Part 96

A sample diet-table constructed on these principles is appended:

Quantity Albumen. Fat. Carbohydrate. in grams. BREAKFAST: A cup of weak 150 0.45 0.9 tea With milk, but 30 1.29 0.9 1.2 no sugar White bread 50 4.8 0.4 30.0 Lean cold meat 50 19.1 0.9 DINNER (Mid-Day): Small cup of 100 1.1 1.5 5.7 clear soup Lean beef 200 76.4 3.4 Green 100 1.6 0.4 8.4 vegetables, salad, etc. Fruit 100 3.0 15.0 Roll 35 2.4 0.2 19.6 AFTERNOON: A cup of weak 150 0.45 0.9 tea With milk, but 30 1.29 0.9 1.2 no sugar SUPPER: Soup 100 1.1 1.5 5.7 Lean roast meat 100 38.2 1.7 Roll 50 4.8 0.4 30.0 ————— ————— ———— ————— Total 1,245 155.9 13.2 118.6 ===== ===== ==== =====

In the selection of individual articles of diet, it is important to bear in mind the fact that in all climacteric women it must be our aim to stimulate intestinal muscular activity (peristalsis) and intestinal secretion to a moderate extent, for by more active intestinal secretion abdominal congestion is to some extent relieved, and by intestinal transudation and by diminution of the lateral pressure the circulation through the abdominal vessels is facilitated. By thus lowering the intra-abdominal blood-pressure, we shall assist in relieving a number of chronic hyperaemic states of the pelvic and various other organs, from which women are prone to suffer at the menopause. Hence all articles of diet must be forbidden which have a tendency to give rise to constipation. But we must also forbid all substances which leave extensive undigested residues, such as the rinds of fruits, large quantities of porridge, etc., hard meats, nuts, and the like. Most suitable are those articles of diet which contain large percentages of fluid constituents, such as milk, thin soups, weak tea (infused only a short time, so as to contain little tannic acid, which is very constipating), white meat—veal, breast of chicken, etc. Of vegetables, those are best which contain plenty of water and an abundance of the organic acids, young, fresh garden produce, lettuce, cauliflower, young green peas, young carrots, turnips, etc. Juicy fruits are good, apples, pears, cherries, and plums. Butter and honey are also excellent. In many persons suffering from constipation, all that is necessary for their relief is to give a tumblerful of cold water the first thing in the morning; with others, the use in addition of whole-meal bread with plenty of butter and honey and uncooked fruit, is required.

In women suffering from the various disturbances of the climacteric period in an aggravated form, either because the menopause occurs at an unusually early age, or because the suppression of menstruation has taken place suddenly instead of gradually—especially in cases of heart-trouble, severe vertigo, pronounced vasomotor disturbances, or mental excitement (also erotic excitement), I have sometimes found a methodical milk-cure carried on for several weeks most beneficial. By this I do not mean an exclusive diet of milk, but a diet consisting chiefly of milk and milk-foods; owing to the absence of all irritation of the nervous and vascular systems, this diet has a very definite sedative influence in such cases. The milk should be skimmed, and should be given four times daily in gradually increasing quantities, the total amount rising from ten ounces to fifty ounces daily. The only other meal should be a substantial mid-day dinner, consisting of soup, roasted white meat, young green vegetables, and a little fruit. In some instances, to prevent constipation, it is necessary to add ten grams of milk sugar to each glass of milk; in other cases it is necessary to dilute the milk with water. It is obvious that the quantity of milk given is not alone sufficient to maintain the metabolic equilibrium of the body; but the defect in this respect is made up by the substantial meal given at mid-day.

Among the stimulating influences which during the sexual epoch of the menopause are as far as possible to be avoided we must unhesitatingly include the practice of coitus, inasmuch as at this time of life there already exists a strong tendency towards the occurrence of hyperaemia of the reproductive organs; and sexual intercourse, increasing as it inevitably must this tendency to hyperaemia, should be indulged in as little as possible. And yet precisely in women of the climacteric age, in “la femme demi-vieille” there often exists a strong desire to drain the cup of sexual pleasure to its dregs. Not infrequently, therefore, the physician is asked to advise regarding the proposed marriage of a woman in whom the menopause is drawing near, the desired husband being young, or at least still fully virile. If the advice is given in all sincerity with a sole eye to the woman’s health, the medical man will definitely forbid the marriage.

When, however, the changes of the menopause are fully completed, when the woman’s reproductive organs have undergone complete senile atrophy, there is no medical reason why a couple who wish to give a tenderer name to an intimate friendship between man and woman, should refrain from marriage—provided that both have attained a like stage of sexual decline. “But,” writes Tilt, “a union between frosty January and blooming May is likely to be as dangerous to the health as it is to the happiness of both.”

Whilst attending to the regulation of the physical diet of his climacteric patient, the physician should not overlook her psychical regimen. A woman’s mind is very powerfully affected by the processes of the menopause. On the one hand, her fears are stimulated by the thought that she is entering upon the “critical age,” of whose dangers she has often been warned; and, on the other hand, she is mentally depressed by the knowledge that she is about to lose the charms of womanhood, and to decline in sexual esteem. It is well, therefore, for women during the years of change, to have some kind of employment, which fills their hours, occupies their thoughts, and—leaves a certain scope for the exercise of feminine vanity. Works of benevolence or of general utility, and literary occupations, are thus of great advantage to climacteric women. Plato, indeed, pointed out that women at this time of their lives should occupy themselves with literature and intellectual culture.

Just as it is the duty of the physician, more especially of the family physician, to enlighten the maiden on the threshold of her sexual development regarding the processes of the awakening sexual life, and to give her the necessary instruction concerning the hygienic measures which it is proper for her to adopt—so also is it his duty to convey medical information to the woman who stands on the threshold of sexual decadence. A woman’s ignorance is often equally profound at both these epochs of the sexual life. A woman in the early forties often does not suspect, or at least refuses to acknowledge, that she is gradually drawing near to the end of her sexual life; and she is still farther from the knowledge that definite rules of general and sexual hygiene must be observed by her if she wishes to minimize the dangers of the critical period.

The medical friend, in an earnest though far from gloomy manner, will expound to her the nature of the physiological processes of the menopause, and will instruct her regarding the corresponding preventive measures—diet, exercise, clothing, care of the skin, and the regulation of sexual intercourse. Moreover, the physician, by means of skilfully directed enquiries regarding certain symptoms, will be enabled to gain early information about the occurrence of abnormal processes at this period of life, and will in this way detect the first beginnings of many diseases which are amenable to treatment only at the very outset of their course. For example, Brierre do Boismont, an early and accurate observer of this sexual epoch in the life of woman, points out that in cases in which, during the change of life, a woman experiences an increased inclination for sexual intercourse, nineteen times out of twenty, a local examination will disclose the existence of some disease of the reproductive apparatus. Similarly, every gynecologist is now familiar with the fact that unusually free, atypical haemorrhages during the climacteric period, are commonly indications of the existence of a uterine neoplasm.

Much evil may be avoided, and much suffering can be diminished if the physician, in accordance with the advice of Hippocrates, does not limit his activities strictly to the exercise of the healing art, but stands by a woman’s side as her mentor and confidant during the troublesome years of her sexual decline. And he will best fulfil these functions, if he succeeds in convincing the climacteric woman of the profound truth embodied in the saying of the great French philosopher:

Qui n’a pas l’esprit de son âge, De son âge a tout le malheur.

INDEX

Abdominal pains, 46.

Abdominal pressure, 46.

Aberration, moral, 46.

Absence of mind, 154.

Absence of ovaries, 182.

Abnormalities, mental, 155.

Abortion, 223, 414.

Abstinence, 256, 398.

Acromegaly, 102.

Act of intercourse, 84.

Activity, sexual in women, 597.

Acton, 276.

Actual intercourse, 84.

Adamites, 302.

Africa, 43, 45.

Age, average, at marriage, 200.