As a result of the study of these cases, the most striking feature was the relation of miscarriages to the sufferings and ill health at the time of the menopause.  Of the nineteen women who had miscarriages, only one did not suffer in some way at the time of the menopause.  Four suffered only slightly, and fourteen suffered extremely, not only during the menopause, but in the post-climacteric period as well.  And the next most striking feature was that the prominent symptoms of the menopause are preeminently reflex or the functional diseases of the nervous system.

Tilt believes that single women suffer less than other women at the time of the menopause.  He further writes:  “As at puberty, from the ignorance in which it is still thought right to leave young women, so at the change of life, women often suffer from ignorance of what may occur, or from exaggerated notions of the perils which await them.  It would be well if they were made to understand that if in tolerable health, provided that they will conform to judicious rules, they have only blessings to expect from the change of life.  Most unfortunately, the individual not cognizant of the invisible changes going on in the economy does not adapt the mode of life to the new conditions of the organism, and the weakened and lessened amount of the digestive fluids is unable to master the large quantities of food.  The absorbents refuse to take more than is needed to repair the tissues.  The atrophying muscles of the digestive tube, unable to hurry on the mixed products of indigestion; fermentation; and micro-organisms inciting fermentations and elaborating toxic alkaloids, poison and disorder the functions of life.  Man’s outdoor life enables him to escape many of these evils.

“Woman’s enervating mode of life, the continued introspection, coupled with the peculiar changes in the nutrition of the body at this time, render the nervous system peculiarly impressionable and liable to the manifold forms of diseases.  ’The woman is told that she must be calm and patient, and in time the tomb-builder will alleviate all her sufferings.’  This critical period may be dangerous to those who are always ailing, for habitiual sufferers at the menstrual periods, and for those affected with uterine diseases.  If, on the first indication of the change of life, women who are in fair health carefully followed a regimen and pursued a line of life in harmony with the physiologic processes on which this change depends, disease would be prevented.  But as the change concerns a natural function, it is left to nature; no additional precautions are taken, and advice is sought only when the mischief is done.”

It is not wise to marry during this period.  On the first appearance of the irregularities of the menopause the amount of food and stimulants to which women have been accustomed should be curtailed rather than augmented.  The system requires supporting by medicine and regimen—­ as, baths, mental and moral hygiene, and occupation—­ rather than stimulating by spirits.