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Bulletin of the History of Medicine 77.2 (2003) 424-425



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Étienne van de Walle and Elisha P. Renne, eds. Regulating Menstruation: Beliefs, Practices, Interpretations. Chicago: University of Chicago Press, 2001. xli + 292 pp. Tables. $50.00 (cloth, 0-226-84743-8), $20.00 (paperbound, 0-846-84744-6).

What makes this multidisciplinary book interesting is its explicit focus on how both women and physicians have endeavored to manage menstrual function. The compilation of articles makes clear that women have actively managed their menstrual function, and consequently their fertility, throughout history and across numerous cultures. The contribution by Terence Hull and Valerie Hull, based on their work in Indonesia, provides a thoughtful discussion of the myriad implications for family-planning research and reproductive-health policy of the lack of knowledge about traditions of menstrual management. However, the editors present a coherent argument that our understanding of these practices should not be limited by viewing them solely as relevant to fertility reduction or abortion. In fact, the book's most important contribution is that it extends the study of this aspect of women's biology beyond the narrow focus on menstruation as a symbol of fertility or, alternatively, an interesting cultural taboo. Various chapters discuss women's focus on menstruation as an integral dimension of their overall health, which, just as with other aspects of physical and mental functioning, requires attention in order to ensure that optimal health is maintained. Differing historical and cultural perceptions of this broader linkage between health and menstruation are explored. Nonetheless, most of the selections emphasize management of the timing of menses—specifically, delayed menses or amenorrhea—and only minimal attention is afforded to the question of how women manage other aspects of menstrual dysfunction.

The first section provides a series of careful and detailed historical analyses of the type and range of plants that have been used by women and physicians to manage the menses, as well as of views of the meaning of various menstrual phenomena. Changing historical perspectives as to whether menstrual dysfunction [End Page 424] is a disease or a symptom of disease is a leitmotif. What is perhaps most striking is the commonality of the menstrual complaints and the consistency with which specific plants are employed to address these complaints across time. However, one begins to desire more than a repeated listing of plant names and properties. The book would have benefited from a greater effort to synthesize these historical findings, and from a more careful review of the scientific accuracy of statements regarding historical beliefs and current medical practice. For example, the folkloric belief that "miscarriages were most likely to occur at the times when a woman would have been menstruating if she were not pregnant" (p. 47) is entirely consistent with current scientific understanding. The assertion that oxytocic drugs are rarely used in modern medical practice (p. 49) is simply wrong: they are commonly used to induce or speed along labor.

Stefania Siedlecky, in her chapter on the pharmacological properties of emmenagogues, examines the historical evidence regarding the mechanism, toxicity, and efficacy of these preparations. In doing so, she addresses the question begged in the preceding chapters—namely, do they work? However, her conclusion—that the presence of several preparations often taken together or serially over prolonged periods argues against their utility—suggests that she has applied an allopathic concept of efficacy and has failed to assess the botanical pharmacopoeia on its own terms. A major motivation for the synthesis of drugs based on botanical compounds is precisely the desire to enhance the efficacy of the herbal preparation. Heidi Bart Johnston's evaluation of the evidence for the efficacy of preparations used by Bangladeshi women provides a nice counterpoint to Siedlecky.

The ethnographic contributions would have benefited from more conceptual consistency. Some chapters, such as that by Patricia Hammer on the Quechua, wander from the central focus of menstrual management. More explicit consideration of the issue of menstrual management from a life-course perspective, as introduced by Sangeetha Madhavan and Aisse Diarra in their discussion of the management...

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