductive Biology, vol. 70, nos. 3–8, 1996, pp. 4, 7.

84  William L. Ledger, ‘The Menstrual Cycle’, in Dewhurst’s Textbook of Obstetrics and Gynaecology, seventh edition, D. Keith Edmonds and John Dewhurst (eds), Wiley-Blackwell, Oxford, 2007, p. 354. Minor editing for non-medical understanding has been made.

85  D. Keith Edmonds, ‘Gynaecological disorders of childhood and adolescence’, in Dewhurst’s Textbook of Obstetrics and Gynaecology (2007), p. 366.

First Blood: A Cultural Study of Menarche

   by Sally Dammery