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It is not wise to marry during this period. On the first appearance of the irregularities of the menopause the amount of food and stimulants to which women have been accustomed should be curtailed rather than augmented. The system requires supporting by medicine and regimen as, baths, mental and moral hygiene, and occupation rather than stimulating by spirits.
In a list of fifty-two cases, eight were added to the list already given, all of whom had passed the menopause. Five were perfectly healthy and had never suffered the slightest inconvenience. Of these, one was single and only one had one miscarriage. Ten had suffered at the time of the menopause from slight malaise, but not sufficiently to call in a medical attendant.
Deterioration of mentality and character so often observed during the menopause, with its apathies or excitements, melancholia or mania, the fits of weeping or gaiety, the loss of grip upon reality, the complete change in mood and temperament that reflect the transformation of the organic outlook, demonstrate clearly the overwhelming influence of the endocrines upon the attitudes of the self toward the self.
Third, the Tubal Theory. Lawson Tait thought that thorough removal of the tubes was far more essential in determining the menopause, and that cases of periodically recurring hemorrhage after the removal of the ovaries were to be explained by the fact that the tubes had not been sufficiently removed.
Peuch found that in one case the ovaries were of normal size three years after the establishment of the menopause. Kiwisch describes the structural change in this gland as consisting, on the one hand, of an increase of the connective-tissue stroma; and, on the other hand, the Graafian vesicles themselves undergo retrograde change.
Each metamorphic or developmental period of life dentition, puberty, and the menopause throws a special strain on the nervous system, and the recent studies of the sympathetic nervous system at the time of the menopause show that very extensive anatomic changes occur at this time.
Dusourd, whose practice lay in an agricultural district in the south of France, as well as Tilt, believes that peasant women suffer little at this time. Their health is generally good when the menopause comes on and they are little liable to nervous disorders.
It was not until the period of the menopause that the long repressed desires broke out, and at last found a symbolical outlet that was no longer normal, but was felt to supply a complete gratification. She sought the close physical contact of the young children in her care.
Nor do I advise a young woman of forty who has not reached the menopause stage to take the operation if she is in good health, in spite of her belief that the goat-glands will enable her to remain indefinitely young. This is experimental work, and is not in the same class as the case of the same woman who has just passed through her menopause and ceased to menstruate.
For it is known that vaso-motor paralysis is not of itself sufficient to induce hæmorrhage, unless the tension of the blood-current be coincidently raised. See Bouchard, Pathogenie des Hæmorrhagies. The "uterine epistaxis" of malignant fevers are evidently foreign to our subject, as also the hæmorrhages of subinvolution, or of the menopause.
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