Causes of Suffering at Menopause.—­ Dusourd, whose practice lay in an agricultural district in the south of France, as well as Tilt, believes that peasant women suffer little at this time.  Their health is generally good when the menopause comes on and they are little liable to nervous disorders.  The poor of large towns suffer much at this epoch—­ the necessity of working hard, the anxieties of poverty and their unhygienic surroundings.  But by a fortunate compensation the necessity for working hard prevents or cures the nervous affections which so often assail the rich at this period.

Tilt’s cases showed that women who suffered much at the menopause had previously suffered at puberty and at the menstrual periods.  And among thirty-nine cases where there was no suffering at the menopause, there was the same immunity from suffering at puberty and at the menstrual epochs.

Tilt’s statistics were, or course, taken from English women.  In forty-four cases of my own, all women past the menopause, the average age of the first menstruation was fourteen years and four months; and the average age of the actual cessation of the menstrual flow was forty-eight years and five and two-thirds months.  Subtracting from this the average age of the first menstruation, we have as the mean age of menstrual life thirty-four years one and two-thirds months; that is, the average duration of the menstrual function was from two to four years longer than that usually given.

A further investigation in order to ascertain any possible relation between the age of marriage and the number of pregnancies and the sufferings of the menopause elicited the following statistics.  The average age of marriage was twenty-five years and ten months.  Of the four women who were married after thirty-eight years, all were sterile; among the remaining there was an average of slightly above three children each.  Forty per cent. of all these cases had one or more miscarriages.  Nine had habitually suffered from severe dysmenorrhea, eleven had slight dysmenorrhea, and twenty-two had never felt the slightest inconvenience.

In a list of fifty-two cases, eight were added to the list already given, all of whom had passed the menopause.  Five were perfectly healthy and had never suffered the slightest inconvenience.  Of these, one was single and only one had one miscarriage.  Ten had suffered at the time of the menopause from slight malaise, but not sufficiently to call in a medical attendant.  Thirty-seven were more or less seriously ill; thirty of these needed local as well as constitutional treatment, and seven constitutional treatment only.

The prominent symptoms of the climacteric were as follows:  Marked debility, 24; intense nervousness, 31; nervous prostration, 9; melancholia, 10; headache, 14; neuralgia, 6; hysteria, 7; irritable heart, 11; tachycardia, 8; insomnia, 19; indigestion, 32; constipation, 28; diarrhea, 3; leucorrhea, 38; rheumatism, 21; gout, 1; Bright’s disease, 12; hemorrhage, 6; alcoholism, 2; corpulency, 2.