The change of life in health and disease : a practical treatise on the nervous and other affections incidental to women at the decline of life

Front matter

THE CHANGE OF LIFE

HEALTH AND DISEASE.

B7 THE SAME AUTHOR.

Preface

Several years have elapsed since I published a little work on Diseases of the Change of Life j since then, I have been diligently engaged in collecting the materials for a fuller elucidation of the subject; and if, in the course of this second edition, I more frequently refer to personal observa¬ tion than to the writings of medical authorities, it is simply because few have written upon the affections incidental to the change of life, although their frequency and importance are generally recognised.

The extinction of reproductive power gives an emphatic in¬ terest to that period of the lifetime of woman comprised within the 40th and 50th years, were it even unattended by many constitutional changes and morbid phenomena. My views on these points will be found sketched in an introductory chapter, and in the following, the results of some interesting inquiries into the physiology of this epoch; but I am anxious to draw the reader’s attention to that portion of the work which relates to nervous diseases.

The present century has witnessed magnificent discoveries in the pathology of the brain and of the spinal marrow; but it will be obvious to those conversant with medical literature that the pathology of the ganglionic nervous system has received comparatively little attention, neither can it be much 6 v i PREFACE.

advanced until experimental physiologists have accurately investigated many points conneeted with the physiology of the ganglia and their nerves. My object has been to prepare the ground for other labourers, by throwing on an intricate subject all the light I could collect I have, moreover, attempted to trace the boundary-line between cerebral an ganglionic affections, now considered entirely dependent upon {. cerebro-spinal disturbance, largely illustrating the varied rela¬ tions in which cerebral disorders stand to ganglionic affec¬ tions. I have also sought to show that there are several | distinct morbid conditions of the nervous system to which the term hysterical is indiscriminately applied.

The first edition has been long out of print, and an apology maybe due for the delay in the appearance of the second; but the prosecution of my undertaking has been so repeatedly interrupted, that I have been obliged again and again to pass over the same ground-a mental process very tedious and irksome to an author, but well calculated to give maturity to his views.

E. J. T.

January, 1857.

Introduction

Synonymy of the change of life—Definition of cessation; of the dodging-time ; of the c. of life—Importance of the epoch—Bibliographical details—Influ¬ ence of the c. of life not invalidated by statistics—Critical, not equivalent to fatal—Definition of crisis—Critical periods—The c. of life full of critical phenomena—Sanative influence of the c. of life—Its influence on insanity— Influence of critical epochs on subsequent periods—The materials of the present work not derived from books—Tabulated results of disease at the c. of life—Physiology and pathology, twin-bom sciences . . . pp. 1—8

Chapter II. On The Physiology Of The Change Of Life

Historical sketch of the reproductive function in woman—Ovarian evolution and involution—Anatomical changes in the ovaries before and after cessation —Theory of ovarian action—Induction of the healthy and morbid symptoms of menstruation—Date of cessation—Cases of protracted cessation and fecun¬ dity—Tables of fecundity—Causes of protracted cessation—Cases of early cessation—Causes of early cessation—Diagnosis of cessation—Physiognomy of women at the c. of life—Three types of women at the c. of life; the ple¬ thoric ; the chlorotic ; the nervous—-Diagnosis of cessation from chlorosis ; from inflammation of the neck of the womb; from uterine polypus ; from hydatids ; from cancer ; from pregnancy—Cases of spurious pregnancy— Length of time allotted for the c. of life-—Average duration of the m. flow and of fecundity—Fecundity possible at the c. of life and after cessation— Eccentricities of the reproductive function—Modes of termination of the m. flow—A practitioner’s view of the ovular theory—To remodel the constitu¬ tion is the object of the c. of life—Interstitial using up of the redundant blood—Increase of fat—Less fat deposited during the dodging-time—More fat accumulated during the second half of the c. of life—Compensating agencies of the m. flow—Periodical occurrence of some symptoms—Relief afforded by respiration ; by increased urinary deposits ; by increased cuta¬ neous exhalation—Table of cutaneous exhalations—Theory of flushes— Theory of heat—Extent of cutaneous surface—Amount of perspira¬

tion—Its analysis—Its critical nature—Relief afforded by mucous discharges —Table of mucous discharges—Periodical leucorrhcea—Relief afforded by

b 2 vin

TABLE OF CONTENTS.

haemorrhage—Table of haemorrhages—Vicarious menstruation—Definitive results of the c. of life—Improvement in health—Comparative freedom from disease—Increased chance of longevity —The physique of woman before and after the final restoration—The mental faculties before and after the final restoration—The moral faculties before and after the final restoration—Mo¬ difications induced by constitution and by temperament . . . pp. 9—68

Chapter III General Principles Of Pathology At The Change Of Life

Diseases of the c. of life incorrectly viewed—Pathology of ages—Morbid liabilities of the e. of life—Table of their comparative frequency—Classification of dis¬ eases of the c. of life—Causes of disease at the c. of life—Weakness of con¬ stitution—Temperamental organization—Weakness of some particular organ —Constitutional diseases—Uterine affections—Unusual suffering at puberty and menstrual eccentricities—Sudden stoppage of the menstrual flow—Disuse or abuse of the reproductive organs—Social position—Real cause of immu¬ nity from diseases of the c. of life—Blood theory of diseases of the c. of life —Nervous theory of diseases of the c. of life—Comparative amount of suffering at the c. of life—Modes of suffering—Prognosis of diseases of cessation.pp. 69—82

CHAPTER IY.

GENERAL PRINCIPLES OF THERAPEUTICS.

Modes of treatment pointed out by nature—Bleeding, as practised by nature— Bleeding, no longer fashionable; why gone out of fashion ; advisable in the plethoric type; sometimes erroneously prescribed for nervous symptoms— Cases in proof—Bleeding, whether from arm or leg—Advantages of full bleeding indicated by nature—Small bleedings most frequently adopted by nature—Leeches and cupping—Leeching the womb disapproved of—Pur¬ gatives—Nature purges—Cases—Purgatives not to be given at a menstrual period—Purgatives most frequently given—Alkalies and diuretics—Given as tissue destroyers; as antacids ; as blood-improvers—Sedatives—Their ne¬ cessity shown by nature—Utility to be derived from their more systematic exhibition—Their anaphrodisiac properties render them useful at the c. of life—Sedatives suit the nervous and the chlorotic types—How to be given to the plethoric and bilious—Advantages of their external exhibition ; of their exhibition by the rectum—Modes of giving opium; hyoscyamus; belladonna; camphor; cherry-laurel water; lupulin—Sudorifics —Their utility shown by nature—Instances of their utility—Sulphur—Baths—Witnesses in favour of their utility—Their three modes of utility—English prejudices against bath¬ ing—Authorities in favour of prolonged baths—Sedative effect of baths— Danger of hot baths at the c. of life—Counter-stimulants often required— Heat the best—Issues—Supposed operation of issues—Their advocacy by some authors—Mineral waters of Aix en Savoie—Their cheTniea.l composi¬ tion; effects; doses ; modes of administration; curative power, pp. 83_116

TABLE OF CONTENTS.

ix

CHAPTEE Y.

HYGIENE OF WOMEN DURING THE CHANGE OF LIFE.

Reasons why women should he made acquainted with what is to occur—Exagge¬ rated fears dispelled—Real dangers anticipated—Signs of the times— “ Principiis obsta”—Hygiene of the reproductive functions—Numbers married during the c. of life—Motives for late marrying—Sexual impulse at the c. of life, a sign of disease—Case—Hygienic applications—Hygiene of the digestive functions—Less food required—Daily regimen of the plethoric type, breakfast, dinner, supper—Danger of stimulants—Abuse of tea— Homoeopathic regimen—Abdominal belts required, and well-adapted stays —Hygiene of the cutaneous functions—Utility of bathing—Cosmetic baths —Utility of friction—Dress and flannel—Hygiene of the muscular system— Exercise relieves the congestion of internal organs, evacuates more urea, in¬ creases perspiration, and expends the morbid concentrations of nervous energy —Modes of exercise—Equitation unadvisable—Hygiene of the nervous system—The habits of life should be suited to the exigencies of the period— Danger of suddenly communicating bad news—Sleep, and its adaptations— Sleeplessness—Travelling, and its combined advantages—Mineral waters not to be taken without advice—Mental and moral hygiene—Medical in¬ genuity sorely taxed—Various motives for consolation to be suggested to women—Autumnal beauty of woman—Management of society trusted to women after cessation—Woman’s chief mission after cessation, pp. 117—131

CHAPTEE VI.

DISEASES OF THE REPRODUCTIVE ORGANS AT THE CHANGE OF LIFE.

Table of liability to diseases of the reproductive organs during the c. of life— Liability to disease of the reproductive organs after cessation—Diseases of menstruation at the c. of life—Regularization of the m. flow—Case—Remit¬ tent menstruation—Treatment—Flooding—Diagnosis of flooding—Flooding from polypus, from uterine ulceration, from cancer—Causes of flooding— Dangers of flooding—Dangers of its too sudden stoppage—Treatment of the attack by antimony, ice, tannin, turpentine—Baths—Bandaging of limbs—Preventive treatment—Bleeding, sedatives, and salines—Leucorrhcea seldom a disease—Vaginitis—Its treatment—Nymphomania—Im¬ portance of the subject—Degree of frequency at the c. of life—Local disorders determining it—Nymphomania in after life—Follicular inflamma¬ tion of the vulva—Its degree of frequency at the c. of life—Treatment— Acetate of lead lotions ; acetate of lead powder ; sedative rectal injections; nitrate of silver lotion ; mercurial lotion—Prurigo pudendi—Frequency at the c. of life—Treatment—Valvo-vaginal neuralgia, a rare disease—Its treatment—Uterine diseases—Uterine catarrh and its treatment—Chronic, hard enlargement of the neck of the womb—Soft enlargement of the neck of the womb—Erectile growth of the neck of the womb—Ulceration of the neck of the womb—Its degree of frequency—Cases—Treatment of uterine

TABLE OF CONTENTS.

affections—Surgical treatment necessary—Nitrate of silver, solid and in solution—Injections—Treatment of chronic swelling of the womb—External application of tincture of iodine—Internal exhibition of Davenport’s syrup of iron and potassium—Potassa fusa c. calce—A safe application in skilful hands—Employed by some to cause a superficial eschar—By others, to cause deep loss of substance—its action uncontrollable in inexperienced hands—Uterine deviations frequently observed—Their freedom from pain —Fallacy of uterine mechanics—Uterine polypi—Their degree of frequency —Uterine fibrous tumours—Impulse given to them by the c. of life—Their frequent atrophy after cessation—Iodine treatment—Calcareous uterine tumours—Cancerous diathesis—Cancer most frequent from 40 to 50— Cancer of the womb most frequent during those years—Treatment of cancer—Belladonna—Cold-water irrigations—Ovarian chronic tumours — Their degree of frequency; effects on the m. flow ; often stationary at cessation ; treatment by iodine—Vesical affections—Hsematuria—Dysuria and incontinence of urine—Erectile tumour of the meatus urinarius—Sur¬ gical treatment by nitric acid —Mammary affections—Mammary irritation and discharges—Treatment—Non-malignant tumours—Sometimes atrophied,- at cessation—Cancer of the breast.pp. 132—160

CHAPTER VII.

DISEASES OF THE DIGESTIVE ORGANS AT THE CHANGE OF LIFE.

Table of liability to diseases of the digestive organs—The experience of other authors—Obstinacy of biliary affections at the c. of life—Cases of dyspepsia —Water-brash—Hsematemesis—Treatment of biliary affections by purga¬ tives ; mercurials ; alkalies ; bleeding ; mineral waters—Vichy and Aix en Savoie—Diarrhoea at the c. of life generally serviceable, sometimes dan¬ gerous — Cases—Treatment—Entorrhagia—Cases—Haemorrhoids—Their frequency tabulated—Causes of their frequency—Treatment—Bleeding and sulphur—Constitutional treatment—Inflammation of the rectum—Mild degrees unnoticed—A severe case.pp. 161—174

CHAPTER VIII.

DISEASES OF THE SKIN AT THE CHANGE OF LIFE.

Table showing the liability to diseases of the skin—Flushes, or “ardor volaticus”—Their aggravating causes—Dry heats—Burning sensations in the feet and hands—Continued sensation of internal cold—Sweats, their fre¬ quency ; less useful than perspiration ; difficult to check—Persistence of strength, notwithstanding sweats—Effects of supposed perspiration at the c. of life—Treatment—Small bleedings ; sedatives; salines ; acids • lotions ; powders—Treatment of suppressed perspiration—Hot and vapour baths— Cutaneous affections—Their frequency—Experience of other authors—Mr. Erasmus Wilson—Mr. Thomas Hunt—Case of nettle-rash at the c. of life— Cutaneous eruptions at puberty recur at the c. of life—Ulceration of legs—Varicose veins—Aix en Savoie—Its mineral waters . pp. 175_182

TABLE OF CONTEXTS.

xi

CHAPTER IX.

NEURALGIC AFFECTIONS AT THE CHANGE OF LIFE.

Table showing the relative proportion of neuralgic affections at the e. of life— Nervous endowment of the reproductive organs—Lumbo-dorsal neuralgia— Its frequency—Hypogastric neuralgia—Its frequency—Dry colics—Case of lumbo-abdominal neuralgia—Treatment—Sedative injections ; soothing li n i ments ; sedative plasters ; blisters ; wadding poultices—Paraplegia— Experience of other authors—R. Leroy d’Etiolles’ inquiry at the Salpetriere—Ollivier d’Angers’ case—Case showing the utility of leeches to the womb—Treatment—Martyrising the back unnecessary—Admirable effects of the waters of Aix en Savoie—Case of Sciatica—Case of intercostal neu¬ ralgia—Neuralgic affections of the eyes—Experience of other authors— Deafness at the c. of life, not senile deafness—Caused by inflammation ; by eczematous eruption of the external auditory canal; by pseudo-narcotism— Aphonia—Case—Treatment by ether; chloroform; emetics—Rheumatic pains—Their great frequency and causes—Treatment—Heat, in every form, beneficial—The baths and waters of Aixen Savoie useful . pp. 183—198.

CHAPTER X.

DISEASES OF THE GANGLIONIC NERVOUS SYSTEM AT THE CHANGE OF LIFE.

Table showing the liability to diseases of the ganglionic nervous system in 500 women at the c. of life—Diseases of the ganglionic nervous system said to be unknown—Sir H. Holland’s estimate of our knowledge upon this point—Physiology of the ganglionic nervous system likewise imperfect—Its anatomy a bone of contention—Claude Bernard’s experiments—-Dr. H. Jones’ views on ganglionic pathology—Debility and exhaustion—It under¬ lies all ganglionic affections—Sliding scale between the severest forms of cardialgia and the slightest sensations of faintness—Description of faintness —Leipothymia and syncope—Definition of syncope; of fainting; of faintness—Definition of fainting—Sliding scale between fainting off and the slightest sensation of faintness—Sudden death during convalescence explained—Sudden death of puerperal women explained—Senile syncope and its attempted explanation—Cardialgia—Cases illustrating intense epi¬ gastric pain—Cases of singular anomalous epigastric sensations—Cases of cardialgia with reflex intercostal and diaphragmatic neuralgia—Synonymy and opinion of other authors on similar cases—Neurosis of the vagus nerve —Causes of cardialgia—Brachet’s experiments—Effects of a blow on the epigastrium—The phenomena of vomiting partly attributable to concussion of the great ganglia—Spontaneous shocks to the great ganglia—Causes of cardialgia—Cardialgia common to both sexes, though most common to women at puberty, pregnancy, lactation, and cessation—Symptoms and diagnosis of cardialgia—Treatment of cardialgia—Power centralized in epigastric centre—Proved by common consent of mankind; by illustrious testimony; by the author’s practice—Local epigastric treatment imperative

TABLE OF CONTENTS.

xii to allay present suffering, and to prevent mental disturbance and habits of intemperance—Constitutional treatment—Treatment of the mild forms of cardialgia by various applications : sedative plasters ; morphine internally ; chloroform externally; blisters—Treatment of its severe forms by ammonia ; chloroform ; chloric-ether ; morphine externally ; veratria ; aconitine— Treatment of other practitioners—Oxide of bismuth and of zinc; hydrocyanate of zinc ; nitrate of bismuth; acetate of lead: nux-vomica; ices— Mineral waters of Aix en Savoie—Hot baths of Aix en Savoie—Chlorosis—• Its great frequency—Frequency at puberty and at cessation—Blood theory insufficient—Ganglionic theory of chlorosis—Local epigastric treatment required ..pp. 199—228

CHAPTER XI.

DISEASES OF THE CEEEBEO-SPINAL SYSTEM AT THE CHANGE OF LIFE.

Table showing the liability to diseases of the brain at the c. of life—Liability to the same diseases after cessation—Testimony of authors as to the frequency of cerebral affections at the c. of life—Nervousness, morbid irritability— Many modes of nervousness—Evidence of nervous plethora—Nervous irri¬ tability, the ground-work of all nervous affections—Headache—Sick-headache—Case of periodical headache—Cases of apoplexy—Pseudo-narcotism illustrated by cases—Description of pseudo-narcotism at the different periods of the reproductive process—Pseudo-narcotism alternating with cardialgia—Pseudo-narcotism after cessation—Instances of pseudo-nar¬ cotism cited by numerous observers—Pomme’s case—Sleep considered —Hysteria—Confusion respecting hysteria—Women at the c. of life little subject to hysterical fits—Subject to the minor forms of hysteria—Car¬ dialgia prefacing hysterical fits—Globus hystericus alternating with car¬ dialgia—Cases of hysteria at cessation—Epilepsy—Occurring only at puberty and at cessation—Cardialgia sometimes a prelude to epileptic fits—Case of the impossibility of speech at the e, of life—Case of fits and cutaneous erup¬ tion at the c. of life—Insanity—Comparative frequency in men and women —Period of life when insanity is most common to women—The c. of life a cause of insanity—Testimony of mental pathologists-—Forms of insanity— Delirium at the c. of life—Cases in illustration—Mania caused by the c. of life—Cases in illustration—Mania of old date subsiding into dementia at cessation—Hypochondriasis and melancholia—Great frequency at the c. of life—Causes of melancholia—-Case in illustration—Uncontrollable im¬ pulses and perversion of moral instincts—Their existence undeniable_

Legally admitted in the puerperal state and during menstruation—Should be ' admitted at the c. of life—Oinomania—Impulse to drink spirits; observed during the m. periods, pregnancy, and at the c. of life—Impulse to steal • observed at puberty, pregnancy, and at the c. of life—Impulse to murder • observed during disordered menstruation, pregnancy, puerperality, lactation and at the c. of life—Impulse to self-murder; observed at puberty, and at the c. of life—Theory of induction of cerebral affections at the e. of life—The blood theory of cerebral affections does not bear examination—Nervous theory of cerebral diseases alone trustworthy—Induction of nervousness;

table oe contents.

headache; hysteria; epilepsy; insanity—Influence of the ganglionic system on the production of hysterical phenomena—Influence of the ganglionic sy stem in the production of insanity—Cardialgia alternating with cerebral affections—Treatment of cerebral affections at the c. of life—Be view of general principles of treatment—Utility of topical applications to the head in cerebral affections—Vinegar and water—Camphorated vinegar and water

_Rasp ail’s “Eau sedative”—Camphorated ointment—Sedative ointments

—Lotions—Sponging—Affusions—Sedatives internally given—Urgency of sleep—Sedatives given by the rectum—Tonics—Prevention of cerebral affec¬ tions at the c. of life.PP- 229 283

CHAPTEB XII.

OTHER AFFECTIONS OCCURRING AT THE CHANGE OF LIFE.

Table showing the liability of 500 women to other affections at the c. of life— Gout, most frequent at puberty and at the c. of life—Table showing the rela¬ tive liability of both sexes to gout—Rheumatic affections—Great frequency at the c. of life—Causes of rheumatism—Ascites—Women most liable to dropsical affections—Breschet’s case—Consumption—Aggravated sometimes

__Dr. Quain’s experience — Bronchitis — Haemoptysis — Heart-disease —

Epistaxis—Otorrhcea—Summary.PP- 284—291

LIST OF TABLES.

Table I.

PAGE

Dates of tbe cessation of menstruation ..16

Table II.

Table of Marriages in Ireland for eleven years ending 1841... 19 Table III.

Fecundity of women at various ages.19

Table IV.

Humber of bachelors, spinsters, widowers, and widows, at different ages who were enumerated; also tbe numbers and proportions wbo were married in tbe year 1851.20

Table V.

Table of tbe number of marriages, and tbe issue from sucb mar¬ riages occurring in tbe eleven years ending 1841, for women of tbe ages under 17, 46 to 55, and above 55.21

Table VI.

Fecundity table for Sweden and Finland.21

Table VII.

Of 10,000 pregnant women, 436 or 43f per 1000 upwards of 40 years of age.22

Table VIII.

Ages of women dying from cbildbirtb in tbe year 1852 in England and Wales ... . . . . . 23

Table IX.

Date of last menstruation in tbe early menstruated and tbe late menstruated.26 xv i

LIST OF TABLES.

Table X.

PAGE

Causes of the early cessation, of the menstrual flow in 27 women . 28 Table XI.

Length of dodging-time.41

Table XII.

Duration of the menstrual function.46

Table XIII.

Influence of early and late menstruation on the duration of the menstrual function.47

Table XIV.

Terminations of the menstrual flow in 687 women.50

Table XV.

Monthly occurrences after cessation, in 53 out of 500 women . . 55 ' Table XVI.

Cutaneous exhalations in 300 out of 500 women.56

Table XVII.

Frequency of mucous discharges amongst 500 women at the change of life.64

Table XVIII.

Comparative frequency of haemorrhages at the change of life amongst 500 women..

Table XIX.

Showing the relative frequency of morbid liabilities at the change of life in 500 women..

Table XX.

Comparative morbid liabilities at puberty and at cessation . . 75

Table XXI.

Nature of the affections of 500 women at the change of life... 82

LIST OF TABLES.

xvii

Table XXII.

PAGE

Liability to diseases of the reproductive organs in 500 women . . 138 Table X X ITT.

Age of 2568 women who died of diseases of tbe sexual organs, in the Department de la Seine, from 1830 to 1835 . 157

Table XXIV.

Liability to diseases of tbe gastro-intestinal organs in 500 women. 161 Table XXV.

Liability of tbe skin to diseases in 500 women at tbe change of life. 174 Table XXVI.

Liability to neuralgic affections in 500 women at tbe change of life. 182 Table XXVII.

Liability to diseases of tbe ganglionic nervous system in 500 women at tbe change of life.199

Table XXVIII.

Liability to cerebral diseases in 500 women at tbe change of life . 229 Table XXIX.

Relative liability of women to insanity at different periods . . . 254 Table XXX.

Liability of 500 women to some other affections at tbe change of life 284 Table XXXI.

Relative liability to gout in both sexes at successive periods . . 285

TABLE OF CASES.

CASE PAGE

1. Cessation, supposed to be ehlorosis.32

2. Ulceration of tbe neck of the womb mistaken for cessation . . 38

3. Uterine polypus mistaken for cessation.34

4. Fibrous tumour of tbe womb during tbe change of life supposed

to be pregnancy . ..34

5. Uterine bydatids supposed to be tbe change of life .... 35

6. Cessation mistaken for pregnancy.38

7. Ditto ditto.39

8. Cessation and spurious pregnancy mistaken for pregnancy. . 41

9. Embonpoint caused by early cessation.53

10. Nervous disorders mistaken for plethora at cessation. ... 87

11. Plethora mistaken for nervous disorders at cessation .... 88

12. Utility of diarrhoea at cessation.92

13. Regularization of the menstrual flow after a long period of irre¬

gularity .134

14. Flooding from ulceration of the neck of the womb .... 137

15. Herpetic affection of the labia at the change of life .... 145

16. Ulceration of the neck of the womb at the change of life . . 148

17. Ulceration of the neck of the womb during the dodging-time . 150

18. Jaundice caused by cessation.163

19. Repeated jaundice at cessation.163

20. Chronic diarrhoea caused by cessation.165

21. Diarrhoea aggravated by cessation.. 166

22. Periodical entorrhagia caused by cessation.167

23. Repeated entorrhagia and haemoptysis caused by cessation . . 168

24. Habitual colics and constipation.169

25. Inflammation of the rectum caused by the change of life . . 171

26. Lumbo-abdominal neuralgia and remittent menstruation caused

by cessation.186

27. Frequent attacks of paraplegia, with ganglionic symptoms . . 189

28. Permanent paraplegia.190

29. Sciatica at the change of life.192

XX

TABLE OF CASES.

CASE PAGE

30. Cardialgia and reflex intercostal neuralgia, aggravated by the

change of life.193

31. Frequently recurring aphonia.197

32. Cardialgia caused by the change of life.204

33. Cardialgia at the change of life.206

34. Cardialgia, with anomalous epigastric sensations, caused by

the change of life.207

35. Cardialgia, with anomalous epigastric symptoms, caused by

cessation ..210

36. Cardialgia, with anomalous epigastric sensations, caused by

cessation. 211

37. Cardialgia with long-continued intense, debility.212

38. Spasmodic contraction of the diaphragm and intercostal

muscles, with subsequent intense debility ....... 213

39. Spasme simultan6 .de la glotte et du diaphragme.214

40. Periodical headache at cessation . ..232

41. Periodical hemicrania at cessation.233

42. Apoplectic fits caused by cessation. 233

43. Hemiplegia from cerebral congestion or hsemorrhage—suc¬

cessive attacks at four years’ interval.. . 234

44. Periodical nervous apoplexy.237

45. Pseudo-narcotism at cessation.. . 238

46. Pseudo-narcotism caused by the change of life.239

47. Successive fits of coma at the menstrual periods.244

48. Hysteria caused by cessation. 248

49. Short and sudden fits of the impossibility of speaking after

cessation.251

50. Fits, and eruptions of the face, caused by the change of life . 252

51. Delirium at cessation. 256

52. Delirium caused by cessation.257

53. Mania caused by cessation. 258

54. Insanity occurring at the change of life ..259

55. Apathy and sudden change of previous habits at c. of life . . 261

56. Melancholia, with suicidal tendencies, caused by cessation . . 262

57. Melancholia caused by cessation.264