It is a deplorable state of affairs that women, not knowing what a normal climacteric is, attribute all hemorrhages, no matter how severe, to the change of life.  Therefore, regarding the hemorrhage as a necessary evil, they fail to consult a specialist until the favorable time for eradicating the disease by means of an operation has passed.  And whatever knowledge science may bring in the future as to the cure of cancer, at present it is a fact universally agreed upon that early operation, while the cancer is still local, is the only radical cure for the disease.

Pruritus Vulvae.  Perhaps one of the most annoying and obstinate symptoms of the menopause is pruritus vulvae.  This is sometimes caused by sugar in the urine; there is a congestion of the liver which results in sugar being thrown into the system and this is eliminated by the kidneys.  It is quite possible that this is due to the altered circulatory conditions of the menopause.

Kidney Disease.—­ The last pathologic condition which we will mention is kidney disease.  Le Gendre believes that the menopause exerts a deleterious effect on the kidneys, whether this be a congestion, followed by a diminution in the quantity of urine, or a sort of auto-intoxication due to the retention of a poison in the system that has been prevented from leaving by the ordinary path.

Armstrong says that in almost all cases at the time of the menopause the amount of urine passed is below normal, the specific gravity is increased, and that the urine contains urates and almost always uric acid in excess.  Further, that the functions of digestion and assimilation and the various metabolic changes are so largely under the control of the nerve-centers that nothing seems more likely than that so great a disturbance of that system as takes place at the menopause should cause secondary derangements of these most important functions.  That being so, the blood becomes loaded with waste products, and the usual symptoms follow—­ gout and so forth.

It has been a grave question in the mind of the medical profession whether the dangers that certainly do attend the menopause are natural or acquired; that is, could these dangers be averted by any precautions or hygienic measures on the part of women, or are these dangers a necessary accompaniment of this period of life?

Tilt has reached the conclusion that:  “The best way to avoid the dangers of this critical time is to meet its approach with a healthy constitution.  A marked want of strength prevents the regular succession of the vital phenomena by which all critical periods are carried on.  And as the change of life is marked by debility, when this is grafted on constitutional weakness, loss of power will be of long duration.  All complaints remain chronic because there is not stamina enough to carry them through their stages.”