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First Blood: A Cultural Study of Menarche

Chapter 6

CONCEALING THE FACT

Sometimes in the street I saw girls having the stain on their dress.
They can’t avoid it.1

Among the culturally diverse interviewees, a shared concern was that of successfully concealing menstruation, particularly at menarche, and many reflected on the difficulties this caused. Although well removed from the days of adapting mosses or fibres to act as menstrual absorbents, the burden of making and caring for menstrual paraphernalia from a fairly young age anticipated the harsher lives of adult women in many cultures. One repeated feature of menarche was the help and advice women gave to each other about managing menstrual life. In many cases older women were the only educators and their attitudes toward menstruation, both positive and negative, were transmitted with their guidance. While recalling the memories, my informants became young girls once again, experiencing menarche many years ago in their countries of birth. Most are now grandmothers, living in a different culture, recreating the world of their youth and the physical practices and cultural values that surrounded an experience through which many of them come to be seen as young women.

The interview data provided by these women makes clear the extent to which menarche and menstruation belonged to a female realm, although as we have seen in earlier chapters, these specifically female aspects of culture and ritual occurred in a framework in which men exercised the wider social and religious control over menarcheal and menstrual bleeding. For the majority of women the concealment of bleeding, beginning at menarche, followed customary methods that involved some curtailment of activity external to the home. There was no thought of protest against this and no suggestion that it might change. Modern sanitary hygiene practice in Western countries, however, did reflect changes in the position of women, including young women’s access to higher education, greater participation in the public space through employment, and the effects of two world wars. However, there were other significant factors as well, including an increasing medical focus on bodily hygiene and scientific and technological developments that made female hygiene into an industry.

Interview data emphasises the importance of concealing menstrual blood for women from non-industrialised countries, and the effects of this concealment on the women themselves. For instance, Yunuva shared the memories of her 11-year-old self in transit from Egypt to Australia in 1957, her existing migratory stresses enhanced by the onset of menarche in Genoa. Although Yanuva had her mother and older sister to help her through the trauma, she recalled with horror the accoutrements of her changed condition, which her mother provided. She remembers being ‘presented with this pad which was made of … like … linen sort of fabric with terry-towelling on top, and it had the shape of being a long … long rectangle with a triangle on either end, and at each side of the triangle there was a loop. And then you had this long piece of … like a belt made out of fabric and you strap it in and you put it all around’.2 Yanuva describes the adult-sized menstrual harness, applied to her small body, that was the introduction to life as a menstruating woman for so many young girls, and which became symbolic of menstrual restriction and discomfort. At a similar time in Manila, Corazon discovered that her first high school project was one with a difference, being both practical and beneficial in the way it opened a forum for discussion among her classmates. She recalled that ‘when we reach high school the girls start to make their own pads. We were taught. That’s the first project we do. You have to make your own pads … made of cotton, cotton cloth, and boiled. There is a pattern that you sew and then you make a belt’. In answer to a question about commercially made pads Corazon replied, ‘no. No we don’t. Sometimes we have to cut old cotton shirts and things like that, and that is what we use’.3 Aleli, who was younger than Corazon at menarche and probably still in primary school, said nothing about pad-making as a high school project, remembering only that ‘in 1959 sanitary pads were not really popular yet. We have things like a binder made of muslin cloth, the brown one like they use for the baby … it’s a soft fabric and you have to fold it and fold it and then clip it to a belt … and then wash it’.4 The story had been much the same in Sicily for Rosalia, who observed that ‘in those days there wasn’t anything to buy and Mum used to buy material and make them … I don’t know if it was the same here’.5 No, it was not the same in Australia, but it was in Ukraine, where ‘they made their own cloths. They did it themselves from the material because we didn’t have such things like here. We washed them’.6

In Korea, Jung discovered that ‘my mother made already, in case, some pads … gauze … long ones and she folded it and made them. We have to wash them’.7 Sun, in Seoul, explained ‘there were no pads here’.8 Maryam remembered ‘cloths like face washers laundered in boiling water like baby nappies’.9 In Suva, Levani tried to maintain her privacy at menarche, explaining ‘my mother did a lot of sewing so I just went to her box and gathered scraps of material. I was very lucky in that but I had to make sure that I chose the ones she wouldn’t miss. I went and had a shower and came back with just a little strip of material and when I got up the blood had gone right through … because we sit on the floor… when I got up my mother saw the blood and she just said to me “look at your sulu”, so I did that and then realised the blood was on it so I went … nothing else was said … I went to the bathroom and cleaned myself up and when I came back she had this thing she wears which is like half a nappy, with two holders like loops, and I had no idea what these things were although I’d seen them hanging on the line. She just said “this is what you do” and she showed me how to fold it and then stick it under the pocket thing and then you loop it around, you tie a string around it and I thought “that’s interesting” so that day I wore it and felt so uncomfortable that I said to myself I’ll never wear it again and I never did’.10

Levani had choice because ‘in Fiji you just ask for money from friends and sisters, and like I said, I had two older sisters so I just told them I needed money and they gave me … I didn’t tell them I was having my period’. As a result, she was able to purchase disposable pads. But not all women could do that, and the interviewees who lacked the opportunity seemed more accepting of being in close contact with their menstrual blood, through washing their cloths or pads. Although some interviewees described pads made from specifically chosen fabric, Corazon alluded to the necessity of cutting up old clothes and other interviewees described the ways in which they made use of what was available for absorbing the menstrual flow. Rara, in Jogjakarta, made the point by demonstrating with paper serviettes how she would fold old material to make a menstrual pad from ‘cloths, cloths, old cloth. My grandma tells me that sometime, because I not very smart, sometime I put pin in pant and the pin stuck open, in me [much laughter from friends]’. The cloths were thrown away ‘because this is old cloth’.11 This statement was discussed among the group, most of whom agreed that menstrual cloths were washed and reused. Nirmala recalled her menarche in Jogjakarta, over a decade later, when many Indonesian women still made their own pads. ‘We grew up in a simple way of life so old cloth like batik just torn off and we make like some sort of parcel with the thick part [demonstrates a roll] just like that. We have another long material to wrap it in. The thick part is where the blood goes through. My mum gave me a belt of material and then the long part you put over and then we put a safety pin in there. When it’s all very wet we have to wash them and hang them so we have two or three. Because it’s not a wealthy family we can’t afford to buy. My friend from a wealthy family would buy some sort of towelling material but even then they still have to wash them and hang them. Nothing got thrown away’.12

Poverty determined the level of menstrual hygiene. In Lucknow, Hetal, who was motherless, lived with her extended family, which included several women. She explained that at menarche ‘I have the liberty to have a cloth and put on. I have lots to try, that’s one advantage we have, and sometime next day I find this cloth, and a new cloth just after that, after some time the squat I use because in market no nappies, no nappies. At that time no cotton’.13 Nevertheless, Hetal also had some awareness of the strategy used by women who were deprived of even rags to absorb menstrual blood. Saha elaborated, remembering that in Bangalore ‘we used to see the ladies sitting on the gunny bags. We’re wondering why. They said they’re sick. We said when you’re sick why would you sit on a gunny bag? It never occurred to me that this was the reason they were sitting for three days, with long blouses just covering themselves … pads were not rampant in those times. You had to tear old clothes and old sheets and even wash them and re-use them. This is what happens in places where you don’t have these pads sold’.14

And there were many such places – including Uganda. Cecile explained ‘because we didn’t have pads we were using cloth from old linen’,15 which introduced the problem of physical discomfort recalled by Ruth. ‘I got used to the habit of putting thick tissues because there were no pads like now we have commercial pads but in those days you had to improvise. Maybe tear pieces of cloth and put together and one thing I realised was during period time I got hurt, really, because when you put pad material, and you’re walking, you’re really rubbing and you get bruised and hurt. You didn’t have actual pads to help so when [a period] caught you without any extra cloths to put on you could easily be messed up’. Ruth related a social occasion when she was travelling to a wedding with a group of young people. ‘I realised I had started to have this thing… and the whole day I felt so uneasy and we had to travel in this little truck where we have so many young men as well and we didn’t have seats … we had to squat the whole way. It was messy and I was holding myself saying “what is going to happen?” I thought everybody thought “what a dirty girl”’.16

Being ‘messed up’ was a shared dread for these women, many speaking of alternative ways to cope with their menstrual flow, including using readily discarded paper. Zosime, in Alexandria, emphasised, ‘poor family, you know? No pads. I was working and it was very hard. I use toilet paper’.17 Elena demonstrated: ‘see what happens in making pads from toilet paper’.18 Melena, in Santiago, recalled ‘Mum folded toilet paper and said “you start this and then you get back and you change”’.19 Lee, in Singapore, described learning about menstruation as she assisted her mother to prepare for her next period. ‘My mother’s a very quiet sort of lady from a different era, born in the early nineteen something and when I was young, at about nine years old I bought the papers for her and helped her with the folding’. Lee told me that the papers were bought by the pound weight, around 500 grams. She continued: ‘the folding was like a fan. It would be quite long and we’ll fold it like a fan and then fold it in half, and I remember she had a piece of cloth where she used it around and there were sort of things she could tuck the paper in between. The paper was very thin, not as thick as blotting paper because if it’s too thick if you fold it’ll crack’.20

Qing made it clear that ‘we can go on our normal life as usual as long as we put on the protective gearing. It is traditional, unlike the pad we use today. We use tissue just like the Chinese tissue paper. Before that we have to do preparations, you know, crumple them and then make piles to put in the underpants with plastic to support it. You wash your stained clothing or underpants separately. Not to mix with the family’s washing because it was something not polite’.21 For both women the use of paper appeared traditional as much as economic but for Bao in Saigon it was different. ‘We have paper. Very hard but the Vietnamese very poor, you know. Have not got the money to buy the pads, but the toilet paper’s very hard, not like here, and we roll, roll to a pad and use a little plastic bit put in the middle, and this is like a pad, you know’.22

Throughout this time commercial disposable pads were available but they seemed very large for small bodies. Malaya brought this to mind, remembering that we ‘had the Kotex pads. They used to be very bulky things and you had to buy the sanitary belt and my mother taught me how to put it on’.23 Gloria, in Manila, remembered ‘we just had the made ones’.24 In Santiago, Ramona had very negative memories. ‘I never liked my period, especially on a hot day and having to go to school with that in place, because I am so heavy I have to use very, very strong Modess. That part was … I hate it. I hate it’.25 Sue, in Singapore, ‘remembered there was Kotex, there was Modess, those were the two I knew of’.26 In Concepcion, Lola recalled the cultural emphasis placed on women’s hymenal virginity: ‘we didn’t have tampons. No’.27 However, the woman who summarised a wider experience of sanitary protection, and the only one to mention the use of tampons, was Marjorie in England. My mother said “I haven’t got any sanitary towels in. You’ll have to make do” and gave me this lump of rag with two big safety pins. In those days we used to wear very thick knickers, like flannelette almost, so you were secure. You weren’t really going to drip anywhere because it would have been absorbed. That night my mother gave me a sanitary belt. I know it was elastic and I think the Dr White’s sanitary towels hooked on to a hook. I remember it being very uncomfortable indeed and it all seemed to be a trial to me. Having two older sisters, they used Tampax and I was determined that I would use Tampax. It was a torturous experience trying to learn to put it in because you have to push them very high up otherwise they’re sort of on nerves I suppose, and I remember walking around with this Tampax not quite pushed in high enough [laughs] and once I got on to them life was so much better’.28

Managing menarcheal and menstrual blood flow for these young girls was clearly problematic in several ways. First, the issue of access to materials, partly determined by income and varying from old rags, cloth or paper for the very poor, to the purchase of suitable absorbent fabric for pad making in more affluent families, to commercially made disposable pads for those with sufficient money who lived in areas of retail distribution. Second, the way in which these devices could be kept in place – the belts, strips of material, loops and pins described and, in the case of a tampon, the difficulty of learning how to place it correctly. Finally, there was the problem of the blood-soaked material and whether to discard it among the household rubbish, or wash and dry it on the family line – both ways introducing issues of privacy. Although many women today can look back and be grateful for advancement in the so-called sanitary hygiene industry, the very different experiences of women from other cultures provide a good framework for looking at the development of that industry.

The issue of access to menstrual absorbents created one of the earliest problems for young immigrant women in transit to Australia – 100 years before my informants made their journeys – and we know about it because of a letter written at the time, significant because so little documentation on the subject of menstruation that has been recovered. A dispatch sent by the vessel’s surgeon-superintendent, Dr Richard Eades, to Stephen Walcott, secretary to the organisation responsible for chartering and provisioning the ship, reported inadequate supplies for the immigrant vessel Roman Emperor, which had just completed a voyage to Adelaide. The ship carried 221 young women, victims of the Irish famine, for whom regular meals during the voyage were to have unexpected consequences. On arrival in 1848, their plight was reported by Eades in an effort to ensure menstrual towels would be provided on future similar vessels – as much, it seems, for the benefit of young women as for the benefit of others, such as the male crewmembers who might witness evidence of the young women’s condition by their stained clothing. Concealment of the menstrual condition was required and Eades’ demand carries the authority of the male medical establishment:

I would like to call attention to a matter of hygienic importance viz the total want of cloths or towels among the young females, the majority had not experienced the catamenial flux, which appeared for the first time with more than one half during the voyage, and for which they were unprepared, the perplexity was increased by the difficulty of having the stained linen both of dresses and bedding privately washed. Suitable means should be adopted for this purpose in vessels bringing young females.29

Eades’ letter points clearly to the social hardship and discomfort menstruating women endured while travelling, in this case for reasons beyond their control. But it also provides medical evidence of the connection between diet and onset of menarche for girls living in conditions of famine.

The difficulties menarche presented for these young 19th-century immigrant women during passage to the Colonies are not without relevance to the memories of my interviewees. Their accounts provide evidence that changes to traditional methods of absorbing menstrual flow were slow and globally uneven, and remain so today. We learned how various sorts of fabrics were folded or sewn as external menstrual absorbents, how pieces of plastic were incorporated by girls in Hong Kong and Vietnam in the 1960s and how the pads were either discarded or washed and reused. But we did not hear of any young girls making tampons and we might ask why, although data suggests the answer is a cultural importance placed on virginity until marriage (and the associated belief that hymenal integrity was proof of virginity). As we learn how extreme deprivation caused some Indian women to remain publicly immobile, squatting on sacks for the duration of their menstrual flow, and how others folded or crushed paper in readiness for the next period, we might ask what the situation is today. Hearing that the onset of a period during a mixed-gender social outing caused shame and fear for the young woman concerned, we might consider how young women in many countries today try to save pieces of absorbent material to hold their menstrual flow, surely an endeavour that is part of the history of women long pre-dating the biblical reference to the ‘menstruous cloth’ and may traditionally reflect the ecology of an area, for instance shredded bark, moss or animal skin.30 In 17th-century England shorn wool, or herbs in linen or silk bags, were prescribed as pads or pessaries in conditions of too much or too little menstrual flow, according to Patricia Crawford in her study of attitudes to menstruation at that time. As tampons, these materials were deemed fit for married women so long as they had some sort of thread attachment for removal.31

How did the evolution from women’s use of primitive materials as menstrual absorbents to the ease of obtaining products developed and manufactured specifically for the purpose come about? This chapter will explore the transition of menstruating women from their confined, domestic and private world into the public sphere. We will examine how Western medical science, technology and marketing created what is now a major international industry based on the concealment of menstruation, while simultaneously revealing its existence through public advertising. Several aspects will be explored, addressing the following questions: what was the social context in which the first manufactured pads were produced and which women benefited most from the innovation? Did women have any input in designs of menstrual absorbents? What benefits did women gain from the technological advances made in menstrual absorbents and how different were the experiences to those who had always used them from the women interviewed who previously had no access to the manufactured product?

The social context from which the early prototypes of modern menstrual absorbents developed will be discussed through events occurring in England and America during the mid-to-late 19th century. These events are part of a wider social change influenced by science and technology that included a deepening social concern about ways of improving the white ‘race’.32 At the time gynaecology, a developing speciality, tended to pathologise menstruation, its theories reflecting male cultural perceptions about girls and women: what they were, and what they ought to be, according to the historian Carroll Smith-Rosenberg.33 Furthermore, the medical link between menarche, menstruation and disease had expanded to a connection between disease and femininity, made worse by mothers lacking the language for communication with their daughters, as historian Julie-Marie Strange points out.34 In her study of Victorian women and madness, Elaine Showalter identifies the domestic conditions in which girls experienced pubescence as the basis of emotional vulnerability. This was a time of physical separation from childhood relationships, when many of the daughters of the English upper and growing middle-class saw their brothers off to boarding school. Puberty for boys represented the dawn of male virility and intellectual power but for their sisters, once their companions in all forms of children’s activities, it signalled rigid domestic confinement. Girls were privately tutored at home, their education considered secondary to learning the social and domestic arts in readiness for their destiny of marriage. It was a time in which sexual innocence was mandatory until the wedding, and both prudery and ignorance of bodily function prevented many mothers adequately preparing their daughters for menstruation. Consequently, for scores of girls, struggling to manage their periods in households where menstruation had no acknowledged existence, menarche was a shocking experience that, for some, became associated with physical and psychological instability.35 Although this was inarguably a traumatic time for girls, it should be understood that ignorance about menarche was not specific to the West, as we saw in chapter two. The difference is that in non-industrialised cultures menarche introduced girls to the sexualised world of women through the knowledge and support of their older female kin.

Toward the close of the 19th century, the publication of women’s health manuals advised middle-class mothers in America, England and Australia how they might guide their daughters through puberty and menarche. Julie-Marie Strange, writing on teaching menstrual etiquette in England, observes that the promulgation of such knowledge as woman-specific underlines the social taboo surrounding the subject of menstruation.36 Concealment of menstruation was of prime importance, and some manuals provided patterns for making linen pads, considered superior to cotton, which the historian Patricia Crawford suggests is due to the ancient belief that clean linen draws forth moisture. The manuals also advised pre-wash soaking of soiled items. Joan Jacobs Brumberg, in her study on the evolution of American hygiene authority and menarche, argues that although disposable pads began to be manufactured around 1890, those home made from cheesecloth, gauze or left-over dressmaking fabrics were preferred, possibly for reasons of cost, but thoughts about perceptions of cleanliness of manufacture ought also to be considered. The influence of Lister and his theory of antisepsis and the connection between dirt, germs and disease was particularly applicable to women and menstrual blood, and doctors, writing in women’s health manuals, emphasised bodily cleanliness during menstruation, including the genital area, and the need for morning and evening pad changes.37

Having theorised that menarche and menstruation for girls was a health problem, doctors set about solving it, basing their recommendations on the conviction that women’s bodies had finite energy that, in the pubescent girl, must be saved for the optimal development of their reproductive organs. Medical thought had been influenced by the work of Victorian biologist and philosopher Herbert Spencer (1862), who argued that ‘Nature was a strict accountant’ meeting excessive demands of energy by one part of the body through deprivation elsewhere. Meanwhile biologist Charles Darwin (1874) developed the theme of intellectual difference between men and women, asserting that puberty affected the mental facilities of girls, leaving them, as women, intellectually inferior to men. Somewhat later, psychiatrist Henry Maudsley (1884), pursued Spencer’s earlier argument, adding that proper establishment of the female reproductive system drew heavily on vital energies at menarche, so that additional demand, caused by education for example, further depleted reserves of energy leaving some girls vulnerable to disease.38 It was understood that girls, biologically inferior to their male counterparts, were at risk from the additional stresses placed upon them at puberty. In her article on Victorian-American thoughts on puberty, Smith-Rosenberg points out that not all medical practitioners agreed on the extent to which limitations should be placed on the activities of the menarcheal girl, although most warned about the hazards of them of becoming too absorbed in any project. Moderate exercise, an almost invalid diet of plain food, and avoidance of stimulating drinks or alcohol were advised. Smith-Rosenberg argues that medical ideas about menarche served social and medical purposes, including an awareness of the development of women’s fundamental sexuality, while controlling it within the framework of marriage and maternity. The normality of adolescent emotions and sexuality was accepted with reservation, but preventative medicine for future physiological and psychological health was practised in the form of confinement to the home and limiting activities to the domestic. The alternative – dances, parties, flirting and emotional excitement – were believed to cause madness and disease, including sterility, a belief Smith-Rosenberg attributes to unresolved historical ideas concerning menarche and menstruation.39

It is clear that for many young women, particularly those of the more privileged classes, limitations on individual freedoms put in place by medical men (and supported by mothers) kept the problems of menarche in the province of medicine. That was until 1872 when Edward Clarke, a physician and professor of Materia Medica at Harvard Medical School, addressed the New-England Women’s Club in Boston.40 His subject, the relationship between gender and education, caused considerable interest among the wider public and was reported in a number of non-medical journals. In response to this, Clarke decided to enlarge the theme and Sex in Education; or, a Fair Chance for the Girls was published in October 1873, with a second edition published the following month, indicating the considerable interest in the topic. Clarke’s work came at a time of educational reform in America, when women’s political activism for advancement influenced girls’ schools to adopt curricula mirroring those of boys. He excluded young working-class women from his concerns, arguing their work-induced physical activities strengthened their bodies and reproductive systems while making their brains torpid, thus ineducable.41

Clarke focuses on what he perceives to be the problem of young women in their mid-teens at a time when the age of menarche was most commonly cited at 14 to 16. He argues that the unhealthy appearance of American girls, compared with their European equivalent, was due to the educational system although the ‘perpetual pie and dough-nut’ diet, corsets, ‘the artificial deformity’ of dress, and gynaecological abnormalities all contributed.42 The core of Clarke’s thesis is twofold: the psychophysical problem of girls’ educational process causing irregularities in the newly commenced menstrual cycle and the ensuing social problem of sterility leading to the spectre of America being propagated by ‘inferior classes’. Clarke argues that the intellectual and muscular effort of study, combined with nervous excitement, deprives the reproductive system of nutrients, which are instead channelled to the brain, an argument not dissimilar to that of Chinese physician Sun Simiao (561–662 CE), referred to in chapter one, who believed that thinking damages the vital organs of a young woman’s body.43 With reference to an earlier work by English psychiatrist Henry Maudsley, Clarke examined clinical aspects of menstrual irregularities, using as evidence examples of high-achieving young women students who became physical and psychological tragedies.44 Having identified the cause and effect of the problem, Clarke proposed the solution of restructuring the identical co-educational schools, which were based around the needs of boys, to accommodate the needs of girls in the 14 to 18 age group.45 He recommends that because of their physiological changes girls should have less than eight hours total study time per day, with a recess free from compulsory exercise, and a one to four-day break without penalty, to coincide with menstruation, every fourth week. Clarke refers to England’s recent parliamentary passage of the Ten-Hour Act (1875) as a means of women’s protection from labour exploitation, although his study excludes any reference to working-class women and adds that the Ten-Hour Act was a recognition of gender difference rather than acknowledgement of women’s menstrual cycle.46

It comes as somewhat of a relief to read Clarke’s clarification that not all young women’s gynaecological problems were due to their education, nor that all young graduates were ‘pathological specimens’.47 However, Sex in Education caused consternation among readers, including Martha Carey Thomas, the American educationalist and president of the American women’s college Bryn Mawr, who recalled initial uncertainty about the effect of education on young women’s health. Carey Thomas insisted her mother read Sex in Education, and was encouraged to learn her mother had never seen, or known of, any young women such as those described by Clarke and thought the whole matter best ignored.48 Sex in Education was reviewed anonymously in the prestigious English medical journal Lancet as handling a delicate subject well, without demeaning the intelligence of women, but proving that the handicap of her ‘periodic functions’ means that to be equal to, she must be more than man. More concisely, as Strange observes, Clarke had constructed a model whereby gender prejudice could be shifted to the physiological.49

In England, Clarke’s theme was taken up by the ‘precociously brilliant, caustic individualist’, Dr Henry Maudsley, in the article ‘Sex in mind and education’, published in the Fortnightly Review in 1874.50 An immediate response to both Clarke and Maudsley by Dr Elizabeth Garrett Anderson was published in the Fortnightly Review, bringing the voice of an educated woman to the public. Anderson had resisted the constraints of middle-class life for girls and had been encouraged by her father to gain an education. She commenced training as a nurse in 1860, at a time women were not permitted to study medicine, but discovered that the charter prohibiting her entry to medical school did not apply to the Society of Apothecaries. Consequently, Anderson undertook a five-year apprenticeship to a physician, passing the required examination and becoming a licentiate of the Society. The following year, 1866, she became registered to practise medicine in England.51 Anderson brings her own experience, and that of many other women, to ‘Sex in mind and education: a reply’. This is an important article because although it shows the contrast between the education of girls in America with those in England, and indicates reforms in girls’ secondary schooling, as well as the shift in social thought towards higher education for women in England, Anderson in effect agrees with Clark that certain allowances for girls at menarche are well justified.

Elizabeth Garrett Anderson begins her critique by expressing her belief that a literary journal was not the appropriate forum for discussing medical and physiological matters, but the need to repudiate both Clarke and Maudsley’s arguments that women’s education and careers were incompatible with their biology overrode her sense that matters such as this ought to be discussed elsewhere.52 Anderson observes that menstruation in adult women rarely interferes with normal activities of mind or body beyond a fleeting malaise for a few days, and that poor and working-class women spend all their energies on their labour, without any menstrual rest allowance, and with no known repercussion to their health.53 However, menarche produces other symptoms, and Anderson considers it to be a time of potentially excessive tiredness and weakness due to accelerated growth, which is dependent on good nutrition, and she recommends some allowances be made by sensible parents or teachers.54 She challenges Clarke’s argument about the psychophysical perils to girls caused by education, and draws attention to the English system, which had already embraced the changes recommended by Clarke. Anderson points out that girls in America take on the stresses of higher education at the age of menarche, and they graduate at 18, studying through the years that Clarke argues to be those of the problematic nervous excitement. In comparison, in England, the regulations at Girton, the girls’ college at Cambridge University, prohibit admission before the age of 18, with graduation three or more years later, by which time any nervous excitement of menarcheal change has settled.55

Contrasting with the American education system was the reform agenda introduced by the London Association of Schoolmistresses, to promote higher education for girls. School terms were shortened and entrance examinations to Oxford and Cambridge Universities began to be shared. The Association introduced hygiene programs, intended to improve health and vigour, including a daily bath and physical activities such as games and gymnastics. Girls were no longer permitted to stand, reciting, for over an hour at a time, or to sit without proper back support. Their hours of mental work, which included music and needlework, were reduced to six to allow time for play, based on current thought that good results could not be obtained by the sacrifice of one part of the human organism to better another.56 However, Anderson’s most cogent counter-argument to Clarke is that education powers the female mind as good food strengthens the body, and the menstrual cycle does not prevent attainment of this power. Moreover, the psychophysical benefit of an education and career for a woman not only results in her better health but also advantages her children.57

While reforms in young women’s educational opportunities were being introduced, the conditions for girls among the working poor were also coming under scrutiny. By 1891 in New South Wales, over 40 per cent of women aged 15–24 were employed, 3 per cent of them girls aged 5–14, and the long hours worked by many ‘forced to stand all day behind the counters’ or ‘sweated by clothing factories, and boot factories’ had been noted with concern by the social activist William Lane in 1888.58 However, in America in 1875, following the publication of Clarke’s Sex in Education, the mills and factories employing women and children working up to 16 hours a day had attracted the attention of Dr Azel Ames, Commissioner of Investigation for the Massachusetts Bureau of Statistics of Labor. Ames interviewed women employed in various industries in an attempt to identify the effects of both work and its conditions on the menstrual function of girls aged 10 to 15, with the object of having child labour practices amended. He argued that poor health in these young women, who lacked financial support, had a social cost and he recommended a periodic rest time of three days a month without penalty to reverse the existing situation of reproductive degeneracy. In her work on the politics of menstruation, historian Sharra Vostral argues that Ames’ good intention created problems for working women through his assertion that rest was essential for good reproductive life to benefit the nation. The argument helped influence a court decision in 1908 restricting the employment of women in factories using machinery to 10 hours a day, which Delaney et al argues established state interest in the reproductive bodies of women.59

As we have seen, the reproductive body, specifically the menstruating body, received considerable attention in the late 19th century. Concurrent with the politics of women’s education was the work of Lister and the changes in living that followed. In his study of personal hygiene, Andrew Wear points out how the meaning of hygiene shifted from that of health to that of social cleanliness embracing the personal, moral and racial.60 Cleanliness of person symbolised an inner moral cleanliness, hence ‘cleanliness is next to godliness’ and, as we saw, the daily bath for girls introduced as part of their education. The importance of personal cleanliness created additional concern about concealment of menstruation, and the stigma any obvious bloodstain would create. Drawers were not worn by English women before the 1840s, and then only by the affluent, as Alia Al-Khalidi showed in her study on menstrual paraphernalia.61 For poor women, already stigmatised by belonging to ‘the great unwashed’, change by improvements to living conditions was slow and, as historian Janet McCalman showed in her study of women’s health in Melbourne, in the mid-19th century not all women wore undergarments and many impoverished women still menstruated in their clothes. However, in Melbourne, the problems for working-class women remained silenced and hidden by custom in the slums of North Melbourne and Richmond as late as the 1930s. Washing facilities were often a shared outdoor tap, and rags were so special that a household of menstruating women might have only one to share. For these women cleanliness was almost impossible.62

Behind the politics of social change in thought and ideas about women and menstruation, a nascent industry was forming, as Alia Al-Khalidi so aptly showed in her study of 19th-century menstrual paraphernalia in Britain. Women’s interest in adopting below-knee drawers, or the American bloomer, introduced at the end of the 1840s, and the subsequent outcry against what was considered male dress despite being hidden under petticoats and skirts, focused attention on the pelvic area of the female body and its natural processes.63 Al-Khalidi argues that this controversy became part of the growing awareness of menstrual matters which ultimately developed into the commodification of menstruation. One outcome was the registering of menstruation-specific technical design patents by British, American and European inventors during the mid-19th century, although as Al-Khalidi noted, registration did not mean the designs were actually manufactured and distributed. However, we can show that specifications and sketches of appliances to be patented in London were indeed precursors to later sanitary hygiene industries, as well as evidence that a sense of thought about the menstrual experience existed. Some patents, utilising recently introduced rubber as moisture-proof rubberised fabric, and elastic, focused on securing an absorbent, rather than on simply being absorbent. They included a design by Theresa Lawrence (1849) of a constructed sanitary belt of red and blue silk with an adjustable piece of elastic in the front, and side insets of soft chamois leather padding, which were repeated under the toggle-type menstrual towel fastener to avoid chafing. Lemuel Dow Owen (1859) registered a menstrual truss using rubber straps, attached to a waistband, to hold two crescent-shaped, air-filled, rubber cushions gripping a sponge or other washable absorbent, covering the labial area. Patent agent William Edward Gedge (1864) applied for registration of a ‘catamenial appliance’ of form fitting linen-covered silk or oilcloth, with an elastic waistband, and open sides with two deerskin strips attached by buttons each side at both waist level and thigh, holding in place a sponge absorbent, allowing change, or voiding of urine, without the need to remove the whole garment.64 This form of innovation indicates that securing menstrual absorbents was of major concern for women, but it also indicates that mature women’s bodies were the objects of design. There was little suitability in the designs for young menarcheal girls, reflecting Victorian unease about the event.

For young women the problems of menstrual absorbents – their tendency to leak and chafe, and the task of soaking and washing – kept the nuisance aspect of menstruation constantly in mind. In the late 19th century, the development of wood-based absorbents introduced the dimension of disposability. According to the journalist Sophia Moseley, an early example was a pad of combined moss and wood shavings developed about 1890 by German naturopath Friedrich Eduard Bliz, which he promoted in his book, The New Natural Healing, as having the qualities of being a deodorant, disposable and economical to produce.65 Wood wool was found to have greater powers of absorbency than cotton; among the first commercially manufactured were Hartmann’s ‘hygienic wood wool towelettes’, advertised in Harrod’s of London’s 1895 catalogue and later reappearing in the end-pages of a midwifery textbook promoting their ‘Invaluable and Indispensable’ qualities for ‘Home Use, Delicate Health, for Ladies Travelling and Accouchement … After Use they are simply Burnt’.66

The transition from obstetrical dressing to menstrual pad seems a natural progression and one might ask if the slow acceptance by women was due to cost, the possible odour of antiseptic-impregnated wool, the social embargo on discussion of menstrual matters preventing women’s promotion of the product to each other, or the disposal of used pads. ‘Simply’ burning, as Hartmann’s advised, is achieved without fuss in a hospital setting but in the home, disposal of a used pad in the family fire or wood-burning stove entails obvious difficulties. A lack of acceptance was supported by the failure of Johnson and Johnson’s initial foray into the American market in 1896 with their disposable Lister’s Towels, sold among household sundries in Sears, Roebuck and Company’s catalogue. The pads, made from gauze-covered cotton wool with a name denoting the safety and modernity of medical antisepsis, were largely ignored. Delaney et al argue this was because 19th-century morality prevented wide-reaching advertising, but Vostral claims that at the time women could make better pads than they could buy.67

Here, as in a number of other areas, the contingencies of war led to new technological developments, in this case the emergence of the absorbent pad. A shortage of cotton for the manufacture of surgical dressings during World War I led to Ernest Mahler, a chemist for the Kimberly-Clark Paper Company of Wisconsin, working on a substitute derived from wood fibre, a cellulose wadding known as ‘cellucotton’. This substance was five times more absorbent than cotton, a factor appreciated by Red Cross nurses at the front, who made use of the dressings for their menstrual needs.68 At the end of the war, left with surplus dressings and aware of their alternative use by the nurses, Kimberly-Clark decided to diversify by forming the Cellucotton Products Company to manufacture disposable menstrual pads. The product would be called Kotex, an amalgam of COtton-TEXture, and sophisticated marketing of the product, beginning in 1921, made it a household name.69

This time, in spite of each pad costing 10 cents, there was considerable consumer response among wealthier women, which the historian Vern Bullough associates with two other developments: a wider incorporation of the indoor toilet in middle-class homes and the the changing fashion in women’s clothing style to the shorter skirt.70 Adding to that were developments in transport and communication, making marketing and distribution of the manufactured product more effective, according to historian Andrew Shail in his study of the economics and waste associated with disposable menstrual products.71 Yet there were cultural constraints, as the historian Joan Brumberg has pointed out, with many Italian-American women expressing fear of health consequences should any interference with menstrual flow occur.72

The success of Kotex compelled Johnson and Johnson to re-think the market and the earlier failure of Lister’s Towels. They made use of the developments in industrial psychology by consulting Gilbreth Incorporated to research the menstrual habits of women across a spectrum of predominantly young college students, with a smaller representation of high-school students, and professional and businesswomen across the north-eastern states of America. The choice of Gilbreth Incorporated was interesting, not only because women were given a voice in the design of a commercially made menstrual pad, but because the newly widowed Lilian Gilbreth was one of America’s early women professionals (with a background in education and a PhD in psychology), a university professor, and full business partner of her husband, Frank, an industrial engineer. Moreover, Lilian had borne 12 children and become something of a celebrity through her son and daughter’s biography of the eccentricities of Gilbreth family life (later a successful film, Cheaper by the Dozen).73

The 1927 survey, based on 1037 returned questionnaires, provides the most comprehensive information of young women’s menstrual experiences in the inter-war years. It was noted that girls living at home made their menstrual pads, finding them more comfortable than the manufactured product, but they were more likely to be influenced by older colleagues to use disposable absorbents on entering the workplace or college. Other factors in purchase decisions were location and category of merchandiser – chemist or department store – and gender of salesperson. The survey findings indicated clearly what young women wanted in a menstrual pad: comfort, adequate protection, inconspicuousness, disposability and availability, in that order. They stated the desired tab length for fixing the pad to a belt; they were critical of the quality of gauze covering and wanted it softer, and also strengthened to withstand pins or clips; the absorbent material was to be thicker in the centre of the pad and tapering to the ends; and belts to which the pads were fixed needed to be circular, without fasteners, less noticeable, unadorned and easily washed. Kotex were considered too long, too wide, too thick and too stiff. Questions regarding packaging focused on the size and shape of container, ease of opening, its colour and labelling. Most telling were the figures predicting the consumer market, estimated at 30 million women of ages 13–45, each of whom would use 4,576 pads during her menstrual life (given as 32 years), based on the monthly average of 11 pads per woman.

Gilbreth estimated that if only a third of menstruating women used menstrual pads, the market potential for America alone would be over 45,000,000,000. She advised Johnson and Johnson on effective marketing, recommending they maintain ‘Modess’ as the trademark name, that they alter the shape and size of their pads, and, surprisingly, that they play down the disposable factor because of the problems of blocked toilets, although instructions for disassembling the pad were enclosed in the box.74 Johnson and Johnson were successful, expanding production of Modess to other countries including Australia in 1932, accompanied by an active advertising campaign in women’s magazines, with stress on ‘style and quality’ intended to appeal to the middle-class Australian woman.

Women had become accustomed to the disposable menstrual pad, but the fear of menstrual odour remained of concern to many, and the discomfort caused by the chafing of a wet pad meant there were many women who would welcome something less cumbersome.75

The development of the menstrual tampon evolved from the use of vaginal absorbents in gynaecology and obstetrics either to stop haemorrhage or as an antiseptic. These varying sized plugs of cotton wool or gauze, with tape or twine attached for removal, were first described by a French physician in 1776 and by German physicians in the 1800s, and were traditionally used by circus performers, dancers and other theatrical performers, but it was not until 1933 that a tampon with a disposable applicator, specifically for absorbing the menstrual flow, was patented in America by E. C. Haas of Denver.76

The Haas tampon, marketed as Tampax in 1936, was accompanied by a vigorous advertising campaign. Although women were eager consumers they began to ask medical practitioners about the safety of absorbents worn internally. Lack of medical evidence stimulated a series of studies. Two were undertaken in America with grants from the now International Cellucotton Company. The first, in 1938, examined the efficacy of three types of tampons used by 95 women between 18 and 46 years of age. The results indicated that during the days of heaviest flow tampons were obstructive and, used alone, were ineffective in 81.1 per cent of women, who required an external pad to absorb leakage.77 The second study, carried out between 1939 and 1942, tested 110 women, aged between 19 and 40 years, for any harmful effects caused by tampon use. The results showed no irritation or infection and no obstruction to menstrual flow, although it was found that 65.5 per cent of subjects required an external pad to prevent leak-through on days of heaviest bleeding.78 However, in 1943 A.E. Taft linked cotton’s fruiting-body spores with the germination of moulds and fungi, pointing out that ideal conditions for such germination existed in the warmth and moisture of the vagina, sealed by a tampon in the menstruating body.79 As we will see, this was later to create significant health problems for young women.

Not to be outdone by Tampax, Johnson and Johnson, having diversified with their Personal Products Corporation, began manufacturing Meds in 1940, having innovatively used X-ray technology to evaluate efficiency of the product. They were advertised in Australia as the choice for respectable, thinking women.80 Medical doubt about tampon use remained, in addition to questions about morality. The idea of young girls handling their genitalia, even becoming familiar with a region of the body supposedly kept in pristine condition until marriage, caused concern. Tampons were deemed unsuitable for the unmarried woman, a judgement upheld by members of the British medical profession in the name of health and expressed in letters to professional journals, including the following two from women practitioners during the Second World War.

I have had many inquiries from young patients or their mothers concerning the sanitary tampons which can now be obtained. While agreeing with advertisers that this product is, for a married woman, an advance over more old-fashioned ones, the frequent inquiries prompt me to protest against the indiscriminate sale of such goods to young unmarried girls … It is obvious that the use of a tampon may result in rupture of the hymen; and whether or not we consider that this per se is to be deplored, I cannot believe that the use of such articles by young virgins can be anything but psychologically bad. Is it not advisable that at least some warning should be printed on the outside of the packings to the effect that the contents may not be satisfactory for unmarried women?81

Three weeks later the Journal published further medico-moral concerns:

Shop keepers inform me that this type, and this type only, are asked for by young girls about the ages of 11, 12, and 13 years, and by young women in general. Careful investigation indicates certain undesirable effects from the use of these products (a) Septic infection due to forgetfulness or the belief that frequent changing is unnecessary. (b) Contusion and soreness of the vaginal and labial mucosa due to forcible efforts at insertion. (c) Undesirable handling of vulval area. Many young girls insert tampons with the aid of a looking glass. The psychological ill effects are obvious. (d) Use of tampons by young unmarried girls as a preventative in conditions of promiscuous intercourse.82

Social fear of promiscuity and medical fear of infection and psychological damage are combined with criticism of marketing practice in England during wartime. Meanwhile in America, the Navy made the decision that menstrual pads took up storage space and disposal of them blocked the plumbing. Consequently, wartime nurses were supplied with Tampax. Sales increased proportionately as young women in the defence forces, compelled to change their menstrual practices, remained tampon users, and those on production lines at home were targeted by advertising, assuring them that by using Tampax their productivity and patriotism were enhanced. Underlying the shifts in social attitudes toward menstruation were the strongly driven American public health programs that aimed to reduce worker absenteeism by changing menstrual disability to menstrual ability. Women benefited by labouring longer hours in a wartime economy to help the nation, and the tampon manufacturer increased sales by almost 50 per cent between 1942 and 1943.83

In Australia, tampons had been sold during the 1930s and advertised, with an emphasis on comfort and freedom, in Woman magazine in 1939. However, the Second World War interrupted availability of the English-manufactured product, and it was not until 1947 that an advertisement in the Australian Women’s Weekly heralded ‘Tampax is back’. Nevertheless, the censure of tampon use for young unmarried girls remained firm until the 1960s.84

During the 1970s, increased technological knowledge in the USA enabled the development of new absorbent materials, including a tampon named ‘Rely’ made from a blend of carboxymethylcellulose (CM-cellulose) combined with polyurethane foam chips that offered complete menstrual absorbency.85 At a time when young women were increasingly benefiting from internal menstrual absorbents, a situation occurred, resonant with Taft’s earlier warning about the potential of cotton tampons for causing germination of fungi. The development of the new super-absorbent tampon enabled rapid growth of bacteria, in this case Staphyloccus aureus, or ‘golden staph’, a pathogen colonising the bodies of many otherwise healthy people. The outcome varied, with menstruating teenagers most affected by either mild flu-like symptoms, or the more serious sudden onset of fever with diarrhoea and vomiting, dramatic drop in blood pressure, and a rash on the face, hands, and feet described as toxic shock syndrome.86 Rely was withdrawn by its manufacturers (Procter and Gamble) in September 1980, after 814 clinical cases and 38 deaths had been reported in the USA, and with case reports from other countries including Australia. Nevertheless, other tampons with a similar high-absorbency content remained on the market, each packet carrying a regulation warning about the link with toxic shock syndrome from June 1982.87 The Rely misadventure is evidence of change both in technological development and in human pathogens and Vostral points out that, as a result, women shunned tampons, choosing safety over the advertised freedom.88

Conclusion

The chapter is divided into two distinct parts. The first examines the interview data, which indicates the concern shared by women from diverse cultures over concealment of menstruation from the onset of menarche. The second examines the historic background to the evolution of disposable sanitary hygiene absorbents, now a major international industry.

The data confirms that until the 1960s, women in non-industrialised countries and cultures shared many of the factors that had denied Western women access to menstrual hygiene products in the 1920s–1940s. These included cost, sanitation facilities for disposal, wider geographical distribution and, in the case of tampons, belief in moral and physical damage to girls’ bodies. The data also gives an example of the way in which women’s clothing, the long sulus, saris, kaftans and hijabs, concealed both the body and the menstrual cloths and rags used to absorb menstrual blood. By contrast, Australian advertisements for sanitary hygiene products during the 1930s indicated that clothing was becoming more shaped to the body of women, preceding the adoption of shorter skirts.

Poverty was a major determinant of access to disposable menstrual absorbents in Western countries, as demonstrated by the instance of sisters in an industrial area of Melbourne, without indoor sanitation, who reportedly shared menstrual rags and whose hardship, like that of many others in similar circumstances at the time, remained hidden. Interview data gives similar instances of girls at menarche deprived of pads and having to use rags, paper, or for one young menstruating woman, an Indian squat.

Concealment is part of the long history of ideas about women and their menstruating bodies, becoming increasingly significant because of social change in the late 19th century. Part of this change affected women through their greater entry into the public space via access to higher education and employment. As women entered the public sphere, controlling and concealing menstruation became increasingly important and difficult to practise through traditional means, so what had historically been a women’s matter moved into the realm of men. Medical advancement demonstrated the links between pathology and hygiene, resulting in scientific research developing disposable surgical dressing materials with properties for greater absorbency. The establishment of the sanitary hygiene industry followed and the role played by women in the early development of disposable menstrual absorbents was discussed.

Concealing menstruation continued to grow easier as women increasingly gained access to disposable sanitary hygiene products while, paradoxically, newspaper and magazine advertisements for the products kept the existence of menarche and menstruation publicly visible. Although the rhetoric of freedom through concealment continued to be part of menstrual product promotion in industrialised countries, it reinforced the perception that menstruation is both disabling and visibly shameful. Moreover, women consumers remained vulnerable, as the introduction of super-absorbents in tampons proved, indicating that innovation in sanitary hygiene products can have serious consequences.

1    Qing, 12 years old at menarche, Hong Kong 1962.

2    Yanuva, 10, Egypt 1957.

3    Corazon, 12, Philippines 1956.

4    Aleli, 10, Philippines 1959.

5    Rosalia, 13, Italy 1950.

6    Alla, 14, Ukraine, year unknown, and Kateryna, 15, Ukraine 1952.

7    Jung, 13, South Korea 1959.

8    Sun, 13, South Korea 1962.

9    Maryam, 15, Lebanon 1942.

10  Levani, 16, Fiji 1967.

11  Rara, 12, Indonesia 1951.

12  Nirmala, 13, Indonesia 1964.

13  Hetal, 14, India c.1952.

14  Saha, 13, India year unknown.

15  Cecile, 16, Uganda 1965.

16  Ruth, 17, Uganda c.1974.

17  Zosime, 11, Egypt 1934.

18  Elena, 14, Greece, year unknown.

19  Melena, 14, Chile, year unknown.

20  Lee, 13, Singapore 1962.

21  Qing, 12, Hong Kong 1962.

22  Bao, 12, Vietnam 1968.

23  Malaya, 12, Philippines 1956.

24  Gloria, 13. Philippines 1959.

25  Ramona, 15, Chile 1964.

26  Sue, 13, Singapore 1967.

27  Lola, 17, Chile 1967.

28  Marjorie, 12, England 1956.

29  Letter, Surgeon-Superintendent Richard Eades, Roman Emperor, to the Secretary, Colonial Land and Emigration Commissioners, Stephen Walcott, 25 October 1848, GRG 24/6/1763/1848, State Records of South Australia.

30  ‘Isaiah’ 30:22, in The Holy Bible, King James version, Cambridge University Press, Cambridge n.d. See also Joan Jacobs Brumberg, ‘“Something happens to girls”: menarche and the emergence of the modern hygiene imperative’, Journal of the History of Sexuality, vol. 4, no. 1, 1993, f.n. 28, p. 113.

31  Patricia Crawford, ‘Attitudes to menstruation in seventeenth-century England’, Past and Present, vol. 91, no. 1, 1981, p. 55. The difference between vaginal tampons and pessaries is the medication contained in the latter.

32  Patricia Vertinsky, ‘Exercise, physical capability, and the eternally wounded woman in late nineteenth century North America’, Journal of Sport History, vol. 14, no. 1, 1987, p. 16.

33  Carroll Smith-Rosenberg, ‘Puberty to menopause: the cycle of femininity in nineteenth-century America’, Feminist Studies, vol. 1, no. 3/4, 1973, pp. 60–62.

34  Julie-Marie Strange, ‘Teaching menstrual etiquette in England, c. 1920s to 1960s’, Social History of Medicine, vol. 14, no. 2, 2001, pp. 249–251.

35  Elaine Showalter, The Female Malady: Women, Madness, and English Culture, 1830–1980, Penguin Books, New York 1987, pp. 56–57.

36  Strange (2001), p. 252.

37  Brumberg (1993), p. 112–114. See also Crawford (1981), p. 55, f.n. 41.

38  Herbert Spencer, Education: Intellectual, Moral, and Physical, Hurst and Company Publishers, New York, 1862, pp. 292–293, http://www.archive.org/stream/educationintelle00spenuoft#page/n297/mode/2up; Charles R. Darwin, The Descent of Man, second edition revised and augmented, John Murray, London 1874, pp. 564–565, http://darwin-online.org.uk/contents.html#descent; Henry Maudsley, Sex in Mind and in Education, C.W. Bardeen Publisher, Syracuse 1884, p. 5, http://www.archive.org/stream/sexinmindandine00maudgoog#page/n8/mode1up

39  Smith-Rosenberg, (1973), pp. 62–63.

40  Sharra L. Vostral, Under Wraps: a History of Menstrual Hygiene Technology, Lexington Books, Lanham, Maryland, 2008, pp. 26–27.

41  Edward H. Clarke, Sex in Education; or, a Fair Chance for the Girls (1873), James R. Osgood and Company, Boston, 1875. Project Gutenberg Literary Archive Foundation 2006, pp. 29–30. http://www.gutenberg.org/ebooks/18504

42  Clarke (2006), p. 6.

43  Clarke (2006), pp. 11, 31. See also Sun Simiao, Prescriptions Worth a Thousand, (Beiji qianjin yaofang), cited in Charlotte Furth, A Flourishing Yin: Gender in Chinese Medical History, 960–1665, University of California Press, Berkeley, 1999, p. 71.

44  Clarke (2006), pp. 9, 11, 16–24, 27. Henry Maudsley’s Body and Mind was published in 1870.

45  Clarke (2006), p. 28.

46  Clarke (2006), pp. 34–35.

47  Clarke (2006), p. 26.

48  Elaine and English Showalter, ‘Victorian women and menstruation’, in Suffer and be Still: Women in the Victorian Age (1972), Martha Vicinus (ed.), Indiana University Press, Bloomington, 1973, pp. 41-42.

49  Author undisclosed, ‘Reviews and notices of books’, Lancet, vol. 103, issue 2645, 9 May 1874, p. 661. See also Strange (2001), p. 253.

50  Showalter (1987), pp. 112, 124.

51  Nathan Roth, ‘The personalities of two pioneer medical women: Elizabeth Blackwell and Elizabeth Garrett Anderson’, Bulletin of the New York Academy of Medicine, vol. 47, no. 1, 1971, pp. 71–72.

52  Anderson, Elizabeth Garrett, ‘Sex in mind and education: a reply’, Fortnightly Review, vol. 15, no. 89, 1 May 1874, p. 582.

53  Anderson (1874), p. 585.

54  Anderson (1874), p. 586.

55  Anderson (1874), pp. 592–593.

56  Anderson (1874), pp. 587, 593.

57  Anderson (1874), pp. 584, 591–592.

58  Radical socialist William Lane cited in Anne Summers, Damned Whores and God’s Police, second revised edition, Penguin Books, Camberwell 2002, pp. 355–356.

59  Vostral (2008), pp. 30–31. See also Janice Delaney, Mary Jane Lupton, and Emily Toth, The Curse: a Cultural History of Menstruation, (1976), revised edition, University of Illinois Press, Urbana 1988, pp. 55–57.

60  Andrew Wear, ‘The history of personal hygiene’, in Companion Encyclopedia of the History of Medicine, vol. 2, W.F. Bynum and Roy Porter (eds), Routledge, London 1997, pp. 1302–1303.

61  Alia Al-Khalidi, ‘Emergent technologies in menstrual paraphernalia in mid-nineteenth-century Britain’, Journal of Design History, vol. 14, no. 4, 2001, p. 259.

62  Janet McCalman, Sex and Suffering: Women’s Health and a Women’s Hospital, Melbourne University Press, Melbourne, 1998, pp. 18, 180.

63  Al-Khalidid (2001), p. 258–259.

64  Al-Kahlali (2001), pp. 260, 261–264, 272 f.n. 42. Gedge is frequently listed in Chronological Index of Patents Applied and Patents Granted 1863, htpp://www.archive.org/details.chronologicalin05offigoog. As yet there is no 1864 index available online.

65  Sophia Moseley, ‘Practical protection’, Nursing Standard, vol. 23, no. 6, 2008, pp. 24–25. The type of moss is unidentified but Moseley draws attention to sphagnum moss holding 20 times its dry weight in water.

66  Advertisement for improved obstetric requirements, end-pages, Watson, J. K., A Complete Handbook of Midwifery for Midwives and Nurses, The Scientific Press Limited, London, 1904.

67  Delaney et al (1988), pp. 138–139; Irene Heywood Jones, ‘Menstruation: the history of sanitary protection’, Nursing Times, March 1980, p. 407; see also Moseley (2008), pp. 24–25 and Fred E. H. Schroeder, ‘Feminine hygiene, fashion and the emancipation of American women’, American Studies, vol. 17, no. 2, 1976, p. 107. See also Vostral (2008), p.64.

68  The story of nurses using dressings as sanitary pads has become part of the Kotex myth and is told in their booklet The Story of Menstruation (1946), Kimberly-Clark Corporation, Lane Cove, NSW, 1953, p. 15.

69  Vostral (2008), p. 65; Moseley (2008), p. 25; Delaney et al (1988), p.139; Jones (1980), p. 407.

70  Vern L. Bullough, ‘Technology and female sexuality: some implications’, The Journal of Sex Research, vol. 16, no. 1, 1980, pp. 67–68.

71  Andrew Shail, ‘“Although a woman’s article”: menstruant economics and creative waste’, Body and Society, vol. 14, no. 4, 2007, p. 79. By the 1930s the cost of menstrual pads had fallen significantly. See also Jane Farrell-Beck and Laura Klosterman Kidd, ‘The roles of health professionals in the development and dissemination of women’s sanitary products, 1880–1940’, The Journal of the History of Medicine and Allied Sciences, vol. 51, no. 3, 1996, p. 351 f.n. 148.

72  Brumberg (1993), p. 120. See also Crawford (1981), f.n. 41, p. 55.

73  Vern L. Bullough, ‘Merchandising the sanitary napkin: Lilian Gilbreth’s 1927 survey’, Signs, vol. 10, no. 3, 1985, pp. 616–617. See also Vostral (2008), p. 68.

74  Bullough (1985), pp. 616–619, 620–624. See also Vostral (2008), p. 72.

75  Mary Barton, ‘Review of the sanitary appliance with a discussion on intravaginal packs’, British Medical Journal, vol. 1, no. 4243, 1942, p. 524.

76  Madeline Thornton, ‘The use of vaginal tampons for the absorption of menstrual discharges’, American Journal of Obstetrics and Gynaecology, vol. 46, no. 2, 1943, p. 260. See also Vostral (2008), pp. 75–79.

77  Lloyd Arnold and Marie Hagele, ‘Vaginal tamponage for catamenial sanitary protection’, The Journal of the American Medical Association, vol. 110, no. 11, 1938, pp. 790–792.

78  Thornton (1943), pp. 261–265.

79  Charlotte Oram and Judith Beck, ‘The tampon: investigated and challenged’, Women and Health, vol. 6, no. 3, 1981, p. 107.

80  Vostral (2008), p. 96.

81  M. S. Brander, ‘Tampons in menstruation’, British Medical Journal, vol. 1, no. 4239, 1942, p. 452.

82  Mary G. Cardwell, ‘Tampons in menstruation’, British Medical Journal, vol.1, no. 4242, 1942, p. 537.

83  Vostral (2008), pp. 77, 108–109.

84  Megan Hicks, http://www.powerhousemuseum.com.rags/internal_protection.php. See also ‘To women who love freedom … Tampax is back’, The Australian Women’s Weekly, 29 March 1947, p. 37.

85  Oram and Beck (1981), pp. 112–113, 119.

86  Steven D. Helgerson, ‘Toxic-shock syndrome: tampons, toxins, and time: the evolution of understanding an illness’, Women and Health, vol. 6, no. 3, 1981, pp. 93, 99–100, 102.

87  Nancy J. Cibulka, ‘Toxic shock syndrome and other tampon related risks’, The Journal of Obstetric, Gynaecologic and Neonatal Nursing,vol. 12, no. 2, 1983, pp. 94–97. See also Vostral (2008), p. 157 and Helgerson (1981), p. 101.

88  Vostral (2008), p. 163.

First Blood: A Cultural Study of Menarche

   by Sally Dammery