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A CONSIDERATION OF THE

PHENOMENA WHICH OCCUR TO WOMEN

AT THE CLOSE OF THE CHILD-BEARING PERIOD,

WITH INCIDENTAL ALLUSIONS TO THEIR RELATIONSHIP

TO MENSTRUATION. ALSO A PARTICULAR

CONSIDERATION OF THE PREMATURE

(ESPECIALLY THE ARTIFICIAL)

MENOPAUSE



BY

ANDREW F. CURRIER, A. B., M. D.

NEW YORK CITY



NEW YORK

D. APPLETON AND COMPANY
1897



C <?7<



COPYRIGHT, 1897,
BY D. APPLETON AND COMPANY.



J

TO i

THE MEMORY OP MY DEAR MOTHER,

LONG AT REST,

THIS BOOK IS AFFECTIONATELY
INSCRIBED.




PREFACE.



IT is many years since an original work
on the menopause in the English language
has appeared before the public. Tilt's work
upon this subject was long the only one of
its kind, and was last seen in a reprint pub-
lished in this country some fifteen years ago.
That work may have been useful in its day,
but it contained a great deal of statistical
information from which, as it seems to the
writer of the present work, unwarrantable
deductions have been drawn. It also has
handed down the hoary tradition, which has
been current from time immemorial among
both the laity and the profession, that the
menopause is an experience fraught with
peril and difficulty. This and all similar
teaching the writer declares to be incorrect



VI



PREFACE.



and unwarrantable in the light of his own
experience and observation.

Tilt's book is further defective because
the great fund of information which has
accumulated in connection with the artificial
menopause did not exist in his time.

A translation of a German work on the
menopause by. Borner was published in this
country about the same time as the reprint
of Tilt. This work, though very brief, is a
decided improvement, in the writer's opinion,
upon Tilt. It seems to have grasped the
subject in a more philosophical and scientific
manner than the work of Tilt, but is deficient,
nevertheless, upon certain important phases, a
comprehensive study of which has only been
possible within the past few years.

The writer would beg leave to say that he
has had the subject of this work under con-
sideration many years. He was never able to
see the sense nor the logic of the traditional
teaching, repeated generation after generation,
that the menopause was a serious yea, even
a most dangerous time and experience ; that



PREFACE. vii

the matron and the maid alike should ap-
proach it with fear and awe ; that if this
dangerous Rubicon were once passed, joy and
felicity would wait upon the remaining years
of life.

If haemorrhage were exhausting the pa-
tient, she was told that if she could only pass
the menopause she would be secure, no mat-
ter whether the haemorrhage were due to
benign or malignant disease, and if the meno-
pause were suspected, too often the doctor
neglected to examine his patient and find out
with assistance, if unable alone whether
the disease were benign or malignant, and
whether there was good reason for thinking
that the menopause could produce a cure.
Now, in so far as this condition of opinion
exists at the present time, if it does exist,
either in the lay or the professional mind, to
that extent the writer wishes to lift up his
voice in earnest protest. The menopause is
not a dangerous time or experience for the
majority of women, any more than puberty
is. The majority of women pass through it



viii PREFACE.

with as little incident or discomfort as they
experience at puberty. It is only the excep-
tional woman who has a hard time, and comes
to the doctor to tell him about it. Upon this
exceptional experience the doctrine of the
danger and serious character of the meno-
pause has been built up.

Another serious error which it is the
writer's desire to controvert is the very prev-
alent one that there is in some way the most
intimate relationship between cancer, espe-
cially cancer of the womb and the breast, and
the menopause. That many cases of malig-
nant disease do occur during the decade in
which the menopause usually takes place is
true. While this number is probably larger
than during any other decade, it by no means
includes the greater number of all cases, and
it is ridiculously small in its percentage when
compared with the total number of women
who undergo the experiences of the meno-
pause. Thus the principal props of this
threadbare theory of the dangerous character
of the menopause are seen to be composed of



PREFACE. ix

the flimsiest material. Let us knock them
down and bury the rubbish out of sight and
memory.

So far as the writer is aware, little or no
attention has been given, in books similar to
this one, to the subject of the artificial meno-
pause. The great development of abdominal
and pelvic surgery within the past generation,
and the enormous number of women, tens of
thousands, who have been deprived of their
ovaries, for one reason or another, has opened
up a rich field for the investigation of the
phenomena which attend the removal of
those important organs. It is hoped that the
writer's contribution to that subject, imper-
fect as it is, may not be uninteresting to his
professional brethren, and may perhaps stimu-
late some one who may be better qualified to
pursue the study more exhaustively.

Concerning the question of the treatment
of the ills of the menopause, the writer earn-
estly hopes that his book may stimulate those
into whose hands it may fall, first, to a more
careful and systematic investigation of those



x PREFACE.

ills than has been the usual custom, and, sec-
ond, to an early resort to surgical measures if
surgical measures are indicated. There are
many cases which can and should be relieved
by such measures, and it is hardly just or
scientific or humane to load them down with
drugs month after month, in the most em-
pirical fashion, if the condition is one which
can be effectually and permanently relieved
by the timely resort to surgery.

ANDREW F. CURKIEK, M. D.

NEW YORK, March, 1897.



CONTENTS.



CHAPTER I.

PAGES

HISTORICAL AND OTHER PRELIMINARY CONSIDERATIONS. . 1-40

On the choice of a term, 1. Relation to menstruation, 3.
Menstruation defined, 4. Literature of the subject, views of
ancient writers, etc., 5. Modern and recent writers and their
scope, 10. New significance to the subject through the de-
velopment of abdominal and pelvic surgery, 11. Various data
concerning the menopause, 13. The menopause should be a
normal function or experience ; previous teachings to the con-
trary are erroneous, 14. Amplified definition, 15. Exagger-
ated views concerning the menopause as a critical time for
good or evil, 16. Views of Kisch upon the subject, with analy-
sis of his table, 18. Analysis of Tilt's table, 21. Other statis-
tics, 22. Explanation of possible degenerative changes in the
tissues during the menopause, 25. Physical condition of wom-
an when the era of the menopause is reached, 27. Age, 28.
Experiences: 1, Normal, 28; 2, Moderately troublesome, 30 ;
3, Severe, 30; 4, Serious, 32. Table of cases of malignant
disease at the Skin and Cancer Hospital, 33. Classes or types
of women in conformity with the above classification, 35.

CHAPTER II.

CONSIDERATIONS CONCERNING THE ORGANS OF THE GENITAL
APPARATUS; ANATOMICAL CHANGES RELATED TO THE

MENOPAUSE 41-88

1. Anatomical changes which are the result of the meno-
pause, 42. 2. Anatomical changes which produce the meno-
pause, 42. 3. Anatomical changes which are coincidental with
the menopause, but not usually its cause or caused by it, 42.
xi



xii CONTENTS.

PAGES

Study, in detail, of the changes in the reproductive organs
which result from the menopause, 42. 1, The ovaries, 42;
2, The uterus, 53 ; 3, The Fallopian tubes, vagina, and cli-
toris, 62 ; 4, The mammary glands, 64. Changes in other
structures of the body, 66.

Study of the changes in the reproductive organs which lead
to the menopause, 66. 1, The ovaries and Fallopian tubes, 66 ;
2, The peritonaeum, 70 ; 3, The uterus, 70 ; 4, The vagina, 75 ;
5, The mammary glands, 76.

Study of those changes which are merely coincidental with
the menopause, 78. Subin volution, 79. Malignant disease, etc.,
80. Influence of destruction of the genital organs, 85. Besume
and conclusions, 86.



CHAPTER III.

SOME OF THE FACTORS WHICH INFLUENCE THE ADVENT AND

PROGRESS OF THE MENOPAUSE 89-186

Scheme of treatment of the subjects in this chapter, 90.
Unusual activity of the genital organs with increased vascu-
larity noticeable at the beginning of the menopause, 90.
Changes in habit and temperament as the menopause pro-
gresses, 91. Factors which influence the menopause vary for
different women and affect them with different degrees of
force, 92. Factors : 1, Age ; 2, Disease and traumatism ; 3,
Climate ; 4, Heredity ; 5, Temperament ; 6, Accidental influ-
ences, 92.

1. Age of the menopause as observed by the author, 93;
Kisch, 96 ; Leudet, 96 ; Tilt, 97 ; Faye, 97 ; Mayer, 97 ; Burner
and others, 97. Cases of early menopause, 99. Cases of late
menstruation by Battey, Felty, and others, 100. Conclusion as
to age limits for the cessation of menstruation, 102.

2 Disease and traumatism in their influence upon the
menopause, 102.

A. (a) Acute inflammatory processes, 'i
(6) Chronic " "

B. Degenerative processes. \ Classification, 103.

C. Neoplasms.

D. Trauma.

Subdivisions of (A) (a) acute, 103, and (J) chronic, 103, in-
flammatory processes. The acute are divided into (I) gen-



CONTENTS. xiii

PAGES

cral and (II) local, the latter being subdivided into (x) puer-
peral, and (y) non-puerperal, ((c) infectious, (d) traumatic).

(b) Chronic inflammatory processes, 108. Wasting diseases
of the lungs and kidneys, 110. Diseases and disorders of the
nervous system, 112. Detailed statements concerning the in-
fluence of (B) degenerative processes, atrophy, obesity, de-
fective development, 115.

Influence of (C) neoplasms on the menopause, 120. Be-
nign and malignant, 121. The latter tend to increase the
menstrual flow and defer the menopause, the former may
hasten it, 122.

(D) Trauma as a factor in the development of the meno-
pause, 130.

3. Climate, including altitude and atmospheric conditions,
131. Observations of Leudet, 132, Kisch, 133, Bonier, 133,
Lieven, 134, Hannover, 134, and others concerning the in-
fluence of climate, 133. Influence of atmospheric pressure, 1 36.

4. Heredity, including family, national, or race pecul-
iarities, 139. The bearing of fertility and sterility upon the
menopause, 143.

5. Temperament, habits, occupation, and social surround-
ings, 150. Sexual excess and abstinence, 155. Concerning the
Oneida Community, 159. Prostitutes, 161. Influence of sexual
abstinence upon the menopause, 166.

6. Accidental influences, fear, emotion, grief, etc., 167.
Statistics with reference to conditions bearing upon the meno-
pause, 169. The influence or bearing of the menopause upon
ovulation and conception, 180.



CHAPTER IV.

THE PHENOMENA OF THE MENOPAUSE, NORMAL AND MORBID,

AND THEIR DURATION 187-229

The type of experience during the menopause should be
a condition of health ; it is not critical in the sense that it is
dangerous either to life or health, 187. Phenomena which are
common to the menopause and others which are less common
or infrequent, 190. Vasomotor phenomena and their types,
191. 1, Heat flash: 2, Sweating; 3, Sweating with chill or
shudder ; 4, Headache ; 5, Melancholia ; 6, Chilliness of ex-
tremities ; 7, Abundant discharge of urine ; 8, Diarrhoea and



xiv CONTENTS.

PAGES

pelvic congestion, 194. Gastro-intestinal disturbances, es-
pecially 1, Constipation ; 2, Intestinal or gastric fermenta-
tion ; 3, Loss of appetite and indigestion, etc ; 4, Diarrhoea,
194. Pseudo-pregnancy, 195. Anaemia, 196. Haemorrhages,
197. Opinions of Scanzoni, 202; Kisch, 202; Frank, 203;
Hegar, 203. Lesions of the mind and nervous system in con-
nection with the menopause, 204. Observations of Merson,
204, and Hegar, 205. Hallucinations and sexual ardor, 206.
Climacteric insanity, investigations and investigators in this
field, 207. Lesions of the skin which accompany the meno-
pause, 218. Cases recorded by Grellety, 219, Martineau, 220,
Deligny, 221, and others. Lesions of other parts or organs,
221. Asthenopia, 222. Gastric troubles, 223. Cardiopathies,
223. Other lesions, especially those of a functional character,
224.

CHAPTER V.

THE PREMATURE MEXOPAUSE 230-266

Definition, 230. Relations to the natural menopause, 231.
Disease as a cause may be constitutional or local, 231. Other
causes climate, heredity, wasting diseases, 231. Excesses,
poverty, venereal disease, poisons, obesity, 233. Excessive
fertility, 235. Traumatism as a cause, 236. Artificial meno-
pause, 237. Respective claims of Battey and Hegar, 239.
Indications for the artificial production of the menopause,
240. 1, Inflammatory disease of the appendages, 241. 2,
Neoplasms of the appendages, 242. 3, Ovarian neuralgia or
dysmenorrhoea if severe and of considerable duration, 242.
4, Cases in which Caesarean section has been required, the
natural passages being entirely incompetent for the delivery
of a viable child, 243. 5, Osteomalacia, 243. 6, Severe dis-
ease of the uterus which can be relieved by no less severe
measures, 243. Insanity and epilepsy, per se, not indications,
243. The phenomena of the premature menopause, including
those which accompany operations for its production, 244. In
some cases the cessation of menstruation is the only symptom
of note, in others the symptoms are more or less like those
which come with the natural menopause, 244. Glaevecke's
investigations, 246. Battey's conclusions, 248. Observations
of Hegar, 250. Experience of the author in this field, 252.
Removal of one ovary and tube, even though seriously dis-



CONTENTS. xv

PAGES

eased, does not bring the menopause, 253. Kemoval of both
ovaries and tubes has invariably brought the menopause, ex-
cepting in cases of uterine myomata with attachments to sur-
rounding structures, 254. Atrophy of the genital organs which
remain proceeds rapidly, 256. Influence upon the sexual appe-
tite, 257. The operation for producing the menopause does not
in all cases relieve the pain which may have been one of the
chief indications for its performance, but the pain will subside
eventually, 259. Effect of removing the ovaries prior to pu-
berty, 260. The analogous operation in young animals may
suggest the changes which might occur in the human female,
260. Arrested development of the genital organs, 261. Ap-
parent menopause occurring prematurely from disease, from
the influence of sea air, 262. Propriety and utility of attempts
to restore suspended menstruation, 264. Many cases entirel7
hopeless, 265.



CHAPTEE VI.

RETARDED MENOPAUSE 267-269

Definition : Cases of true menstruation beyond the fiftieth
year very infrequent, 267. Petrequin, 268. Scanzoni's limit,
268. (See also Chapter III, under Age, p. 101.) Mayer's cases,
also those of Kennedy, Eodsewitch, Sutherland, 268.

CHAPTEE VII.

TREATMENT 270-283

First requisite during the menopause is watchfulness on
the part of both patient and physician, 270. Treatment ia
that of symptoms, as they appear, 271. Diet should be sim-
ple, bowels kept freely open, sedatives given as indicated, skin
kept active, 273. Eemoval of blood when the genitals are con-
gested and cause erotism, 274. Particular attention should be
given to the haemorrhages of the menopause which are not
physiological, 274. Treatment is mainly surgical, 275. The
means which may be of use are the electro-cautery, curette,
tampon, etc., 276. Hysterectomy is indicated if the symptoms
are severe or threatening, 277. Astringent drugs sometimes
beneficial to check hiemorrhage, 277. Treatment of the neu-



xvi CONTENTS.

roses of the menopause, especially the mental disorders, 278.
Depletive measures indicated, also hygienic and dietetic meas-
ures, 279. For treatment of neuralgias, etc., consult standard
works on diseases of the nervous system, 280. Cutaneous le-
sions treated locally, 280. For other lesions see works on
general medicine, 282.




THE MENOPAUSE.



CHAPTER I.

IIISTOKICAL AND OTHER PRELIMINARY CON-
SIDERATIONS.

Definition. What do we mean by the
term menopause? Obviously the cessation
of the menstrual function. But is that all ?
By no means, for the arrest of the monthly
discharge of blood forms but a single inci-
dent in the concatenation of events which
occur in the experience of a great number
of women who reach and pass the limit of the-
childbeariug period.

Want of Comprehensiveness of tlie Term.
The definition which has been given is there-
fore lacking in comprehensiveness, and specifies
only one of the most noteworthy and impor-
tant facts which occur at an important epoch

in a woman's life.

2 l



2 THE MENOPAUSE.

Substitutes for Term employed and their
Ambiguity. Should we then substitute for
menopause the term change of life, critical
time, climacteric, etc., as many writers have
done ? No, for these terms involve more of
ambiguity than does menopause.

The change of life is, with many individ-
uals, quite as definite an event at puberty as
at the end of the period which is inaugurated
by puberty nay, in many cases that change
is even more definite.

Critical times occur frequently in the lives
of some women,* and climacteric merely sub-
stitutes a synonym of Greek origin in the
place of critical time or period.

Obsolete Terms. Other terms such as
dodging time, climacteric disease, etc., have
become obsolete for various good reasons,
and need only be mentioned.

* Several periods in the lives of both men and women,
and not identical in the two sexes, have been determined by
different writers as critical or climacteric periods. See Hal-
ford, Medical Transactions, Royal College of Physicians,
London, 1813, iv, p. 316; Connolly, Dublin Journal of the
Medical Sciences, 1844, xxv, p. 245; O'Connor, ibid., 1875,
Ix, p. 78.



PRELIMINARY CONSIDERATIONS. 3

The Term Menopause to he employed.
On the whole, while admitting the narrow-
ness of its etymological scope, the term meno-
pause is as little objectionable as any that is
now available, and will therefore be em-
ployed in this work to direct the mind of the
reader to the events which transpire during
those months and years in the life of a
woman when the childbearing function is
drawing to its close a period forming an
isthmus between growth and decay, a lull
between flowing and ebbing tides, a mile-
stone to mark the end of a definite period
of existence.

Relation to Menstruation. As the term
which has been thus chosen refers definitely
to the cessation of an important function, no
apology will be deemed necessary for such
reference to and consideration of that func-
tion as may have a bearing upon the sub-
ject in hand; at the same time no attempt
will be made to analyze exhaustively the
various interesting propositions in histol-
ogy and physiology with which it is in-



4 THE MENOPAUSE.

timately related, in which both speculation
and fact are abundant, and concerning
which there still remains much to be
learned.*

Menstruation defined. As a working
definition of menstruation it may be said that
it is a function common to females of the
human species during that portion of life in
which fruitfulness is a characteristic. It
recurs with tolerable regularity each lunar
month and continues the greater portion of
a week. Its chief objective feature is a dis-
charge of blood from the uterine canal with
which epithelium and glandular secretion
from the uterus and vagina are mingled.
With the discharge are frequently associated
phenomena of considerable variety, appertain-
ing principally to the vascular and nervous
systems. From this definition the many ir-



* For the consideration of the subject of menstruation, es-
pecially in its histological aspect, the reader is directed to the
writings of Leopold, Wyder, Moricke, Kundrat and Engel-
mann, and John Williams, and for an exhaustive considera-
tion of the function to the brochure of Dr. Mary Putnam
Jacobi, American Journal of Obstetrics, 1885.



PRELIMINAEY CONSIDERATIONS. 5

regularities of menstruation which are possi-
ble may be deduced.*

Importance of Menstruation has been ob-
served for Ages. From time immemorial
the importance of the menstrual function in
women has been a recognized fact among
critical observers. Its significance has, of
course, been differently interpreted by ob-
servers in different ages and in different con-
ditions of intellectual development. Among
the crude, the barbarous, and the super-
stitious the solution of such a problem
would not be one which would be univer-
sally satisfactory. Even among highly de-
veloped nations, like the Greeks, the inter-

* "The menstrual flow is due to the influence of the tubo-
ovarian (hypogastric) plexus which, in its turn, is controlled
by the solar plexus. The uterus, tubes, and ovaries are sup-
plied by the hypogastric plexus, and menstruation must con-
tinue as long as the influence of this plexus continues. With
the cessation of this influence the flow ceases and atrophy of
structure begins. The radiating currents of the ganglionic
centers with all their protean reflex actions are the sources of
the phenomena of the climacteric. When they are no longer
needed for reproductive purposes they expend their force in
every conceivable direction." Nowlin, The Climacteric, its
Phenomena and Dangers, Nashville Journal of Medicine and
Surgery, 1895, Ixxvii, p. 7.



6 THE MENOPAUSE.

pretation could not be expected to conform
to the facts because of imperfect knowl-
edge in physiology and anatomy. And
among the observers of recent times, with
incorrect and imperfect views of pathology,
menstruation and its aberrations must neces-
sarily receive an entirely different interpre-
tation from that which is given them by us
who enjoy the accumulation of the knowl-
edge of all previous ages, but more especially
the results of the precise investigations of
the century which is now drawing to a
close.*

The Egyptians, who investigated so many
matters concerning the human body, realized
that menstruation was an important function.
This is shown in the books of Moses, much
of the information in which was derived

* For example, Paracelsus believed that the menstmal
blood was the greatest of poisons, and that with it the devil
produced spiders in the air; also that fleas, beetles, cater-
pillars, and other insects were generated by it. Democrates
in his Book of Antipathy declares that all those caterpillars
and other insects which destroy a garden fall off and die if a
woman with her menses upon her walk three times around
each quarter of the garden barefoot and with her hair loose.



PRELIMINARY CONSIDERATIONS. 7

from Egyptian sources, and in which a men-
struating woman was declared ceremonially
unclean, coitus with her being forbidden, etc.

The Menopause not carefully observed by
most of the Ancient Writers. But while the
importance of menstruation was quite gener-
ally recognized among the more acute of
the ancient observers, it was not so with
the menopause. By some it was passed
over as a matter occult and inexplicable,
and, in general, it failed to receive that broad
and philosophic treatment with which so
many questions were discussed by the an-
cients. The following selections will show,
however, that with some of them the sub-
ject had not escaped their attention.

The Humoral Pathologists.^l&s humoral
pathologists believed that the humors or
juices ascended like gases, and that they
often settled in the brain and produced great
disorder, which required the abstraction of
blood from the head, arm, foot, or other part.
In the cessation of the menses, either tempo-
rarily or permanently, they saw the possibility



8 THE MENOPAUSE.

of serious consequences, and they are prob-
ably responsible for much of the foreboding
of evil which is associated with the meno-
pause in the minds of so many of the
laity*

* Amid much that is curious in the writings of the hu-
moral pathologists we find it stated by Hoffmann, one of
their number, that if venesection is omitted when the menses
cease, violent cardialgias will result, accompanied with in-
tense heat and pain about the praecordia, the back, and scapu-
lae, especially in the nighttime. Others will suffer with in-
tolerable heat, pain in the joints, and erysipelatous fevers,
while still others will be affected with nephritic disorders
accompanied with pain in the loins, and terminating in cal-


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Online LibraryAndrew F. (Andrew Fay) CurrierThe menopause; a consideration of the phenomena which occur to women at the close of the child-bearing period .. → online text (page 1 of 16)