280 SKIN DISEASES AT THE CHANGE OF LIFE.

a horse-hair or a spring mattress, instead of on a feather bed. Suppressed perspiration may be recalled by a warm bath, by letting the patient sit, wrapped in a blanket, on a common cane chair, under which a lighted spirit-lamp is placed, and in ten or fifteen minutes the skin will perspire profusely. Gentle, continuous perspiration may be promoted by sulphur and sudorifics.

CUTANEOUS AFFECTIONS.-Out of 500 women, forty-one had some form of cutaneous disease, but whether the proportion would have been smaller in 500 men, between forty and fifty years of age, I cannot determine, though I have certainly found eczema very intractable and relapsing, and prurigo very troublesome at this epoch, and both complaints more common than would appear from my statistics. Dr. Ashwell thinks skin diseases by no means rare at the change of life. Dusourd and B. de Boismont say that lupus is frequent; and the latter observes that herpetic affections, long forgotten, then reappear. Gendrin, Gardanne, and myself have repeatedly seen erysipelas at this period, and a case is cited by Tissot of erysipelas of the face occurring fifteen times during the two first years after cessation, less frequently in the two next years, and only once during the fifth year. Mr. Erasmus Wilson, on the other hand, informs me, that he does not consider women more liable to cutaneous diseases at this critical period than at any other, though when such diseases do arise, they are peculiarly obstinate. Prurigo and eczema he deems the most frequent. Mr. Harvey has frequently seen eczematous eruption of the auricle, and behind the ear, begin at the change of life, last for many years, and resist all treatment, until at last it disappeared by a spontaneous effort of nature. This has occurred several times in my own practice. Mr. T. Hunt assures me that, the change of life has often been followed by acne rosacea, lichen in the face or elsewhere, prurigo, and especially prurigo pudendi. He says, that chronic, scaly affections of the skin, such as lepra and psoriasis, which have commenced before this critical period, are unaffected by it, and that cutaneous affections seldom disappear spontaneously at this epoch. A patient of mine had never had the slightest rash before the ménopause, whereas nettle-rash appeared four times in the year which followed ces

sation; I believe it, therefore, to have been caused by this crisis, as erysipelas was in Tissot's case. M. B., aged fifty, first menstruated between her eighteenth and nineteenth years, with little previous disturbance, and continued regular until twenty, when she married. She had nine children, the last when forty-four. At forty-eight, she had several floodings, but without much increase of pains in the head. The catamenia ceased at forty-nine; this was followed by no disturbance of health, except three months after, by a severe attack of nettlerash, on the chest and body, which disappeared on the proper medicines being administered; twice, however, it has occurred at irregular periods, and she applied for relief, at the Farringdon Dispensary, for a fourth well-marked attack of the disease on the lower part of the body and the thighs. Alibert observed some cutaneous eruptions appear twice only in life-once before first menstruation, and again at its cessation. I have twice known both epochs to be preceded by an abundant eruption of boils, and Gardanne mentions the same occurrence. That form of lupus which attacks the vulva, and was confounded with cancer, until the distinction was clearly made by Huguier, is as frequent at the change of life as at any other period, but is not observed after fifty. Amongst the poor, ulceration of the leg, without being peculiarly intractable, is not an unfrequent complaint at this epoch. Edematous legs I have fretwo cases of varicose veins

quently noticed, and I have had occurring then for the first time. For the local treatment of prurigo, eczema, and other cutaneous affections of the pudenda, I refer to that of the affections determining nymphomania, p. 237. The practitioner will bear in mind that pathologists are adopting what has been long taught in Vienna and in Paris, that prurigo senilis depends on pediculi, and that the disease is therefore propagated by the patient's clothes. Patients occasionally take strange fancies about insects. A dispensary patient was intensely miserable for many months, because, said she, lice kept coming out of her body. I gave her sulphur baths, and I often tried to ascertain whether there was truth in the assertion, but I always found the skin perfectly clean, and without a rash. Another patient, who was very queer in

the head, for six months after the ménopause, had the same notion, and actually put some bugs in a bottle, and used to exhibit them as having come out from different parts of the body. I again bear witness to the admirable effects produced upon cutaneous affections by the external and internal exhibition of the mineral waters of Harrogate and Aix in Savoy.

CHAPTER XII.

OTHER AFFECTIONS OCCURRING AT THE CHANGE OF LIFE IN 500 WOMEN.

TABLE XXXIII.

Liability of 500 Women to other Affections at the Change of Life.

GOUT. According to Hippocrates, women are not subject to gout until after cessation; but he alluded to Grecian women living in retirement. When women lead the life of men, they become to a certain extent, liable to their disorders; and, therefore, Seneca might have been justified in saying of the women of his time, that they were liable to gout "ob varii generis debachationes." As far as my experience goes, women are little subject to gout, but I have, like Chomel and Ferrus, ob

served it at puberty and when menstruation was fully established, and most frequently after the ménopause, when it assumed an anomalous form, as noticed by Dr. Gairdner. Even then, it is a disease of rare occurrence, so much so that I do not remember more than four cases amongst women of the upper classes during the last twelve years, subsequent to my collecting from dispensary and other patients the statistics on which this work was originally founded.

The following table, extracted from the Registrar-General's Report, throws light on this subject:

TABLE XXXIV.

Relative Mortality from Gout in both Sexes at successive Periods.

This shows that women are most liable to gout at puberty and at the change of life; but before the menstrual flow is regularly established, gout generally assumes an anomalous character, being accompanied by singular nervous symptoms, of which I have seen some remarkable instances. At the change of life, and after cessation, this disease may follow its usual course, and Trousseau has observed that hysterical symptoms may be cut short by an attack of gout. It is curious to note that up to fifteen, no seeds of gout have been evolved in the male sex, whereas many had grown up in the female, and