Cancer.-Galen observed, that cancer of the breast was frequent at the change of life, and Mr. Paget has lately shown that it occurs most frequently from forty-five to fifty years of age.

TUMOR OF THE MEATUS URINARIUS.-I have met with three cases of erectile tumor of the meatus urinarius, a disease thought by Sir C. M. Clarke to occur most frequently in the earlier part of woman's life; but I am confirmed in the contrary opinion by Mr. B. Norman, who has observed fifteen cases, eleven of which were in women during or after the change of life. Four of my five cases came under treatment after the ménopause, and in a case that I attended with Dr. Bennet, the tumor, successfully treated by him several years before the change, returned after the ménopause, and was so very hard that we thought it preferable to cut it away, which was skilfully done by my friend. At the time of the operation there was very little bleeding; and when, on the following morning, it became necessary to draw off the urine, I found it largely mixed with blood, and as this continued to be the case during the following days, I came to the conclusion that the blood had been oozing from the wounded urethra into the bladder. At all events, one application of the undiluted perchloride of iron prevented any subsequent mixture of blood with the urine. Diseases of the bladder and urethra so frequently afflict men from the fortieth to the sixtieth year, and women of the same age are so free from such diseases, that this may be viewed as compensating favorably for the many other diseases to which women are specially liable.

DISEASES OF THE KIDNEYS.-The forty-nine cases in which women were, for a few months, habitually subject to an increased amount of the urinary salts, are rather to be considered as instances of a critical evacuation from the blood than as proofs of diseased action, and the same applies to Hæmaturia -a rare disease-which has been observed by Chouffe, Menville, and Dusourd. My cases yielded to bleeding and mild treatment. The eight cases of pain in, and difficulty of, passing water, and those of incontinence of urine, soon yielded to diluents, baths, and mild measures.

The following case of inflammation of the pelvis and calices of the kidneys is instructive :

CASE 46.—The wife of a physician, who was born and had passed the first fifteen years of her life in India, enjoyed excellent health until the change of life, which unfortunately coincided with the sudden loss of a dear sister and an unusually cold spring. The result of which was a sluggish liver, dyspepsia, pains in the bladder, dysuria, and abundant deposits in the urine. As this condition did not abate, the husband consulted an eminent surgeon, who tested the urine by nitric acid, and said the patient was suffering from albuminuria. This diagnosis was unfortunately told her, for she had dabbled in medicine, and knew that albuminuria meant an ugly future, so she gave herself up to despair, made her will, settled the distribution of her trinkets, and kept her husband without sleep for two nights, which was decidedly useful, as it suggested to him the advisability of consulting Dr. Owen Rees. He also examined the urine, not neglecting to use the microscope, and he found there was pus in the urine, and he supposed it to be caused by a renal calculus. Two months of careful dieting, Vals water, and rest, removed pus from the urine and all symptoms of disease, and as there never was either persistent pain or paroxysms of pain in the region of the kidneys; as there was no bloody urine, and no calculus was ever passed-may be there was none-but merely inflammation of the pelvis and calices of the kidneys. Towards the following autumn the patient had a relapse, so she went to the south of France and derived so much benefit from passing the winter in a milder climate that she has continued to do so.

CHAPTER X.

DISEASES OF THE GASTRO-INTESTINAL ORGANS.

TABLE XXXI.

Liability to Diseases of the Gastro-intestinal Organs in

This table means that 354 kinds of gastro-intestinal suffering were noted in 500 women at the change of life, and many of the 354 presented several kinds of gastro-intestinal disturbance. The practical bearing of this table is the great liability to biliousness, dyspepsia, diarrhoea, and piles. Later in life, the

GREAT FREQUENCY OF BILIARY AFFECTIONS.

263

tendency to jaundice, biliousness, and dyspepsia diminishes, and appetite and digestion improve; there is also less tendency to lose blood by the bowels; piles cease to bleed, and generally subside in advanced life.

BILIARY AND DYSPEPTIC AFFECTIONS. The liability to derangements of the biliary apparatus at this period has been noted by Burns, Gendrin, Meissner, Otterburg, and Aran; by Sir C. Mansfield Clarke, Sir J. Simpson, Dr. Evory Kennedy, and Dr. West. Hepatitis and jaundice have been observed by Gardanne, and Sir H. Halford mentions having seen abscess of the liver at cessation.

The late Dr. B. Lane's observations on the coincidence of the derangement of the biliary secretions at the change of life, are true to nature:- "Nothing can be more common than to find severe biliary derangement occurring at or about the period of menstrual cessation; and, looking at the great physiological change which then takes place in connection with hepatic development, it is naturally to be expected. A woman will complain of being bilious-there may be a bitter, oily taste in the mouth, a burning in the throat, frontal headache, nausea, and even vomiting, the urine high-colored, the bile abounding in the alvine dejections, and, perhaps, causing heat and a stinging sensation in the rectum, the tongue furred, a biliary tinge pervading the cutaneous surface."

The worst cases of disease at the change of life for which I am consulted have been ascribed to a torpid condition of the liver by other medical men; and though the preceding table shows clearly how liable women are to sickness, dyspepsia, and biliousness at this epoch, it cannot give an idea of the obstinacy of the biliary symptoms in many of these cases. Thus, P. K. was a strongly-built woman, of a sanguine temperament, in whom the menstrual flow had been irregular for the last eight months; till then she had enjoyed good health, but since, in spite of purgatives, alteratives, and tonics, I found it difficult to set right the gastro-intestinal functions, or to improve the appearance of the tongue, which was permanently coated with a yellow fur.

CASE 47.-Jaundice.—Mrs. W. is a tall, stout lady, with dark hair, forty-nine years of age, and the mother of thirteen chil

264 GREAT FREQUENCY OF BILIARY AFFECTIONS.

dren. The menstrual flow appeared at twelve, and continued regular until it ceased suddenly at forty-seven. Six weeks afterwards the skin became yellow, and she suffered considerably in the region of the liver. She was soon cured, but every three or four months there was a return of jaundice. This lady is habitually low-spirited, and so drowsy that she can neither read nor do fancy work during the day, and is restless at night. She has often flushes and chills, but no perspirations. After diminishing the size of the engorged liver, and curing the actual attack of jaundice by blue pill and alkalies, the question was, how to prevent that congestion of the liver which had returned with a certain kind of periodicity, since the sudden cessation of menstruation. I gave blue pill and alkalies for a week every month, and I established a free determination of blood to the skin, so that it might diminish the congestion of the internal organs, by warm baths, prolonged for two hours every other day, and daily scruple doses of the comp. sulphur powder. I advised 2 oz. of blood to be taken from the arm every third or fourth month, as might be otherwise indicated. Gentle perspirations soon showed that the blood currents were steadily setting in a right direction, health became good, and for the last two years there had been no return of jaundice. The same plan of treatment succeeded equally well in the following case.

CASE 48.-Repeated jaundice at cessation.—Mrs. H., a robust lady, with a bilious look, consulted me in June, 1854, being then fifty-five. The menstrual flow came at fifteen, and continued regular until she was forty-eight, when it ceased suddenly. She was then troubled with piles, which bled freely every six or eight weeks. This went on for six months. When the piles ceased bleeding, her skin became yellow, and the liver was found extending several inches below the edge of the false ribs. She has had several slight fits of jaundice, and her motions are often black, offensive, and "burn " the passage. It should be observed that both this and the patient in the previous case, had never been particularly bilious before cessation. The cause of long-continued biliousness at the change of life, is the congestion of the portal system, no longer relieved by the menstrual flow, so that the liver is overworked.