20 Diseases of Women, p. 283.
21 Change of Life, p. 197.
Leucorrhoea.—Closely allied in function to the floodings of the menopause is the profuse flow of mucus, unmixed with pus, from the cervix and vagina. This phenomenon is of frequent occurrence in connection with the other signs of the change of life. In the absence of local disease and constitutional vice it may be regarded as a critical discharge, an effort of nature to relieve pelvic congestion.22
22 Emmet, Gynæcology, 1884, p. 184.
Diarrhoea.—The recurrence of a profuse serous diarrhoea at more or less regular intervals during the change of life is common. Gendrin, Brierre de Boismont, and Chambon regard diarrhoea as habitual at this time. It acquires particular prominence as a symptom in the absence of the other critical discharges already mentioned. Indeed, it may constitute the only sign of the menopause apart from cessation of the menstrual flow. Care must be exercised, however, to differentiate in the concrete case between the purely functional serous diarrhoea of the change of life and those forms of the affection which depend upon local or general causes.
The explanation of the serous diarrhoea of the menopause, viewed as a critical discharge, is simple when the intimate connection between the pelvic circulation and that of the mesentery is considered.23
23 Ibid.
FUNCTIONAL DISORDERS IN CONNECTION WITH THE MENOPAUSE.—Vague, indefinite, and speculative as our conception of the physiology of the climacterium is, the deficiency of precise knowledge becomes more apparent when we come to consider the functional disorders of cessation. Many women pass through the change of life without the slightest disturbance of normal functional activity. In such women menstruation has usually been established at an early age and without local or general disorders. Moreover, all traces of disease of the uterus and adnexa are usually absent. Again, it is not an uncommon observation to see hysterical women, afflicted for years with uterine disease, begin to improve in health at an early stage of the pre-cessation period. These facts indicate that the change of life does not necessarily involve morbid phenomena.
In the large majority of cases, however, various functional and organic disorders are observed during this period of life. Under these circumstances it becomes a matter of extreme difficulty to distinguish between accidental complications, dependent upon collateral disease and pathological conditions of the pelvic viscera, and those disorders which stand in some causal nexus with the change of life. The scanty literature of the subject is to a great extent a mass of confused generalizations, in which the distinction between the relation of cause and effect and mere coincidence in point of time is seldom adequately drawn. Tilt's meritorious treatise is not free from this defect. In Table xxi., among the morbid liabilities at the change of life in five hundred women, heart disease, rheumatism, erysipelas, hysteria, epilepsy, cancer of the womb, ovarian tumors, and more than one hundred and fifty other pathological states are mentioned! Any paper on the subject at the present time, to perform a serviceable office, must direct attention to the obscure, confused, inadequate state of knowledge rather than aid in the perpetuation of error by the description of purely hypothetical forms of disease. The comparatively few functional disorders which stand in direct pathological connection with the change of life are, in the large majority of cases, examples of pathological exaggerations of physiological processes. Under these conditions it requires an unusual degree of diagnostic skill and penetration to draw the boundary-line between health and disease. Then in the matter of treatment, as remarked by Spiegelberg, it requires tact to determine how long a purely expectant attitude should be maintained and the time when active interference should be instituted.
The woman passing through the change of life possesses no immunity from accidental diseases. But some of these accidental diseases may be modified in symptoms and course by the changes consequent upon the climacterium.