that while in man, the liability to gout goes on increasing from fifteen to sixty, in women, puberty seems to sweep away its tendency, for there is none from fifteen to twenty, though after that age, when the body has attained its full size, the seeds develop themselves, gout becoming most frequent between forty and fifty. RHEUMATIC FEVER.-The statistics of rheumatic affections likewise evince that from forty to fifty a change takes place in the female constitution, for up to forty more men than women die from rheumatic affections, while from forty to fifty the deaths from these affections are as 604 women to 295 men, and from fifty to sixty as 755 women to 338 men. This increased liability to rheumatism after the ménopause may, perhaps, depend on the skin being then more given to perspire, and on the greater frequency of checked perspiration. The rheumatism of those who are nursing can be thus accounted for. ASCITES. I have seen only two cases of this affection at the change of life, but I have very frequently noticed the pitting, on pressure, of both the lower limbs at this period. On referring to the Registrar-General's Reports, I find that more women, than men, die of dropsy from forty to fifty, in the proportion of nine to five; and from fifty to sixty, in the proportion of fourteen to six. Portal and Gardanne have both stated, that women were particularly subject to dropsical effusions of an obstinate nature at the change of life. Breschet, in his researches on Hydropsies Actives, relates the case of a lady: menstruation came at thirteen, and ceased at forty-eight, though the characteristic phenomena of cessation are said to have only appeared at fifty-four; namely, great debility, flushes, vertigo, headache. At fifty-five, after a fit of anger, the whole body swelled considerably, except the arms. There was fever, furred tongue, headache, oppression, and sediments in the urine. Twelve days after this, eighteen leeches were applied to the anus, and the swelling diminished; on the eighteenth day an emetic was given, and on the twenty-eighth all signs of effusion had disappeared. This case brings to my recollection another instance of dropsy, caused by severe and sudden mental perturbation. A gentleman, aged twenty-five, who had habitually enjoyed good health, was standing at the altar and about to be married, when some one stepped forward to forbid the ceremony. On his return home his legs swelled, serum was effused in the cellular tissue, ascites appeared, the urine was albuminous, and in a few months the patient died. A post-mortem examination was not permitted. CONSUMPTION. On consulting those practitioners whose experience in pulmonary disorders enables them to speak authoritatively on the subject, I find them of my opinion, that the morbid influence of the change of life on consumption is not great. If consumption appear at this period, it has previously existed under a latent form, as in the three cases noted in my statistics, in which the disease was aggravated by the ménopause, and I have not met with another case during the last twelve years. I must observe, however, that Dubois mentions that two ladies who were saved from phthisis by the regular establishment of the menstrual flow, fell victims to that complaint at the change of life without any other apparent cause. B. de Boismont says, that in ten cases he has been the sad spectator of the rapid progress of consumption at this epoch, which had previously remained stationary for years. More recently, Dr. Emmett, of New York, has recorded his conviction that dysmenorrhoea, by causing the early cessation of menstruation, is a frequent cause of phthisis in comparatively young women; but this assertion does not accord with my own observation. BRONCHITIS.-In four of my cases, habitual bronchitis dated from the change of life, and seemed to have been caused by it; and Bordeu has noted similar cases. HEMOPTYSIS. This occurred to eight patients, and was evidently caused by the change of life arresting an habitual hemorrhage. Bordeu has also observed cessation to be followed by monthly attacks of congestion of the lungs, and by spitting of blood. HEART-DISEASE. The heart suffers very little at the change of life; my experience on this point again coincides with that of Dr. Quain, for out of my 500 cases, there was only one of hypertrophy with morbid sounds, in a woman, aged sixty, and she presented the only instance of arcus senilis. EPISTAXIS. This critical effort of nature may become a dis ease, and the nose may require plugging. Menville gives a case wherein slight epistaxis occurred repeatedly until the dodging time, when it became very abundant until the menstrual flow ceased. I have seen women subject to this complaint for from three to five years after cessation, but never to any great extent. RUPTURED VARICOSE VEINS. -Stahl has observed this to occur at cessation. I have seen it in three instances, and I have repeatedly been told that after cessation the legs had swelled and were hard, hot, and red, the capillaries of the skin being greatly injected. HYPERTROPHY OF THE THYROID GLAND.-In three patients, during the last few years, I have seen cessation followed by an increase of the thyroid gland to about treble its usual size. All three patients had long suffered from chronic uterine disease; two got well under the influence of iodine rubbed in and taken internally, and I lost sight of the other. OTORRHOEA. I have noticed this complaint to come on periodically with the menstrual flow, and the fact has not escaped Mr. Harvey's notice. M. S., aged fifty-two, suffered much from otorrhoea for two years previous to the first menstrual flow, very little from it while menstruation continued regular, but it returned with renewed pertinacity some months before cessation took place. SPINAL DEVIATION.-B. de Boismont has related two cases in which very extensive deviation immediately followed the change of life, but in all probability a certain amount of deviation had occurred at puberty, and had remained stationary until the ménopause; and I have known this to happen once. PTYALISM.-Abundant and long-continued salivation has been noticed by Bouchut as a symptom of cessation, but I have only noticed it to occur at that time in connection with very intense cerebral neuralgia. Blisters in gangliopathy, 160 benignant tumors of, 259 malignant tumors of, 260 Bronchitis, 286 Cessation, late, 40 taken for pregnancy, 60 Change of life a cause of insanity, 21 a cure of insanity, 21, 22 its morbid liabilities, 88 its real diseases, 90 the constitution strengthened Childbirth late in life, 45 Chloral, 115, 214 Chloroform, 115, 160 Chlorosis, its diagnosis from cessa- Climacteric decay, 25 disease, 17 insanity, 184 Coeliac neuralgia, 155 Cold, a cause of gangliopathy, 153 Conium, 114 Constipation, 269 Constitutional taints, causing dis- Cancer of the womb taken for the Consumption, 286 Camphor, 114, 161, 213 Cancer, mammary, 260 neuralgia, management of, 128 Debility, a prominent symptom of gangliopathy, 153 Delirium, 185 Demonomania, 198 spinal, 287 Deviations, uterine, 252 Diarrhoea, 266 at the change of life, 106 |