from years. This is a dangerous period to women; more so, perhaps, than any other stage of maturity. In this island the menses usually cease about 48, 45, or sometimes at 41, and earlier; especially after frequent parturition. The springs of life, or generative powers, then become effete; but in the male sex, the faculty of procreation continues ten, twenty, and in some thirty years later. In most cases, women do not conceive before menstruation, nor after its cessation. Towards the final drain, women commonly are irregular in the recurrence, duration, or quantity of the discharge; which is often excessive. The longer or shorter duration of menstruation depends, in some degree, on its earlier or later commencement. Women who never had children, nor enjoyed sound health; those whose constitutions have been impaired by frequent parturition and miscarriages, and others of delicate nerves and structure, all these are frequently obnoxious to complaints and diseases at the final uterine ebb. As infirmities and bad health are frequently removed on the first flow of the menses, such are also again prone to relapse in this autumn of life, into nervous complaints, hystericks, consumption, dropsy.
Hystericks,
uterine suffocation, and female nervous diseases. This morbid Proteus rarely attacks before puberty, most frequently between puberty and middle age. Married and single women are obnoxious to it; but more so the latter and widows, and those barren, or irregular in menstruation. It is not so frequent amongst the laborious class, or those of clumsy organs, as in the higher ranks, and particularly in those constitutions strung to a morbid extreme of nervous and muscular sensibility and irritability. It may also affect females of robust muscular constitutions. It very rarely attacks the male sex; the only disease in them, somewhat analogous to it, is hypochondriasm. The regular hysterick paroxism generally attacks by surprize, with a sensation of some pain and fulness, and of a convoluted ball or lump, rising up from the lower part of the belly to the stomach and throat, where it seems to stick, and excites efforts to cough it up, or to gulp it down; with difficulty of swallowing and sense of strangulation, and often suspension of the functions of voice and speech. In others, the ball, without ascending, rolls tumultuously and convulsively round the abdomen. The paroxisms are preceded and accompanied with palpitation of the heart: the patient often falls down in a fainting fit, turns cold and pale, and the breath and pulse are scarce perceptible. Sometimes the paroxism deviates into immoderate laughter or tears; sometimes into muscular convulsions and distortions, resembling epilepsy; or into stupor and insensibility; and there is usually a profuse secretion of limpid urine; sometimes there is vomiting. After some remission and exacerbation, the paroxisms cease, the patient recovers, stupid, and seemingly dozing, with repeated sighing and sobbing; and generally with some remembrance of the paroxism. The form, duration, violence, recurrence, and repetition of the hysterick paroxisms are various, not only in different women, but even in the same at different times; and, however alarming in appearance, are seldom immediately dangerous to life: but by continuance, may derange the machine, and lay the foundation of diseases. They sometimes occasion, symptoms of dyspepsy; but oftener the appetite and digestion are unimpaired.
The prolifick brood of what may be termed Nervous symptoms, or irregular hysterick paroxisms, in their turn interrupt and disturb most of the important functions and organs of the human body; the brain and nerves; the heart, blood vessels, circulation, and respiration; the stomach and intestines. Amongst this medley of afflictions are nausea and vomiting, flatulence, coldness of the stomach, depraved appetite, indigestion, unusual cravings, colick pains, sudden flushes of heat and cold, formication, transient fugacious pains, fixed spasms, fainting, convulsions, headach, general or partial, and fixed like a nail in a small compass; vertigo, drowsiness, lethargy; alarm, trembling and starting at the least noise or surprize; the spirits sometimes exhilarated to excess, at other times plunged into despair: to these may be added timidity, capricious temper, palpitation of the heart, resemblance of spasmodic asthma, flow of limpid urine, or of saliva, difficulty of urine, night sweats; “cum multis aliis.” If the symptoms of each are properly understood, hystericks cannot be confounded with syncope, epilepsy, and apoplexy; to all which it has some resemblance.
The predisposing and occasional causes of hystericks are, excessive delicacy, sensibility, and irritability of the nervous and muscular fibres, and laxity of the muscular solids; retention and suppression of usual evacuations, especially the menses; scantiness and also excess in menstruation; fluor albus; profuse hemorrhages, and other evacuations by stool and urine; sanguineous plethora; hereditary; obstructions in some of the abdominal viscera, or in the circulation of the vena porta; scirrhous abdominal viscera; flatulence in the stomach and intestines; tough phlegm and sordes in the stomach and intestines; weak stomach; worms; improper food; drunkenness; indolent, luxurious, voluptuous, sedentary life; valetudinarian regimen; irritability of mind; passions of mind, particularly the disagreeable and depressing, as cares, grief, disappointed love, jealousy, frights, intense fixed mental application to one object, religion, envy, anger, grievous misfortunes, joy, concealed uneasiness of mind; celibacy; salacity; sudden and great changes in the constitution from menstruation, generation, pregnancy, and parturition; impure blood, its acrid tenuity; repulsion of cutaneous eruptions; general bad health, and diseased state of the fluids or solids; irregular gout. It is often difficult and impracticable to dive into the real efficient causes.
Childbed
Mortality in London is nearly one eightieth part of the whole funeral catalogue. It is in storms and hurricanes; or within a very short space of time. The mortality of this group must occur between the two extremes of 16 and 50 years of age. Or, as marriages in this island, one with another, are computed to commence on the side of the woman at 25, we may, with safety, rate the principal mortality in the stage of life between 20 and 50. On this interesting subject there are several curious and useful propositions, which I have attempted to establish by demonstrative proof.
These are, 1st, The number of women who, on an average, die in childbed: 2dly, The proportion between natural, laborious, preternatural, and complex labours: 3dly, The number of abortive and stillborn infants to those brought forth alive: 4thly, The proportion of twins and tergemini to single births: 5thly, The diseases principally fatal to women during pregnancy and parturition, and afterwards, with the arithmetical ratio and fatality of each, and also of labours. To the investigation of these corollaries I proceed in a regular order.
From twenty-four years of the London, and from several country registers in England and Germany, Dr. Short calculates, that on an average, 1 of every 60 women die in childbed: others rate the decrement at 1 of 66, or 3 in 200. Upon a much broader basis I formed a puerperal estimate. From the year 1700 to 1776, the christenings in the London registers amount to 1,220,656; and the abortives and stillborn in the same interval, to 46,831. The sum total therefore of the births, including the christenings and abortives, amounts to 1,267,487. During the above period of 76 years, the deaths in childbed are 17,057; which number employed as a dividend to the former, makes about 1 of 74 pregnant women to perish in childbed. But as a considerable number of infants, after being brought into the world alive, die before baptism or christening, and consequently are excluded from the publick enrolment of births and christenings, this is an additional reason for believing that the perils of childbed are not rated by us too low.
Respecting the proportion of natural, laborious, and preternatural parturition, Dr. Smellie says, “That of 1000 women in childbed, 920 of them will be delivered in the ordinary way, with little or no accocheur trouble, skill, or assistance: 70 more of the thousand will be difficult labours, or slow and tedious, when often some skill and aid of the accocheur will be necessary; and the remaining ten of the thousand will be preternatural labours.” There will, therefore, according to this author, be about 8 per cent. of slow, laborious, preternatural, and anomalous labours, which, in different gradations, will be more tedious, difficult, and dangerous than in the usual process of nature.