For these reasons it is an established rule in practice to inform women of the tuberculous diathesis of the dangers entailed by the marital relation. A woman affected with tuberculosis ought never to nurse her own child. As a rule, however, there is seldom any necessity for such a warning, as the function of lactation is rarely established under these conditions.
FUNCTIONAL DISORDERS IN CONNECTION WITH THE MENOPAUSE.
BY W. W. JAGGARD, A.M., M.D.
DEFINITION AND TERMINOLOGY.—The time of life in a woman when the natural cessation of ovulation and menstruation occurs has received a variety of appellations more or less descriptive of the phenomena which are supposed to precede, attend, and follow that event. Change of life, Turn of life, Critical time, Climacteric, in English; Das klimacterium, Das aufhören menstrualer Ausscheidung, Das aufhören der Weiblichen Reinigung, in German; Ménopause, Âge de retour, Âge critique, Temps critique, in French; Cessatio mensium, Climacterium, in Latin; Menolipsis, in Greek,—are terms used to mark out a certain period of time commencing with the functional and organic disorders connected with the cessation of ovulation and menstruation in a causal relation, and terminating with the permanent resettlement of health.
DATE OF CESSATION OF MENSTRUATION, AND DURATION OF THE CHANGE OF LIFE.—The function of ovulation, as far as we know, ceases with the discontinuance of menstruation, although immature ova still exist in the ovaries. The date of natural cessation of menstruation and ovulation is variable in different women. It is difficult to determine an average date, because the menopause may be gradually ushered in, and then women are apt to interpret any genital hemorrhage as menstruation. In certain cases the menstrual flow may cease between the ages of thirty and forty years, or even at an earlier period. On the other hand, the function has been noted by competent observers1 to continue up to and beyond the sixtieth year. According to tradition, Cornelia, the mother of the Gracchi, was confined in her seventieth year. Parvin2 has recently called attention to another historical instance of alleged late menstruation, recorded in a note to the fifty-sixth chapter of the Decline and Fall of the Roman Empire. On the authority of D'Herbelot's great work, Bibliothèque orientale, 1777, Gibbon mentions the case of Asima, the mother of Abdallah. When the tidings of the death of her son were borne to Asima her menses reappeared at the age of ninety as the physical effect of her grief. The historian informs us that the flow proved fatal in five days. These anomalous cases of so-called protracted menstruation are frequently examples of pathological hemorrhages dependent upon structural changes, sometimes of a malignant character. Even admitting the possibility of the condition of extremely protracted menstruation, such cases, as remarked by Playfair, like examples of unusually precocious menstruation, cannot be regarded as having any bearing on the general rule.
1 Tilt, The Change of Life, 4th ed., 1882, p. 24.
2 The Medical News 26th Sept., 1885, p. 352.