THE MENOPAUSE.

Average Duration of the Menstrual Function; Duration of Menopause; the
Menopause; General Phenomena of the Menopause; Prominent Symptoms of
Menopause; Pathologic Conditions of the Menopause; Hemorrhage at the
Menopause a Significant Symptom of Cancer; Causes of Suffering at
Menopause.

  “Yet I doubt not through the ages one increasing purpose runs,
   And the thoughts of men are widened with the process of the suns. 
   Knowledge comes, but wisdom lingers, and I linger on the shore,
   And the individual withers, and the world is more and more. 
   Knowledge comes, but wisdom lingers, and he bears a laden breast,
   Full of sad experience, moving toward the stillness of his rest.”

—­“Locksley Hall.”

Average Duration of Menstrual Function.—­ The average duration of the menstrual function is from thirty to thirty-two years.  Raciborski estimated the duration of menstrual life at about thirty-one years and nine months.  According to him, the mean age of puberty at Paris was fourteen years and seven months; therefore, the average age of the menopause was forty-six and one-half years.  Tilt gives the average age of the cessation of menstruation in 1082 cases as forty-five years and nine months.  The average age is between forty-five and fifty years.  It has been shown by Krieger, Kisch, and others, that the earlier the menses appear, the later they cease, and vice versa.  However, when the first period is unusually early or late, the menopause comes very early.  Also that the sexual function is usually abolished earlier in the laboring classes, who are compelled to work hard and who have many cares, than in the well-to-do and rich.

Race does unquestionably influence the duration, but given a sound healthy race, which is not too much enervated with civilization, and the menstrual process will, equally with the total physical vigor and the vitality, be increased.  At the present day there is an increased sexual vitality, which shows itself in the fact that the duration of menstrual life has been increased three to four years during the past generation.  The inference can be fairly deduced that vigorous vitality causes prolongation of the menstrual process and the actual age.

Duration of Menopause.—­ By the menopause or climacteric is understood the whole period from the beginning irregularities in the time of appearance of the menstrual flow until its actual cessation.  The average duration of the menopause is from two and a half to three years.

The Menopause.—­ The menopause is a physiologic and conservative process.  It occurs at a time of life when all the tissues are most stable and the nutrition of the body is at its best.  Other physiologic changes which occur at the same time are decrease in the size of the spleen and lymphatic glands, the muscular coats of the intestine atrophy, and lessened peristalsis ensues; hence the increased tendency to constipation.  These are not the degenerations of age, but the blood-supplying, blood-making, and blood-elaborating organs of the body have completed the growth of the organism, done their work, and are striking a balance with the needs of the economy.