I The Sexual Epoch of the Menarche
(Puberty.)
The term menarche (μήν, a month, ἀρχή, the beginning) was introduced by me into medical literature to denote the period of life in which, as a sign of puberty, menstruation first makes its appearance.
The age at which this occurs is subject to variations depending upon race, occupation, hereditary tendencies, and climate; but in Germany and Austria the average age at puberty is 14 or 15, the extreme limits being 12 to 19.
Until about the age of 13, the physical differentiation of the sexes, except for the anatomical peculiarities of the genital organs, is in our climates a trifling one. But at puberty the important changes occur by which the sexes are so strikingly differentiated. Whereas in the growing boy all physical change takes the form of increasing strength and energy, in the development of the girl, we note the appearances of the rounded outlines so characteristic of womanhood. At the same time the voice alters, becoming less sharp, with a softer quality, and yet a fuller tone; and we may observe that young brunettes have commonly a contralto voice, young blondes, more often a soprano. The intellectual changes undergone by the girl at puberty are no less extensive and characteristic than the physical changes. In brief, the undifferentiated, neuter girl is transformed into a young woman, endowed with all the attributes, mental and bodily, characteristic of femininity.
As regards the age at which the menarche usually occurs, and the manner in which its occurrence is anticipated or retarded by the various influences already mentioned, the following propositions may be put forward, based on the available statistics and observations:
1. Climate is an important factor. In the torrid zone, menstruation appears at a very early age, on the average from 11 to 14; in the temperate zone, it appears later, on the average from the age of 13 to 16; in the frigid zone, later still, on the average from the age of 15 to 18. The mean temperature of the atmosphere appears to have a direct influence on the age at which menstruation begins, the hotter the climate, the earlier being the menarche. The height of the place of residence above the sea level and its distance from the coast also have a certain influence.
2. Race and constitution have a distinct influence upon the age at which menstruation makes its appearance. In women of the Semitic races the menarche occurs earlier than in women of the Aryan races. The average age at which menstruation begins is in Jewish girls, from 14 to 15; in Magyar girls from 15 to 16; in German girls from 16 to 16½; and in Slavonic girls from 16 to 17.
In general the menarche is earlier in girls of a sanguine, lively temperament and a powerful constitution than in girls of a phlegmatic temperament and a weakly constitution; further, other things being equal, menstruation appears earlier in brunettes, girls with black hair, thick skin, dark eyes, and a dark complexion, than it appears in blondes, girls with light hair, thin skin, blue eyes, and a fair complexion.
3. The age at which menstruation begins is also affected by the conditions of life and the social circumstances. In the higher circles of society, in the upper, well-to-do classes, menstruation appears earlier than among women of the laboring classes, who are compelled to strive for their daily bread. Amongst upper-class girls the menarche occurs at the age of 14 in one-fourth of their number, whereas among lower-class girls barely one-sixth begin to menstruate at the age of 14.
In large towns, again, menstruation appears earlier than in small towns, whilst in the open country the menarche is still further delayed. In the women of Paris the average age at the menarche is 14 years and 6 months, in the women of smaller French towns it is 14 years and 9 months, in French countrywomen it is 14 years and 10 months.
How far the mode of nutrition is concerned in the production of these results is not yet determined.
4. The time of the menarche appears to be influenced by inheritance to this extent, that the daughters of women who began to menstruate early begin themselves to menstruate at an early age, whereas in other families we observe that both mothers and daughters began to menstruate late. But this relation is by no means a constant one.
Ploss has collected observations made in various countries and towns regarding the age at which menstruation begins, and the mean results of these observations are given below.
The average age at which menstruation began was:
| In Swedish Lapland | 18 years, | 0 months, | 0 days. |
| In Christiania | 16 years, | 9 months, | 25 days. |
| In Copenhagen | 16 years, | 9 months, | 12 days. |
| In Munich | 16 years, | 5 months, | 12 days. |
| In Göttingen | 16 years, | 2 months, | 2 days. |
| In Vienna | 15 years, | 8 months, | 15 days. |
| In Berlin | 15 years, | 7 months, | 6 days. |
| In Stockholm | 15 years, | 6 months, | 22 days. |
| In Manchester | 15 years, | 6 months, | 0 days. |
| In Warsaw | 15 years, | 1 month, | 23 days. |
| In London, between | 15 years, | 1 month, | 4 days. |
| and | 14 years, | 9 months, | 9 days. |
| In Paris, between | 15 years, | 7 months, | 18 days. |
| and | 14 years, | 5 months, | 17 days. |
| In Madeira | 14 years, | 3 months, | 0 days. |
| In Montpellier | 14 years, | 2 months, | 0 days. |
| In Corfu | 14 years, | 0 months, | 0 days. |
| In Marseilles | 13 years, | 11 months, | 11 days. |
| In Calcutta | 12 years, | 6 months, | 0 days. |
| In Egypt | 10 years, | 0 months, | 0 days. |
The collective results of the investigations of French authors regarding the average age at which menstruation first appears are given in the following table:
| I. In Temperate Climates: | ||||
|---|---|---|---|---|
| Observer. | Place. | No. of Cases. | Average Age. | |
| De Soye | Paris | 1,000 | 15 years, | 0 months. |
| Dubois | Paris | 600 | 15 years, | 3 months. |
| Raciborski | Paris | 200 | 14 years, | 5 months. |
| M. Despines | Paris | 85 | 14 years, | 11 months. |
| Arau | Paris | 100 | 15 years, | 4 months. |
| Courty | Montpellier | 600 | 14 years, | 3 months. |
| Puech | Nîmes | 941 | 14 years, | 2 months. |
| M. Despines | Toulon | 43 | 14 years, | 1 month. |
| M. Despines | Marseilles | 25 | 14 years, | 1 month. |
| Puech | Toulon | 144 | 14 years, | 1 month. |
| Grey | London | 1,498 | 15 years, | 6 months. |
| Lee & Murphy | London | 1,719 | 15 years, | 6 month |
| Torisiano | Corfu | 33 | 14 years, | 6 months. |
| Lebrun | Warsaw | 100 | 15 years, | 1 month. |
from these observations we obtain an average of 15 years.
| II. In Cold Climates: | ||||
|---|---|---|---|---|
| Observer. | Place. | No. of Cases. | Average Age. | |
| Ravn | Copenhagen | 3,840 | 16 years, | 9 months. |
| Frugel | Christiania | 157 | 16 years, | 6 months. |
| Dubois | Russia | 600 | 16 years, | 8 months. |
| Faye | Norway | 100 | 15 years, | 6 months. |
| Lundborg | Esquimaux | 16 | 15 years, | 6 months. |
| Wistrand | Stockholm | 100 | 15 years, | 7 months. |
from these observations we obtain an average of 16 years and 3 months.
from these observations we obtain an average of 12 years and 7 months.
In 6,550 cases collected by Krieger menstruation first appeared:
| At the age of: | |
|---|---|
| 9 years in | 1 instance. |
| 10 years in | 7 instances. |
| 11 years in | 43 instances. |
| 12 years in | 184 instances. |
| 13 years in | 605 instances. |
| 14 years in | 1193 instances. |
| 15 years in | 1240 instances. |
| 16 years in | 1026 instances. |
| 17 years in | 758 instances. |
| 18 years in | 582 instances. |
| 19 years in | 425 instances. |
| 20 years in | 281 instances. |
| 21 years in | 111 instances. |
| 22 years in | 55 instances. |
| 23 years in | 15 instances. |
| 24 years in | 15 instances. |
| 25 years in | 1 instance. |
| 26 years in | 4 instances. |
| 27 years in | 2 instances. |
| 28 years in | 1 instance. |
| 29 years in | 1 instance. |
From these figures it appears that in the 6,550 cases under consideration, the age 15 was that at which the first appearance of menstruation was most frequently observed, namely in 1,240 instances, or 18.9 per cent. The age 14 comes next, with 1,193 instances, or 18.2 per cent. The case in this series in which menstruation appeared earliest, namely in the ninth year, was observed by Mayer, the girl being a blonde of average height, good family, and German descent; the case in which menstruation appeared latest, namely in the twenty-ninth year, was that of a woman living in Berlin, who was sickly and chlorotic up to the time of her marriage, and in whom menstruation did not appear until some years after that event.
As regards climatic influences, all the data at our disposal prove that the hotter the climate the earlier the menarche. According to Marc d’Espine the age at puberty varies in an almost geometrical ratio with the mean annual temperature.
The dependence of the menarche upon climatic influences is clearly shown by the statistical data collected from various regions of the world. We append the general compilation of Gebhard dealing with this question.
A. Europe
For Europe the data furnished by Ploss are grouped by Gebhard in the following manner.
1. Northern Europe
The average age at which menstruation first appears, according to the older statistics, is in Swedish Lapland 18, in Norway, 16.12. In Copenhagen it is 16.75, in St. Petersburg 14.5.
More recent statistics for Finland are furnished by Engström. Among 3,500 women of pure Finnish descent, he found that menstruation began:
| At the age of: | |
|---|---|
| 8 years in | 2 instances. |
| 9 years in | 2 instances. |
| 10 years in | 4 instances. |
| 11 years in | 41 instances. |
| 12 years in | 178 instances. |
| 13 years in | 458 instances. |
| 14 years in | 715 instances. |
| 15 years in | 778 instances. |
| 16 years in | 614 instances. |
| 17 years in | 369 instances. |
| 18 years in | 195 instances. |
| 19 years in | 91 instances. |
| 20 years in | 31 instances. |
| 21 years in | 8 instances. |
| 22 years in | 10 instances. |
| 23 years in | 2 instances. |
| 24 years in | 1 instance. |
| 25 years in | 0 instance. |
| 26 years in | 1 instance. |
Thus, in nearly half of all Finnish women, menstruation begins with the completion of the fourteenth and fifteenth years. The statistics include women of all classes of society.
At the Pirogoff Congress Grusdeff furnished particulars of the first onset of menstruation in Russia among 10,000 women. Menstruation began:
| At the age of: | |
|---|---|
| 9 years in | 1 instance. |
| 10 years in | 4 instances. |
| 11 years in | 31 instances. |
| 12 years in | 244 instances. |
| 13 years in | 864 instances. |
| 14 years in | 1641 instances. |
| 15 years in | 1795 instances. |
| 16 years in | 2012 instances. |
| 17 years in | 1692 instances. |
| 18 years in | 910 instances. |
| 19 years in | 498 instances. |
| 20 years in | 183 instances. |
| 21 years in | 65 instances. |
| 22 years in | 19 instances. |
| 23 years in | 5 instances. |
| 24 years in | 3 instances. |
| 32 years in | 1 instance. |
In women of German race living in Russia puberty was earliest, occurring at the average age of 15.16 years; in Finnish women it was latest, occurring at the average age of 16.17 years.
2. Middle Europe
In Germany, according to the tables of Krieger and L. Mayer, who have recorded 11,500 cases in all, menstruation begins most commonly (in 18.931 per cent. of the cases) at the age of 15; the next most frequent age is 14 (18.213 per cent. of the cases).
For Berlin, in a number of cases collected from the lower classes of society, we find the average age for the first appearance of menstruation to be 16.18 years.
Notwithstanding the more northerly situation of Berlin, the average age at puberty is somewhat less than in Munich, situated 4½ degrees to the southward, for the reason that the retardation dependent upon altitude makes itself manifest in the latter town, which is situate about 500 metres (1,640 feet) higher above the sea level. Whereas in Berlin 18 per cent. of all cases begin to menstruate at the age of 14, and 19 per cent. at the age of 15, in Munich the two leading years are 15 with a percentage of 17½, and 16 with a percentage of 18¾.
In Great Britain, according to Krieger, the average age at which menstruation begins is 15 years, 1 month, and 5 days. For Manchester the age given is 15 years, 6 months, and 23 days. In France, according to the calculation of Brierre de Boismont, the most frequent age for the first onset of menstruation is 16. In Paris the average age is 14 years, 6 months, and 14 days. Bohemia, Upper and Lower Austria, and Moravia have an average age of 16 years and 2 to 3 months.
3. Southern Europe
In Southern Europe the influence of the higher mean temperature manifests itself. The average age at which Spanish girls begin to menstruate is 12. In Northern and Middle Italy the most frequent age is 14; in Southern Italy, 13. In Lyons the average age at which menstruation begins is 14 years, 5 months, and 29 days; in Marseilles and Toulon it is 13 years and 10 months. For Hungary, Doktor gives the statistics of 9,600 cases. In 22⅓ per cent. menstruation began at the age of 15; in 20½ per cent. at the age of 16, and in 10 per cent. at the age of 17. The earliest age among these cases was 8 years; the latest, 33 years. (The latter must no doubt be regarded as pathological.)
B. Asia
In Palestine puberty most commonly occurs at the age of 13; in Turkey even as early as 10. Rouvier calculated the average of 742 cases observed in Syria to be the age of 12. As regards Persian women, the data vary between the age of 14 for the northern part of the country and the age of 9 or 10 for the southern. According to Joubert’s data in 46.4 per cent. of the indigens of India, menstruation begins at the age of 12 or 13. Similar figures are given for Ceylon and for Siam. In Japan menstruation most frequently begins at the age of 14, sometimes as early as 13; mothers of 15 are by no means rarities in this country, but for menstruation to begin before the age of 12 is considered a very exceptional occurrence. According to a table dealing with 584 women of Tokio menstruation began:
| At the age of: | |
|---|---|
| 11 years in | 2 instances. |
| 12 years in | 2 instances. |
| 13 years in | 26 instances. |
| 14 years in | 78 instances. |
| 15 years in | 224 instances. |
| 16 years in | 228 instances. |
| 17 years in | 68 instances. |
| 18 years in | 44 instances. |
| 19 years in | 10 instances. |
| 20 years in | 2 instances. |
The data available regarding China are so exceedingly variable that little importance can be attached to them.