aspect of the matter. At the Birmingham meet- ing of the British Medical Association in 1890, Dr. Wilberforce Smith read a paper concerning some investigations he had made " On the Alleged Differ- ence between Male and Female Respiratory Move- ments." 1 Using Burdon Sanderson's stethograph in a modified form, Dr. Smith took tracings of about fifty persons at the anterior middle line, over (1) sternum, (2) liver below ensiform cartilage, (3) just above navel, (4) just below navel, (5) midway between navel and pubes. The dress was entirely loosened; and it was rightly regarded as of considerable import- ance to keep the subject of the experiment ignorant of its object It was found that at the sternal level of the chest in both sexes there was free respiratory movement, and also that over the liver there was free and regular movement in both sexes; just above the navel the results were variable, and between the navel and pubes in many cases there was no respira- tory movement The most characteristic differences occurred just below the navel: among the men a principal group showed free movement, while a smaller group, having soft abdominal walls, only showed slight movement; among the women, habitu- ally dressed and corseted in the usual manner, a large group showed excessive diminution or entire abolition of movement, while a smaller group of young and muscular women, wearing corsets, retained free move- ment; among women habitually wearing no corsets, a large group showed free movement in no degree less marked than among males, and in at least one case actually freer than among most males, and a smaller group of non-corseted women, having soft abdominal walls, showed only slight movement Dr. Smith also independently examined nine ayahs; they all wore Oriental dress and had all borne more than one child. Without exception 1 Published in the Brit. Med. Journal, nth Oct. 1890.
206 MAN AND WOMAN.
they exhibited respiratory movement below the navel not less free than in average English men.
As a result of his investigations, Dr. Wilberforce Smith concluded " that the tracings exhibited tended to invalidate the routine physiological teaching that there is a natural difference in the respiratory move- ments of the sexes, and they tended to confirm the belief of Sibson that the alleged difference is chiefly or wholly due to the effects of women's conventional dress." Professor Cunningham, after the paper was read, remarked that these physiological experiments confirmed his own views, founded on anatomical grounds, that there ought to be no essential differ- ence in respiratory movements in man and woman. Charpy, I may add, had also previously come to the conclusion, from extensive anatomical investigations, that up to the age of 15 boys and girls have identical chests, and that the thoracic type of breathing is only found in women of at least 25 years of age who bear on their viscera/ especially the liver, signs of deformation produced by tight clothing. 1 Dr. Smith makes the following supplementary remarks in a private letter (5th Oct. 1892):— " I might have added in 1890 that the cases of which I had obtained graphic record were preceded by daily observation for many years without such record. They have been followed by similar daily observation ever since, and are, I have no doubt, founded on unalterable truth.
" The only fact of interest I have to add is, that so far from pregnancy affording a reason for a different mode of respiration, it is associated with marked abdominal respiratory movements. I take it that the comparatively firm mass of the gravid uterus, like the liver, readily conveys movements of the diaphragm to the surface.
" The same difficulty occasionally occurs in men where the action of the diaphragm is impeded by an enlarged stomach, the result of a recent meal, or undue corpulence."
I may here add that Mr. Lennox Browne, from another point of view, has reached the same conclusion that there are no sexual differences in respiration. He writes in a private letter: " It METABOLISM. 207 is only where the corset confines the lower ribs or in cases of pregnancy or abdominal tumours that diaphragmatic breathing is impaired, and that costal breathing is resorted to."
Simultaneously with the publication of Dr. Smith's investigations, additional evidence on the same point from America was published in a paper by Professor H. Sewall (Michigan University) and Myra Pollard. 1 Some original observations were here given by Dr. Mays of Philadelphia, made by means of the graphical method on the respiratory movements of female de- scendants of an uncivilised race. He writes: — "In all I examined the movements of 82 chests, and in each case took an abdominal and a costal tracing. The girls were partly pure and partly mixed with white blood, and their ages ranged from between ten and twenty years. Thus there were 33 full-blooded Indians, 5 one-fourth, 35 one-half, and 2 were three- fourths white; 75 showed a decided abdominal type of breathing, 3 a costal type, and in 3 both were about even. Those who showed the costal type, or diver- gence from the abdominal type, came from the more civilised tribes, like the Mohawks and Chippewas, and were either one-half or three-fourths white; while in no single instance did a full-blooded Indian girl possess this type of breathing." Dr. J. H. Kellogg of Michigan supplied the authors of this paper with un- published observations (made with a Marey's stetho- graph and rotating cylinder) to the same effect. He wrote: — " I observed the breathing of 20 Chinese women and the same number of Indian women, and I found the abdominal type very marked in every case. The tracings given by the Chinese women were not like those of robust men, but were identical with those from men of sedentary habits...Of the Indian women 14 were of the Yuma tribe, 1 " On the Relations of Diaphragmatic and Costal Respiration, with particular reference to Phonation," Journal of Physiology ', 1890, Google MAN AND WOMAN.
the most primitive Indians in the United States...The majority of them still wear their bark dresses; GERMAN PEASANT WOMAN. AMERICAN WOMAN, {After Kellogg.)
Google METABOLISM. 209 the only garment in addition to this is a long strip of red cloth thrown over the shoulders and folded about the body...The waist is not restrained in the slightest degree. In these women the abdominal movements were 4 to 6 times as great as the costal movements. I examined several of the Cherokee and Google 2IO MAN AND WOMAN.
The evidence clearly points to the conclusion that the sexual differences in respiration found among civilised races are not natural secondary sexual characters, but are merely the result of the artificial ,r constrictions of the dress usually worn by women.
It would be interesting to trace the origin and development of the modern waist in women. The Greeks of the finest period knew nothing of it, but during the period of decadence women began to compress the body with the apparent object of emphasising the sexual attraction of a conspicuously large pelvis. Hippocrates vigorously denounced the women of Cos for constricting the waist with a girdle. Among the Romans, who adopted this practice from the depraved Greeks, Martial often alludes to the small waists of the women of his time, and Galen speaks much in the same way as a modern physician regarding the evils of tight-lacing. Since then matters have changed, but very slightly. The apparent development of the pelvis has been further artificially exaggerated by that con- trivance which in Elizabethan times was called a " bum-roll," and more recently a "bustle." The tightening of the waist does not merely emphasise the pelvic sexual characters; it also emphasises the not less important thoracic sexual characters; as Dr. Louis Robinson expresses it (in a private letter)—" I think it very likely one of the reasons (and there must be strong ones) for the persistent habit of tightening up the belly -girth among Christian damsels is that such constriction renders the breathing thoracic and so advertises the alluring bosom by keeping it in constant and manifest movement. The heaving of a sub-clavicular sigh is likely to cause more sensation than the heaving of an epigastric or umbilical sigh." This double effect of waist-constriction upon hips and chest is fully sufficient to account for its origin, and it has been kept up partly by custom and partly from that " sense of support " always felt by those who have for years been subjected to the practice.
That the practice will become less common, and this artificial sexual difference be gradually abolished, we may reasonably expect, now that the advantages of allowing free play to the diaphragm are being slowly recognised. It is probable, as Professor Sewall and Miss Pollard (in the paper in the Journal of Physiology already referred to) point out, that diaphragm- atic contraction by pressing upon the abdominal viscera has an important function in squeezing blood to the heart and so assisting the circulation; it also promotes, as these authors show, the mechanical mixture of air in the lungs, thus causing in the most perfect manner possible the mixture of fresh with foul air, which is the great function of respiratory movement. It is Google METABOLISM. 211 noteworthy that women who expend an unusual amount of energy in work in a large number of cases find it better to discard or minimise the use of corsets. So far as accurate observation has gone, it is also clear that the corset-wearing woman is inferior in muscular power and physical endurance to the non-corset-wearing woman. This is, for instance, well shown in some observations on the pupils at the North London Collegiate School for Girls, the results of which were published in the Womeris Gazette, January 1890, by Mrs. Bryant. The trial included a high leap, a long leap, a tug-of-war, and a running competition. The struggle was between " loose stays and none," and there were sixteen girls on each side. In a brief muscular effort, such as leaping, the corset-wearers came out as well as the non-corset-wearers, but in efforts requiring more sustained endurance, as in running and the tug-of-war, the non-corset-wearers had much the best of it. The results, as measured by the pulse-rates and breathing capacity, after "endurance running," were decidedly unfavourable to the corset- Google 212 MAN AND WOMAN.
lurig capacity when corsets were worn was 134 cubic inches; when the corsets were removed the test showed an average lung capacity of 167 inches — a gain of 33 cubic inches."
Temperature. — The evidence concerning sexual differences in temperature is small and incon- sistent We know that increased metabolic activity, as well as a greater afflux of blood, produces higher temperature. In children and adolescents it is well recognised that the temperature is higher than in adults, and more liable to variations which are of less significance than in grown-up persons. Davy, Roger, Mignot, and Delaunay found the temperature of men higher than that of women by about '5° C; Ogle and Wunderlich found the temperature of women higher by about the same amount Stockton Hough found that males have, as a rule, from the beginning to the end of life, a higher temperature than women and greater individual variations. 1 We are probably justified in agreeing with those physiologists who assert that no sexual difference has yet been established.
Waller states that the variations of temperature in women from time to time are greater than in men and of less significance. Squire found a slight rise of temperature before menstruation and a fall after it Dr. Mary Jacobi from an examination of six cases found that " the temperature rises from one to eight-tenths of a degree during the week preceding menstruation. It falls gradually during the flow, but in the majority of cases does not even then reach the normal average." (M. P. Jacobi, The Question of Rest for Women during Menstruation^ New York, Martius took the temperature of 85 domestic ducks— in the north and south of France — under various conditions, and found the temperature of the females higher (averaging 42.2 against 41.9 for the males) and also more variable. (Gavarret, Art. " Chaleur Animate," in Diet. ency. des Sciences Mddicales y and in the same writer's Phenomlnes Physiques de la Vie, 1869, pp. 80-89, the temperature of a large number of animals is given.)
1 Papei in Philadelphia Medical Times, 8th Nov. 1873, summarised in Popular Science Monthly, 1874, p. 97.
Google METABOLISM. 21 3 Excretion. — The sexual differences in the metabolic processes which we have already found are also indi- cated by an examination of the excreta, of which the best known and the most important is the urine. Not only does the amount of liquid and of nitro- genous food very largely influence the urine and its composition, but the kidneys are especially susceptible to a variety of influences; the nature of the food, of the salts it contains, emotional excitement,mental exertion, nervous tone, 1 frequency of urination, the temperature of the air, are among the factors to be taken into account, and there is a compensatory relationship with the excreta by the skin. During the night we should expect these influences to cause less disturb- ance than during the day; and Beigel's observations seem to confirm this; he found that the amount of urine excreted during the night is almost equal in men and women, but that during the day there is a marked excess in men. Beaunis has found that, notwithstanding the disturbing elements, and inde- pendently of the water drunk, a regular diurnal rhythm may be traced in the excretion of urine. 2 A slight sexual difference appears soon after birth, both the solid and liquid constituents of the urine of the female infant being less. At from 3 to 7 years of age the amount of urine excreted by boys during 24 hours, according to Beaunis, is 750 c. cm., by girls 700 c. cm. This is 1 £ times more than in the adult in propor- tion to body-weight. The amount of urea excreted by 1 "Beneke (Archiv. des Vereinsfur wiss. Heilk., Bd. i.)" — remarks Parkes, Composition of the Urine, p. 100 — "from observations on himself has noticed that when the nervous system is, so to speak, in good tone, *.*., when there is a feeling of vigorous health, and when all the functions are rightly performed, the amount of urine increases. On the other hand, when there is languor and depression, the urine is less in amount. The difficulty here, of course, is to define the term, ' tone of the nervous system'; that something real is meant is certain; and the immediate influence on the amount of the urine is, I think, put beyond doubt by Beneke's elaborate inquiry." This is of interest in connection with Dr. A. Haig*s recent investigations as recorded in his remarkable and suggestive work, Uric Acid.
Google 214 MAN AND WOMAN.
the child is even greater relatively than that of water, and the importance of this function of elimination in children is indicated by the large size of their kidneys. At the age of eighteen the urine reaches the adult standard. 1 The amount is, absolutely, usually rather smaller in women, but relatively it is usually greater.
The amount is, roughly speaking, in a man about iooo to 1500 c. cm. (or about 50 ozs.), and in a woman about 900 to 1200 c. cm, during the 24 hours (Landois and Stirling); accord- ing to Yvon and Berlioz, in man 1360 c cm., in woman 11 00 c. cm. {Revue Mid, viii. p. 713); according to Beaunis, the amount is practically identical in both sexes, and therefore relatively greater in woman, in man the average being 1875 c. cm., in woman 18 12; while M'Kendrick places it at 1500-2000 c. cm. for a man, and 400-500 c cm. less in a woman. Bec- querel and Rodier, on the other hand, as the result of a large number of experiments, came to the conclusion that the quantity of urine discharged by women during 24 hours is, even absolutely, slightly greater than in men, the average being as 1227 in men to 1337 in women (Becquerel and Rodier, Traite* de Chimie pathologique, 1854). Mosler found (comparing men from the age of 18 to 21 with women of from 17 to 26) that while the absolute amount of urine was greater in men, in proportion to body-weight it was greater in women {Archiv. des Vereins fur gemeinschaft Arbeiten zur For de rung der wissen. Heiikunde, iii., 1858, pp. 431, 441). English physiologists usually find the sexual difference rather considerable. French physiologists more frequently find the amount nearly equal, and thus rela- tively greater in women; this is probably due to differences in national habit and custom.
While the amount of water excreted by the kidneys in women is probably above what the difference in body-weight would lead us to expect, there seems little doubt that the amount of urinary solids excreted by women is both absolutely and relatively rather below that excreted by men. The urine of women is usually of lighter colour than men's, and its specific gravity is lower. All physiologists are agreed on this point, 2 and the fact is a more important index of 1 Parkes, Composition of Urine.
2 See, for instance, E. A. Parkes, Composition of the Urine, 1860, Google METABOLISM. 21$ metabolism than the relative amounts of water ex- creted. Children in whom metabolism is very active excrete relatively considerably more urea and salts than adults; among adults the amount in women is relatively less than in men; in old age, when the metabolic processes of life are low, there is in both sexes a great diminution in the excretion of both solid and liquid constituents. The urine of women, like the blood of women, is more watery than that of men.
In women the influence of the menstrual cycle, which so largely affects the organism, has its effects here also. That the urine is frequently increased in amount at this period is a matter of common observation, and according to the usual rule this increase should involve an increase in the solids. This does not, however, appear to be always the case. Delaunay stated that menstruation diminished the urea 20 per cent, but without mentioning the extent of the data on which this opinion was founded. Beigel found lessening of urea during, and increase after, menstruation. Dr. Mary Jacobi made fourteen series of observations on six women, and found that in nine the urea was diminished during the flow, in five increased..But in the majority the urea during the menstrual period was more abundant than during the following week, when the lowest point was reached, and before the flow there was usually an increase of urea. A larger series of observations is necessary to obtain definite results. Our knowledge of the influence of pregnancy and lactation on meta- bolic activity, as measured by the urine, is very slight Dr. Hagemann, at a meeting of the Berlin Physiological Society (6th June 1890), gave an account of some experiments on two dogs with reference to this point They were supplied with a constant nitrogenous diet, and it was found that during the first half of the period of pregnancy more nitrogen was excreted than was taken with the food, so that Google 2l6 MAN AND WOMAN.
the nitrogen requisite for the growth of the foetus must have been derived from the tissue-proteids of the mother; after this period the nitrogenous excre- tion sank to a condition of equilibrium in the middle of pregnancy, and then fell further, until the birth of the offspring; while immediately after parturition there was a very marked increase in the excretion of nitrogen, followed by a sudden fall, which led to the output being, during four weeks of the period of lactation, less than the intake. It is probable that in women the metabolic cycle during pregnancy and lactation is somewhat similar; thus Laulanie* and Chambrelent have recently noticed a marked diminu- tion in the toxicity of the urine of pregnant women, especially towards the end of this period (when in the dogs the excretion of urea was also lowest); in two experiments out of ten the urine of pregnant women was entirely free from the toxic substances present in normal urine, so that these appear to be retained towards the period of childbirth.
SUSCEPTIBILITY TO POISONS.
There are various ways in which the varying effects of poisons on men and women might throw an interesting light on differences in metabolism and in nervous organisation. We know something of the special susceptibilities of children with regard to poisons, when given in small doses as drugs to produce beneficial effects, and also as to their effects on various animals, but not much is known as to sexual differences. These differences are usually of so slight a character that considerable precision of observation and a large body of cases are necessary to reach definite results. The poison which has most persistently been observed to exhibit sexual differ- ences in its effects is alcohol; it is evident that this is simply because the effects of no other poison have been so widely studied. If medical men took the Google METABOLISM. 217 trouble to note systematically the effects of the drugs they administered we should be in possession of a considerable body of evidence; but they have rarely, if ever, done so on an extended scale.
From our present point of view, there are various questions which observation of the effect of drugs would help to elucidate. For example: (1) Do any drugs tend to produce greater effect on an organ in one sex than in the other? (2) Are there in one or the other sex examples of such marked susceptibility to a poison that the therapeutical doses must be decidedly smaller than considera- tions of size, eta, would lead us to anticipate? (3) Especially, are the higher nervous centres more apt to be affected in one sex than in the other?
(1.) Observations on a large scale, or carefully recorded in their details, tending to prove or disprove any selective action of poisons on different organs in the two sexes are, so far as I am aware, very few. I have met with a paper, by Dr. F. Augustus Cox, containing a summary of the notes of over 1700 cases treated with arsenic which had been under his observation. In this paper 1 some sexual differ- ences in symptoms are noted, although it was not found that the influence of sex was marked in the evolution of unpleasant symptoms. Gastric symp- toms were commoner in women, intestinal in men; conjunctival symptoms were met with rather oftener in the male sex; nervous symptoms were of more frequent occurrence in women. It may be added that, in Mr. Jonathan Hutchinson's experience, children and the young bear arsenic well, while the old are susceptible to it, and it is specially apt to call out the signs of nerve degeneration whenever this is present 2 Trousseau and Pidoux record some interesting 1 " The Administration of Arsenic," Provincial Medical Journal) 8 "Arsenic as a Drug," Brit. Med. Journal, 6th June 1891.
Google 2l8 MAN AND WOMAN.
observations on the varying action of opium on men and women. They found that in women it acts more on the skin, in men on the kidneys; they only observed hypersecretion of urine twice in women. They found also from observation on 22 men and 20 women that vomiting with opium, when administered by the skin, was three times more frequent in women than in men. When given internally it produced vomiting 4 out of 10 times in men, 6 out of 10 times in women. The women who vomited were mostly nervous or neuralgic. Lauder Brunton also states that women, under the influence of opium, are more liable to nausea and also to headache.
Trousseau and Pidoux also found that the adminis- tration of mercury more easily produces salivation in women than either in men or in children, who easily bear large doses. 1 This, also, is confirmed by Lauder Brunton.
(2.) Men are said to bear the action of antimony much better than women; children bear it badly (De Savignac). Zuccarelli found in 37 cases in which he treated epilepsy by injection of atropine that the benefit was much less in the case of women than of men; children also are very tolerant of belladonna, as is well established. Sulphonal, which is apt to pro- duce nervous symptoms, should be given to women in much smaller doses than to men; Monod found that to produce the hypnotic effect women only required half the dose required by a man. 2 On the other hand, in treating the insane with somnal, Umpfenbach found that women are much less susceptible to its influence than men. Germain Sfee has found that women are especially sensitive to antipyrin. 8 Women are also said to be very readily affected by bromide (which 1 R. W. Parker has suggested that this is merely due to the large amount of milk taken by children, which may deprive the mercury of its irritant effects.
8 Arch, fur exp. Path, und Pharm. t i. 31.
3 Paris Academie de M&lecine, 14th February 1888.
Google METABOLISM. 219 possesses the cerebral and especially the spinal system), while children (according to Voisin) bear it well, but (according to Radcliffe Crocker) bromide eruptions are most common in children.
It is remarkable that, as first noted by English authors, the overwhelming majority of deaths from chloroform are in males. The materials furnished by Sansom show that, according to various authorities, the proportion is at the highest estimate two men to one woman, and according to one estimate four men to one woman, although, as Sansom remarked, chloroform is so extensively used in childbirth. Children, as the very large experience of the Moorfields Hospital shows, bear chloroform extremely well. The robust and healthy, according to Sansom, seem more exposed to the dangerous effects of chloroform than the delicate and weakly, and the largest relative number of fatal cases has occurred in very trifling surgical cases when the general health of the patient has been tolerably good.
Some allusion may here be made to the group of lead salts (which, according to Goetzke and others, primarily affect the central nervous system), as there is reason to believe that women are more susceptible to their action than men. Sir J. Alderson in his Lumleian Lectures in 1852 concluded that men are more frequently affected, but Tanquerel found that women are more susceptible to lead-.poisoning, and Professor T. Oliver of Newcastle, one of the chief centres of the lead industries, is decidedly of this opinion. In his Goulstonian Lectures on Lead- Poisoning (1891, pp. 21-25) ne remarks: — " There is, in my opinion, no doubt in regard to the very much greater suscepti- bility of the female to be contaminated with lead compared to the male; and this is not due simply to the fact of exposure in a lead factory to what may be regarded as the greater dangers, but depends upon sexual idiosyncrasy. This is an opinion so totally at variance with that given by several authors that I require to explain myself. My experience drawn from hundreds of cases is that, both as regards the acute and chronic forms of lead-poisoning, women are much more quickly brought under its influence than men. The ratio of men to women employed in lead factories is in favour of the women, and at first sight it might appear as if the liability was explained by the greater Google 220 MAN AND WOMAN.
number of women exposed. Taking a period of five years, I find that 135 cases of lead-poisoning were admitted as in-patients at the Royal Infirmary, in Newcastle. Of these, ninety-one were women and forty-four were men. To me there is no comparison of the greater susceptibility of the female; and that it is not altogether a question of trade is shown by the fact that in the recent epidemic of lead-poisoning in Yorkshire, where out of 1000 cases due to the drinking of water contaminated by the metal, the special correspon- dent of the British Medical Journal, 1890, vol. i. p. 974» found the proportion of females to males to be as four to one. Against this may be urged the fact that women prob- ably drink more water than men; but allowing for this, the proportion would still be in favour of the female; Brown found 153 males as against 251 females. Not only is the female more susceptible, but she is so at an earlier age than the male, and is more likely to suffer severely, and from such nervous accidents as epilepsy. The interesting point in regard to exposure to lead is that whilst young women suffer readily from saturnine poisoning, recovering quickly from colic only to be more readily and severely affected on again exposing themselves, men may go on working for years, ten to twenty, having only one or two attacks of colic, and then, after a very lengthened period of service, may still fall victims, either to lead paralysis, or die from the effects of a kidney leison due to the poison...One of the first noticeable effects of the pernicious influence of lead is the production of anaemia or cachexia. Nearly all young women, those particularly between the ages of eighteen to twenty-four, when thus exposed suffer from deranged menstrual function; haematosis and ovarian activity are interfered with, and the result is either amenorrhea or menorrhagia. Once the functional activity of the ovaries and blood-making is interfered with, then is that woman already in a critical condition, and at any moment she may become the subject of any of those explosive outbursts of plumbism known by the name of lead encephalopathy. To sexual peculiarity I therefore attribute much of the danger from exposure to lead. Lead as a poison strikes early at the functions of blood-making and reproduction, producing sterility, liability to abortion, and amenorrhoea or menorrhagia. Woman, from her constitutional idiosyncrasy, is therefore more liable to be impressed by lead." Mr. W. Bevan Lewis {Text-Book of Mental Diseases, 1889, p. 350) indirectly confirms Dr. Oliver by the vivid picture which he presents of the various nervous symptoms which are found among the young girls (" white-lead ghosts" they are called in the neighbourhood) who work in lead manufactories. These include arrest of sexual development with perverted instincts and unnatural desires, hysteria, chorea, epileptiform seizures,