3 „ 35 „
3 „ 36 „
4 „ 37 „
7 „ 38 „
11 „ 39 „
29 „ 40 „
13 „ 41 „
18 „ 42 „
4 „ 43 „
14 „ 44 „
35 „ 45 „
21 „ 46 „
30 „ 47 „
49 „ 48 „
30 „ 49 „
47 „ 50 „
10 „ 51 „
17 „ 52 „
11 „ 53 „
13 „ 54 „
7 „ 55 „
7 „ 56 „
3 „ 57 „
7 „ 58 „
0 „ 59 „
14 „ 60 „
4 „ 61 „
5 „ 62 „
6 „ 63 „
7 „ 64 „
2 „ 65 „
3 „ 66 „
2 „ 67 „
1 „ 68 „
5 „ 69 „
M. Brierre de Boismont, a French author, remarks: “It has been said, in
a general way, that the cessation of the menstrua takes place about the
forty-fifth year in this country—a little sooner or a little later. The
fact is true; but we believe that a better appreciation would be made by
presenting a table indicating the different periods of the critical
age.” This author collected 181 cases of women, indicating the age at
which they had ceased to menstruate, and here are the results:
At 21 2
24 1
26 0
27 1
28 1
29 1
30 3
32 2
34 4
35 6
36 7
37 4
38 7
39 1
40 18
41 10
42 7
43 4
44 13
45 13
46 9
47 13
48 8
49 7
50 12
51 4
52 8
53 2
54 5
55 2
56 2
57 2
60 1
The time at which menstruation ceases in Great Britain, must be
doubtless very nearly or quite the same as in this country. In the above
table it will be perceived that twenty-six females had menstruation
until fifty, and only three to forty-four, and four to forty-five years
of age. According to this, the average is considerably above forty-five
years in Great Britain; and it is probably about the same thing with us
in the United States.
EXTENT OF THE FRUITFUL PERIOD.
The cessation of the menses, as I have remarked, is generally the limit
of the period of child-bearing; but this rule, like all others, has its
exceptions.
Bartholomew Mosse, according to Dr. Guy, mentions four cases of women
pregnant in their fifty-first year, and Dr. Labatt, of Dublin, one;
Knebel and Lamatte each one in the fifty-second year; Bartholomew Mosse
and Knebel each one in the fifty-fourth year; a case of pregnancy at the
same age (that of Mrs. Ashley) is also related in the Edinburgh Annual
Register for 1816, in the French accusation, in which the succession to
an estate was disputed on the ground of the mother being fifty-eight
years old when the child was born, and the decision was given in favor
of the fact.
Pliny, Valescus de Tarenta, and Marra, of Venice, record cases of
pregnancy at sixty.
Capuron, a French author, states that a woman of sixty-three was
generally believed in Paris to have given birth to a daughter.
Dr. Beck, of Albany, quotes a case from the Boston Medical and Surgical
Journal, of a woman at White Hall, New York, becoming a mother at
sixty-four.
A writer in the Edinburgh Medical and Surgical Journal, Mr. Robertson,
states that out of 10,000 pregnant females registered at the Manchester
Lying-in Hospital, 436 were upward of forty-six years of age. Of these
there were—
397 from 40 to 46
13 in their 47th year
8 „ 48th „
6 „ 49th „
9 „ 50th „
1 „ 52d „
1 „ 53d „
1 „ 54th „
In some rare instances, also, conception has been known to take place
prior to menstruation. Cases of premature fruitfulness are related by
high authorities. Montgomery delivered a female of twins before the
completion of her fifteenth year; La Motte and Sir E. Horne give
instances of pregnancy in the thirteenth year; the last-named author
another in the twelfth; and Bruce, in Abyssinia, and Demboss, in Bengal,
met with mothers of eleven years. These facts I take from Dr. Guy.
I am next to speak of the cessation of the menstrual function, the turn,
or change of life, as it is called. And I will here observe, that this
period is as natural to the system of the female as puberty, or any
other. But notwithstanding it is so, it is important to be remembered
that all great changes or evolutions of the body render it probably, on
the whole, more liable to take on diseased action than it is at ordinary
times.
IS THIS PERIOD A DANGEROUS ONE?
From a long-prevailing idea that the cessation of the menstrual function
is attended necessarily with a greater or less degree of danger to the
general health, it has been called the _critical_ period.
Doubtless, the health of some persons does at this time become worse;
but, on the other hand, there are those who improve, and become in every
respect stronger at the cessation of the menstrual function.
The learned Dr. Dewees, of Philadelphia, whose experience in the
treatment of the diseases of women was perhaps as great as that of any
other man, went so far even as to say, “The vulgar error that women at
this period of life are always in danger, is replete with danger to the
suffering sex;” and he continues: “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.”
According to observations made on the bills of mortality in France, by
M. Benoiston de Chateaunauf, as quoted by Dr. Dewees, it appears that
fewer women die between the ages of forty and fifty than men, or,
indeed, at any other period of their lives after puberty; and further,
that this change is effected without much disturbance; that they live
not only longer than men, but are more free from morbid inconveniences.
These facts are well worthy of notice.
In some cases, the menstrual function becomes more copious about the
time at which it is to cease, and amounts almost, or quite, to an
hemorrhage.
Sometimes it ceases, and then returns again; and thus an irregularity is
caused. At length a final cessation occurs. In the place of menstrual
fluid, a sort of mucous discharge takes place at times; the individual
experiences lassitude and depression of spirits, nervous complaints set
in, and, in some cases, serious diseases come on. But, poorly as the
rules of health are by the many observed, the picture is often
reversed—the woman’s health becomes re-established, and firmer and
better than before. She appears often more plump and ruddy after the
change of life has taken place, and does, in fact, seem to grow younger
for a time.
THE CHANGE OF LIFE.
Fanciful writers have sometimes indulged in poetic strains, depicting
the changes of this season, as being very unfavorable to the personal
attraction of woman. It is said, “that the bosom and cheeks become
flaccid, the skin is wrinkled and appears to be too large, and loses its
delicateness; the eyes sink in their orbits; the carnation of the cheeks
is supplanted by a yellow tint; that empurpled flush which once, amid
smiles, sat on her rosy lips, is chased away by a bluish or leaden hue.
Every circumstance proclaims that the season of the pleasures is past,
and that she can no longer rely on the attractions peculiar to her sex.”
This delineation is by far more fanciful than true; and it oftener
happens that, in consequence of the pernicious habits of civic and
civilized life, changes as great, and often greater than these, occur at
a much earlier date than this critical period, so called. Were the laws
of life and health reasonably observed, there could no sudden or
considerable change take place at _any_ one time in life. As middle age
merges into the more advanced, so, gradually and imperceptibly, comes on
the riper and more mature state, before which woman does not arrive at
the full time of her dignity, and the full period of the magnitude of
her moral power.
But it must be admitted that there are in some cases reasons why the
time of cessation of the menstrual function should be called the
“critical period,” or the “turn of life.” Thus, with the beginning of
suppression, or cessation, there may occur swelling of the abdomen,
nausea, sickness, and loathing of food, as in pregnancy.
The imagination, too, may have something to do with this matter, for it
is doubtless true, that some women “have such a dislike to age, that
they would rather persuade themselves that they are with child, than
suppose they are feeling any of the consequences of growing old.”
I ought here to mention, that in those cases where pregnancy does not
exist, the abdomen is softer and more equally enlarged, and swells more
speedily after the obstruction than it does from real pregnancy.
Some persons are, at this period, so imaginative, as even to believe
that they actually experience motions of the child, whereas there is
only wind or flatulency in the bowels, which, by rumbling, or shifting
from place to place, causes a sensation analogous to that of the motions
of a real child. Some persons have even gone so far in this matter as to
believe that they had passed through the entire period of pregnancy, and
have called physicians and attendants, believing that labor had actually
began. And some physicians, even, have remained many hours with these
patients, when at last it has been discovered, to the great
mortification of all concerned, that one important feature was yet
wanting, in order for labor to take place, namely, the presence in the
mother’s womb of an actual child.
This change of life, I remarked, is a natural occurrence to every woman.
It is as natural for menstruation to cease as it is for it to begin.
Were the habits of society such as they should be, health, and health
only, would be the natural result in all these changes; but such is not
always the case. Some are barren and unhealthy, and have not vital
stamina enough for them ever to gain truly firm and enduring health.
Others, too, and probably a far greater number, have their health
destroyed, either by the ignorance of their parents or themselves, or of
both combined. In such cases, some of the following symptoms may be
noticed. If any organic disease is already present, with many it appears
to be aggravated or increased. This is especially true in diseases of
the womb and the breasts. It seems, indeed, that cancer of these organs
is more apt to become developed about this time. Symptoms of dyspepsia
are apt to be aggravated. Some become more corpulent, and as corpulency
is a state of disease, more or less general debility, and inaptitude for
walking and physical exertion of whatever kind, is experienced. There
appears also, at this time, to be with many a greater tendency to
inflammatory disease, diarrhea, dysentery, cholera morbus, or, on the
other hand, a constipated state of the bowels; or the constipation may
alternate, with one or more of the former complaints.
But, as I have already remarked, there are other cases in which the
health becomes, in every respect, more firmly established and better
after menstruation has ceased, than it was before.
MANAGEMENT AT THE CHANGE OF LIFE.
The explanation I have already given will indicate to you the nature of
the general management which should be employed at the period of the
cessation of the menstrual function.
I have said it should be regarded as a natural change in the system. The
best local and general treatment that can be adopted, therefore, will be
that which is calculated to fortify and invigorate the general health.
Every thing in diet, exercise, bathing, the daily occupation, and the
moral and mental habits of the individual, should be, as far as
possible, regulated according to physiological principles, and the laws
of health.
Especially let not fear excite in you any unnecessary alarm respecting
this period. Trust nature, and do by her properly, and she will do
safely, faithfully, and efficiently her own work.
Those methods of dosing and drugging the system which have by many been
practiced on such occasions, are, as a general fact, pernicious, doing a
great deal of harm. Those especially who take powerful, and so-called
expulsive medicines, with the view of forcing nature to continue the
menstrual discharge, render themselves liable to serious injury. It is
easy thus, by, as it were, a single misstep, to seal the inevitable doom
of life-long ill health.
Doctor Dewees, in speaking of the great advantages of a well-regulated
regimen in securing the woman against injuries which may arise from the
irregularities of the menstrual discharge at this period of life,
judiciously observes, “that 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, 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 insure 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 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.
The advantages of a suitable degree of care in regard to exercise, diet,
and all those habits that tend to the promotion of the general health,
will likewise appear evident when we take into consideration the manner
in which the system is sometimes found to suffer at this period.
During that part of the woman’s life in which menstruation occurs, the
constitution is under the necessity, so to say, of forming not only a
sufficiency of blood for its own support, but a superfluous quantity for
the purposes of menstruation. Now it must be the order of nature, that
in a healthy and well-balanced constitution, enough blood only will be
elaborated for the normal purposes of the economy; but if too great an
amount is formed after the menses cease, there will be no outlet for it,
and as a consequence, there will be, perhaps, fullness and congestion of
the head, and other symptoms of plethora.
For this reason, physicians have often thought it necessary to abstract
blood, and to use other depletive means. But I am led here to remark,
how very much better, under such circumstances, it would be to employ
fasting, or, at least, a proper degree of abstinence, and the other
measures calculated to keep off too great fullness of the body. Nothing
in the world is easier—provided a woman has sufficient control over
herself, and perseverance—than to vary to any desirable extent, the
quantity of blood in the system; and all physicians agree that it is far
better to regulate these matters by diet, and other hygienic measures,
than to have to resort to bleeding and cathartics, provided that it can
be done.
The practical deductions to be drawn from these remarks then, is, that
if, at the change of life, the woman feels any of the symptoms of
plethora and too great fullness in her system, she should adopt all good
rules in regard to the improvement of the general health, and she should
be especially guarded in reference to the amount and quality of food
taken. In so far as she attends to all these matters, will she be more
than doubly rewarded for her patience, her perseverance, and her self
denial.
In conclusion, I remark, that if any one of you who is about arriving at
the turn of life, feels that you are growing old, that you will be less
attractive to those about you, and that you will enjoy less of the
social pleasures of life after this change has taken place, there is yet
a comfort for you, even in this world. You will now no longer be subject
to those monthly troubles which, for these thirty years, have been your
lot. All the annoyance, the irregularity, the tardiness, the
suppression, and the pain—these all are now gone from you, no more to
return. No doubt you may feel sad as the sighing wind reminds you in the
autumn that we can be young but once. We all feel sad at times when we
think how age is creeping upon us. But may I not say to you, there is
yet that which can make us triumph over all of these things, yea, over
death and the grave.
LETTER V.
OF MENSTRUATION.
Tardy and Suppressed Menstruation—Chlorosis—Sudden Check of the Menses.
One of the most important of all subjects connected with the health of
females, is that of disordered menstruation.
You will find, as you read medical works on Females, the word
_amenorrhœa_, which signifies a partial or total obstruction of the
menses in women, from other causes than pregnancy and old age. You will
find, also, the words _menorrhagia_, signifying an immoderate flow of
this discharge, and _dysmenorrhea_, meaning difficult or painful
menstruation.
Before proceeding to speak of obstructed menstruation, I ought to make
some remarks upon the too tardy appearance of this discharge.
As I have before observed, the catamenia usually appear at from the
fourteenth to the fifteenth years of age. Now, when there is a failure
on the part of nature to bring about this state of things, there is not
unfrequently a great deal of anxiety experienced on the part of mothers
and those most intimately concerned. If, likewise, the girl at this time
is attacked with any particular ailment, it is almost sure to be
attributed to this cause. Too often, under these circumstances, she is
also subjected to various modes of medical treatment, with the view of
forcing nature into that sort of work which it is believed she ought to
do, but will not. Now, the effect of such a course can be only harmful,
as a general fact. To aid nature, it should be remembered that we must
_increase_ her powers, and not _diminish_ them, as is almost necessarily
the case if a course of drug-medication is practiced.
Please notice, then, that I wish to persuade you that this plan of
drugging the system for tardy menstruation is a most unwise and
unnatural one. Attend well to nature, and nature will take care of
herself. Let me give you a few words from an honest, good man, Dr.
Dewees, who years ago went to his long home. He says:
“Our exertions in favor of such patients, should tend to the
invigoration of the system in general, and the development of the
uterine system in particular. The first should be attempted—First: By
the establishment of a regular course of exercise; such as riding on
horseback, when practicable; walking in proper weather; skipping the
rope within doors, when the weather will not permit exercise abroad;
dancing moderately, and with strict regard not to become overheated, and
cooling too suddenly. Secondly: By proper attention to dress; wearing
flannel next the skin in cold weather, and properly protecting the feet
and legs against cold; carefully avoiding damp and wet places, and
partial streams of cold air, especially when warm. Thirdly: By a diet of
easily-digested substances, both of the vegetable and animal kind;
avoiding all stimulating drinks, such as wine, spirits, or beer, etc.,
under the specious pretext of their being strengthening.”
I give you these words, not that I would altogether agree with every
idea advanced, but because of the general worth and correctness of the
remarks, and the high authority from which they come. I do not believe
it best for any one to wear flannel next to the skin, but I _do_ believe
in guarding the body sufficiently against cold, a thing which young
ladies too often neglect. Dancing, too, as a general rule, cannot be
regulated in the way it should be; and as for animal food, it is not
necessary, to say the least.
I do not wish to appear to be fault-finding with your sex; but I must
say, in all frankness, that some have taken an unreasonable course in
regard to bringing on the courses, when they are tardy. The following
case happened to a physician of eminence: The girl was a most amiable
and interesting creature, for whom he was requested to prescribe for the
expected menses, but who had not one mark which would justify an
interference, and especially as she was in perfectly good health. She
was fifteen, it is true; and this was all that could be urged by the
mother in favor of an attempt to “bring down her courses.” He relied too
much upon the good sense of her anxious parent, and freely explained
himself to her. She left him apparently satisfied with his reasoning,
and he heard nothing of the poor child for six months; but at the end of
this time he was suddenly summoned to attend her, as she was said to be
alarmingly ill.
When he saw her, she was throwing up blood in considerable quantities
from the lungs; she died a few days after from the excess of this
discharge. The distracted mother told him, that though she appeared
satisfied with what he had said when she left him, she was convinced he
was wrong, and that her daughter’s health required the immediate
establishment of the menstrual evacuation. With this view, she
determined upon the trial of a medicine of much celebrity in similar
cases, vended by a quack. She procured it, and gave it according to
direction; in a few days her daughter became feverish, lost her
appetite, and frequently vomited; her strength failed, and after a short
time she was confined to her bed. She called upon the “doctor,” and made
known to him the condition of her daughter; he encouraged her to
persevere, and told her that the fever, etc., was an effort nature was
making for the end proposed. She persevered, fatally persevered, for in
a few days she lost her lovely and only daughter. The medicine given in
this case proved, on examination, to be the oil of savin (_juniperas
sabina_), a most active poison, and one which, in the smallest doses,
has been known to produce disastrous results.
EFFECTS OF WATER-TREATMENT.
There is one remarkable fact concerning the effects of water-treatment,
as affecting menstruation, which should here be spoken of. Where a
vigorous course of hydropathy is practiced for chronic disease, the
menstrual function, in some cases, ceases for months, and even a whole
year or more. I had first to learn this fact for myself, no other
practitioner ever having promulgated the doctrine, so far as I know. And
it is a remarkable fact, that in such cases no injury arises from the
circumstance; but the individual’s health grows, month by month, in all
respects better. No inconvenience is experienced from the suppression,
nor need the slightest alarm be felt. The probable reason why
menstruation thus ceases is, that a vigorous action of the skin is
caused by the water process; elimination, or the throwing off of the
waste, morbid, and impure matters, is made to go on so rapidly and
vigorously, that there is no need of the purification of menstruation at
the time. This doctrine, however, is conjecture and mere speculation,
and one that does not appear to be susceptible of positive proof. That
the occurrence does takes place, and that women have, at the same time,
been remarkably benefited in health; cured, as we may say, of
long-standing and most obstinate chronic diseases, we know to be a fact.
But whenever retention of the menses occurs, and is not caused by
pregnancy, or by the age of the individual, at which the function ceases
naturally, or by a course of water-treatment, we are to suspect some
derangement of the general health. This is a natural function, and if we
find it ceasing when it ought to go on, we may safely conclude, that the
efforts of nature are by some means thwarted; otherwise she would do her
work.
CHLOROSIS.
Retention of the menses is very often attended with what is technically
termed _chlorosis_.
The word chlorosis signifies a greenish, or greenish-yellow hue of the
skin, and might, therefore, be applied to certain affections belonging
to both sexes; but the term is “generally confined to that modification
of amenorrhea, which is attended by a dingy-pale, or greenish color of
the skin.” Chlorosis also goes often under the name of _green sickness_.
In this disease there is “heaviness, listlessness of motion, on the
least exercise palpitations of the heart, pains in the loins, back, and
hips, flatulency and acidity in the stomach and bowels, a preternatural
appetite for chalk, lime, and various other absorbents, together with
many dyspeptic symptoms.” In the progress of the disease the face and
lips become pale, and after a time assume a more yellow hue; there is
great general debility, flaccidity of the muscles, and not unfrequently,
swelling of the feet and lower limbs; there is, in short, a great
variety of symptoms, varying more or less, endlessly, as we may say, in
different cases, and such as denote a very depraved state of the
constitution generally.