THE CHANGE OF LIFE.

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After a certain number of years, woman lays aside those functions with which she had been endowed for the perpetuation of the species, and resumes once more that exclusively individual life which had been hers when a child. The evening of her days approaches; and if she has observed the precepts of wisdom, she may look forward to a long and placid period of rest, blessed with health,—honored, yes, loved with a purer flame than any which she inspired in the bloom of youth and beauty. Those who are familiar with the delightful memoirs of Madame Swetchine or Madame Recamier will not dispute even so bold an assertion as this.

But ere this haven of rest is reached, there is a crisis to pass which is ever the subject of anxious solicitude. Unscientific people, in their vivid language, call it the change of life; physicians know it as the menopause—the period of the cessation of the monthly flow. It is the epoch when the ovaries cease producing any more ova, and the woman becomes therefore incapable of bearing any more children.

The age at which it occurs is very variable. In this country from forty-five to fifty 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 illnesses.

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 twenty-eight in whom the flow had ceased.

The physical change which is most apparent at this time is the tendency to grow stout. The fat increases as the power of reproduction decreases. And here a curious observation comes in. We have said that when the girl changes to a woman, a similar deposit of fat takes place (though less in amount), which commences at the loins. This is the first sign 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 vertebræ. 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 that she is to be a mother,—a delusion sometimes strengthened by the absence of the monthly sickness. Finally, a perceptible tendency to a beard at times manifests itself, the voice grows harder, and the characteristics of the female sex become less and less distinct.

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 for ever 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 that nearly all these threatening affections can be avoided by such care, as they depend upon causes under the control of the individual. 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, every one 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 ages 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.

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 would be 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. 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 all 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 to him.

SIGNS AND SYMPTOMS.

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 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 disappeared as soon as the periodical function was established, may be expected to reappear when the function has reached its natural termination. Therefore if a woman past the change notices 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. 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 women 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 of 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.

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. One of them is an increasing irregularity in the monthly appearance. This is frequently accompanied with a sinking sensation,—a 'feeling of goneness,' as the sufferer says—at the pit of the stomach, often attended 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. This is sometimes accompanied by a sense of fulness in the head, a giddiness, and dulness of the brain, sometimes going so far as to cause an uncertainty in the step, a slowness of comprehension, and a feeling as if one might fall at any moment in some sort of a fit.

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. Society loses its attractions, and solitude does but allow her opportunity to indulge to a still more injurious extent such brooding phantasms. Every ache and pain is magnified. Does her heart palpitate, as it is very apt to do? Straightway she is certain that she has some terrible disease of that organ, and that she will drop down dead some day in the street. 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.

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 too 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.

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, inability to fix the mind on reading or in following a discourse, 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.

EFFECTS ON THE CHARACTER.

The effects on the character of this 'grand climacteric' are often marked. Not unfrequently the woman becomes more masculine in thought and habit, as has been admirably described by Dr. Tilt:—'There are almost always while the change is progressing various forms of nervous irritability and some amount of confusion and bewilderment, which seem to deprive women of the mental endowments to which they had acquired a good title by forty years' enjoyment. They often lose confidence in themselves, are unable to manage domestic or other business, and are more likely to be imposed on either within or without the family circle. When the change is effected, the mind emerges from the clouds in which it has seemed lost. Thankful that they have escaped from real sufferings, women cease to torture themselves with imaginary woes, and as they feel the ground grow steadier underfoot, they are less dependent on others—for, like the body, the mental faculties then assume a masculine character. The change of life does not give talents, but it often imparts a firmness of purpose to bring out effectively those that are possessed, whether it be to govern a household, to preside in a drawing-room, or to thread and unravel political entanglements. When women are no longer hampered by a bodily infirmity periodically returning, they have more time at their disposal, and for obvious reasons they are less subject to be led astray by a too ardent imagination, or by wild flights of passion.'

Changes in the moral character also frequently show themselves, and for a time astonish friends and relatives. These shades of moral insanity all disappear in a little while, if there be no family tendency to insanity to prolong and intensify them.

THOSE WHO SUFFER MOST.

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 labors 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 to some of those displacements or local ulcerations which we have mentioned in our chapter on Health in Marriage. 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.

The constitution and temperament have much to do with the liability to disease and suffering during the change of life. Those of weak constitutions sometimes fail of the necessary stamina to carry them easily through the trials of this transition period. It has been remarked that the lymphatic temperament is the most favorable to an easy change. Women with this temperament suffer less from nervous or bilious disorders, and quickly show signs of having been benefited by what has occurred. Those of a sanguine temperament are more liable to floodings and to head symptoms; but such disorders with them usually readily yield to treatment. The bilious temperament predisposes to disorders of the stomach and liver at this epoch; while the union of the nervous with the bilious temperament seems to predispose to mental diseases. The most suffering at this time of life is experienced by women of a nervous temperament.

The social position exerts an influence on the pain and the tendency to disease at this epoch. The poor who are forced to labor beyond their strength and who are exhausted by fatigue, anxiety, and want, suffer much. So also do those who have recently been exposed to some great sorrow. As the poet says:—

The occupations of women also have an influence upon the change of life. Washerwomen are said in particular to suffer more than others on account of the exposure to which they are subject by their trade. Those who are confined many hours a day in close or damp rooms are unfavorably situated for passing through the various stages of the 'grand climacteric.' The rich, with plenty of time and means to care for themselves, often blindly or obstinately create an atmosphere about them and follow a mode of life, quite as deleterious as the enforced surroundings of their poorer sisters.

DISEASES AND DISCOMFORTS.

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, and 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 a 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 doctor 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 off by bleeding at the nose, or is spat 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.

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 that all such pretensions are false. It is often a matter of no little difficulty, requiring an experienced eye, to pronounce positively whether a tumour 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 develope 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 than 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 searches in this direction. A touching story is related in this connection of Raymond Sully, the celebrated philosopher. When a young man, he 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 fervor 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.

At this time, too, tumors or swellings of the ovaries are 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.

Generally, from the 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.

PRECAUTIONS AND REMEDIES.

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. When plethora, flooding, or congestion is apparent, the food should be light, chiefly vegetable, and moderate in quantity. 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 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 too much blood, nourishing food, tonic medicines, and perhaps some stimulant, are called for. When the perspiration is excessive, flannel should be worn next the skin in the daytime, and a flannel night-dress at night. A tepid bath before retiring is also useful. 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. Internally, we think, nothing at all is needed; but as something must be taken, let it not be spirits or wine, but half a tea-spoonful of aromatic spirits of ammonia in a few table-spoonfuls 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. The pains in the back and loins often experienced, can generally 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.

Once safely through this critical period, the woman has a better chance for long life and a green old age than the man of equal years. Tables of human life show this conclusively. With the sweet consciousness of duty performed, she is now prepared to assist others by intelligent advice, cheerful counsel, and tender offices; she can now surround herself with that saintly halo of kind words and good works which wins a worthier love than passion offers; and, passing onward to the silence of eternal rest, she will leave in the memory of all who knew her, pleasant impressions and affectionate reminiscences.