LITMIR.BIZ

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however, that we may accept a monthly cycle in men. "We may," he concludes, "regard the human being—both male and female—as the subject of a monthly pulsation which begins with the beginning of life, and continues till death," menstruation being regarded as a function accidentally ingrafted upon this primordial rhythm.

      It is not unreasonable to argue that the possibility of such a menstrual cycle is increased, if we can believe that in women, also, the menstrual cycle persists even when its outward manifestations no longer occur. Aëtius said that menstrual changes take place during gestation; in more modern times, Buffon was of the same opinion. Laycock also maintained that menstrual changes take place during pregnancy (Nervous Diseases of Women, p. 47). Fliess considers that it is certainly incorrect to assert that the menstrual process is arrested during pregnancy, and he refers to the frequency of monthly epistaxis and other nasal symptoms throughout this period (W. Fliess, Beziehungen zwischen Nase und Geschlechts-Organen, pp. 44 et seq.). Beard, who attaches importance to the persistence of a cyclical period in gestation, calls it the muffled striking of the clock. Harry Campbell (Causation of Disease, p. 54) has found post-climacteric menstrual rhythm in a fair sprinkling of cases up to the age of sixty.

      It is somewhat remarkable that, so far as I have observed, none of these authors refer to the possibility of any heightening of the sexual appetite at the monthly crisis which they believe to exist in men. This omission indicates that, as is suggested by the absence of definite statements on the matter of increase of sexual desire at menstruation, it was an ignored or unknown fact. Of recent years, however, many writers, especially alienists, have stated their conviction that sexual desire in men tends to be heightened at approximately monthly intervals, though they have not always been able to give definite evidence in support of their statements.

      Clouston, for instance, has frequently asserted this monthly periodic sexual heightening in men. In the article, "Developmental Insanity," in Tuke's Psychological Dictionary, he refers to the periodic physiological heightening of the reproductive nisus; and, again, in an article on "Alternation, Periodicity, and Relapse in Mental Diseases" (Edinburgh Medical Journal, July, 1882), he records the case of "an insane gentleman, aged 49, who, for the past twenty-six years, has been subject to the most regularly occurring brain-exaltation every four weeks, almost to a day. It sometimes passes off without becoming acutely maniacal, or even showing itself in outward acts; at other times it becomes so, and lasts for periods of from one to four weeks. It is always preceded by an uncomfortable feeling in the head, and pain in the back, mental hebetude, and slight depression. The nisus generativus is greatly increased, and he says that, if in that condition, he has full and free seminal emissions during sleep, the excitement passes off; if not, it goes on. A full dose of bromide or iodide of potassium often, but not always, has the effect of stopping the excitement, and a very long walk sometimes does the same. When the excitement gets to a height, it is always followed by about a week of stupid depression." In the same article Clouston remarks: "I have for a long time been impressed with the relationship of the mental and bodily alternations and periodicities in insanity to the great physiological alternations and periodicities, and I have generally been led to the conclusion that they are the same in all essential respects, and only differ in degree of intensity or duration. By far the majority of the cases in women follow the law of the menstrual and sexual periodicity; the majority of the cases in men follow the law of the more irregular periodicities of the nisus generativus in that sex. Many of the cases in both sexes follow the seasonal periodicity which perhaps in man is merely a reversion to the seasonal generative activities of the majority of the lower animals." He found that among 338 cases of insanity, chiefly mania and melancholia, 46 per cent, of females and 40 per cent, of males showed periodicity—diurnal, monthly, seasonal, or annual, and more marked in women than in men, and in mania than in melancholia—and adds: "I found that the younger the patient, the greater is the tendency to periodic remission and relapse. The phenomenon finds its acme in the cases of pubescent and adolescent insanity."

      Conolly Norman, in the article "Mania, Hysterical" (Tuke's Psychological Dictionary), states that "the activity of the sexual organs is probably in both sexes fundamentally periodic."

      Krafft-Ebing records the case of a neurasthenic Russian, aged 24, who experienced sexual desires of urologinic character, with fair regularity, every four weeks (Psychopathia Sexualis), and Näcke mentions the case of a man who had nocturnal emissions at intervals of four weeks (Archiv für Kriminal-Anthropologie, 1908, p. 363), while Moll (Libido Sexualis, Bd. I, pp. 621–623) recorded the case of a man, otherwise normal, who had attacks of homosexual feeling every four weeks, and Rohleder (Zeitschrift für Sexualwissenschaft, Nov., 1908) gives the case of an unmarried slightly neuropathic physician who for several days every three to five weeks has attacks of almost satyriacal sexual excitement.

      Féré, whose attention was called to this point, from time to time noted the existence of sexual periodicity. Thus, in a case of general paralysis, attacks of continuous sexual excitement, with sleeplessness, occurred every twenty-eight days; at other times, the patient, a man of 42, in the stage of dementia, slept well, and showed no signs of sexual excitation (Société de Biologie, October 6, 1900). In another case, of a man of sound heredity and good health till middle life, periodic sexual manifestations began from puberty, with localized genital congestion, erotic ideas, and copious urination, lasting for two or three days. These manifestations became menstrual, with a period of intermenstrual excitement appearing regularly, but never became intense. Between the age of 36 and 42, the intermenstrual crises gradually ceased; at about 45, the menstrual crises ceased; the periodic crises continued, however, with the sole manifestation of increased frequency of urination (Société de Biologie, July 23, 1904). In a third case, of sexual neurasthenia, Féré found that from puberty, onwards to middle life, there appeared, every twenty-five to twenty-eight days, tenderness and swelling below the nipple, accompanied by slight sexual excitation and erotic dreams, lasting for one or two days (Revue de Médecine, March, 1905).

It is in the domain of disease that the most strenuous and, on the whole, the most successful efforts have been made to discover a menstrual cycle in men. Such a field seems promising at the outset, for many morbid exaggerations or defects of the nervous system might be expected to emphasize, or to free from inhibition, fundamental rhythmical processes of the organism which in health, and under the varying conditions of social existence, are overlaid by the higher mental activities and the pressure of external stimuli. In the eighteenth century Erasmus Darwin wrote a remarkable and interesting chapter on "The Periods of Disease," dealing with solar and lunar influence on biological processes.^[121] Since then, many writers have brought forward evidence, especially in the domain of nervous and mental disease, which seems to justify a belief that, under pathological conditions, a tendency to a male menstrual rhythm may be clearly laid bare.

We should expect an organ so primitive in character as the heart, and with so powerful a rhythm already stamped upon its nervous organization, to be peculiarly apt to display a menstrual rhythm under the stress of abnormal conditions. This expectation might be strengthened by the menstrual rhythm which Mr. Perry-Coste has found reason to suspect in pulse-frequency during health. I am able to present a case in which such a periodicity seems to be indicated. It is that of a gentleman who suffered severely for some years before his death from valvular disease of the heart, with a tendency to pulmonary congestion, and attacks of "cardiac asthma." His wife, a lady of great intelligence, kept notes of her husband's condition,^[122] and at last observed that there was a certain periodicity in the occurrence of the exacerbations. The periods were not quite regular, but show a curious tendency to recur at about thirty days' interval, a few days before the end of every month; it was during one of these attacks that he finally died. There was also a tendency to minor attacks about ten days after the major attacks. It is noteworthy that the subject showed a tendency to periodicity when in health, and once remarked laughingly before his illness: "I am just like a woman, always most excitable at a particular time of the month."

      Periodicity has been noted in various disorders of nervous character. Periodic insanity has long been known and studied (see, e.g., Pilcz,

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