LETTER IV.. Of Menstruation.

OF MENSTRUATION.

Cessation of the Menses—Turn of Life—Management at this Period.

In every department of nature we see the most unquestionable evidences of design.

Who but an Almighty Hand could have created a being so complex, and a body so admirably adapted in every respect to his wants, as that of man? Every part of this great piece of God’s handiwork is most accurately fitted to its place, and every function is performed for some important end.

Menstruation and child-bearing are, as we have seen, intimately connected with each other. Suppose a woman could bear children at any period of her life she might choose, what a premature offspring would that be which she would bring forth in childhood, and what a feeble, decrepid one in old age.

But it is not so. Nature has set up bounds which all the art and ingenuity of the whole combined world cannot pass.

It was the benevolence of the Creator that formed her body in this way; for if it had been left to the choice of us poor erring mortals, women would bear children at those times when it would be very improper to do so. And this benevolence extends equally to both mother and child.

Menstruation commences, as we have seen, usually at the age of from fourteen to fifteen years.

AGE AT WHICH THE MENSES CEASE.

The age at which the menstrual function ceases is somewhat various. The average has been regarded in this country as being at about forty-four or forty-five years of age. It is, at least, so with the community at large. In seventy-seven cases quoted by Dr. Maunsel, of Dublin, the period was as follows:

1 at the age of 35 years. 4 „ 40 „ 1 „ 42 „ 1 „ 43 „ 3 „ 44 „ 4 „ 45 „ 3 „ 47 „ 10 „ 48 „ 7 „ 49 „ 26 „ 50 „ 2 „ 51 „ 7 „ 52 „ 2 „ 53 „ 2 „ 54 „ 1 „ 57 „ 2 „ 60 „ 1 „ 70 „

Dr. Guy gives a table showing the ages at which 443 persons ceased menstruating, 337 having been collected and communicated to him by Dr. James Reed, and 106 by himself. The table is as follows:

1 at the age of 34 years. 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.