The nearer a woman approaches her forty-fifth year (_cæteris paribus_),
will be the risk of some irregularity in the menses; and as this period
is more frequently the one at which any latent disease of the uterus
shows itself, it is always looked forward to with much anxiety by women.
Indeed, so replete is this time with horrors to many, that we may very
justly suspect apprehension to be the cause of some of the distressing
symptoms, which sometimes accompany this interesting process of the
human uterus.
Delicate women, and especially those who have lived idly, have this
period of life arrive earlier than those of a contrary constitution, and
opposite habits. We have already noticed, in our section on Suppression,
that this change sometimes takes place at a very early period of life,
and this without leaving any injurious consequences behind it; and, on
the other hand, we find many cases on record, where this discharge had
continued with regularity to a much longer period than the ordinary one.
Gardien mentions a case which fell under his own notice, where this
evacuation continued with great exactness, until beyond the
seventy-fifth year; others, still more uncommon, are mentioned by
various writers.[7]
This change is sometimes effected so silently, that the woman scarcely
notices her altered condition; at others, its approach is so gradual, as
not to attract observation, until the diminished quantity gives warning
that it is about to take its leave for ever; while, again, the
irregularity, both in period and quantity, may be such, as justly to
give alarm, as well as to produce the most serious danger.
But, as a general rule, it may be observed, that when the woman arrives
at about her forty-fifth year, she finds her menses to become irregular,
both in the quantity of fluid evacuated, and in the periods they
observe; being sometimes in advance, and at others, not appearing until
long after the accustomed time. The woman also finds some alteration has
taken place in her general health; she becomes pale, debilitated, and
nervous; arising, however, for the most part, from the too frequent
returns of this discharge, or its too great abundance.
At this time, also, the woman sometimes becomes the victim of a strange
illusion, should the menses not have returned for several periods; for
she now supposes herself to be pregnant, as her abdomen enlarges, as do
the mammæ; her appetite becomes capricious, or she has strange longings,
&c., the whole of the rational signs of this condition being present, in
her imagination, even to the motion of the child. This delusion is most
common to women who marry late in life, and who are very desirous of
offspring. Now the breasts lose their intumescency; the morning sickness
vanishes; the swelling of the abdomen subsides; the imagined stirrings
of the fœtus cease, or the sensation becomes so unequivocal as to
satisfy that it arises from the movement of wind; and, to put everything
beyond hope, the menses return in overwhelming quantity. It is highly
proper, that practitioners, and especially the younger part of them,
should be put upon their guard in respect to this condition of the
patient, and not too easily yield credence to all her wishes may
dictate, or absolutely to treat as an impossibility, a circumstance of
which there is occasionally an example.
It seems that the apprehensions of this period of life have arisen
mainly from the notions entertained of the final cause of the menses;
namely, that it gives vent to peccant humours. But females should be
made to know, that all this is purely the theory of the vulgar; as the
menstrual blood is formed from the general mass; and, consequently, if
that be pure, the other will be; therefore, the idea is altogether
ill-founded. But unfortunately, whenever this discharge is less abundant
than usual, the most serious fears are entertained, that there will be a
retention of a portion, which will cause disease, either in the uterus
itself, or in some other part of the body; hence, a diminished
menstruous secretion is always more alarming to the female, than an
unusual flow. But it may be well to remark, that there is a great
difference between the cessation of this discharge, and the suppression
of it. In the one instance, it is an event which nature has designed
should take place, and is effected altogether by arrangements of the
system itself; and, of course, one of its natural processes: in a word,
as much so as its commencement; but the suppression, from some morbid
agency, is in direct opposition to the intentions of nature, and will,
of course, be followed by some baleful consequence, if it continue
beyond a certain period.
The vulgar error, that “women at this period of life are always in
danger,” is replete with mischief to the suffering sex; and I feel it a
duty to declare, that they are not necessarily more obnoxious to disease
at this, than at any other period of their existence.[8] That they are
sometimes liable to a disease at this time; and that disease one of the
most terrible in the long list of human infirmities, I admit; but must,
nevertheless, insist that _Cancer_ (the disease to which I allude, and
the one so much dreaded) is more rare in the uterus than in certain
other portions of the body; for instance, the mammæ; and, perhaps, I am
within the truth, when I say, that there are three instances of the
latter for one of the former. If latent dispositions to disease, either
in the uterus or other parts, become active about this period of life,
it is not because the declining menses excite them; but because the
disease is slow in developing itself, and is, perhaps, kept in check for
a long time, by the menstrual discharge serving as an important
evacuation; especially when the uterus may be the seat of the complaint.
In such instances, the foundation of the disease was laid, perhaps, at
the time when the menses were the most perfect, as regards period and
quantity; consequently, they could have had no agency in its production;
but, on the contrary, from its frequently relieving the engorgement of
the vessels, served to keep it in subjection for a long time; not as a
specific discharge, but as a mere depletion; or, in other words, that if
an equal quantity of blood could have been by any other means as
certainly abstracted from the uterus, the same favorable result would
have followed. Coincidences in the human system are so common, that they
are frequently mistaken for cause and effect; hence the cessation of the
menstrual discharge, and the appearance of scirrhi and cancers, are
considered as cause and effect.
At this period of life, nothing will so effectually secure the woman
against injuries which may arise from the irregularities of the
menstrual discharge, as a well-regulated regimen. By regimen, in this
place, we would wish to be understood, not only eating and drinking, but
exercise of both body and mind, including the proper government of the
passions; in a word, everything which relates to both moral and physical
existence.
A well-ordered course of exercise in the open air in well-selected
weather, and great simplicity of diet, is of the utmost importance to
the female at this period of life, and should never be neglected, if it
be possible to indulge in them. By these means, the nervous, muscular,
vascular, and lymphatic systems are all preserved more certainly in
equilibrium with each other, since they are the best calculated to
ensure a reciprocation of their respective offices; and, consequently,
to maintain that condition of the system, termed health. Hence, the
justness of the remark, that the women who live in the country, and who
exercise freely in the open air; who have fulfilled their duties
scrupulously as mothers, by suckling their children, agreeably to the
views of nature; who do not goad their systems by over-stimulating food
and drinks; who do not relax their bodies by too long indulgence in bed,
have but little suffering at this period.
From this it will follow, that a milk and vegetable diet, together with
pure water as a drink; regular exercise, not carried to fatigue; keeping
the bowels well open, by well-selected food, as the fruits of the season
in proper quantities: the bran bread if necessary; but not by medicine,
unless absolutely required; governing the temper; restraining the
passions, as well mental as animal, will largely contribute to the
safety and comfort of this period. All that we have just recommended, is
calculated to place the system in a condition by which it shall preserve
its various forces; have its irritability diminished; its sensibility
moderated; and pretty certainly prevent that condition of the
blood-vessels, most decidedly unfriendly to the general health at this
time, called plethora. And, though last, not least in fair estimation,
is an attention to cleanliness. The external organs should be washed
with lukewarm water at least twice a day, and the whole body once a
week, by going into a lukewarm bath. In using the bath, care should be
taken to come out of it as soon as the purposes of cleanliness are
answered.
Our next concern is with the derangement of the discharge at or about
the period of cessation: this will consist, 1st, in a diminution of the
proper quantity; and, 2dly, in an excess of it. As regards the first, we
have already said enough when treating of the suppression of the menses;
and, with respect to the second, it must be treated according to the
rules prescribed for the management of hemorrhage from the uterus from
any other cause, that is, first, to diminish the quantity discharging;
secondly, to prevent an excessive return.
CONCEPTION;
OR,
PREGNANCY.