DISORDERS AT MENSTRUAL DECLINE.

1 SHALL now say a few words on the disorders sometimes attending the cessation of menstruation. It is a very general opinion, that this period must be attended with illness, but this is a great mistake, for healthy women frequently pass over it without the least inconvenience. Women themselves regard it as a very critical and perilous time; and this is a most unfortunate idea, for it causes much needless anxiety, and indeed often gives rise itself to symptoms of ill-health. There is no more danger naturally connected with the decline or menstruation, than with its commencement; and a woman, who is healthy, and who lives temperately need not look upon the "turn of life," with any apprehension.

The most frequent symptoms of disturbance, observed at this period are mental. A hysterical nervous state is so common, as to excite little attention. The woman has a tendency to solitude, disordered sleep, impaired appetite, &c., with frequently a dread of organic disease. In some cases there is great agitation of mind and nervousness, amounting nearly to insanity; but soothing quieting means, not restraint, should be used. Now all these symptoms are so prevalent, most probably, just because women have an unfounded dread of this period. Their mind is unnecessarily anxious about it, and this gives rise in very many cases to the nervous symptoms. Another reason probably is, that in this country, where there are so many involuntary nuns, it must be a most painful thought to many, that the season of their youth, the last rose of their summer, is fading; that their sexual life has been totally unfulfilled, and that there is no more hope for them of a child to gladden their old age. Alas that such lives and such sad thoughts are so common among us! I believe that if these causes did not operate, and if the general health of women were stronger than it is, these mental disturbances would rarely appear; although they are probably in part owing to the alteration in the nervous currents at the decline of the uterine functions.

In other cases, in corpulent, indolent women, there is apt to be an increased tendency to congestions and inflammations in other organs, suck as apoplexy, and pulmonary congestion. The reason of this is, that a periodical safety valve is now shut, and if plethora exist, there is no na tural mode of relief for the fulness. In these cases stimulants should b

forbidden, and plenty of exercise taken, along with a somewhat spare diet. But it is a very common and very pernicious error among women, to use purgatives frequently at this time, and to reduce themselves by spare diet to avert fancied dangers. A great deal of mischief is done by this mistaken opinion, which is akin to the old prejudice among the poor, in favour of a precautionary bleeding in the spring, which has now happily almost died out. There is no time of life, and no natural changes in the system, which call for these artificial precautions. If a woman have been living healthily and temperately, she may trust with perfect confidence, that nature will do her own work, without any disturbance; and if she have been living too luxuriously, and requires to reduce herself, the proper means is always to increase the exercise, give up inordinate indulgences, and brace the system by natural and not by artificial means. For reducing.plethora and averting a threatened apoplexy, there is, I believe, no constitutional means so powerful as a course of hydropathic treatment. Dr. Gully, in his excellent work on the "Water Cure in chronic disease," states, that were he to choose the case in which the benefits of the water cure are most certainly and strikingly evinced, it would be one of apoplectic fulness.

There is a very general idea, that incurable organic affections, such as cancer, are liable to come on at menstrual decline, but the cessation of the natural function can evidently have no tendency to cause them. These diseases generally occur in both sexes in advanced life, and if there have been a latent pre-disposition, it may be favoured by the conzestion of the sexual organs, which is apt to accompany menstrual decline, but no malignant disease can be directly caused by it.

The mode in which the cessation occurs, varies in different women. Sometimes, but rarely, it is sudden; something having occurred to arrest a menstrual period, nature takes the opportunity of putting an end to the function at once. More generally the decline is gradual; there may be a long interval, and then an excessive return; then another long interval and a scanty return, and so on till the function entirely disappears. From months to years may be required to accomplish this change.

INFLAMMATION OF THE SEXUAL ORGANS.

THE next class of diseases which I shall speak of are the infiammations of the various sexual organs; an exceedingly important ene common class. The diseases which have been already treated of, are often termed in medical works the Functional ones, as they are frequently seen without any structural alteration, to be recognised either during life or after death. Still, all of them are frequently connected with, and dependent upon, inflammatory disease, and there has been a growing tendency of late years, since the more accurate investigation of the sexual organs by the speculum, to consider them more and more of an inflammatory nature. Leucorrhea used to be constantly regarded, as well by the medical profession as by women in general, as a disease of debility, and "the whites" are still prevalently thought to be only "a weakness." But Dr. Bennett has shown that in the great majority of cases of any severity, these discharges are of an inflammatory nature, connected very frequently with ulceration of the mouth of the womb; and that, instead of being the effect of the dyspepsia and general debility usually found along with them, they are the cause. He has shown likewise, that all the disorders of menstruation are frequently owing to such ulceration. Dr. Tilt has in like manner traced many of these diseases to an inflamed state of the ovaries, showing that amenorrhoea, dysmenorrhoea, menorrhagia, &c., are frequently dependent on this cause. Hence arises the extreme importance, in all cases of these so-called functional diseases, of making a careful examination, whether they be not connected with an inflammatory affection.

I shall begin with the ovaries, which are the most important parts of the female organs. There are very few organs in the body, which are so little understood, and have been so little attended to, as these most important ones. In reality they preside over the female sexual system, just as the testicles do over the male; and the peculiar sexual sympathies and feelings, both moral and physical, depend on them, and not on the womb. From their small size, their hidden position, and still more from the ignorance of their physiology, (for the new views of ovulation and menstruation are among the most recent discoveries in physiology,) they have been neglected; and the womb has received the main share of the attention of physicians, and to it were ascribed the various sexual sympathies. Hence the pathology, (or knowledge of the 'diseases) of the ovaries, is stil! quite in its infancy, and medical works are very meagre on this sub

ject. It is indeed known that the ovaries are exceedingly prone to disease, for in no organs are morbid appearances more common after death. But the causes of these appearances, and the symptoms of disease, which they produce in life, are still wrapped in great obscurity; although the new light thrown on the functions of the ovaries by the theory of ovulation, and the labours of physicians who are now earnestly investigating these organs, will, it is to be hoped, soon illus. trate the subject. Nothing more retards our knowledge than the false sexual delicacy, which prevents women from speaking of the minor derangements of menstruation, or of applying for aid in the incipient stages. Science and the female health alike suffer by this most unfortunate feeling. Moreover the repugnance to the necessary modes of examination is a great obstacle. Dr. Tilt remarks, that it is only when the patient's sufferings are habitually intense, or when the prospect of marriage has overcome her reluctance, that an examination is permitted; from this insufficient examination also the disease is frequently only partially cured, and relapses take place.

The necessary modes of examining the ovaries are through the walls of the abdomen, vagina, and rectum. All of these must be carefully used, where there is a suspicion that the ovaries are in a diseased state; and it is fortunate for woman that it is possible by these means to arrive at a true knowledge of the nature of some of her most miserable diseases, and to be able therefore to relieve them. But there are very few physicians, who have the tact and experience necessary to make such an examination with profit. To make a physical examination, to use the speculum or the finger with advantage, requires a long and careful training, of the difficulties of which the public seem to have no idea, but to suppose that all medical men have such knowledge by a kind of intuition, or as a matter of course. Now the fact is, that with regard to the examination of the female organs, and especially the ovaries, very few physicians have had a proper training, and most of them have had absolutely no training at all. The reason of this enormous medical deficiency is, that such training does not form a part, unless as a rare exception, of the ordinary medical education, on account of the unfortunate scruples of sexual delicacy; and thus the great mass of physicians, though frequently called upon to treat female disease, are really quite incompetent to do so. Thus unfortunate woman, even when she does reluctantly make up her mind, after long concealed suffering, to apply for aid, very probably consults a man, who is not much more capable of forming a true opinion in her case than she is herself,

It is not correct to say, that this class of diseases is specially cultivated by certain physicians, and that it is sufficient for these to be conversant with female complaints; a large proportion of sexual diseascs are masked diseases, whose real sexual nature is not recognisable without a careful analysis and examination of the organs, by a man who is competent to form a fair opinion on the matter. Although it is a great advantage, that some men should devote a special attention to certain organs and diseases, yet every medical man should be

able to examine all the different organs in the body, and have a tolerable degree of skill in the management of each. This is especially requisite for the great proportion of medical men, who live in the country, and in small towns, where there is no distinction of medicine into special branches, and each man has to treat every disease that may present itself.

In the abdominal mode of examining the ovaries, the patient lies on the back with the legs flexed, so as to relax the abdominal muscles. Unless however, the ovarian swelling be large, it will not be felt thus. In examining through the vagina, the patient lies in what is called the obstetric position, namely, on the side, with the legs drawn up. The fore-finger of one hand is introduced into the vagina, while with the other hand the examiner presses on the lower part of the abdomen, so as to bring the ovaries within reach of the finger. In examining by the rectum, the obstetric position should be used. The ovaries can be felt in this way, even in their healthy state, although with difficulty; but when enlarged by inflammation they are readily reached. The finger passed into the rectum can feel half of the posterior surface of the womb, bulging through its wall, and on each side the ovaries like two knuckles. When these bodies are healthy," pressure on them gives no pain, but it does, if they be inflamed. Increase of volume can also be recognised in this way. Another method of examining is by what is called the double touch, the fore-finger being in the rectum and the thumb in the vagina. This is very use fal La recognising tumours between these two passages.