CHAPTER XI. DISEASES OF THE SKIN AT THE CHANGE OF LIFE. TABLE XXXII. Liabilities of the Skin to Disease at the Change of Life in 500 Flushes, Dry flushes, Women. Legs and feet burning, and very painful, Distressing aching under the finger nails, Falling off of all the finger nails, Pruritus, or itching without apparent lesion, Edematous, or swelled legs, . Monthly swelling of legs for three days for a year, Inflammation of legs, and painful distension of their Carried forward, 287 14 2 3 2 4 1 201 2 13 89 18 5 1 3 5 16 1 3 3 686 Thus, 500 women divided 705 modes of slight or severe cutaneous suffering at this epoch, many suffering in various ways at the same time. The liability to cutaneous disease passes off in after-life; and though flushes and perspirations may occasionally occur, they are no longer a source of annoyance. Prurigo and eczema are, however, sometimes very troublesome to women in advanced age. These affections may be registered under three heads,flushes, sweats, and cutaneous affections. I shall be brief on the last, but as the flushes and sweats of the change of life have never been sufficiently studied, I shall devote a few lines to their pathological import, referring the reader to p. 76 for further details. FLUSHES. This is the popular name, and I adopt it, because it is short and expressive. "Hot blooms," is another expression, which faithfully indicates what really occurs. Flushes are mentioned by nosologists under the name of ardor volaticus, or fugax. Romberg correctly calls it one of the cutaneous hyperæsthesia, and notices its greatest frequency at the change of life. Flushes may be increased to a painful extent by external heat, over-clothing, hot rooms, hot drinks, and overfeeding, by the checking of diarrhoea or of leucorrhoea. Some feel so faint under their influence, that they must have air, or they would swoon. M. C. could drop down with weakness when the flushes came on. Dry heats are morbid flushes; they torment a patient without the subsequent relief of perspiration. The cheeks are not the only parts susceptible of burning sensations, for two patients complained most of the burning of the legs and feet; cold water applications did not much abate the annoyance, but warm did; and at night they slept with their feet out of bed. Three others complained bitterly of similar sufferings in their hands, and of aching under their finger nails. The flushes are sometimes preceded by chilly sensations, and some women tremble with internal cold, and remain, for a long time, habitually cold, notwithstanding the flushing of the face. One patient continued in this state for seven years; she had slight flushes without perspiration, was very nervous, and often fainted. Others feel so cold that they approach the fire, reaction then soon coming on, they fly to the window. In such cases, the perspirations will be cold and clammy, denoting debility, and the congestion of some internal organ. When the flushes are thus anomalous, they are often preceded by ganglionic dysæsthesia; strange sensations, which have been said to resemble "pulses, like a live animal throbbing in the stomach," or "the fluttering of a bird;" sensations which vanish on the appearance of perspiration. SWEATS. Perspiration was carried to a morbid extent in seventy-nine out of 500 women, who often complained of heavy perspirations. They were constantly wiping the sweat off the face, their hair was often wet, they were obliged to change their linen twice a day, and although slightly covered, their bedclothes became soaked. Gardanne, Chambon, and B. de Boismont, notice the occurrence of sweats at this period, but the little importance attached to them is shown by the fact, that in an elaborate article, with a host of references, on idiopathic sweating, J. Frank merely quotes Tissot's having observed it at the change of life. It would seem that sweating ought to be more beneficial than perspiration, but a very accurate observer, Sanctorius, remarks: "That perspiration which is beneficial, and most clears the body of superfluous matter, is not what goes off with sweat, but that insensible steam or vapor which in winter exhales to about the quantity of fifty ounces in the space of one natural day." "Sweat is always from some violent cause; and as such—as static experiments demonstrate it hinders the insensible exhalation of the digested perspirable matter." The intensity of the force which impels the sweat from the 278 FLUSHES AND PERSPIRATION. skin is shown, not only by the length of time it may last, but by its often resisting all the attemps made by women to diminish or suppress it. They wear less clothing, take cold drinks, place themselves in draughts, but still the impulse is stronger than their efforts, for they seldom succeed. In general, it is some internal focus of active congestion which checks perspiration, or renders it cold and clammy. When this occurs, great debility is felt, with an increase of epigastric pain in some, in others, pseudo-narcotism; which, as Dusourd remarks, is immediately relieved when the skin perspires. It is very strange that these sweats are sometimes prolonged for months, without weakening women, or preventing their becoming fat, though the fat often seems to be half liquid. Women of a nervous or chlorotic type, have habitually a cold clammy perspiration, like that coming from the blanched skin of those who are vomiting or in syncope; a passive permeability of the skin, determined by loss of nervous power. TREATMENT. I have shown the advantages of promoting perspiration to check the serious disturbance of the internal organs, how then should it be restrained so as to inconvenience the patient as little as possible? Blood is the fuel, the interstitial and molecular combustion of which keeps alive the continuous heat of the body. The relative superabundance of blood is often the cause of the superabundant heat, and therefore of the perspirations, as shown by the case related by J. Frank, of a man who became subject to excessive perspirations after the supression of an hæmorrhoidal discharge. Diminish the mass of blood by taking three or four ounces from the arm at two or three months' interval, and the sweats will also diminish. The irritability of the nervous system may be relieved by the sedative preparations already recommended. Baths are very useful. They should be tepid, and prolonged for an hour at least. Tissot recommends them highly, and their effects may be increased by adding from one-half a pint, to a pint of camphorated vinegar. The saline matters, which are otherwise removed by perspiration, must be directed to the kidneys, by giving the salines, as already indicated, the acidulated and effervescing drinks, and small doses of nitre and borax. I cannot too strongly recommend mineral acids for those who suffer much from heats and sweating, for they tone the nerves as well as cool the blood. The greatest amount of testimony runs in favor of sulphuric acid, which I have found most effectual. Thus Pereira bears witness to the sedative action of sulphuric acid in distressing tingling of the skin; Hufeland gave Haller's acid elixir, which is a mixture of one part of sulphuric acid in volume with three parts of spirits of wine; other Germans give at the change of life, Mynsicht's elixir, in which sulphuric acid and alcohol are associated with aromatics. I order from 10 to 20 drops of the diluted acid to be taken in a wineglassful of cold water, three times a day, or else the acidum sulphuricum aromaticum of the British Pharmacopoeia; but these remedies require time, and will not satisfy a patient whose cheeks burn repeatedly in the course of the day, and who wants something to give immediate relief. Then a lotion of 1 ounce of cherry-laurel to 5 of elder-flower water, may be tried, or water in which camphor has been allowed to float, or vinegar and water, or water containing 1 or 2 ounces of camphorated vinegar to the pint. Chomel advised the treating the hot cheeks by a kind of steam douche, and I have found it useful to do so two or three times a day; in the same way burning feet and hands are soothed by soaking them in hot water. Some patients have derived great benefit from using, with the powder puff, one of the following powders : Some describe with energy their sufferings in winter nights, when, bathed in perspiration, they are afraid of turning, lest they should be chilled by the damp cold, and have given me their warmest thanks for suggesting that a long, thin, flannel dress be worn over the night-gown, and that they should lie on |