184 THE FOLKLORE OF MENSTRUATION.

was delivered ; it was not bile-stained, though the placentaand membranes were. The patient died the same evening.At the necropsy the liver was found to be enlarged and to

weigh 64 ounces. It was yellowish-red in colour and

mottled in appearance. On section it was firm and not

greasy, and on microscopical examination only very smallareas of haemorrhage and necrosis were discoverable, the

widespread necrosis usually found in acute yellow atrophybeing absent. The kidneys presented a definite early tubal

nephritis. The diagnosis in this case offers many difficulties,even with the information brought out at the necropsy. The

obvious possibility of phosphorus poisoning analogous to thecase just considered was negatived by the absence of indica-tions of irritant poisoning and by the failure to find phos-phorus or its oxides in the gastric contents. The diagnosisof acute yellow atrophy, though highly probable when theclinical features alone are considered, is not conclusivelyestablished by the post-mortem investigations, and fails toaccount satisfactorily for the very marked urinary changesand the methæmoglobinuria. On the other hand, it must be

confessed that acute yellow atrophy is a condition which bothfrom the clinical and pathological standpoints is not sharply

defined. It is now generally admitted to be the result ofa profound toxaemia, of as yet unrecognised causation, andit is therefore readily conceivable that in a given case thetoxaemia, while giving rise to very extensive haemolyticchanges and to eclampsia, and inducing early necrosis inthe liver and kidneys, might prove fatal before sufficient

time had elapsed to permit of the marked autolyticchanges in the liver usually found in acute yellow atrophy.The clinical features and the pathological changes pro-duced might, in other words, conceivably depend uponthe virulence of the toxin and upon the organs upon which

its main stress fell. Some such hypothesis has been putforward in regard to the three conditions-toxæmic vomit-

ing of pregnancy, eclampsia, and acute yellow atrophy--bySTONE, MACDONALD, EWING, and WOLF, who regard themif not as one and the same disease with different manifesta-

tions, at any rate as pathologically very closely related.These views are skilfully discussed by Dr. ENGLAND and Mr.THORNTON, and they regard their own case as going far to

prove this contention. It is difficult to resist the conclusion

that the fulminating toxaemia in their patient led to a con-dition which was in effect a combination of eclampsia andacute yellow atrophy. It is to be hoped that further

chemical and perhaps bacteriological investigation of

similar cases will throw more light upon them, and

meanwhile careful records of any showing unusual featuresform a valuable and often suggestive addition to our

B

knowledge.Another obscure and interesting form of jaundice is that

to which Dr. F. J. POYNTON draws attention in an instruc-

tive lecture which we publish on p. 153. The various names

of congenital family cholaemia, family acholuric jaundice,and recurrent familial jaundice have been applied to it. The

special features of this form are admirably illustrated bythe three cases which Dr. POYNTON records and are, briefly,the occurrence of jaundice at birth and at intervals after-

wards, the association of enlargement of the spleen, andcertain blood changes leading to definite anaemia. During

the attacks of jaundice the liver enlarges also. Thoughsuch patients are often undersized and delicate, as in Dr.POYNTON’S cases, they may live to adult life and bear children,as the family history demonstrates. Pregnancy in one of thesecases coinciding with an attack of jaundice might lead todifficulties in diagnosis, and in a case recorded by Dr.

CLAUDE WILSON the patient died from jaundice during-pregnancy. Dr. POYNTON’s cases were investigated with

modern hsematological methods by Mr. D. EMBLETON, whofound that the red corpuscles were unusually fragile as

tested in vitro, but that the serum had no hasmolytic power.The view which Dr. POYNTON regards as best explaining the

phenomena of this disease is that of MINKOWSKI, and

HAWKINS and DUDGEON that the primary change is

in the blood-forming organs and that the fragilityof the corpuscles is the cause of the jaundice. The

general theory is that this condition is a congenital familydefect rather than an acquired disease. It is of interest to’

note that other forms of congenital jaundice of a family typeare known, such as the cases described by Dr. JOHN"

THOMSON, these, however, often proving rapidly fatal. It is

desirable that all cases of obscure family affections should beput on record and the genealogy given according to the

recognised methods. In another column Dr. A. ROWLEY

MOODY describes some family cases of Friedreich’s ataxia

with some interesting features ; and, no doubt, if largestatistics of family affections can be collected, much usefulinformation will be eventually elicited.

The Folklore of Menstruation.ARE women during their menses centres of mysterious

infection, and, as such, should they be allowed to handle

articles of food designed for human consumption ? Should

they be allowed to act as nurses ? We learn from a letter

in the Medical Press and Circular that butchers’ and bakers’

salesmen are at all times averse to having their wares

handled by women, but we do not think this proves much.This aversion may be due to the unwillingness which a shop-man with a poor and inquisitive clientèle feels to seeing hiswares pulled about. On the other hand, it may have a

venerable folklore origin. The lore of the shop and of thehousehold has been little examined and is rarely viewed inits racial and historical connexions. That women duringmenstruation have in all ages and climes been regardedin a hostile light is a commonplace of anthropology. Old-

fashioned Wessex and Worcestershire countrywomen, for

instance, believed, and perhaps still believe, that when inthis condition they ought not to handle raw meat for fear of

spoiling it. German peasants, in the same way, believe,according to PLOSS (Das Weib,1884), that a menstruous womanentering a cellar turns the wine of the Fatherland to a

sourness, and that if she cross a field she spoils ther

growth of young vegetation. The humbler class of Jewesses

are accustomed to signal their menstrual condition to theirhusbands by a curious ritual observance. They tie bowsof blue ribbon to their beds or chairs. The colour blue is

here probably reminiscent of purple or blood-red. Similarlycertain negresses in Africa wear a scarf of glaring colours

folded three-cornerwise over the bosom during the menses.

185TUBERCULOSIS IN CHILDHOOD.

Along the Congo the "house of blood," a hut daubed ormarked with red, is used for the purpose of segregating thetribeswomen of each village when in this condition.

The Bible is explicit on the subject of menstruation, thoughit shows a delicacy, probably prompted by no idea of modern

modesty, in mentioning the word. Indeed, the word" menstruous " only occurs some three times in the Scriptures,and then it is used by the Prophets, whose influence to someextent must have depended upon a deliberate contempt for

euphemism. "Jerusalem is as a menstruous woman among

them," says Jeremiah, and Ezekiel defines the just man as one

who, among other things, has not come near a menstruouswoman. The Books of the Law refer to the condition in

periphrases, which were probably dictated by the earlyHebrew’s dread of mentioning an unlucky subject. " ° Issues "

and a "time of separation for women, as for men, are

dealt with at length in Leviticus xv. The wording ofthe chapter suggests venereal disease, but in the case of

women it is held to refer to the menses. The menstruous

woman was held to be unclean for seven days, at the

end of which she sacrificed turtle-doves as a sin and

burnt offering. Coitus at such a period was a very

grave ofEence. In ancient Persia the persons guilty of itwere devoted to the fires of Hell until the Day of Judgment.The Zend-Avesta is full of regulations tending to isolateI unclean " women, and metrorrhagia is condemned as a crimeto be visited with 100 strokes of the lash. The feeling was

kept up in the East under Mahommedanism, and is found in

Turkey at this day. Among the early Christians we find thesame idea, for the Councils of Nice and Laodicaea in thefourth century refused the Communion, and even entry to

the church, to women in this perfectly natural condition.Heathen antiquity in Greece and Rome was full of super-stition with regard to the menses, and we need only quotePLINY who believed that a menstruous woman walking throughthe fields before sunrise kills noxious insects, while afterthe sun is up she exerts a withering effect on green corn and

young vines. Her presence rusts razors, dulls mirrors, andcauses abortion. The Middle Ages improved on all this. The

menstrual fluid was held to generate vipers and vampires, and,conversely, it possessed medicinal qualities. Among savagesall these beliefs flourish in crude forms. Everywhere thereis the idea of uncleanness and of the necessity for isolation.This is so among the South Sea Islanders, the negroes, and a

variety of other races. We may here mention the New

Caledonians, who, like the Congo natives and indeed the

Persians, set apart a special place for the segregation of theaffected.

Pseudo-hygienic motives for the treatment of females

during their "separation" " cannot always have prevailed.Primitive man, as indeed all primitive savages, doubtless

regarded the menstrual flow as something mysterious and

containing the soul or life-principle. We know that blood

in general, semen, sputum, excrements have been so re-

garded. Colour is given to this theory from the fact that inthe Middle Ages menstrual blood was held to cure Geist-

krankheiten-epilepsy and hydrophobia. The customs of the

herd may also have given rise to the attitude of the earliestmen towards menstruation. It has been pointed out that

whereas coitus only takes place among the lower animals

during seasons of rut, among all human tribes such connexionis regarded with horror. Have we not here a survival of the

customs of the herd, which, at some infinitely remote epoch,allowed coitus during the period of separation only to the

patriarch while refusing it to the other males of the

primitive human group. There can be no doubt, anyhow,that ritual segregation has during the ages been an immense

handicap to the female sex, and from the physiological pointof view the fact of menstruation must still have its influences.

GOETHE pointed out that man and woman could not be

properly termed equal while the latter had perforce to

snfEer from physiological disabilities, more or less severe,

during many days of each year, and the dictum cannot be

explained away. But sound physiologists would be the firstto protest against the maintenance of the rubbishy and

degrading superstitions to which we have alluded above.

Tuberculosis in Childhood.THE importance of a careful study of tuberculosis as it

occurs in childhood cannot be exaggerated, and we have

recently on several occasions drawn attention to the subject.In another column we publish an article by Dr. CLIVE

RIVIERE under the heading "Phthisis in Children." In

discussing the condition which he is describing Dr.

RIVIERE alludes to the importance of clearness in nomen-

clature, and we agree that it is essential that there

should be no confusion as to the terminology to be

adopted. For many years all writers on diseases of the

chest adopted the word "phthisis" as indicating a diseasecharacterised by destruction of the lung tissue. Then a

heated controversy arose as to the relation of tubercle

to the disease, when certain conditions at one time

included under the term "phthisis" were shown not

to be of a tuberculous nature. Dr. J. KINGSTON

FOWLER was one of the earliest to urge that the

term phthisis should no longer be used when tubercle was

present, because of the confusion which was associated withthe word, and for many years we have employed the term

"pulmonary tuberculosis in its place. We consider that

in so doing we are adopting a more exact expression,harmonising the affection of the lungs with tubercle

occurring in other organs and tissues of the body. The

nature of the disease as well as the organ affected

is thus definitely indicated. The word "phthisis" " is

generally used according to the meaning given to it

by Dr. RIVIERE-namely, "a chronic pulmonary tuber-

culosis of a type similar to that found in the adult"; butwe do not follow his suggestion that when others use it

"to cover all cases of tuberculosis of the lungs," they are

any more or less correct. Dr. F. T. ROBERTS, in deliveringthe Lumleian lectures in 1902, said: 1 " I have employed the

expression thoracic phthisis’ advisedly to emphasise what

are, in my opinion, two most important practical facts-

namely, first, that in the cases of chest disease usuallyand conveniently grouped as consumption ’ the morbid

changes are by no means limited to the lungs,but in the large majority of instances other thoracic

1 THE LANCET, March 29th, 1902, p. 867.