Chapter XIX: Part VII: The Change of Life (11)

We will consider first that _form of white discharge which affects pregnant women_. It ordinarily comes on during the latter half of pregnancy. Not only does it occasion much inconvenience, but it may, when copious, seriously weaken the system and impair the health.

The best treatment consists in a regulated, but supporting, diet without stimulants, the avoidance of all marital relations, plenty of rest in bed or on a sofa, a warm hip bath every morning, and the use of injections. One of the best injections for this purpose is made by adding a table-spoonful of lead-water to a pint of water, and injecting the whole twice a day, by means of a rubber, hard-ball syringe. As this solution will stain the body-linen, due precautions should be taken. Instead of this injection, a small tea-spoonful of alum dissolved in a pint of water and injected once a day may be used.

We will now say a few words upon the _form of white-flowing which affects women after childbirth_. It is a common result of too frequent confinements or of successive abortions. In women of a tendency to consumption it has been observed that white-flowing is more apt to arise in connection with child-bearing. Prolonged nursing, resulting in great debility of the mother, often produces very profuse white discharges.

In warm countries this affection is much more frequent than elsewhere. Moist and damp climates are said also to render women particularly prone to it.

The _treatment_ must have regard to the general health of the patient. The mode of life must be regulated. A change of scene, if it can be procured, is often of the greatest benefit. Baths are also very useful. They may be taken in the form of a 'sponge bath,' or 'hip bath.' If the former be preferred, the patient should every morning, in a warm room, sponge the whole body, at first with tepid water and, after a time, with cold, the skin being well dried and rubbed with a coarse towel. The hip-bath may be employed either of simple, or of salt, or of medicated water. It should be at first warm, and afterwards cold. The skin is to be well rubbed after the hip as after the sponge-bath. The hip-bath may be medicated with three or four table-spoonfuls of alum, or with a quarter of a pound of common household soda.

In connection with this treatment, injections should be employed in the manner just directed for the white-flowing of pregnancy.

MILK-LEG.

This affection usually appears about ten days or two weeks after confinement. The first symptoms which show themselves are general uneasiness, chills, headache, and a quickened pulse. Then pains in the groin, extending down the thigh and leg of that side are complained of. Soon the whole limb becomes enlarged, hot, white, and shining. Feverishness and sleeplessness now naturally show themselves.

The disease rarely lasts more than two or three weeks, although the limb remains stiff, perhaps, for a number of weeks longer. It is painful, but not dangerous--rarely proving fatal.

When one leg is recovering, the disease sometimes attacks the other, and runs through the same course.

The treatment consists in enveloping the limb in turpentine stupes, followed by the application of poultices to the groin and a light diet at first. So soon as the severity of the attack is over, tonics and a generous diet should be given. The limb is then to be painted with tincture of iodine, or rather a mixture of one part of the tincture of iodine with two parts of alcohol, and afterwards wrapped in a flannel bandage.

The term 'milk-leg' has been applied to this inflammation, for such it is, from the notion that in some way the milk was diverted from the breasts to the limb causing the white swelling. It is scarcely necessary to say this theory is entirely erroneous.

INWARD WEAKNESS.

Many, we may say most, married women whose health is broken down by some disease peculiar to their sex, refer the commencement of their suffering to some confinement or premature birth. Perhaps, in four cases out of five, this breaking down is one of the symptoms of a displacement of the internal organs,--a malposition, in other words, of the uterus. This is familiarly known as an 'inward weakness;' and many a woman drags through years of misery caused by a trouble of this sort.

It is true that these malpositions occur in unmarried women, and occasionally in young girls. But it is also true that their most frequent causes are associated with the condition of maternity. The relaxation of the ligaments or bands which hold the uterus in its place, which takes place during pregnancy and parturition, predisposes to such troubles. It requires time and care for these ligaments to resume their natural strength and elasticity after childbirth. Then, too, the walls of the abdomen are one of the supports provided by nature to keep all the organs they contain in proper place by a constant elastic pressure. When, as in pregnancy, these walls are distended and put on the strain, suddenly to be relaxed after confinement, the organs miss their support, and are liable to take positions which interfere with the performance of their natural functions. Therefore we may rightly place the greater tendency of married women to this class of diseases among the perils of maternity.

Within the last fifteen years, probably no one branch of medical science has received greater attention at the hands of physicians than this of diseases of women. Many hitherto inexplicable cases of disease, much suffering referred to other parts of the system, have been traced to local misfortunes of the character we have just described. Medical works are replete with cases of the highest interest illustrative of this. We are afraid to state some of the estimates which have been given of the number of women in this country who suffer from these maladies; nor do we intend to give in detail the long train of symptoms which characterize them. Such a sad rehearsal would avail little or nothing to the non-medical reader. It is enough to say, that the woman who finds herself afflicted by manifold aches and pains, without obvious cause; who suffers with her head and her stomach and her nerves; who discovers that, in spite of the precepts of religion and the efforts of will, she is becoming irritable, impatient, dissatisfied with her friends, her family, and herself; who is, in short, unable any longer to perceive anything of beauty and of pleasure in this world, and hardly anything to hope for in the next,--this woman, in all probability, is suffering from a displacement or an ulceration of the uterus. Let this be relieved, and her sufferings are ended. Often a very simple procedure can do this. We recall to mind a case described in touching language by a distinguished teacher of medicine. It is of an interesting young married lady, who came from the Southern States to consult him on her condition. She could not walk across the room without support, and was forced to wear, at great inconvenience to herself, an abdominal supporter. Her mind was confused, and she was the victim of apparently causeless unpleasant sensations. She was convinced that she had been, and still was, deranged.

The physician could discover nothing wrong about her system other than a slight falling of the womb. This was easily relieved. She at once improved in body and mind, soon was able to walk with ease and freedom, and once more enjoyed the pleasure of life. In a letter written soon after her return home, she said, 'This beautiful world, which at one time I could not look upon without disgust, has become once more a source of delight.' How strongly do these deeply felt words reveal the difference between her two conditions!

There is one source of great comfort in considering these afflictions. It is, that they are in the great majority of cases traceable to

CAUSES WHICH ARE AVOIDABLE.

Most of them are the penalties inflicted by stern nature on infractions of her laws. Hence the great, the unspeakable, importance of women being made aware of the dangers to which they are exposed, and being fully informed how to avoid them. This task we now assume.

There is, we concede, a tendency in the changes which take place during pregnancy and parturition to expose the system to such accidents. But this tendency can be counteracted by care, and by the avoidance of certain notorious and familiar infractions of the laws of health. It is usually not until she gets up and commences to go about the house, that the woman feels any pain referable to a displaced womb. Very frequently the origin of it is leaving the bed too soon, or attempting to do some work, too much for her strength, shortly after a premature birth or a confinement. Not only should a woman keep her bed, as a rule, for nineteen days after every abortion and every confinement, but for weeks after she commences to move about she should avoid any severe muscular exertion, especially lifting, long walks, straining, or working on the sewing-machine. Straining at stool is one of the commonest causes. Many women have a tendency to constipation for weeks or months after childbirth. They are aware that it is unfavorable to health, and they seek to aid nature by violent muscular effort. They cannot possibly do a more unwise act. Necessarily the efforts they make press the womb forcibly down, and its ligaments being relaxed, it assumes either suddenly on some one well-remembered occasion, or gradually after a succession of efforts, some unnatural position. The same reasoning applies to relieving the bladder, which is connected in some persons with undue effort.

Constipation, if present, must, and almost always can, be relieved by a judicious diet, and the moderate use of injections. These simple methods are much to be preferred to purgative medicines, which are rarely satisfactory if they are continued for much time. When anything more is needed, we recommend a glass of some laxative mineral water, which should be taken before breakfast.

For the difficulty with the bladder we mentioned, diet is also efficacious. It is familiarly known that several popular articles of food have a decided action in stimulating the kidneys: for instance, asparagus and water-melon. Such articles should be freely partaken, and their effect can be increased by some vegetable infusion, taken warm,--as juniper-tea or broom-tea. The application to the parts of a cloth wrung out in water as hot as it can conveniently be borne, is also a most excellent assistant to nature.

Similar strains on the muscles of the abdomen are consequent on violent coughing and vomiting. Therefore these should be alleviated, as they always can be, by some anodyne taken internally. Any medical man is familiar with many such preparations, so that it seems unnecessary to give any formula, particularly as it would have to be altered, more or less, to suit any given case.

OTHER CAUSES OF INWARD WEAKNESS.

Women of languid disposition and relaxed muscles are frequently urged to 'take exercise,' and to 'go to work.' Their condition sometimes excites censure rather than commiseration, because it is thought that they do not exert, and thus strengthen, themselves as much as they should. We are quite as much in favour of work and vigorous muscles as any one. But often it were the most foolish advice possible to give a woman, to tell her to seek active exercise. It is just what she should avoid, as it may ultimately give rise to that very trouble which, now only threatening, is the cause of her listlessness. Many instances are familiar to every physician of extensive experience, where a long walk, a hard day's work, a vigorous dance in the evening, or a horseback ride, has left behind it a uterine weakness which has caused years of misery. Especially after confinement or premature delivery it is prudent for a woman to avoid any such exertion for months and months. Moderate employment of her muscles in any light avocation, short walks and drives, fresh air, with judicious exercise,--these are well enough in every instance, but beyond them there is danger. We know too well that advice like this will sound like mockery to some who read these lines. They have to work, and work hard; they have no opportunity to spare themselves; the iron hand of necessity is upon them, and they must obey. We can but sympathize with them, and cheer them with the consolation that many a woman has borne all this and lived to a healthy and happy old age. Nature has surrounded the infinitely delicate machinery of woman's organization with a thousand safeguards, but for all that, the delicacy remains; and it is because so many women are forced to neglect their duties to their ownselves, that so many thousands walk the streets of our great cities, living martyrs.

But no. We must modify what we have just written. In justice to our own sex, and in all truthfulness, we cannot allow the blame to be removed altogether from women themselves. They alone are responsible for one of the most fruitful causes of their wretchedness. The theme is a threadbare one. We approach it without hardly any hope that we shall do good by repeated warnings utterly monotonous and tiresome. But still less can we feel comfortable in mind to pass it over in silence. We refer to the foolish and injurious pressure which is exerted on the lower part of the chest and the abdomen by tight corsets, belts, and bands to support the under-clothing; in other words,

TIGHT LACING.

Why it is, by what strange freak of fashion and blindness to artistic rules, women of the present day think that a deformed and ill-proportioned waist is a requisite of beauty, we do not know. Certainly they never derived such an idea from a contemplation of those monuments of perfect beauty bequeathed to posterity by the chisels of Attic artists, nor from those exquisite figures which lend to the canvas of Titian and Raphael such immortal fame. Look, for instance, at that work of the former artist, now rendered so familiar by the chromo-lithographic process, called 'Titian's Daughter.' It is the portrait of a blonde-haired maiden holding aloft a trencher heaped with fruits. She turns her face to the beholder, leaning slightly backward to keep her equilibrium. Her waist is encircled by a zone of pearls; and it is this waist we would have our readers observe with something more than an æsthetic eye. It is the waist of health as well as beauty. Narrower than either the shoulders or the hips, it is yet anything than that 'wasplike waist,' which is so fashionable a deformity. With such a waist, a woman is fitted to pass through her married state with health and pleasure. There is little fear that she will be the tenant of doctors' chairs, and the victim of drugs and instruments. Let women aim at beauty, let them regard it as a matter of very high importance, worth money and time and trouble, and we will applaud them to the echo. But let them not mistake deformity, vicious shape, unnatural and injurious attitudes, and hurtful distortions for beauty. That not only degrades their physical nature, but it lowers their tastes, and places them in æsthetics on a level with the Indian squaw who flattens her head and bores her nose, and with the Chinese woman who gilds her teeth, and compresses her foot into a shapeless mass. True beauty is ever synonymous with health; and the woman who, out of subservience to the demands of fashion, for years squeezes her waist and flattens her breast, will live to rue it when she becomes a mother. Away, then, with tight corsets and all similar contrivances.

Of a similar objectionable character are many of the devices which ignorant men connected with the medical profession urge upon the public for the sake of remedying curvature of the spine, restoring the figure, or supporting the abdomen. Not a few of such braces and supporters are seriously dangerous. A good brace, well-fitting, carefully adjusted, suited to the particular case, is often of excellent service; but the majority of them do not answer this description. Our advice is, that no girl, and still more no mother, should wear one of these without it is fitted upon her by an experienced hand. We have known more than one instance where the binder put on after childbirth has been wrongly placed, and pinned so firmly that it has resulted in producing falling of the womb. This, too, should be sedulously looked after.

All these are causes which are strictly under the control of the woman herself. They are therefore such as she should have in mind and be on her guard against. There are others, but they are less frequent, which are beyond her power; and it would be labor lost, therefore, for us to mention them.

Equally vain would it be for us to speak of the various means by which difficulties of this nature are removed. Probably no one branch of medical surgery has been more assiduously cultivated than this; and the number of supporters, pessaries, braces, and levers which have been recently brought before the medical profession for this purpose is simply appalling. There are women and men who make it their business to carry them through the country and sell them on commission. We distinctly warn our readers against this class. They are almost invariably ignorant and unscrupulous, rich in promises, and regardless of performances. She who patronizes them will be sure to lose her money, and will be lucky if she does not forfeit her health also.

The most we shall do is to give some advice how to treat such complaints on principles of hygiene. And indeed this means nearly one-half the battle. For without these simple cares, treatment of any kind is useless, and sure to fail; and with them, many complaints are remedied as well as avoided.

THE HYGIENIC TREATMENT OF INWARD WEAKNESS.

The first point we would urge is, that the woman who finds herself thus afflicted should seek to have such a position that she can _rest_. If she is burdened with family cares, let her, if possible, diminish or escape them for a time. A rest of a month or two, not at a fashionable watering-place, nor at a first-class hotel in some noisy city, but in quiet lodgings, or with some sympathizing friend, will be of great advantage. This she should obtain without travelling too far. Prolonged motion in railway carriages is in every instance injurious. If it must be undertaken, for instance, in order to consult a qualified physician or to reach some friends, the modern appliances of comfort, such as air-cushions, foot-rests, and head-supports, should be provided. They cost but little, and to the invalid their value is great. No such journey should be undertaken at or near the time when the monthly illness might come on, as the suffering is always greater at these periods.

The pleasant associations which group themselves around a _happy home_ are an important element in the treatment of diseases which, like these, are so intimately connected with the mind and nervous system. It will not do heedlessly to throw such advantages away. When the home _is_ pleasant, and rest can there be had, the patient, in the majority of instances, will do well to abide there. But when this is not the case, for any reason, be it domestic infelicities, in which the husband has a share,--be it disagreeable relatives, or importunate and tedious visitors,--then the sooner such a mental weight is removed or avoided the better.

The _diet_ is a very common subject of error. It is popularly supposed that everybody who is weak should eat a 'strengthening' diet,--meat three times a day,--eggs, ale, and beef-tea to any extent. This is a great error. Frequently such a diet has just the contrary effect from what is expected. The patient becomes dyspeptic, nervous, and more debilitated than ever. The rule is, that only that diet is strengthening which is thoroughly digested, and taken up in the system. Frequently, we may say in the majority of cases, a small amount of animal food, especially game, fowls, fish, and soups, with fresh vegetables, and ripe fruits, will be far more invigorating than heavier foods. Pastry, cakes, and confectionery should be discarded, and great regularity in the hours of meals observed. Stimulants of all kinds are, as a rule, unnecessary, and highly spiced food is to be avoided. There is an old German proverb which says, 'Pepper helps a man on his horse, and a woman to her grave.' This is much too strong; but we may avail ourselves, in this connection, of the grain of truth that it contains.

_Cleanliness_, in its widest sense, is an important element in the treatment. Not only should the whole surface of the body be thoroughly washed several times a week, but the whole person should be _soaked_ by remaining in the water for an hour or more. This has an excellent effect, and is far from unpleasant. It was regarded in the days of ancient Rome as such a delightful luxury, and such a necessity, indeed, that every municipality erected public bathing establishments, with furnaces to heat the water to such a temperature that persons could remain in it for several hours without inconvenience.

The use of public baths is almost unknown in this country; but, in place of them, every modern house of even moderate pretensions has its own bath-room, so that the custom of cleanliness might appear to be hardly less general among all classes than in old Rome.

The difficulty is, that so few people appreciate that to thoroughly cleanse the skin, still more for the bath to have a medicinal effect, it must be prolonged far beyond the usual time we allow it. The European physicians, who, as a rule, attach much greater importance to this than ourselves, require their patients to remain immersed two, three, four, and occasionally even ten or twelve hours daily! This is said to have most beneficial results; but who would attempt to introduce it in this country?

Local cleanliness is of equal importance. This is obtained by means of----

INJECTIONS AND IRRIGATIONS

of simple water, or of some infusion or solution. The use of the syringe as an article of essential service in preserving the health of married women should never be overlooked. Even when they are aware of no tendency to weakness or unusual discharge, it should be employed once or twice a week; and when there is debility or disease of the parts actually present, it is often of the greatest service.

There are many varieties of female syringes now manufactured and sold, some of which are quite worthless. Much the most convenient, cleanly, and efficient is the self-injecting india-rubber syringe, which is worked by means of a ball held in the hand, and which throws a constant and powerful stream. They come neatly packed in boxes, occupying small space, and readily transported from place to place. Much depends on knowing how to apply them. The patient should be seated on the edge of a low chair or stool with a hard seat, immediately over a basin. The tube should then be introduced as far as possible without causing pain, and the liquid should be thrown up for five or ten minutes. About one or two quarts may be used of a temperature, in ordinary cases, a little lower than that of the apartment. Water actually cold is by no means to be recommended, in spite of what some physicians say to the contrary. It unquestionably occasionally leads to those very evils which the judicious use of the syringe is intended to avoid.

No fluid but water should be used in ordinary cases. When, however, there is much discharge, a pinch of powdered alum can be dissolved in the water; and when there is an unpleasant odor present, a sufficient amount of solution of permanganate of potash may be added to the water, to change it to a light pink color. This latter substance is most admirable in removing all unpleasant odors; but it will stain the clothing, and must on that account be employed with caution.

We will add a few warnings to what we have just said about injections. There are times when they should be omitted,--as for instance during the periodical illness, when the body is either chilled or heated, and generally when their administration gives pain. There are also some women in whom the mouth of the womb remains open, especially those who have borne many children. In such cases, the liquid used is liable to be thrown into the womb itself, and may give rise to serious troubles. These should either omit the use of the syringe altogether, or obtain one of those which throw the water backward and not forward. This variety is manufactured and sold by various dealers.

_Irrigations_ are more convenient in some respects than injections. They are administered in the following manner:--A jar holding about a gallon of water, simple or medicated, as may be advisable, is placed upon a table or high stand. A long india-rubber tube is attached to the bottom of the jar, ending in a metallic tube, and furnished with a stopcock. The patient seats herself on the edge of a chair over a basin, introduces the tube, and turns the stopcock. The liquid is thus thrown up in a gentle, equable stream, without any exertion on her part. No assistant is required, and the force and amount of the liquid can be exactly graduated by elevating or lowering the jar, or by turning the stopcock. When there is much debility, or when it is desirable to apply the liquid for a long time, this method is much preferable to syringing. The necessary apparatus can readily be obtained in any large city. It has, however, the drawback that the jar is large, and not convenient to carry on journeys.

We shall close this chapter on Health in Marriage by a few words on some of the _ailments to which mothers are subject while nursing._

GATHERED BREASTS.

Gathering of the breasts may occur at any time during the period of nursing, but it is most frequently met with within the first three months after childbirth, and is more common after the first than after subsequent confinements. All women are more or less liable to it, but those who are weakly, and particularly those who are scrofulous, are most prone to its attacks.

The _causes_ of inflammation of the breast are numerous. It may be created by a blow or fall, by a cold, by mental excitement, by indiscretions in eating or drinking, and by moving the arms too much when the breasts are enlarged, but its most common cause is undue accumulation of milk in the breasts. Dr. Bedford is of the opinion that in nineteen cases out of twenty it is the result of carelessness--of neglect in not having the breasts properly drawn. 'For example, the child may be delicate, and not able to extract the milk; or the nurse, in the gratification of some ancient prejudice derived from a remote ancestry, does not think it proper to allow the infant to be put to the breast for two or three days after its birth. In this way, the milk ducts become greatly distended, inflammation ensues, which, if not promptly arrested, terminates in suppuration.'

Often the love of pleasure brings with it this punishment to the nursing mother who neglects her maternal duties. During an evening spent in society or at the theatre the breasts cannot be relieved in the manner required for the preservation of their health.

Soreness of the nipples, which renders suckling painful, often leads the mother to avoid putting the child to the breast as often as she should. It is only when forced by the pain in the over-distended parts that she can summon courage to permit of their being emptied. This partial and irregular nursing is very dangerous, and cannot fail, in most cases, to lead to the very painful affection of which we are now speaking.

No nursing mother is safe whose breasts are not properly and daily emptied. If this cannot be done by the child, another infant should be applied, or a small puppy, either of which expedients is preferable to a breast-pump, which, however, is much better than neither. If the tender or chapped condition of the nipples interferes with free nursing, this condition must be promptly remedied. When undue accumulation of milk is threatened gentle friction of the breasts with sweet oil and camphor is also of service; and they should be supported by means of a handkerchief placed under them and tied over the shoulders.

It must not be forgotten, however, that though _gentle_ rubbing afford relief to the breasts when they are hard, knotty, and over-distended, any friction is injurious if gathering has actually commenced. In all cases, therefore, it is of importance to distinguish between over-distension (which may _lead_ to inflammation) and a condition of already established gathering of the breasts. This it is not difficult to do. In the former case the skin is pale, there is little or no tenderness, and the hardness is evenly diffused over the whole of the breast; whereas, when gathering has taken place there is a blush of redness on some portion of the breast, which is always painful to the touch, and which will be found to be particularly hard and sore in some one spot.

The _symptoms_ of gathered breasts we have just described in part. The severity of the symptoms will depend upon the extent and depth of the inflammation. The affection is always ushered in by shivering, followed by fever and a shooting pain in the breasts. A small, hard, painful swelling will be noticed in the breast even before the skin shows any sign of redness. This swelling increases in size and the suffering becomes very great and difficult to bear, preventing sleep and prostrating the whole system. The secretion of milk is suspended at least during the first active stage of the disease.

The object of _treatment_ is to prevent the formation of an abscess by subduing the inflammation as speedily as possible. This is to be sought first by keeping the breast as nearly empty as possible. For this reason the child should be assiduously applied to the affected rather than to the well side, although suckling will be painful. Indeed, it is better, if it can be done, to procure an older child and let it keep the milk under. When, however, the inflammation is fully established, the pain will compel the restriction of the child to the well side. The application of warmth is both grateful to the part and beneficial. This may be done by means of poultices or fomentations, or by immersing a wooden bowl in hot water and putting the breast, wrapped in flannel, within it. This latter means will be found an easy and agreeable one of keeping up the application of dry heat. The bowels should be briskly purged by a dose of citrate of magnesia or cream of tartar. The diet must be mild, and the breasts supported in a sling. If, in spite of all these efforts, an abscess actually forms, the attending physician will doubtless advise its immediate opening, to which advice the patient should accede, as that is the course which will afford her quicker and more effectual relief than she can hope for from nature's unaided efforts at effecting a discharge of the pent-up matter.

It is interesting for the mother to know that if her child be still-born, or if unfortunately she be unable from any of the reasons mentioned in our chapter on Hindrances to Nursing to give the breast at all to her child, she is not liable to gathering on this account. This is contrary to what might be expected. It is not the mother who is unable to nurse at all who suffers, but she who does so in an unsatisfactory manner and who fails to have her breasts properly emptied.

The first milk which makes its appearance in the breast towards recovery from inflammation is likely to be stringy and thick, and should, therefore, be rejected before nursing is resumed.

THE SINGLE LIFE.

A few words, ere we pass to another branch of our subject, on the physical relations of her who by choice or other reasons never marries. It is a common observation among physicians who have devoted themselves to the study of woman's physical nature, that, in spite of those perils of maternity which we have taken no pains to conceal, the health of single women during the child-bearing period is, as a general rule, not better, not even so good, as that of their married sisters. Those insurance companies who take female risks, do not ask any higher premium for the married than the unmarried.

Various suggestions have been made to account for this unexpected fact. Some writers have pointed out that in many diseases marriage exerts a decidedly curative influence, especially in chronic nervous ailments. Chorea, for instance, or St. Vitus's dance, as it is popularly termed, has been repeatedly cured by marriage. As a rule, painful menstruation, which always arises from some defect or disease of the ovaries or adjacent organs, is improved, and often completely removed, by the same act. There are, as is well known, a whole series of emotional disorders,--hysteria, and various kinds of mania and hallucination,--which are almost exclusively confined to single persons, and only occur in the married under exceptional circumstances. An instance has lately been detailed in the medical journals by a Prussian physician, of a case of undoubted hereditary insanity which was greatly benefited--indeed temporarily cured--by a fortunate nuptial relation. Few who have watched a large circle of lady acquaintances but will have observed that many of them increased in flesh and improved in health when they had been married some months. An English writer of distinction accounts for these favourable results in a peculiar manner. Success, he says, is always a tonic, and the best of tonics. Now, to women, marriage is a success. It is their aim in social life; and this accomplished, health and strength follow. We are not quite ready to subscribe to such a sweeping assertion, but no doubt it is applicable in a limited number of cases. Our own opinion is, that nature gave to each sex certain functions, and that the whole system is in better health when all parts and powers fulfil their destiny.

Common proverbs portray the character of the spinster as peevish, selfish, given to queer fancies, and unpleasant eccentricities. In many a case we are glad to say this is untrue. Instances of noble devotion, broad and generous sympathy, and distinguished self-sacrifice, are by no means rare in single women. But take the whole class, the popular opinion, as it often is, must be granted to be correct. Deprived of the natural objects of interest, the sentiments are apt to fix themselves on parrots and poodles, or to be confined within the breast, and wither for want of nourishment. Too often the history of those sisterhoods who assume vows of singleness in the interest of religion, presents to the physician the sad spectacle of prolonged nervous maladies, and to the Christian that of a sickly sensibility.

In this connection we may answer a question not unfrequently put to the medical attendant. Are those women who marry late in their sexual life more apt to bear living children than the married of the same age; and are they more likely to prolong their child-bearing period by their deferred nuptials? To both these inquiries we answer No. On the contrary, the woman who marries a few years only before her change of life, is almost sure to have no children who will survive. She is decidedly less apt to have any than the woman of the same age who married young. If, therefore, love of children and a desire for offspring form, as they rightly should, one of the inducements to marry, let not the act be postponed too long, or it will probably fail of any such result.

THE CHANGE OF LIFE.

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:--

Danger, long travel, want, or woe,
Soon change the form that best we know----
For deadly fear can time out-go,
And blanch at once the hair.
Hard toil can roughen form and face,
And want can quell the eye's bright grace,
Nor does old age a wrinkle trace
More deeply than despair.

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.