DISORDERS OF THE ALIMENTARY CANAL.—Salivation.—Ptyalism has been observed by Bouchut and other observers to occur in connection with the other symptoms of the change of life. It is a phenomenon of infrequent occurrence. In the absence of any other adequate explanation it may be regarded as an example of sympathetic irritation strictly analogous to the salivation sometimes observed in pregnancy.
The milder degrees of this affection deserve slight attention. When, however, the flow of saliva is so great as to incommode the individual or seriously endanger her health, active treatment must be instituted. Chalybeate tonics, quinine, hypodermatic injections of atropia over the glands—especially the submaxillary—and iodide of potassium, are among the more reliable remedies. Astringent mouth-washes are grateful and relieve the congestion of the mucous membrane.
Constipation.—The habit of constipation, although not induced, may be aggravated, during the change of life. Interference with the action of the voluntary muscles and intestinal peristalsis by the deposition of adipose tissue in the abdominal walls and omentum, diminution of the intestinal secretions as the result of profuse perspirations and critical discharges, are etiological factors frequently referable to the menopause. Alterations in the innervation of the intestinal walls are probably productive of conditions which tend to constipation. The nature of the changes in the functions of the abdominal sympathetic nervous system during the menopause is a matter of pure speculation. There are many a priori considerations, however, which render probable the view that the constipation in connection with the menopause is, in some degree at least, a visceral neurosis. The prominence of the symptoms, enteralgia and flatulence, lends additional probability to this opinion. The treatment of constipation in connection with the menopause is a subject of the greatest practical importance. Many of the obscure nervous symptoms, distressing perspirations, and critical discharges may be relieved, if not prevented, by attention to the regular daily evacuation of the bowels. The specific hygienic and medical means to be used to secure this end are fully discussed in other portions of this work.
Diarrhoea.—Diarrhoea referable to the menopause and regarded simply as a critical discharge, sometimes, though rarely, passes beyond physiological limits and demands active remedial treatment. This statement holds true especially in cases of chronic diarrhoea aggravated by cessation. It is frequently a matter of extreme difficulty to draw the boundary-line between the physiological process and its pathological exaggeration. Careful attention to the symptoms, however, will usually disclose the fact whether or no the frequent alvine dejections conduce to the patient's well-being. Sometimes the stools are very profuse, and threaten life from the loss of large quantities of serum. Entorrhagia and colic are frequently observed under these circumstances. Rest, restricted diet, opium, the vegetable and mineral astringents, usually suffice to fulfil all the indications.
DISORDERS OF THE LIVER.—Many eminent clinicians unite in the opinion that functional derangements of the liver are peculiarly liable to occur during the change of life. Sir J. Y. Simpson, Robert Barnes, Tilt, Gardanne, Gendrin, Meissner, and Otterburg may be mentioned among the observers who hold that there is some direct relation between certain dynamic disorders of the liver and the menopause. There are also many a priori considerations in favor of this view. Habitual or long-continued constipation—a condition frequently observed in connection with the change of life—interferes materially with the secretion and excretion of bile. Barnes ascribes to the menstrual flow an excretory function. In the absence of this emunctory an increased amount of work is thrown on the liver and other secretory organs. The portal venous system is engorged. Under these circumstances disorders are apt to arise as the result of increased functional activity in an organ which may be undergoing organic change.
Well-pronounced jaundice, however, is of infrequent occurrence during this period in the absence of more potent factors than those just mentioned. It is not more justifiable to speak of the icterus of the menopause than of the icterus of menstruation. Flint24 has justly said that the occurrence of jaundice at the menstrual periods is too infrequent to suppose that there is any direct pathological connection, as implied in the term icterus menstrualis proposed by Senator.
24 Practice of Medicine, 1881, p. 637.
On the other hand, that condition vaguely described as biliousness, implying the constitutional effects of chronic hepatic hyperæmia, has been noted by many clinical observers. The derangement referred to is aptly described in the words of B. Lane and quoted by Tilt:25 "Nothing can be more common than to find severe biliary derangement occurring at or about the period of menstrual cessation; and, looking at the great physiological change which then takes place in connection with hepatic development, it is naturally to be expected. A woman will complain of being bilious; there may be a bitter taste in the mouth, a burning in the throat, frontal headache, nausea, and even vomiting, the urine high-colored, the bile abounding in the alvine dejections, and perhaps causing heat and a stinging sensation in the rectum; the tongue furred, a biliary tinge pervading the cutaneous surface." The propriety of ascribing the symptoms so graphically described in these words to excess, deficiency, or vitiation of the biliary secretion, in the entire absence of precise knowledge, may well be questioned. Tilt is of the opinion that the gastro-intestinal disorders produced by functional disturbances of the liver during the menopause are peculiarly obstinate in their resistance to treatment. Many other clinicians bear testimony to the truth of this statement. This fact increases the importance of the subject of treatment. As this matter is very fully discussed in other parts of this work, it is only necessary to call attention at this time to the importance of directing the therapy to the gastro-intestinal disorders, such as the accompanying subacute gastro-duodenitis and constipation, rather than to the hepatic viscus itself.
25 The Change of Life, 4th ed., p. 227, 1882.
Incidentally, it may be remarked that gall-stones are apt to give origin to distressing symptoms during the menopause. The causes in operation are substantially the same as those already mentioned in connection with the functional disorders of the liver.