University of Virginia Library

19. Hygiene for Women in Advanced Life.

CHANGE OF LIFE. — The two most important periods in a woman's life are those which mark the beginning and the end of the menstrual function. The duration of sexual activity in women is usually thirty-two years, extending from the average age of thirteen to forty-five or forty-six. There is great individual variation in this respect, however, the termination of the menstrual function in some persons occurring as early as the thirtieth year, while in others it is delayed until the age of sixty or upwards. In a case under the author's care a few years ago, the patient, aged sixty, was still menstruating regularly. It is never possible to predict with any degree of accuracy just at what age the change of life, or menopause, will occur.

The physical changes which occur at the change of life, are the opposite to those which mark the period of puberty. The ovaries, womb, and vagina undergo a process of atrophy, or shrinkage, by which they become reduced to a smaller size than before development occurred.

The symptoms which mark the beginning of the change of life are: irregularity of the menses, both as to time and quantity; nervousness and general decline of health, signified by loss of flesh, and various disturbances in the stomach, bowels, bladder, and other organs;

Occasionally eruptions of the skin, particularly upon the face; sometimes a slight growth of hair upon the upper lip; suffering from neuralgia, nervousness, and sometimes hysteria; complaint of sudden flushing of the face, or "rush of blood to the head;" the hands, legs, and trunk of the body may be affected, as well as the head and face. These flushings are sudden, and usually last but a few minutes, and are followed by profuse perspiration. Sometimes a perspiration does not occur, a condition known as "dry flushing," which is much more distressing than the ordinary form, taking its place. Profuse perspiration sometimes occurs during sleep, and is very likely to follow excitement, either mental or nervous. A great variety of other symptoms, involving nearly every organ of the body, are present during this period.

One of the dangers which should be especially mentioned, is the liability of morbid growths to make their appearance at this time. Various tumors of the womb, as fibroids and cancers, select this as their favorite time of attack. A cancer is not likely to occur, however, unless the womb has some time been torn at childbirth, and through neglect the laceration has not been repaired. Growths of the urethra are not unlikely to occur at this time.

Hygiene of the Menopause. — Many of the ills to which women are subject at this period, may be avoided by proper preventive measures. Pre-existing disease of the womb, which through neglect or improper treatment has not been cured, lays the foundation for much suffering at this time. It is indeed probable that previous womb disease is the leading cause of suffering at this period, as it is hardly supposable that in the normal state

such vital disturbances and great suffering as are observed at this period would occur. This emphasizes the importance of adopting such measures as will secure relief from whatever local disorders may exist before this period arrives, thus avoiding much of the inconvenience and suffering of later years to which the individual will otherwise be exposed. The following suggestions will be found of especial service in preventing and mitigating the sufferings attendant at this period: —

1. Individuals passing through the change of life should be relieved from all burdensome cares, and should be kept free from all sources of worry and excitement. Cheerfulness and harmony of spirits are particularly important. If this cannot be obtained at home, arrangements should be made for the patient to go to some suitable place away from home for a few weeks or months.

2. Special attention should be given to diet, which should be simple, wholesome, and nourishing, but free from exciting stimulants of all sorts. Tea and coffee, as well as all other narcotics and stimulants, should be studiously avoided. The enforcement of this rule is sometimes difficult, owing to the intense craving for nerve stimulants which many women experience at this period. Bitters and patent medicines of all sorts do a great deal of mischief when employed as they are apt to be. Their use is wholly without good results, and is often productive of almost irreparable damage.

3. The general health should be maintained by all possible means. Outdoor exercises, carriage-riding when the patient is unable to take a sufficient amount of exercise by walking, are to be commended. Careful atten-

tion should be given to the bowels, which may be emptied regularly by the use of coarse grains, and an abundance of fruit, etc.

4. The flushings or profuse perspirations are best relieved by hot saline sponge baths, hot and cold applications to the spine, and the avoidance of all sources of physical, mental, or nervous excitement.

5. Most of the local symptoms which give annoyance at this period may be relieved by the hot vaginal douche. The distressing leucorrhœal discharge, accompanied by violent itching, which often makes its appearance just after the change of life, may usually be relieved by appropriate treatment, though there is no one method which will answer for all cases.