The Menopause: Reward or Punishment? MARCHA FUNT, INTRODUCTION
Menopause, simply defincd, is the time when a women ceases to menstruatc; and this cessation of menstruation is usually a gradual process taking two or more years. It should not be confused with the climacteric or "change of life" which is the transitional period between the childbearing phase and the phase of senescence.! Rather, menopause is related to the climacteric much as menarche is related to puberty. The menopause, occurring in most women between the ages of forty-fivc and fifty years, is explained primarily in tcrms of failure of ovarian function. "Alone of all the endocrine glands. the ovary has a limited and foreordained span of functional life-thirty to thirty-five years."2 Goldfarb:! has listed the following stages of physiological ovarian failure: 1. ovarian release of abnormal gametes (proven by increase in incidence of children with congenital malformations born to women late in life) 2. poor corpus luteum formation with rcduced progcsterone production 3. anovulation 4. failmc to respond to gonadotropins 5. rclative hypoestronemic states 6. cortical granuloma formation With aging, the production of estrogen by the ovaries begins to falter several years before the menopause itself. With the decrease of maturable primordial follicles and thc failure of the cyclic production of progesterone, estrogen production fails to reach the levels necessary to induce endometrial bleeding. Menstruation becomes irregular, the interval between periods increases, and the menstrual loss gradually diminishes until amenorrhea occurs. MacGregor 4 finds that 75-80% of women have the aforementioned pattern of menopausal termination. While the ovaries have become unable to function in the production of estrogen and ova, the pituitary does not stop its output of trophic hormones. Rather. unchecked by the inhibitory effect of the estrogenic hormones from the ovaries, the hypothalamic neurosecretory cells release FSH-RH and LH-RH in increasing amounts to the anterior pituitary, triggering increased secretions of the pituitary trophic hormones, particularly gonadotropins. The thyrotrophic and adrenocorticotrophic hormones increase in the blood Dr. Flint is from Department of Anthropology, Montclair State College, Upper Montclair, New Jersey 07043. October/November/December, 1975
Ph.D.
causing their respective target organs to become hyperactive. "It is the combination of the lowered estrogen levels and altered thyroid and adrenocortical function to which the symptoms commonly experienced by climacteric (menopausal) women are usually ascribed."o This endocrine imbalance is believed responsible for many subjective symptoms that women suffer during the climacteric. The most common of these-hot flushes and sweating and hot flashes-are vasomotor in nature. "The hot flushes are a sensation of heat over the body, particularly the face and neck. accompanied by reddening of skin in these areas. This is followed by profuse perspiration and chilliness and may occur once or twice a day or every onehalf hour."! Hot flashes involve hot tingling over the whole body without flushing or perspiration. Most authorities feel the symptoms of the climacteric have their etiology in the disturbance of the equilibrium between the hypothalamus and autonomic nervous systems, both of which have become conditioned to a high estrogen level and then react to its decline. possible by some instability or "loss of control" of the mechanism regulating blood vessel caliber. /l This autonomic nervous system also stimulates large volumes of blood from the splanchnic areas toward the periphery due to sympathetic stimulation. Rogers 7 feels that these hot flushes occur most commonly under conditions in which heat production is increased such as excitement, emotion, exercise, and eating or in which heat loss is impaired-that is, warm weather and heavy bedclothes. Willson et al. ! writing about these symptoms of menopause, do not feel that they are due to estrogen deficiency or the increased levels of FSH in the blood or urine, but, rather, to some unknown factors operating to produce the vasomotor symptoms. One of these might be the hyperactivity of other glands involved in the endocrine upheaval of the climacteric. While disagreeing about the etiology of these climacteric symptoms, most researchers. nevertheless, agree that other symptoms often accompanying the hot flushes, sweating, and hot flashes are dependent on the sympathetic nervous system. These other symptoms and/or psychological responses of the individual include cold, moist and numb extremities, chills, palpitations, headaches (including migraine), vertigo, fatigue, arthralgia, nervousness, irritability, dizziness, insomnia, jealousies, depression, self-depreciation, and various gastro-intestinal complaints.1.2./l.8 161
PSYCHOSOMATICS
The syndromes of the climacteric starting early in this time span, usually a few years before the menopause, terminate when the menopause is reached; but other physiological changes continue on into old age and seem to be percipitated by the menopause. The atrophic changes which are most pronounced affect the skin, all the reproductive organs, the bones and the cardiovascular system. While the skin becomes thinner and loses its elasticity and turgor, the reproductive organs atrophy and the body bone mass steadily declines from menopause on and is often called osteporotic. The bone disease, osteoporosis, is due to the inability of new bone formation to keep pace with bone resorption; the deficiency manifests itself in decreased density and increased porosity of the skeleton. It is believed that the estrogen deficiency occurring with menopause deprives the osteoblasts of a necessary stimulus to the formation of the bone matrix around which calcium is deposited to form new bone tissue. The disease, atherosclerosis, can also be shown to be related to this lowered estrogen level in women achieving the menopause. This relationship is direct; as the estrogen levels decrease in the blood stream, there is a rapid and progressive increase in the incidence of atherosclerosis. The menopause also increases the levels of serum cholesterol, triglycerides and phospholipids. Beside the lack of estrogen, sympathicotonia and emotional stability may be factors that accelerate atherogenesis by altering lipid and carbohydrate metabolism. 9 THE PROBLEM
The most severe problems associated with the menopause are not these two diseases, however, but, rather, the menopausal syndromes themselves. In our country, according to the National Health Survey of 1960-62,10 there were 18.5 million women between the ages of 45-64 (the mean age of menopause being 50 years) and of these, 10% had severe menopausal symptoms, 16% were completely free of any symptomatology, and about 75% of these women experienced some disturbance or discomfort; but few brought these to their physiciansl l In 1953, the British Council of Medical Women also found about these same percentagesaround 11 % of married women and 9% of single women were absent from work one or more times because of disabling symptoms, while 85% of British women go through this period of life with no interruptions of their daily routine. 22 The National Survey of 1960-62 also showed that from 26-28% (about 5 million) of American women age 50-64 years have had surgical menopause most commonly as a result of a hysterectomy. We have to ask ourselves why, in 1960-62, did we have two million women in this country with 162
severe menopausal symptoms, and are these found cross-eulturaIly, or are these just restricted to American and Western European women? Almost no research has been done in third world countries about this problem. However, I did study 483 Indian women of the Rajput caste in the states of Rajasthan and Himachal Pradesh and found that very few women had any problems with their menopause other than menstrual cycle changes l2-there were no depressions, dizziness, no incapacitations nor any of the symptoms associated with what we call "the menopausal syndrome." Why? Certainly there had to be the same physiological changes in the estrogen levels as other menopausal women, no matter where they lived, but why weren't these mentioned when these Rajput women were queried? There may b:: an explanation for this phenomenon. When these women achieve their menopause, a role change is precipitated by this culture. In Rajasthan, Rajput women who, until their menopause, had to live in purdah (veiled and secluded) could now come downstairs from their women's quarters to where the men talked and drank their home brew; they could partake of these activities-something never allowed before this time. In Himachal Pradesh, the Rajput women could publicly visit and joke with men after attaining menopause. These women were no longer considered to be contaminative, not being able to menstruate or bear children any longer. Other cultures also treat their menopausal women differently. The Qemant, a pagan- Hebraic peasant population in Ethiopia, allow the woman who has achieved menopause to tred upon the ground of a sacred site and come in contact with ritual food and beverage, something unheard of before this time as she was considered unclean while she was capable of menstruating. 13 Among the Hutterites of South Dakota, women age 45-50 years are relieved of their heavy jobs in agriculture such as milking and hoeing but maintain an important function in their extended families, along with a great deal of respect. H At the time of menopause, a woman in Ulithi, in Micronesia, may become a healer; she can work sorcery and magic and make amulets and good luck pieces. She may even become a medium. 15 Among the Bantu of South Africa, a woman who has achieved menopause may put on the clothing of the widows, as contamination of death is not dangerous for her; she can proceed to the purification of the village in certain cases of epidemics and to the purification of the weapons of warriors in war time. After the sacrifice of a black ram for rain, she will be allowed to partake of the flesh of the ram-all marks of high status. 16 While menopause per se is not described by many authors cross-culturally, references to respect and Volume XVI
THE MENOPAUSE-FLINT
even veneration of middle aged and older women are mentioned for such diverse populations as the Palau in Micronesia;17 Turkish women;18 the Tiwi of Australia;lD and the Magars of Nepal. 20 What we can see in all these populations is that the menopausal woman is rewarded for having achieved her menopause. While able to bear children, her role was very different from that she assumes after menopause. She is allowed to partake of the once forbidden and her status in her culture is much more elevated than before her menopause. Menopause is treated much differently in our culture. As Marya Mannes has stated so well, just as women have been given the capacity to live longer than ever before into their later years (in our culture the age is 73 years). this youth and sex-saturated society enshrines the 16 year old as a female incarnate. ~t Alexander Simon, a psychiatrist, has noted that, with its emphasis on youth and glamour, the loss of youth signified by the menopause presents difficulties for many women. tt For some, it is a race against time shown in hypochondriachal concern about health, sexual promiscuity aimed at proving desirability, and a frenetic fight to stay young by cosmetics, clothing and plastic surgery. Yet, many women surmount this period's difficulties by social, cultural, community and philanthropic activities. But for those who cannot, fear begins at forty and it's downhill after that. with death waiting at the end. Is it any wonder that two million American women suffer severe menopausal symptoms? In our culture, there is no reward for attaining menopause. In fact, for many women it is a time of punishment. At the time most American women are menopausal, their children will have gone from home and many will suffer the "empty nest" syndrome, and for many their husbands will be suffering a male climacteric and will be out chasing younger women to prove their virility. There is no elevation in status for the menopausal woman in our culture either. If she does attain a higher status during this time period, it is by socia-economic means. Either she inherits her husband's wealth at his death or has attained this higher status by dint of her own professional endeavors. Crossens has also noted that. for women who have had psychoneurotic tendencies, these are apt to be aggravated in the climacteric. Further, with endocrine lessening and other aging factors, a woman's stress tolerance may decrease at this time when the flexibility to seek adjustments to change is lessening.~~ And in Our society, today's woman still falls prey to such ludicrous fears as the end of her sexual desires or femininity with the advent of her menopause.
October/November/December, 1975
However, there are means of relieving some of the menopausal syndromes suffered by the American woman. Psychotherapy may alleviate many of the problems associated with self-image and identity crises that these menopausal women suffer; hormone therapy, which replaces the lessening estrogen circulating in a woman's blood system, may well alleviate many of the physiological symptoms of this aging process as well; and for many women joining feminist movements has proved to be a means of exchanging ideas about their menopausal problems and being enlightened about the possibilities that much of what we call "menopausal symptomatology" may well be culturally defined and engendered.
2. 3. 4. 5. 6. 7. 8. 9. 10.
11. 12.
13.
14.
15. 16. 17. 18. 19. 20. 21. 22.
REFERENCES Willson, J. R., Beecham, C. T., and Carrington, E. R.: Obstetrics and Gynecology. 51. Louis: C. V. Mosby Co., 1971. Novak, Edmund: I.A.M.A., 156:575, 1954. Goldfarb, Alvin: Med. Sci., 18:49, 1967. MacGregor, T. H.: The Practitioner, 34:542, 1962. Swyer, G.: The BioioRY of ARing. London: The Institute of Biology, 1956. Taylor, Howard: Nelson New Loose Leaf Surgery. New York: Thomas Nelson & Sons, 1937. Rogers, J.: New Engl. J. Med., 2542:697, 1956. A Clinical Guide to the Menopause and the Post Menopause. New York: Ayerst Laboratories, 1968. Pelkonen, R.: Acta Obstet. Gynecol. Seand., 50:21, 1971. MacMahon, Brian, and Worcester, J.: ARe at Menopause, United States-1960-62. Washington: U.S. Government Printing Office, 1966. Simon, Alexander: Psychosomatics. 9: 12, 1968. Flint, Marcha: Menarche and Menopause of Rajput Women, Unpublished Ph.D. dissertation. City University of New York, Graduate Center, 1974. Gamst, Frederick: The Qcmant, A PaRan Hebraic Peasantry of Ethiopia. New York: Holt, Rinehart and Winston, 1969. Hostetler, John, and Huntington, Gertrude E.: The Hulterites of North Amnica. New York: Holt. Rinehart and Winston, 1967. Lessa, William: Ulithi; A Micronesian Design for Lil"inR. New York: Holt, Rinehart and Winston, 1966. Junod, Henri: The Life of a South African Trihc·. New Hyde Park: University Books, Inc., 1965. Barnett, H. G.: Being a Palauan. New York: Holt, Rinehart and Winston, 1960. Pierce, Joe: Life in a Turkish Village. New York: Holt, Rinehart and Winston, 1964. Hart, C. W, M., and Pilling. R.: The Tiwi of North Australia. New York: Holt, Rinehart and Winston, 1969. Hitchcock, John T.: The Magars of Banyan Hill. New York: Holt, Rinehart and Winston, 1966. Mannes, Marya: Psychosomatics, 9:9, 1968. Crossens, Robert J.: Diseases of Women. 51. Louis: C. V. Mosby Co., 1953.
1(;3
Menopause, simply defincd, is the time when a women ceases to menstruatc; and this cessation of menstruation is usually a gradual process taking two or more years. It should not be confused with the climacteric or "change of life" which is the transitional period between the childbearing phase and the phase of senescence.! Rather, menopause is related to the climacteric much as menarche is related to puberty. The menopause, occurring in most women between the ages of forty-fivc and fifty years, is explained primarily in tcrms of failure of ovarian function. "Alone of all the endocrine glands. the ovary has a limited and foreordained span of functional life-thirty to thirty-five years."2 Goldfarb:! has listed the following stages of physiological ovarian failure: 1. ovarian release of abnormal gametes (proven by increase in incidence of children with congenital malformations born to women late in life) 2. poor corpus luteum formation with rcduced progcsterone production 3. anovulation 4. failmc to respond to gonadotropins 5. rclative hypoestronemic states 6. cortical granuloma formation With aging, the production of estrogen by the ovaries begins to falter several years before the menopause itself. With the decrease of maturable primordial follicles and thc failure of the cyclic production of progesterone, estrogen production fails to reach the levels necessary to induce endometrial bleeding. Menstruation becomes irregular, the interval between periods increases, and the menstrual loss gradually diminishes until amenorrhea occurs. MacGregor 4 finds that 75-80% of women have the aforementioned pattern of menopausal termination. While the ovaries have become unable to function in the production of estrogen and ova, the pituitary does not stop its output of trophic hormones. Rather. unchecked by the inhibitory effect of the estrogenic hormones from the ovaries, the hypothalamic neurosecretory cells release FSH-RH and LH-RH in increasing amounts to the anterior pituitary, triggering increased secretions of the pituitary trophic hormones, particularly gonadotropins. The thyrotrophic and adrenocorticotrophic hormones increase in the blood Dr. Flint is from Department of Anthropology, Montclair State College, Upper Montclair, New Jersey 07043. October/November/December, 1975
Ph.D.
causing their respective target organs to become hyperactive. "It is the combination of the lowered estrogen levels and altered thyroid and adrenocortical function to which the symptoms commonly experienced by climacteric (menopausal) women are usually ascribed."o This endocrine imbalance is believed responsible for many subjective symptoms that women suffer during the climacteric. The most common of these-hot flushes and sweating and hot flashes-are vasomotor in nature. "The hot flushes are a sensation of heat over the body, particularly the face and neck. accompanied by reddening of skin in these areas. This is followed by profuse perspiration and chilliness and may occur once or twice a day or every onehalf hour."! Hot flashes involve hot tingling over the whole body without flushing or perspiration. Most authorities feel the symptoms of the climacteric have their etiology in the disturbance of the equilibrium between the hypothalamus and autonomic nervous systems, both of which have become conditioned to a high estrogen level and then react to its decline. possible by some instability or "loss of control" of the mechanism regulating blood vessel caliber. /l This autonomic nervous system also stimulates large volumes of blood from the splanchnic areas toward the periphery due to sympathetic stimulation. Rogers 7 feels that these hot flushes occur most commonly under conditions in which heat production is increased such as excitement, emotion, exercise, and eating or in which heat loss is impaired-that is, warm weather and heavy bedclothes. Willson et al. ! writing about these symptoms of menopause, do not feel that they are due to estrogen deficiency or the increased levels of FSH in the blood or urine, but, rather, to some unknown factors operating to produce the vasomotor symptoms. One of these might be the hyperactivity of other glands involved in the endocrine upheaval of the climacteric. While disagreeing about the etiology of these climacteric symptoms, most researchers. nevertheless, agree that other symptoms often accompanying the hot flushes, sweating, and hot flashes are dependent on the sympathetic nervous system. These other symptoms and/or psychological responses of the individual include cold, moist and numb extremities, chills, palpitations, headaches (including migraine), vertigo, fatigue, arthralgia, nervousness, irritability, dizziness, insomnia, jealousies, depression, self-depreciation, and various gastro-intestinal complaints.1.2./l.8 161
PSYCHOSOMATICS
The syndromes of the climacteric starting early in this time span, usually a few years before the menopause, terminate when the menopause is reached; but other physiological changes continue on into old age and seem to be percipitated by the menopause. The atrophic changes which are most pronounced affect the skin, all the reproductive organs, the bones and the cardiovascular system. While the skin becomes thinner and loses its elasticity and turgor, the reproductive organs atrophy and the body bone mass steadily declines from menopause on and is often called osteporotic. The bone disease, osteoporosis, is due to the inability of new bone formation to keep pace with bone resorption; the deficiency manifests itself in decreased density and increased porosity of the skeleton. It is believed that the estrogen deficiency occurring with menopause deprives the osteoblasts of a necessary stimulus to the formation of the bone matrix around which calcium is deposited to form new bone tissue. The disease, atherosclerosis, can also be shown to be related to this lowered estrogen level in women achieving the menopause. This relationship is direct; as the estrogen levels decrease in the blood stream, there is a rapid and progressive increase in the incidence of atherosclerosis. The menopause also increases the levels of serum cholesterol, triglycerides and phospholipids. Beside the lack of estrogen, sympathicotonia and emotional stability may be factors that accelerate atherogenesis by altering lipid and carbohydrate metabolism. 9 THE PROBLEM
The most severe problems associated with the menopause are not these two diseases, however, but, rather, the menopausal syndromes themselves. In our country, according to the National Health Survey of 1960-62,10 there were 18.5 million women between the ages of 45-64 (the mean age of menopause being 50 years) and of these, 10% had severe menopausal symptoms, 16% were completely free of any symptomatology, and about 75% of these women experienced some disturbance or discomfort; but few brought these to their physiciansl l In 1953, the British Council of Medical Women also found about these same percentagesaround 11 % of married women and 9% of single women were absent from work one or more times because of disabling symptoms, while 85% of British women go through this period of life with no interruptions of their daily routine. 22 The National Survey of 1960-62 also showed that from 26-28% (about 5 million) of American women age 50-64 years have had surgical menopause most commonly as a result of a hysterectomy. We have to ask ourselves why, in 1960-62, did we have two million women in this country with 162
severe menopausal symptoms, and are these found cross-eulturaIly, or are these just restricted to American and Western European women? Almost no research has been done in third world countries about this problem. However, I did study 483 Indian women of the Rajput caste in the states of Rajasthan and Himachal Pradesh and found that very few women had any problems with their menopause other than menstrual cycle changes l2-there were no depressions, dizziness, no incapacitations nor any of the symptoms associated with what we call "the menopausal syndrome." Why? Certainly there had to be the same physiological changes in the estrogen levels as other menopausal women, no matter where they lived, but why weren't these mentioned when these Rajput women were queried? There may b:: an explanation for this phenomenon. When these women achieve their menopause, a role change is precipitated by this culture. In Rajasthan, Rajput women who, until their menopause, had to live in purdah (veiled and secluded) could now come downstairs from their women's quarters to where the men talked and drank their home brew; they could partake of these activities-something never allowed before this time. In Himachal Pradesh, the Rajput women could publicly visit and joke with men after attaining menopause. These women were no longer considered to be contaminative, not being able to menstruate or bear children any longer. Other cultures also treat their menopausal women differently. The Qemant, a pagan- Hebraic peasant population in Ethiopia, allow the woman who has achieved menopause to tred upon the ground of a sacred site and come in contact with ritual food and beverage, something unheard of before this time as she was considered unclean while she was capable of menstruating. 13 Among the Hutterites of South Dakota, women age 45-50 years are relieved of their heavy jobs in agriculture such as milking and hoeing but maintain an important function in their extended families, along with a great deal of respect. H At the time of menopause, a woman in Ulithi, in Micronesia, may become a healer; she can work sorcery and magic and make amulets and good luck pieces. She may even become a medium. 15 Among the Bantu of South Africa, a woman who has achieved menopause may put on the clothing of the widows, as contamination of death is not dangerous for her; she can proceed to the purification of the village in certain cases of epidemics and to the purification of the weapons of warriors in war time. After the sacrifice of a black ram for rain, she will be allowed to partake of the flesh of the ram-all marks of high status. 16 While menopause per se is not described by many authors cross-culturally, references to respect and Volume XVI
THE MENOPAUSE-FLINT
even veneration of middle aged and older women are mentioned for such diverse populations as the Palau in Micronesia;17 Turkish women;18 the Tiwi of Australia;lD and the Magars of Nepal. 20 What we can see in all these populations is that the menopausal woman is rewarded for having achieved her menopause. While able to bear children, her role was very different from that she assumes after menopause. She is allowed to partake of the once forbidden and her status in her culture is much more elevated than before her menopause. Menopause is treated much differently in our culture. As Marya Mannes has stated so well, just as women have been given the capacity to live longer than ever before into their later years (in our culture the age is 73 years). this youth and sex-saturated society enshrines the 16 year old as a female incarnate. ~t Alexander Simon, a psychiatrist, has noted that, with its emphasis on youth and glamour, the loss of youth signified by the menopause presents difficulties for many women. tt For some, it is a race against time shown in hypochondriachal concern about health, sexual promiscuity aimed at proving desirability, and a frenetic fight to stay young by cosmetics, clothing and plastic surgery. Yet, many women surmount this period's difficulties by social, cultural, community and philanthropic activities. But for those who cannot, fear begins at forty and it's downhill after that. with death waiting at the end. Is it any wonder that two million American women suffer severe menopausal symptoms? In our culture, there is no reward for attaining menopause. In fact, for many women it is a time of punishment. At the time most American women are menopausal, their children will have gone from home and many will suffer the "empty nest" syndrome, and for many their husbands will be suffering a male climacteric and will be out chasing younger women to prove their virility. There is no elevation in status for the menopausal woman in our culture either. If she does attain a higher status during this time period, it is by socia-economic means. Either she inherits her husband's wealth at his death or has attained this higher status by dint of her own professional endeavors. Crossens has also noted that. for women who have had psychoneurotic tendencies, these are apt to be aggravated in the climacteric. Further, with endocrine lessening and other aging factors, a woman's stress tolerance may decrease at this time when the flexibility to seek adjustments to change is lessening.~~ And in Our society, today's woman still falls prey to such ludicrous fears as the end of her sexual desires or femininity with the advent of her menopause.
October/November/December, 1975
However, there are means of relieving some of the menopausal syndromes suffered by the American woman. Psychotherapy may alleviate many of the problems associated with self-image and identity crises that these menopausal women suffer; hormone therapy, which replaces the lessening estrogen circulating in a woman's blood system, may well alleviate many of the physiological symptoms of this aging process as well; and for many women joining feminist movements has proved to be a means of exchanging ideas about their menopausal problems and being enlightened about the possibilities that much of what we call "menopausal symptomatology" may well be culturally defined and engendered.
2. 3. 4. 5. 6. 7. 8. 9. 10.
11. 12.
13.
14.
15. 16. 17. 18. 19. 20. 21. 22.
REFERENCES Willson, J. R., Beecham, C. T., and Carrington, E. R.: Obstetrics and Gynecology. 51. Louis: C. V. Mosby Co., 1971. Novak, Edmund: I.A.M.A., 156:575, 1954. Goldfarb, Alvin: Med. Sci., 18:49, 1967. MacGregor, T. H.: The Practitioner, 34:542, 1962. Swyer, G.: The BioioRY of ARing. London: The Institute of Biology, 1956. Taylor, Howard: Nelson New Loose Leaf Surgery. New York: Thomas Nelson & Sons, 1937. Rogers, J.: New Engl. J. Med., 2542:697, 1956. A Clinical Guide to the Menopause and the Post Menopause. New York: Ayerst Laboratories, 1968. Pelkonen, R.: Acta Obstet. Gynecol. Seand., 50:21, 1971. MacMahon, Brian, and Worcester, J.: ARe at Menopause, United States-1960-62. Washington: U.S. Government Printing Office, 1966. Simon, Alexander: Psychosomatics. 9: 12, 1968. Flint, Marcha: Menarche and Menopause of Rajput Women, Unpublished Ph.D. dissertation. City University of New York, Graduate Center, 1974. Gamst, Frederick: The Qcmant, A PaRan Hebraic Peasantry of Ethiopia. New York: Holt, Rinehart and Winston, 1969. Hostetler, John, and Huntington, Gertrude E.: The Hulterites of North Amnica. New York: Holt. Rinehart and Winston, 1967. Lessa, William: Ulithi; A Micronesian Design for Lil"inR. New York: Holt, Rinehart and Winston, 1966. Junod, Henri: The Life of a South African Trihc·. New Hyde Park: University Books, Inc., 1965. Barnett, H. G.: Being a Palauan. New York: Holt, Rinehart and Winston, 1960. Pierce, Joe: Life in a Turkish Village. New York: Holt, Rinehart and Winston, 1964. Hart, C. W, M., and Pilling. R.: The Tiwi of North Australia. New York: Holt, Rinehart and Winston, 1969. Hitchcock, John T.: The Magars of Banyan Hill. New York: Holt, Rinehart and Winston, 1966. Mannes, Marya: Psychosomatics, 9:9, 1968. Crossens, Robert J.: Diseases of Women. 51. Louis: C. V. Mosby Co., 1953.
1(;3
