Beverages: Water, with or without fruit juices or essences.
Changes in the above diet-table could very readily be effected, whereby the quantity of carbohydrate could be increased and the quantity of albumen lessened.
In women of sanguine temperament and full habit of body, who at the time of the menopause very rapidly become obese, important changes in the diet become necessary. The main principles of a fat-reducing diet are the following: Avoidance of all overfeeding, reduction of the quantity of food taken below the former average amount, with retention, however, of a sufficiency of nutrient material to maintain the metabolic equilibrium of the essential tissues; the maintenance of this metabolic equilibrium demands a sufficiency of nitrogenous foods, but the fats in the diet may be reduced to a minimum, and the carbohydrates may also be very greatly diminished. At the same time, there must be systematic bodily exercise, and the hours of sleep must not exceed a nightly average of seven.
For obese women at the climacteric period, a suitable average diet would contain 160 grams albumen, 12 grams fat, and 120 grams carbohydrate, yielding a daily heat-equivalent of 1,250 to 1,300 calories.
A sample diet-table constructed on these principles is appended:
| Quantity in grams. | Albumen. | Fat. | Carbohydrate. | ||
|---|---|---|---|---|---|
| Breakfast: | |||||
| A cup of weak tea | 150 | 0.45 | 0.9 | ||
| With milk, but no sugar | 30 | 1.29 | 0.9 | 1.2 | |
| White bread | 50 | 4.8 | 0.4 | 30.0 | |
| Lean cold meat | 50 | 19.1 | 0.9 | ||
| Dinner (Mid-Day): | |||||
| Small cup of clear soup | 100 | 1.1 | 1.5 | 5.7 | |
| Lean beef | 200 | 76.4 | 3.4 | ||
| Green vegetables, salad, etc. | 100 | 1.6 | 0.4 | 8.4 | |
| Fruit | 100 | 3.0 | 15.0 | ||
| Roll | 35 | 2.4 | 0.2 | 19.6 | |
| Afternoon: | |||||
| A cup of weak tea | 150 | 0.45 | 0.9 | ||
| With milk, but no sugar | 30 | 1.29 | 0.9 | 1.2 | |
| Supper: | |||||
| Soup | 100 | 1.1 | 1.5 | 5.7 | |
| Lean roast meat | 100 | 38.2 | 1.7 | ||
| Roll | 50 | 4.8 | 0.4 | 30.0 | |
| Total | 1,245 | 155.9 | 13.2 | 118.6 | |
In the selection of individual articles of diet, it is important to bear in mind the fact that in all climacteric women it must be our aim to stimulate intestinal muscular activity (peristalsis) and intestinal secretion to a moderate extent, for by more active intestinal secretion abdominal congestion is to some extent relieved, and by intestinal transudation and by diminution of the lateral pressure the circulation through the abdominal vessels is facilitated. By thus lowering the intra-abdominal blood-pressure, we shall assist in relieving a number of chronic hyperaemic states of the pelvic and various other organs, from which women are prone to suffer at the menopause. Hence all articles of diet must be forbidden which have a tendency to give rise to constipation. But we must also forbid all substances which leave extensive undigested residues, such as the rinds of fruits, large quantities of porridge, etc., hard meats, nuts, and the like. Most suitable are those articles of diet which contain large percentages of fluid constituents, such as milk, thin soups, weak tea (infused only a short time, so as to contain little tannic acid, which is very constipating), white meat—veal, breast of chicken, etc. Of vegetables, those are best which contain plenty of water and an abundance of the organic acids, young, fresh garden produce, lettuce, cauliflower, young green peas, young carrots, turnips, etc. Juicy fruits are good, apples, pears, cherries, and plums. Butter and honey are also excellent. In many persons suffering from constipation, all that is necessary for their relief is to give a tumblerful of cold water the first thing in the morning; with others, the use in addition of whole-meal bread with plenty of butter and honey and uncooked fruit, is required.
In women suffering from the various disturbances of the climacteric period in an aggravated form, either because the menopause occurs at an unusually early age, or because the suppression of menstruation has taken place suddenly instead of gradually—especially in cases of heart-trouble, severe vertigo, pronounced vasomotor disturbances, or mental excitement (also erotic excitement), I have sometimes found a methodical milk-cure carried on for several weeks most beneficial. By this I do not mean an exclusive diet of milk, but a diet consisting chiefly of milk and milk-foods; owing to the absence of all irritation of the nervous and vascular systems, this diet has a very definite sedative influence in such cases. The milk should be skimmed, and should be given four times daily in gradually increasing quantities, the total amount rising from ten ounces to fifty ounces daily. The only other meal should be a substantial mid-day dinner, consisting of soup, roasted white meat, young green vegetables, and a little fruit. In some instances, to prevent constipation, it is necessary to add ten grams of milk sugar to each glass of milk; in other cases it is necessary to dilute the milk with water. It is obvious that the quantity of milk given is not alone sufficient to maintain the metabolic equilibrium of the body; but the defect in this respect is made up by the substantial meal given at mid-day.
Among the stimulating influences which during the sexual epoch of the menopause are as far as possible to be avoided we must unhesitatingly include the practice of coitus, inasmuch as at this time of life there already exists a strong tendency towards the occurrence of hyperaemia of the reproductive organs; and sexual intercourse, increasing as it inevitably must this tendency to hyperaemia, should be indulged in as little as possible. And yet precisely in women of the climacteric age, in “la femme demi-vieille” there often exists a strong desire to drain the cup of sexual pleasure to its dregs. Not infrequently, therefore, the physician is asked to advise regarding the proposed marriage of a woman in whom the menopause is drawing near, the desired husband being young, or at least still fully virile. If the advice is given in all sincerity with a sole eye to the woman’s health, the medical man will definitely forbid the marriage.
When, however, the changes of the menopause are fully completed, when the woman’s reproductive organs have undergone complete senile atrophy, there is no medical reason why a couple who wish to give a tenderer name to an intimate friendship between man and woman, should refrain from marriage—provided that both have attained a like stage of sexual decline. “But,” writes Tilt, “a union between frosty January and blooming May is likely to be as dangerous to the health as it is to the happiness of both.”