In Germany Tobler has investigated the menstrual histories of over one thousand women (Monatsschrift fuer Geburtshuelfe und Gynaekologie, July, 1905).  He finds that in the great majority of women at the present day menstruation is associated with distinct deterioration of the general health, and diminution of functional energy.  In 26 per cent. local pain, general malaise, and mental and nervous anomalies coexisted; in larger proportion come the cases in which local pain, general weak health or psychic abnormality was experienced alone at this period.  In 16 per cent. only none of these symptoms were experienced.  In a very small separate group the physical and mental functions were stronger during this period, but in half of these cases there was distinct disturbance during the intermenstrual period.  Tobler concludes that, while menstruation itself is physiological, all these disturbances are pathological.

As far as England is concerned, at a discussion of normal and painful menstruation at a meeting of the British Association of Registered Medical Women on the 7th of July, 1908, it was stated by Miss Bentham that 50 per cent. of girls in good position suffered from painful menstruation.  Mrs. Dunnett said it usually occurred between the ages of twenty-four and thirty, being frequently due to neglect to rest during menstruation in the earlier years, and Mrs. Grainger Evans had found that this condition was very common among elementary school teachers who had worked hard for examinations during early girlhood.

In America various investigations have been carried out, showing the prevalence of disturbance in the sexual health of school girls and young women.  Thus Dr. Helen P. Kennedy obtained elaborate data concerning the menstrual life of one hundred and twenty-five high school girls of the average age of eighteen ("Effect of High School Work upon Girls During Adolescence,” Pedagogical Seminary, June, 1896).  Only twenty-eight felt no pain during the period; half the total number experienced disagreeable symptoms before the period (such as headache, malaise, irritability of temper), while forty-four complained of other symptoms besides pain during the period (especially headache and great weakness).  Jane Kelley Sabine (quoted in Boston Medical and Surgical Journal, Sept. 15, 1904) found in New England schools among two thousand girls that 75 per cent. had menstrual troubles, 90 per cent. had leucorrhoea and ovarian neuralgia, and 60 per cent. had to give up work for two days during each month.  These results seem more than usually unfavorable, but are significant, as they cover a large number of cases.  The conditions in the Pacific States are not much better.  Dr. Mary Ritter (in a paper read before the California State Medical Society in 1903) stated that of 660 Freshmen girls at the University of California, 67 per cent. were subject to menstrual disorders,