CHANGE OF LIFE.

CHAPTER I.

INTRODUCTION.

THE terms "Climacteria" in Latin, "Climacteric disease," "Change of life," "Critical time," "Turn of life," in English, "Temps critique," "Age de retour," "Ménopause," in French, and "Aufhören der Weiblichen Reinigung," in German, are understood to mean a certain period of time, beginning with those irregularities which precede the last appearance of the menstrual flow, and ending with the recovery of health.

Variable as the duration of this time is in different women, it receives a certain degree of precision from the date of the last menstrual flow, which divides the change of life into two periods. When in the course of this work I speak of cessation, I always mean the cessation of the menstrual flow. There is no medical term to designate the time included between the first indications of the failure of ovarian energy, and cessation, but women call it "the dodging time," and as it happily expresses the uncertain and erratic appearance of the menstrual flow, I shall use the phrase to indicate the first part of the change of life in contradistinction to the last part, which begins at cessation, and concludes with the permanent restoration of health.

Although the importance of this epoch has been denied by Tissot, Dewees, Meissner, Saucerotte, and Landouzy, their opinion is not generally admitted by the profession, as is evident from many works of the last century, and from the more

modern writings of Fothergill, Sir C. M. Clarke, Dr. Meigs, and Dr. G. Bedford. The last author has truly stated, that "in addition to structural and malignant disorders so frequent at this period, there are many forms of eccentric nervous disturbance, various forms of temporary or permanent paralysis, and that the varieties of simple nervous irritation, without involving any peculiar lesion, are beyond calculation." German pathologists have admitted the importance of this epoch, which has, however, been chiefly recognized by the French. In addition to those whose names I shall soon have occasion to cite, Lisfranc completely adopted the popular belief in the dangers of the change of life; and Moreau de la Sarthe says, that "the change of life is characterized by headaches, syncope, leipothymia, general or partial spasmodic affections, hypochondriasis, the various symptoms of hysteria, and of insanity." Brierre de Boismont and Dr. Dusourd have recognized the vast influence of the change of life on the health of women, and I shall have frequent occasion to refer to their valuable works. I cannot equally commend the only two works expressly written on this subject, with which I am acquainted—one by Gardanne, in 1816, entitled Avis aux Femmes entrant dans l'Age critique, and the other, a treatise by Dr. Menville, published in 1840, and called Du Temps critique chez les Femmes. These two works have little scientific merit, but their hazardous assertions have suggested inquiries which would not otherwise have been undertaken, and they have afforded me some valuable cases for the illustration of the subject.

Some admit, with Voisin, the frequency and singularity of nervous affections at the change of life, but deny they can be caused by the monthly retention of a few ounces of blood; whereas it is contended that the cessation of the menstrual flow and the attendant changes, whether physiological or morbid, are principally induced by structural changes progressing in the ovaries, and by their various reactions on the system. One objection claims special notice, because it is founded on an erroneous interpretation of statistics. Benoiston de Chateauneuf and Odier de Genève have proved that, if a large number of women, between the

ages of forty and fifty, be compared with a similar number of men within the same periods of life, the rate of mortality will be greater among the males than the females. But those who bring forward these results, may as well say that parturition has no influence on the health of women, because it has little on their mortality; and, moreover, Finlayson has shown that, at all periods of life, more men die than women. Those who deny that the change of life is a critical period, argue as if critical meant fatal. In medical language, crisis means a sudden change for the better or the worse, leading as often to recovery as to death. Instead of flowing on in smooth tranquillity from the cradle to the grave, the stream of life is marked by rapids, which have been called critical, metamorphic, or developmental epochs, and during which an unusual predominance is acquired by one or by several of the organs which together form the human frame. The object of each successive critical readjustment of our frame is, to insure the greatest possible amount of health consistent with each subsequent period of life. This object is attained in the vast majority of cases, but the constitution only rallies after having been severely shaken for a certain period, varying according to constitution and temperament. In some, the critical changes of dentition and puberty are brought about without ill-health, but in many, these epochs are marked by disease, or by a prolonged condition resembling convalescence, and often checkered by serious disease. At all critical epochs, the activity of some important apparatus may be too powerful, and totally disturb the functions of its allied organs, as do the reproductive organs in hysteria, or it may be too feeble to react with sufficient energy on the system, as is the case with the reproductive organs in chlorosis. Whether the energy of the preponderance-seeking power is above or below par, health is impaired, for the system is deprived of the power of duly reacting against stimuli, whether physical or emotional. With regard to the pathogenic influence of the critical periods of life, first and second dentition seem to influence both sexes in the same way. Puberty is common to both, but the impulse then given to the constitution of man by the sexual apparatus is, in general, fully effective and all

sufficient to insure its permanent activity until extreme old age; whereas, in woman this crisis is very liable to be delayed or perverted, and even when puberty has been effectually established, the health of woman is dependent on those oscillations of vital power which render menstruation healthy or morbid. Matrimony, pregnancy, parturition, lactation, are like critical periods, curing some complaints, giving greater activity to others; and when, after having lasted thirty-two years, the action of the reproductive organs is withdrawn from the system, prolonged ill-health is a frequent result. Then arise a series of beautifully adjusted critical movements, the object of which is to endow woman with a greater degree of strength than she had previously enjoyed; but if the seeds of destruction have been slumbering for years in the system, the change of life will give them increased activity. Thus Dionis of old, and Madame Boivin, Dupuytren, Tanchou in our time, have proved, that the greatest proportion of cancerous affections and polypi of the womb are complained of at that period, and it is the same with cancer of the breast, as well as with adenoid and neuromatic tumors of the breast, according to Velpeau. If the term critical be taken in a more restricted sense, as indicating a period in which the system finds relief by critical discharges, what time of life is so rife with critical phenomena? The floodings, leucorrhoea, diarrhoea, and perspirations, are eminently critical, and restore to health the vast majority of women.

This volume will forcibly show the evil effects of the change of life; its sanative influence cannot be so easily depicted, as patients consult the profession for actual disease, not to tell of diseases previously cured. With respect, however, to women who had been suffering for many years from intractable chronic affections that had baffled our best efforts to bring about recovery, the results of cessation are in general eminently satisfactory. We are most of us in the habit of telling our patients that they will be certainly cured by the change of life, and although this promise is often given to keep up the patient's hope rather than as the result of a well-grounded prognosis, still it is surprising how frequently the prophecy proves true.

This remark particularly applies to ovarian

congestion and subacute inflammation, and to most chronic diseases of the womb.

I have notes of some forty patients who were for many years before the ménopause confined to the bed or the sofa by chronic uterine inflammation, who made marvellous recoveries very soon after the change was effected, and who are once more actively engaged in those pleasures and duties of society from which they had been divorced for ten or fifteen years. Out of many similar cases, in which recovery was not thus rapid and perfect, I cannot call to my recollection a single instance in which great improvement was not obtained. I have also ascertained from twenty-six women who had ceased to menstruate, that they were no longer troubled by habitual leucorrhoea, and doubtless many suffer for years from unrecognized uterine affections, which are at last completely cured by the change of life. Prolapsus of the womb was cured in three cases; thirty-five women no longer suffered from uterine deviations, though they still existed; in four cases varicose veins had gone down; in twenty-four, piles had disappeared; and in eight other cases they had ceased to bleed. Fifty-three women spoke of the great additional strength obtained, and of the abatement of their liability to dyspepsia. Ganglionic affections then often lose their gravity and become less frequent, and the same remark applies to almost all cerebro-spinal affections, even to the most formidable, for Esquirol has seen many women remain maniacal so long as menstruation lasted, who immediately and spontaneously recovered after the ménopause.

Reporting on the female lunatics at Colney Hatch, Dr. Davey says: "There are many females between the ages of forty and fifty, whose recoveries may be expected when the uterus shall have fairly resumed its original inaction, and when also the brain shall have lost a fertile source of irritation and disease. Unfortunately it happens that the poorer classes are much too unmindful of the health of women at the critical periods of life, and pay too little attention to the means whereby the uterus may be assisted in its efforts to preserve its due influence on the human economy; and therefore is it, in a very great measure, that insanity is of so frequent an occurrence among women." I have dwelt on this subject in