THE CHANGE OF LIFE IN WOMEN and the ILLS AND AILINGS INCIDENT THERETO by J. COMPTON BURNETT, M.D.
It stands in evil repute does the change of life in women; and when a more than usually curious patient enquires of us the nature of this or that, and we reply, “Oh, it is the change of life!” a more or less sufficient reason is thereby supposedly given, and the women is heard resignedly to exclaim, “Ah, I suppose I must except trouble at my time of life!” But why should poor woman except trouble at the change of life? That she does, a a matter of fact, often suffer at and after that time of life is all too evident; but again, Why?
Surely the thing can be accounted for, and measures taken to prevent, cure or palliate said sufferings.
Girls are more forward than boys at a given early age up to the looming of the menses, as any of us can see in our own families; but no sooner does menstruation begin than the superiority of the girl over the boy is at and end. The boy slowly gains upon her and becomes more aggressive, and the girl more retiring..
The explanation of this lies close at hand, -the girl’s digestion and assimilation are so arranged that she shall for some thirty years or so of her life’s course, from puberty to menopause, make blood enough for her own maintenance and activities plus what should or might be needed for gestation and lactation, the menstruation being primarily a means of maintaining her equipoise by throwing overboard at stated times a given not called for blood supply, prepared by the time of each ovulation as a possibly needed food reserve, which throwing overboard of said supercargo does not occur if impregnation of the ovule take place. It is this menstrual arrangement which must be kept in view if we are to understand the change of life and its sequels, and indeed if we are understand women’s diseases at all any period.
The resignation of many women to their various sufferings is to me often absolutely astonishing, and many times have I enquired of my professors, of books, of myself, and finally of old mother Nature, what this change really is. It is not a little instructive to work out clinical problems for one’s self, just as they really are, without the godfathership of schoolmen, who often seem to me to stand between truth and one’s mental vision; we very commonly learn our professor’s teachings only, and never see the things themselves.
Unobscured by Preconceptions
The importance of the change of life in the practice of medical men, notably in those who see much of diseases of women, needs no demonstration. The change of life is very commonly regarded as something positive that, so to speak, attacks the woman’s health, “I suppose it is all the ‘change’,” one hears very constantly.
Now, what is this “change of life” that causes so much misery to so many women?
I am treating a lady for haemorrhoids that bleed furiously here and there, causing alarming symptoms of faintness, so that tonics and stimulants are in constant requisition.
“My family doctor says I must undergo an operation for the piles, or I shall never get well, but I think myself it is all the change.”
I saw a lady yesterday for rheumatoid arthritis and lumbago; she is fifty one years age, and the ends of her finger bones are getting knobby, and the erstwhile elegant little hand, with tapering fingers, is becoming “full of horrid knobs,”…… said she, “I suppose it’s due to the change of life; you know I have turned fifty, and those things have left me.”
And continuing – “And these horrid flushes: my family doctor has given me no end of things for it, and Dr. Jones gave me Lachesis and you gave me Urtica, but nothing has done me the least bit of good.”
If we are to understand what a CHANGE of life signifies we must first have a clear notion of what that LIFE really is, that in its “Change” is so surest. Life in general, as common to both man and woman, I am here not dealing with, but with its modification as manifested in the female, and specifically with that part of her life which is called THE CHANGE, which change consists in the cessation of the monthly period, and with this leaving off of the menses seemingly begin the ills and ailings incident thereto. Not that they really begin in the individuals at the menopause they were for the most part there before only that at this time of life the manifestations change form.
In order to get clear idea of the subject are considering, we must first have a just conception of what the menstruation that here leaves off really is, so let us dwell a little on the subject.
We need not go far afield to get at the bottom of this function in its main essentials. The normal woman, as we all know, ovulates in certain known cycles in order to supply the ovule necessary for continuing the race, but as the ovule seeking spermatozoon may not be in the way, and in obedience to its own life-history, the ovule appears at intervals. Should the ovule meet at the proper trysting place, and there marry the spermatozoon, we have normal impregnation.
We have here nothing more to do with the ovule, the product of each menstruation; but we must see what good the menstrual flow itself may be, apart from being the medium of the ovule. The flow itself stands before our minds thus:- Suppose the monthly period were a mere ovulation and nothing more, how would matters stand? The woman would have nothing wherewith to nourish the impregnated ovule; with each ovulation there is a menstrual flow of the vital fluid; and if there be no impregnation, the flow is, as we have seen, cast away as waste, purely and simply: with the ovulation and for the contingency of an impregnated ovule, comes the flow.
After impregnation the period ceases. Why? Because the nourishment it contains is needed within the economy of the mother for feeding and building up the child, AND FOR STRENGTHENING the woman for the work of parturition, and then for suckling. The expansion and consolidation of the woman during gestation is very striking and remarkable, and for this extra growth food is required, and this can only come from her own blood.
Thus the normal woman’s digestion is equal to producing blood enough for himself, together with a monthly surplus, which goes to waste if the ovule meet with no spermatozoon; but if it does, and due fructification result, the woman’s organism simply goes on as usual, only the monthly surplus is here not cast away as waste, but is retained and used for building up the new being until it is born, and then during lactation there no monthly flow, as it is diverted into the breasts in the form of milk, to nourish the babe during the early months of its life till its teeth grow, and then in due course the breasts become dry, the female organism reverts to active menstrual life, and goes over the same ground again and again within its known limitations. But that is not all!
The Menses Constitute a Means of Purification for the Organism.
The monthly flow, however, subserves a further use, viz., that of purifying the woman’s blood and through it her organism; and here we must pause and fix upon our minds the importance of this monthly loss as a means of purifying the entire individual for the time being, for herein lies the central idea of this work.
With the monthly period the woman throws away her disease elements and products, her monthly period is a monthly purification.
Has any one ever seen normally menstruating woman in an acute attack of gout of the classic variety? I never have; clearly the gout is cast out menstrually. And so we observe that menstrually active women have- apart from their own peculiar ailings- by far fever diseases than the corresponding man. So much is this the case, that women commonly live longer than men, and this I attribute top their power of monthly purification, to a very large extent.
In my opinion it is very rare for a woman to die of childbearing, through deaths in childbed are not uncommon; at any rate I have rarely known a woman die “of” childbed: in childbed, yes.
Assuming that there is no danger of blood poisoning from the accoucher of nurse, or from food, air, or water, or what not, and assuming that the woman is well built, and that she have no CONSTITUTIONAL TAINT, then there is practically no danger in child- bearing.
Deaths in childbed are very largely due to pre-existing disease proclivities in the parturient person, and these are generally expressed by inflammation and haemorrhage. The most common causes of childbed mortality are certainly inflammation and haemorrhage.
Haemorrhage is, most usually, due either to a consumptive taint of the individual expressed in the pelvic parts, or to other locally expressed disease, and is no necessary part of child- bearing. That is to say, child-bearing is, in the normal and under healthy conditions, a healthy thing, fraught with absolutely no danger whatever to the parturient person, all danger is from the abnormal. A distinguished lady journalist wrote not long since that a women ” descended into the valley of the shadow of death in order to bear a child!”
What ineffable twaddle!
Dysmenorrhoea, or Painful, Menstruation.
Pain at the period is so very common that not a few regard the pain as a part of the bargain. Such is, however not the case by any means. I am prepared to grant that a little discomfort and malaise may be normal to the time of the period but only very slightly so; if it ever comes to pain, there is something wrong.
I hold that every woman who suffers from dysmenorrhoea is, so far, abnormal and ailing in some particular; it may not be much, but pain at the period is not normal.
The precise amount of the period to be within the limits of normality is not easy to determine, depending as it does on family, race, mode of life, and other things; still we can in a given case fairly easily determine where enough leaves off and the too much begins.
Just a pain at the period proclaims that something is wrong, so does an excess of the flow, in an even louder tone. I have noticed many, many times that whenever a woman has persistently suffered from excessive menstruation, the change of life rarely fails to disclose the cause; for, as the flow diminishes, so in equal pace, do some other constitutional ailings crop up. A very common thing is rheumatoid arthritis, expressed as swelling of the bones of the fingers.
When the menorrhoea ceases we call it amenorrhoea. That this state is wrong needs no demonstration, and of course the same may be said of insufficient menstruation.
It lies without the scope of this little work to dwell upon menstruation other than in this short manner. We are here concerned more with its final cessation, and thus only glance at it in outline to get a clear notion of where we are in considering the Ills and Ailings incident to the Change of Life.
We may as well begin with, perhaps, the most common of all post- menopausal troubles, viz., The Flushes.
Heats and Flushes
One of the most common complaints of women after the menopause is Heats and Flushes, and the phenomena are very curious and not easily understood. Personally I have never been able to satisfy my mind whether they are morbid or normal; but all things considered, I incline to the view than they are not normal.
When I first read that Lachesis controlled these flushes, I was very much astonished, and took an early opportunity of putting the statement to the test of clinical experiment, and found it quite true. Forthwith I jumped to the conclusion that Lachesis cured this flushes; but after a time I found that though they are to a large extent controlled by it, they are not really curable thereby. The flushes persist in recurring.
The same may be said of Glonine, but of this I have but small experience. Dr. Richard Hughes speaks very highly of it. The similitude offered by the provings of Urtica urens to the flushes led me to use it in lieu of or after Lachesis, with the same results, viz., – prompt but passing amelioration. And there the matter rests with me. A genuine cure of the flushes as a morbid entity I do not know. We must fall back on the repertory, and find the similimum for each individual case an awful labour, deny it who may. That something which lies behind the symptoms of the flushes is to me an unknown quantity.
Leucorrhoea in Relation to the Menopause
Ordinary leucorrhoea ceases with the period to which it very commonly stands in relationship. Where the whites persist after the change of life, we must regard it as the expression of a morbid constitutional state, and very often of positive womb disease. And as Leucorrhoea usually ceases with the period, the organism is also thereby robbed of a constitutional outlet for many morbid products. This may not be orthodox doctrine in the schools, but it is certainly the doctrine of nature, as any clear unbiased observer may see for himself. The practice of using injections for the whites is utterly bad, a downright sin against nature’s ways.
Years ago I was called upon to treat a young wife for a small tumour of the breast (interstitial mastitis) that much puzzled me; patient was accustomed to use injections for the whites, and do this I attributed the lump in the breast. My view of the case was so distasteful to the lady and to her husband that I was dismissed as an incompetent adviser. The sequel proved, however, that I was right, and after the lady’s death, the grief-stricken husband came round to my view –too late.
For twenty years I have noting the ill- effects due to the suppression of the whites by injections, and I could fill a book with proofs thereof. I take every opportunity of denouncing the practice as altogether damnable. If you cannot cure the cause of the whites, for heaven’s sake let the thing alone- at least do no harm. But patients will have them, colleagues tell me. Will they? They never have them from me, and the thing, duly explained to the sufferers, usually offers no difficulties. Moreover, leucorrhoea can be readily cured by homoeopathic remedies, and injections are therefore needless.
The talk about personal cleanliness and comfort is mere moonshine: all mucous membranes are self-cleansing, and the use of injections, far from being sweet and clean, is in fact a dirty proceeding. Why, the epithelial cells are being constantly cast off with all the impurities clinging to them, and extruded from the body, and exquisitely clean brand new cells are left behind – the tubings of the human body are living tissue, not drainpipes.
Who cleans the lining membrane of the faeces carrying gut? It is self- cleansing, and so is the lining membrane of the civilized world tell their lady patients to use vaginal injections for purposes of cleanliness: the error of this teaching is stupendous, and fraught with untold evil consequences, and nasty and vulgar to boot. Am I conscious of the terrible opposition my thus expressed view of the perniciousness of the practice of using vaginal injections will call forth?
I am, and defy it all. The practice of using vaginal injections is damnable, and I damn it accordingly. Leucorrhoea is not in itself and the disease, but the cause of the leucorrhoea is the disease. And not only so, but the leucorrhoea is of many different natures and qualities, just the same as is haemorrhage: in fact, what is leucorrhoea but haemorrhage without the red blood corpuscles? At this point it seems almost imperative to prove that leucorrhoea is a constitutional ailing that may not be suppressed; but its full consideration here would lead me too far away from ” the Change of Life,” when the whites is a thing of the past.
Nature’s Days of Wrath and Vengeance
So long as the menses offer an outlet for disease products and disease germs, so long is the organism of the woman kept free for the time being;but neither primary nor what I would term “echoic” disease are thereby cured, and we may very aptly compare the state to that of baling- out a leaky ship; if the baling out process be adequate the navigation of the leaky ship is not greatly interfered with, but if the baling -out is less than the leakage the water accumulates and in time sinks the ship.
Precisely so is it with the diseases of menstruating women: during the period of active menstruation the bailing -out of disease elements by the female organism is commonly adequate, and the woman lives on fairly well; she is indeed a leaky vessel constitutionally, but the leakage of the month is baled out, so to speak, with every menstruation. And just as with the leaky vessel, the time of the ultimate sinking comes on by degrees, not all at once; so, as the menopause begins to cast its shadows before it, we see symptoms in our patients of defective depuration in the from of “spasms,” dyspepsia, rheumatoid arthritis, uterine trouble, tumours, eczema, asthma, cancer.
Let any physician listen attentively and sympathetically to the health-histories of a few scores of ladies in their sufferings at the change of life, and carefully note all their historic points, and he will find that the troubles at the change of life are not of the same, but far anterior to it: the ills and ailings incident to the change of life in women date from, often, far back in their lives, or in the lives of their parents, and are, as it were, the stems, branches, leaves, flowers, and fruits of the long-gone-before.
This in a general way, I will come to the concrete anon; here I merely desire to state in general terms the ground -thought that many of the ailments at and after the menopause seem to me to be, so to speak, nature’s wreakings of wrathful vengeance for persistent disobedience during the previous course of the life, and by Nature I mean the laws of nature in accordance with which we do not reap oats when we sowed barley. What evidence of this can I bring?
Let me go to some of the first of the cases that have passed under my own observation, and which I took down from time to time.
Addison’s Disease from Suppressed Leucorrhoea
In the month of July, 1982, a New York merchant brought his wife to London to place her under my care for vomiting, great debility, weakness, and a brown discoloration of the skin. Patient was forty-one years of age, and was still regular, but had had no children. That Addison’s disease is a branch of the tree known as tuberculosis seems very possible; but although this patient was in a state of debility in her youth which bordered, they said, on consumption, and her own father had succumbed to phthisis, still the most striking symptom was a fearful backache that resisted all treatment, and in the main my remedies did patient but very little good.
It did not matter whether the remedies chosen were high, low, or medium, or whether the prescriptions were routine ones, “snap-shot” ones or laboriously repertorial — they all failed more or less; and although amelioration frequently set in here and there, and patient would begin to get better and to carry a little healthier colour, still none of the spells of improvement was lasting– mine was a veritable work of Sisyphus. So passed three years, till one day she exclaimed to me – “I have the whites, and I am now not able to check them like I have been.”
Further conversations elicited the fact that the beginning of patient’s ill – health coincided with the cure (?) of her severe leucorrhoea with injections! And during all these three years of my generally pretty close prescribing, as soon as she began to mend a bit the whites appeared, whereupon these were attacked and quelled with injections, and patient went worse again! It was a very different affair as soon as the injections were given up, and in a few months patient was vastly improved, and got into fair health, but never really well, and died of vomiting and debility after a very long railway journey, followed by a long carriage drive in the cold in July, 1896, no doubt of Addison’s disease.
I quote the case here merely to show the part in it played by leucorrhoea, otherwise it does not touch our subject very closely. But it brings home to my mind the fact that in this case, at any rate, the leucorrhoea was an outlet from the economy, and beneficial to it in the same sense as a leaky boat may be kept afloat by adequate bailing-out of the water, no matter how laborious the bailing-out might be. It is most probable that if this lady’s leucorrhoea had been let alone, she would have fared better; and had the causal tuberculosis been first cured, early in life Addison’s disease would never have developed.