disappear suddenly; in one case it came on suddenly at cessation, when flooding abated about six years ago, but the deafness has continued ever since; and I have known women driven to desperation by continued noises in the ear, which baffle all treatment. M. S., a dispensary patient, aged fifty-two, never had a day's illness until forty-five, when she saw a man executed, which brought on flooding. The menstrual flow never reappeared, but loud and continued noises were constantly heard, which Mr. Harvey could not account for by a diseased condition of the internal ear. Cupping, blisters to the nape of the neck, and other treatment were useless. In a very nervous lady, erysipelas of the face occurred at the change of life, and left an excruciating pain, sometimes accompanied by a most annoying "forcing sensation" behind the ears. This had lasted for three years, but it yielded to general treatment, to the local measures necessary to cure uterine irritation, and to the rubbing in of belladonna ointment behind the ears.

RHEUMATIC PAINS.-Neuralgia of the nervous filaments of the skin is often caused by the damp state in which the underclothing is kept by continued perspirations at the change of life.

TREATMENT.-Heat under any form is good. Passing a hot iron over the painful part, previously protected by brown paper and flannel, may cure the patient. Vapor baths are serviceable. Sponging, with alternately hot and cold water, or shower baths of the same, will harden the surface against rheumatic influences. The thermal waters of Aix en Savoie are very effectual, and the best preventive is to wear flannel next the skin. In advanced age, these rheumatic cutaneous pains are often exceedingly troublesome, but women are then generally free from the eccentric nervous pains and temporary paralysis which have afflicted them in youth, and have been described, by Sir B. Brodie, as hysterical.

CHAPTER IX.

DISEASES OF THE REPRODUCTIVE ORGANS AT THE CHANGE

OF LIFE.

TABLE XXVIII.

Liability to Diseases of the Reproductive Organs in 500 Women.

Ulceration of the neck of the womb,.

Hypertrophic inflammation of the neck of the womb,
Prolapsus of the womb,

Uterine polypi,

Uterine fibrous tumors,.

Uterine cancer,

Chronic ovarian tumors,

Irritation and swelling of the breasts,

Milky or glutinous secretion of the breasts,
Hard, non-malignant tumor of the breast,

Cancer of the breast,

Habitual deposits in the urine,

Pain and difficulty in passing urine,

Incontinence of urine,

Hæmaturia,.

Erectile tumor of the meatus urinarius, .

Perineal abscess,

Total,

The foregoing table gives a fair idea of the derangements of the reproductive organs that were met with in 500 patients

at the period of the change of life, various forms of suffering being frequently met with in the same patient. Hence it is clear that the change of life is a time of turbulent activity for the reproductive organs; and though they are less liable than before to acute inflammation, they are more than usually so to congestion, hemorrhage, mucous flows, and neuralgic affections.

When the change of life is over, the rule is, that the reproductive organs become more or less atrophied, and it is this process of involution which protects women against the frequent occurrence of inflammatory diseases of the womb. If these complaints occasionally occur, it depends on this process of involution having been checked by chronic inflammation; in other words, uterine inflammation seldom occurs at, and after cessation, except in those who have previously suffered from it. After cessation uterine inflammation may be due to a fibroid development in the substance of the womb, or to a polypus growing from the cervical canal, or from the mouth of the womb. I sometimes find the os uteri ulcerated, but never to the same extent as at the previous period of life. When occurring at the change of life, it seems to me that uterine inflammation is oftener accompanied by biliary disturbance than at an earlier period, and I have known patients daily bring up what seemed a pint of bile, for two or three weeks, notwithstanding all remedies. Of sexual infirmities after cessation, it strikes me that vaginitis is the most frequent, sometimes origi nated and attended by slight ulceration of the cervix; sometimes without any uterine lesion. The frequency of vaginitis is to be explained by the continuance of sexual intercourse long after cessation, for I have been repeatedly asked by women about sixty years of age whether, on account of vaginitis, it would be dangerous for their husbands to have connection with them.

Sometimes vaginitis coincides with a similar affection of another mucous membrane, which implies a general failure of health, and explains the frequency of relapses. It may be laid down as a rule that, during the change and after cessation, inflammatory affections of the sexual organs are less frequent and less severe, and that when these organs then assume great activity, it is an activity of a lower type, denoting a deterio

ration of the plastic force; the ovary, the womb, the breast, becoming more frequently the seat of cystic, fibrous, or cancerous growths.

DISEASES OF MENSTRUATION AT THE CHANGE OF LIFE. Flooding seems to have been the only disease of menstruation, at this period, which has engaged the attention of medical men; but besides flooding there is the stillicidium uteri, or continual dribbling from the womb, lasting for weeks or months, and effectually undermining strength. The pains accompanying menstruation may become unusually intense, and have been considered in the chapter on "diseases of the nerves;" but the mode of recurrence of the menstrual flow calls for some remarks. It is better for women that the menstrual flow should cease gradually, and its stopping suddenly may depend upon some removable circumstance. Attention to the general health, sedatives, mild tonics, and purgatives, an occasional tepid bath, and rest, will often cause the flow to reappear with comparative regularity, for some time longer; but I do not agree with Dr. Ashwell in recommending mustard hip-baths, stimulating embrocations, and sexual intercourse. Instead of returning every two or three months, the menstrual flow may return every two or three weeks. This occurred in twenty-six cases out of 383, in whom the catamenia were ceasing. It is unnecessary to point out how weakening and how irritating to the nervous system is this too frequent recurrence, which can, in most cases, be prevented by the exhibition of sulphate of quinia, in three-grain doses, to be given at night. If quinia, combined with the avoidance of hot drinks and rest do not check the too frequent flow, I give a mixture with sulphuric acid and alum, and advise the use of cold vinegar and water to the vulva and adjacent parts.

FLOODING. Mauriceau, Levy, and others, look upon flooding, at the change of life, as indicating cancer of the womb; Astruc, Gardanne, and some modern pathologists, consider it to depend on ulceration of the womb or its chronic hypertrophy; but as I have known women, free from all uterine symptoms, and in every other respect well, have flooding from a fall, from suddenly hearing of the death of a relative, flooding need not be accounted for by ulceration of the neck of the womb,

and to test the accuracy of that opinion, I examined twenty such patients, and in two only did I find uterine ulceration. This brings me again to the diagnosis of flooding at the change. of life, for I have already shown, at p. 55, that the flooding of internal metritis, uterine hydatids and fibroids, uterine polypi and cancer, are sometimes attributed to the change of life. I have known these mistakes to be made by the most talented, because they would not take the trouble to make a digital examination before giving a diagnosis. I have thus seen women reduced to the last stage of debility by a uterine blood flow, more or less abundant, being allowed to continue for two, three, or four years without an examination being made, because these patients were at the time of life when the menstrual flow usually ceases. Quinia and port wine were given, and change of air recommended; but no astringent vaginal injections, not even cold applications, had been made. I have now under my care a lady, with cheeks as white as my paper, who has been flooding more or less for the last two years, and who was repeatedly told that there was nothing to be done, that it depended on the change of life. On examination, I found a polypus hanging to a cavity of the womb by a pedicle as thick as my little finger. Another lady was allowed to flood, at short intervals for three years, and on examining her I found the cervix three or four times the right size, giving the idea of a soft and podgy substance, and quite denuded of epithelium. My first impression of the case was cancer, but I afterwards became convinced it was not specific, for I cured the patient by the means of nitrate of silver; and she regularly menstruated for several years.

When flooding occurs at a catamenial period, as a critical discharge, subsiding completely after a few days, every one recognizes it as depending on the change of life; likewise if successive floodings occur at successive menstrual periods. When flooding occurs a few months or even years after the absence of the menstrual flow, and is accompanied by flushes, perspirations, and other symptoms of cessation, without being explained by uterine disease, it is fair to suppose that it depends upon the change of life; but whenever it does not appear as a downright critical flow, when it is followed by a lingering