Menopause in 1869

Age	The age at which it occurs is very variable. In this country, from forty to fortysix is the most common. Instances are not at all unusual when it does not appear until the half century has been turned, and we have known instances where women past sixty still continued to have their periodical illness. Examples of very early cessation are more rare, We do not remember to have met any, in our experience, earlier than thirty years, but others have observed healthy women as young as twentyeight oft reproduction decreases.
Anatomical signs	And here a curious observation comes in. We have said that when the girl changes be a woman, a similar deposit of fat take place (though less in amount), which commences at the loins. This is the first signs of puberty. In the change of life the first sign is visible at the lower part of the back of the neck, on a level with the bones known as the two lowest cervical vertebrae. Here commences an accumulation of fat which often grows to form two distinct prominences, and is an infallible index of the period of a woman's life. The breasts do not partake of this increase, but become flat and hard, the substance of the gland losing its spongy structure. The legs and arms lose their roundness of outline, and where they do not grow fat, dry up and resemble those of the other sex. The abdomen enlarges even to the extent occasionally of leading the wife to believe she is to be a mother—a delusion sometimes strengthened by the absence of the monthly sickness. Finally, a perceptible tendency to a beard often manifests itself, the voice grows harder, and the characteristics of the female sex become less and less distinct.
Variation in experience	Some who are more fortunate than their neighbours do not experience the least discomfort at the change of life. They simply note that at the expected time the illness does not appear, and forever after they are free from it. These are the exceptions. More commonly marked alterations in the health accompany this important crisis, and call for sedulous hygienic care. It is gratifying to know nearly all these threatening affections can be avoided by such care, as they depend upon causes under the control of the individual
Good prognosis	Another fact, to which we have already referred, is full of consolation. It is an unexpected fact, one that we should hardly credit, did it not rest on statistical evidence of the most indisputable character. The popular opinion, everyone knows, is that the period of the change of life is one peculiarly dangerous to women. If this is so, we might expect that if the number of deaths between the age of forty and fifty years in the two sexes be compared, we should find that those of females far exceed those of males. This is, however, not the case. On the contrary, the deaths of the males exceed in number those of the females.
Caution advised	Hasty readers may draw a false conclusion from this statement. They may at once infer that the change of life merits little or no attention, if it thus in nowise increases the bills of mortality. This is a serious error. All intelligent physicians know that there are in very many cases a most unpleasant train of symptoms which characterize this epoch in the physical life of woman. They are alarming, painful, often entailing sad consequences, though rarely fatal.
Beware of unintelligent physicians	All physicians are, however, not intelligent, and there are too many who are inclined to ridicule such complaints, to impute them to fancy, and to think that they have done their full duty when they tell the sufferer that such sensations are merely indicative of her age, and that in a year or two they will pass away. Such medical attendants do not appreciate the gravity ,of the sufferings they have been called to relieve. Says a distinguished writer on the subject, after entering into some details in the matter:"I would not dwell on things apparently so trivial as these, had I not seen some of the worst misery this world witnesses induced thereby." Such a conviction should be in the mind of the physician, and lead him to attach their full weight to the vague, transitory, unstable, but most distressing symptoms described by him.
Return to prepubertal ailments	We shall speak of the various signs and symptoms which occur at and mark the change, and in commencing so to do, we call attention to an interesting illustration of the rhythm which controls the laws of life. As in old age, when we draw near the last scene of all, we re- enter childhood, and grow into second infancy, so the woman, finishing her pilgrimage of sexual life, encounters the same landmarks and stations which greeted her when she first set out. She obeys at eve the voice of her own nature which she obeyed at her prime. The same diseases, and disorders, the same nervous and mental sensations, the same pains and weaknesses which preceded the first appearance of her monthly illness will, in all probability, precede its cessation Even those affections of the skin or of the brain, as epilepsy, which were suffered in childhood, and which disappear as soon as the periodical function was established, may be expected to re-appear when the function has reached its natural ter mination. Therefore, if a woman, past the change, notes that she suffers from bleeding at the nose, headache, boils, or some skin disease, let her bethink herself whether it is not a repetition of some similar trouble with which she was plagued before the eventful period which metamorphosed her from a girl into a woman. So true is what we have just said, that in detailing the symptoms which frequently occur at the change of life, -we could turn back to the previous pages where we discussed the dangers of puberty, and repeat much that we there said as of equal application here.
Chlorosis	For instance, the green-sickness, chlorosis, is by no means exclusively a disease of girls. It may occur at any period of child-bearing life, but is much more frequent at the beginning and the end of this term. Hardly any one has watched woman closely without having observed the peculiar tint of skin, the debility, the dislike of society, the change of temper, the fitful appetite, the paleness of the eye, and the other traits that show the presence of such a condition at the nervous system in those about renouncing their powers of reproduction. The precautions and rules which we before laid down can be read with equal profit in this connection [N.B. "Chlorosis" disappeared with improved nutrition -it appears to have been acute anemia]
In addition to these symptoms, which in a measure belong to the individual's own history, there are others of a general character which betoken the approaching change.
Irregular periods	One of them is an increasing irregularity in the monthly appearance.
Hot flash	This is frequently accompanied with a sinking sensation, a ‘feeling of goneness as the sufferer says, at the pit of the stomach, often accompanied by flushes of heat, commencing at the stomach and extending over the whole surface of the body. The face, neck and hands are suffused at inopportune moments, and greatly to the annoyance of the sufferer.
Dizziness	This is sometimes accompanied by a sense of fullness In the head, a giddiness, and a dullness of the brain, sometimes going so far as to cause an uncertainty in the step, a slowness of comprehension, and feeling as if one might fall at any moment in some sort of a fit.
Confusion	This is not the worst of It. These physical troubles react upon the mind. An inward nervousness, intensely painful to bear, is very sure to be developed. She fears she will be thought to have taken liquor, and to be overcome with wine; she grows more confused, and imagines that she is watched with suspicious and unkind eyes, and often she worries herself by such unfounded fancies into a most harassing state of mental distress.
Desire to be alone	Society loses its attractions, and solitude does but allow her opportunity to indulge to a still more injurious extent such brooding phantasms
Aches	Every ache and pain is magnified
Palpitations	Does her heart palpitate, as it is very apt to do? Straightway she it certain that she has some terrible disease of that organ, and that she will drop down dead some day in the street.
Sore breasts	Is one of her breasts somewhat sore, which, too, is not unusual? She knows at once it is a cancer, and suffers an agony of terror from a cause wholly imaginary.
Mood swings Rage	Vibrating between a distressing excitement and a gloomy depression, her temper gives way, and even the words of the Divine Master lose their influence over her.She becomes fretful, and yet full of remorse for yielding to her peevishness; she seeks for sympathy without being able to give reasons for needing it; she annoys those around her by groundless fears, and is angered when they show their annoyance. In fine, she is utterly wretched, without any obvious cause of wretchedness.
This is a dark picture, but it is a true one, inexorably true. Let us hasten to add that such a mental condition is, however, neither a necessary nor a frequent concomitant of the change. We depict it, so that friends and relatives may better appreciate the sufferings of a class so little understood, and so that women themselves, by knowing the cause of such complaints and the sad results which flow from them, may make the more earnest efforts to avoid them.
General strangeness	Other symptoms are a sense of choking, a feeling of faintness, shooting pains in the back and loins, creepings, and chilliness, a feeling as if a hand were applied to the back or the cheek, a fidgety restlessness,
Brain fog	inability to fix the mind on reading or in following a discourse
Sudden tears	and a loss of control over the emotions, so that she is easily affected to tears or to laughter.
All these merely indicate that Nature is employing all her powers to bring about that mysterious transformation in the economy by which she deprives the one sex for ever of partaking in the creative act after a certain age, while she only diminishes the power of the other.
Effect of general health	Those women especially may anticipate serious trouble at this epoch in whom the change at puberty was accompanied by distressful and obstinate disorders, those in whom the menstrual periods have usually been attended with considerable pain and prostration, and those in whose married life several abortions or several tedious and unnatural labours have occurred. Also those who from some temporary cause are reduced in health and strength, as from repeated attacks of intermittent fever or disorders of the liver and digestive organs. Still more predisposed are they who are subject naturally to those displacements or local ulcerations which we have mentioned among the‘perils of maternity-" It becomes of great consequence that any such deviation from the healthy standard shall be corrected before a woman reaches this trying passage in her career.
Flooding	In rather more than one out of every four cases the change of life is either ushered in or accompanied by considerable flooding. When this occurs at the regular period, is not in sufficient quantity to cause debility, and is not associated with much pain, it need not give rise to any alarm. It is an effort of Nature to relieve the impending plethora of the system, to drain away the excessive amount of blood which would otherwise accumulate by the cessation of the flow. When it is remembered that every month for some thirty years of life the woman, of forty-five has been moderately bled, we need not wonder that suddenly to break off this long habit would bring about plethora, which would in turn be the source of manifold inconveniences to the whole system. Therefore, — this flooding may be regarded as a wise act of Nature, and as such, allowed to take its course so long as it is not attended with the symptoms mentioned above. When this is the case, however, the physician should be consulted, as then the bleeding may be from inflammation, or ulceration, or even from that dreaded foe to life, cancer. Instead of finding this exit, the blood occasionally is thrown oft by bleeding at the nose, or is spit up from the lungs, or is passed from bleeding piles. Due caution must be used about stopping such discharges too promptly. Rest, cool drinks, and the application of cold to the parts, are generally all that is needed.
Cancer	We have just spoken of cancer. This is a subject of terror to many women, and their fears are often increased and deliberately played upon by base knaves who journey about the country calling themselves ‘cancer doctors," and professing to have some secret remedy with which they work infallible cures. It should be generally known is often a matter of no little difficulty, requiring en experienced eye, to pronounce positively whether a tumor or ulcer is cancerous. These charlatans have no such ability, but they pronounce every sore they see a cancer, and all their pretended cures are of innocent, non- malignant disorders. Cancers are more apt to develop themselves at this period. Their seat is most frequently in the womb or the breast, and they are said to be especially liable to arise in those women who have suffered several abortions or unnatural labours.. Undoubtedly they are more frequent in the married life than In the unmarried, and they evidently bear some relation to the amount of disturbance which the system has suffered during childbirth, and the grief and mental pain experienced. For this reason a celebrated teacher of obstetrics insists upon classing them among nervous diseases. The surgeon alone can cure them, and he but rarely. Medicine is of no avail, however long and painstaking have been its researches in this direction. A touching story is related in this connection of Raymond Sully, the celebrated philosopher. When a young man be was deeply impressed with the beauty of a lady, and repeatedly urged his suit, which she as persistently repelled, though it was evident she loved him. One day, when he insisted with more than usual fervour that she should explain her mysterious hesitation, she drew aside the folds of her dress and exposed her breast partly destroyed by a cancer. Shocked and horrified, but unmoved in his affection, he rushed to the physicians and demanded their aid. They replied they could give none. He determined to find a cure if he had to seek in all parts of the earth. He visited the learned doctors of Africa and Asia, and learned many wonderful things, even it was said, the composition of the philosopher's stone itself, but what he did not find and what has never yet been found, was what he went forth to seek—a cure for cancer.
Enlarging ovaries	At this time, too, enlarging or swelling of the ovaries is apt to commence. They are nearly always preceded by scanty or painful menstruation, and this, therefore, it is the duty of every woman, as she values the preservation of her future health, to remedy by every means In her power.
Change in libido	Generally, from the of commencement of the change of life, commences also a steady diminution of the sexual passions, and soon after this period they quite disappear. Sometimes, however, the reverse takes place, and the sensations increase in intensity, occasionally exceeding what they even were before. This should be regarded with alarm. it is contrary to the design of Nature, and can but mean that something is wrong. Deep-seated disease of the uterus or ovaries is likely to be present, or an unnatural nervous excitability is there, which, if indulged, will bring about dangerous consequences. Gratification, therefore, should be temperate, and at rare intervals or wholly denied.
To guard against the dangers of this epoch, those general rules of health which we have throughout insisted upon should be rigidly observed. If during the whole of her sexual life the woman has been diligent in observing the laws of health, she has little to fear at this period. Some simple remedies will suffice to allay the disagreeable symptoms, and the knowledge that most of them are temporary, common to her sex, and not significant of any peculiar malady, will aid her in opposing their attacks on her peace of mind.
Avoid meat	When plethora, flooding, or congestion is apparent, the food should be light, chiefly vegetable, and moderate in quantity.
Avoid stimulants	Liquors, wines, strong tea, coffee, and chocolate should be avoided; an occasional purgative or a glass of some laxative mineral water should be taken, and cool bathing regularly observed.
Exercise only cautiously	Exercise should be indulged in with caution, and care taken to avoid excitement, severe mental or bodily effort, and exhaustion. If the system is debilitated, and the danger is rather from a want of blood than much blood, nourishing and perhaps some stimulant are called for.
Wear flannel	When the perspiration is excessive, flannel should be worn next to the skin in the daytime, and a flannel night- dress at night. A tepid bath before retiring is also useful.
Use stomach plasters	The "goneness" and other unpleasant sensations referred to the pit of the stomach may be much relieved by wearing a well-made spice-plaster over the stomach, or binding there a bag of gum camphor, or if these fail, an opium plaster will hardly fail to be of service .
Beware alcohol	Internally, we think nothing at all is needed; but as something must be taken, let it not be spirits or wine, but half a teaspoonful of aromatic spirits of ammonia in a few tablespoonsful of water. There is too much of a tendency among some women to seek alleviation in intoxicating compounds, "bitters," "tonics," and so forth, at such times. They can only result In injury, and should be shunned.
Apply heat	The pains in the back and loins often experienced can be removed by rubbing the parts with hot mustard- water, and taking a gentle purgative, or by placing against the lower part of the spine a hot brick wrapped in a flannel cloth wrung out in warm water or laudanum and water.