CHAPTER XXIX THE MENOPAUSE AND OLD AGE (Part 3)

in which the birth of his wife was recorded as having been May 5, 1801. July 3, 1853, Dr. Robson having died, I attended this lady in her second con- finement. The mother and both daughters (now married) are still living." John Davies (Lond. Med. Gazette, 1847, Vol. 39, p. 950) reported the case of a woman proved to be sixty-three years old by her baptismal certificate, who had a child when fifty-five years old. The child, a girl eight years old, the youngest of eleven children, was brought to see Dr. Davies. The mother had not menstruated since the birth of her youngest child and she thought that men- struation had begun early, when she was twelve or thirteen years old. More remarkable still is a case reported by W. J. Kennedy (Trans. Edinburgh Obstet. Soc, 1881-82, Vol. VII., p. 77) of regular menstruation and a child born at sixty-two, to a thrice-married woman, the mother of twenty-one children. The facts in the case are well authenticated, Dr. Kennedy having known the woman for ten years and attended her in her last labor, in November, 1880. I ler husband, when applying to the parochial board for relief in 1879, stated that his wife was then sixty years old. She was borii in October, 1818, and was first married in 1838, her husband dying after one child was born. By her second husband she had nine children, (wins once, and two miscarriages, and by her third husband eleven children and one miscarriage. Her great fecundity outlasting the THE MENOPAUSE 603 normal limit and the regularity of childbearing are attested by the following table of the years when the last pregnancies oc- curred : — Year Age of Patient 1865 47 1867 49" 1869 51 1871 53 1874 56 1878 60 miscarriage 1880 62 Apparently ovulation continues sometimes after menstruation has ceased, as attested by the following cases. Taylor ("Medical Jurisprudence/' p. 736) reports the following: "A woman at forty- four had given birth to nine children. Then the menses were scanty at the regular periods for two years. They then ceased entirely for a year and a half and at the end of that time she , wTas delivered of her tenth child. Therefore, conception must have taken place eight or nine months after the cessation of the menses." R. G. Hann (Journ. Obstet. and Gyn. of Brit. Empire, 1902; Vol. II., p. 290) reports the case of a woman who in her forty-ninth year gave birth to her thirteenth child after a period of amenorrhea of three years following the birth of the twelfth child at forty-six. That ovulation may take place without menstruation the patho- logical finding of De Sinety (Progres medical, 1877, No. 23, p. 450) goes to show. He described the post-mortem appearances in a woman thirty-eight years of age who had never menstruated. The uterus consisted principally of cervix, as in the fetus, and the uterine cavity measured one and a half to two inches in length. The ovaries contained numerous corpora lutea. I think we may assume that menstruation as well as ovulation occasionally lasts as late as sixty years. Kisch (loc. cit., p. 27) cites a case of Brierre de Boismont as follows: — The woman men- struated first at twelve, was married, had several children, and continued to menstruate without interruption until sixty, after which she had an irrregular show for four or five months. Raci- borski (idem) observed in the Salpetriere one woman who men- struated at fifty-seven, one at fifty-six, one at fifty-three, and two 604 THE MENOPAUSE AND OLD AGE at fifty-two. Tilt (loc. cit., p. 26) gives the following list of his cases of over fifty years of age, including fibroids, cancer, and all diseases presumably: — Age 51.. 52.. 53.. 54.. 55.. 56.. No. of Cases 27 16 Age 57. 58. 59. 60. 61. No. of Cases 2 In my own list of cases, from which fibroids were excluded, the menopause occurred at over fifty years as follows: — Age 51.. 52.. 53.. No. of Cases 5 2 1 Age 54.. 55.. No. of Cases 2 2 As before stated, it has been my observation that fibroid tumors cause a delay in the menopause. Often in these cases irregular hemorrhages take the place of menstruation and a most pains- taking inquiry into the symptomatology is necessary to distin- guish menstruation from hemorrhage. LIST OF WOMEN BETWEEN THE AGES OF 41 AND 59 WHO WERE PASSING THROUGH OR HAD RECENTLY PASSED THE MENOPAUSE. 6 o5 a 6 > w CD O bO .fi.5 CD +3 m q --a Leading symptoms and fe & < Kg cd ° £ <! CD £ CD diagnosis. 1. A. B. 43 Mar. 6ch. youngest 8 yrs. 42J 6mos. Tachycardia, pruritus vul- vae, ovaries atrophied. 2. J. B. 42 Mar. lch. 17 yrs. 42 40 2 yrs. Flowing, feeling of suffo- cation, uterine polyp, tubo-ovaritis. 3. S. B. 43 Mar. lch. 22 yrs. 43 42 1 yr. Headaches, lacerated cer- vix and perineum, ret- roversion, uterus atro- phic. 4. R.K.B. 58 Mar. No. ch. No. ab. 55 46 9 yrs. Dyspepsia, tubo-ovarian abscess, under observa- tion eleven years. 5. E.J.C. 55 Mar. lch. 52 3 yrs. Neurasthenia, subinvolu- tion, lacerated cervix, uterus atrophic 1 yr. 2 mos. after dodging. THE MENOPAUSE THE MENOPAUSE. — {Continued.) 605 6 6 g 6 «j.2 i — '"^03 O c3_0 > m cl) O M fs.§ 3*" Leading symptoms and fc <3 bj() < o all < <V &J0 bo diagnosis. 6. N.M.C. 45 Mar. lch. 13 yrs. ... 35 10 yrs. Irritating leucorrhea, va- ginitis, uterus normal in 7. J.E.C. 46 Mar. 6ch. youngest 10 yrs. 45f size. Eczema of knees, face, and arms, neurasthenia, re- lieved since menopause, retroversion, lacerated cervix and perineum. 8. D. D. 42 Mar. 6ch. youngest 7 yrs. 41 lyr. Frequency of micturition, lacerated cervix and perineum, prolapse. 9. A.M.G. 55 Mar. No. ch. No. ab. 44i 40 4J yrs. Flowing, retroversion, ec- zema of vulva. 10. M.F.H. 49 Mar. 5ch. youngest 8 yrs. 48 3 mos. Retroflexion, subinvolu- tion of vagina. 11. M.H. 41 Mar. 3ch. youngest 18 yrs. 40 5mos. Headaches, hot flashes, retroversion, lacerated cervix. 12. E.G.H. 50 Mar. 2ch. youngest 25 yrs. 48 46 2 yrs. Indigestion, rheumatism, uterus atrophic, pro- lapse. 13. A. K. 47 Mar. 3ch. youngest 23 yrs. 46J Hot flashes, lacerated cer- vix and perineum, through sphincter. 14. L. L. 48 Sing. No ch. No ab. 43 Pain in abdomen and back, frequent micturi- tion, retroversion. 15. G. M. 44 Mar. lch. 23 yrs. 42 2 yrs. Nervous invalid 23 years, tubo-ovaritis for 23 years. 16. M.C.M. 46 Mar. No ch. Noab. ... 45i 7 mos. Flowing, retroversion. 17. D.L.M. 41 Sing. Noch. No ab. 39 2 yrs. Hysteria for many years, appendicitis, ovaries atrophic at operation. 18. R.H.B. 56 Mar. lch. 27 yrs. 50 Leucorrhea, frequency of micturition, cystocele, hemorrhoids. 19. A. S. 56 Mar. No ch. Noab. 51 43 8 yrs. Dyspareunia from erosion of fourchette, frequent micturition, atrophic uterus. 20. L. S. 49 Mar. 7ch. youngest 15 yrs. 48 2 yrs. Hot flashes, dizziness, flowing, subinvolution, lacerated cervix. 21. L. S. 51 Sing. No ch. No ab. 50i 45 6 yrs. Lifelong neurasthenia, re- troversion. 22. M.W. 41 Sing. No ch. No ab. 41 39 2 yrs. Neurasthenia, atrophic uterus. 23. M.A.W. 48 Mar. 7ch. youngest 17 yrs. 46^ H yrs. Sense of prolapse, retro- version, lacerated cervix and perineum, ovaries 606 THE MENOPAUSE AND OLD AGE THE MENOPAUSE. — {Continued.) 6 q5 a <v 3.9 ^T3 m d CD CO • fe 2 ^ > d 03 O M .d.5 <u |5- Leading symptoms and fc c3 < o'-S o o O Cm . <L> O m CD c3 Sag diagnosis. • atrophic at operation, uterus not. 24. L. S. 45 Mar. 2ch. youngest 10 yrs. 44 None Excitable, can't control herself, retroversion, • atrophic uterus and vagina. 25. KM. 52 Mar. 4ch. 48 44 4 yrs. Flowing for 2 years of [youngest dodging time, hot flash- 16 yrs. es, stricture of urethra. 26. M. L. 43 Mar. 6ch. youngest 6 yrs. 43 Burning in vulva, retro- flexion, lacerated cervix and perineum, caruncle. 27. H. C. 51 Mar. 1 ch. 31 yrs. 51 46 5 yrs. Asthma, heart disease, subinvolution, lacerated cervix, uterus still large 11 years later. 28. N.F.L. 48 Mar. 3ch. youngest 18 yrs. 47 1 yr. Flowing, subinvolution, lacerated cervix. 29. W. H. 50 Mar. 12 ch. youngest 7 yrs. 46 41 5 yrs. Neurasthenia, retroflexed senile uterus, proctitis. 30. E. C. 46 Mar. No ch. No ab. 45 44* 6 mos. Frequent and painful micturition, urethritis, debility. 31. M.E.H. 57 Mar. 2ch. youngest 37 yrs. 50 • • • Hot flashes since meno- pause, depression, ure- thritis. 32. M.I. 56 Mar. 8ch. youngest 17 yrs. 49 None Headaches, dyspnea with menopause, cancer of cervix, flowing for 6 weeks, ovaries and tubes atrophic at operation. 33. J. S. 59 Sing. No ch. Noab. 55 53i Hyrs. Enlargement of abdomen, cancer of ovary (large cystoma). 34. B.C. 45 Mar. 8ch. youngest 6 yrs. 44i 434 lyr. Pregnancy suspected, ec- zema of vulva, subin- volution, retroversion. 35. 0. L. 46 Mar. No ch. No ab. 3ch. 43 3 yrs. Flowing, polypi in cervix. 36. O.A.B. 46 Mar. 45J Hot flashes, incontinence youngest of urine, rheumatism, 24 yrs. hemorrhoids, subinvolu- tion. 37. C. T. 46 Mar. 2ch. youngest 12 yrs. 45i Flowing for two months, retroflexion, lacerated cervix and perineum. 38. M. R. 52 Mar. 2ch. youngest 22 yrs. 51 8 mos. Pain in thigh, retroflexion, polypi, proctitis, sciat- ica. 39. J.G.B. 59 Mar. 3ch. 50 Frequent micturition, re- troversion, stenosis of canal. THE MENOPAUSE THE MENOPAUSE. — {Continued.) 607 6 a5 05 s| si v — 5g£ O m Leading symptoms and fc c3 < o'-S O o . ?> o < diagnosis. 40. G.P.P. 57 Mar. 4ch. youngest 27 yrs. 50 Leucorrhea, endometri- tis, cervix atrophic, uter- ine cavity 3^- inches. 41. C.A.N. 52 Mar. lch. 15 yrs. 51J 6 mos. Indigestion, headaches, tubo-ovaritis, anemia. 42. S. H. 56 Mar. 1 ch. 32 yrs. 48 47 1 yr. Leucorrhea 1 year, pain in groin 1 year, cancer of cervix, atrophic vagina. 43. E. S. 57 Mar. 3ch. 54 Vaginismus, headaches, cicatrix in perineum, le- sion of central nervous system. 44. CD. 50 Mar. 4ch. youngest 15 yrs. 49 Watery leucorrhea for two months, cancer of cervix. 45. A. J. 50 Mar. 5 ch. youngest 12 yrs. 43 None Endometritis, uterus and vagina atrophic, hemor- rhoids, leucorrhea. 46. E. H. 49 Mar. 44 Foul leucorrhea for two months, cancer of cervix. 47. M.A.S. 45 Sing. No ch. No ab. 41 None Cystocele and prolapse, cancer of ovary, breast, and liver later. 48. M.N. 51 Mar. 8ch. youngest 18 yrs. 43 Painful lump in abdomen for 6 months, colloid carcinoma of ovary, lacerated perineum, gradual cessation of menses. 49. C. T. 55 Sing. No ch. No ab. 52 52 3 mos. Pain in vulva, urethral caruncle, senile atro- phic uterus and vagina. 50. H. 0. 42 Mar. No ch. No ab. 40 2 yrs. Pain in bowels, tubo-ovar- itis, lacerated cervix. 51. M.A.R. 49 Mar. 2ch. youngest 20 yrs. 43 Foul leucorrhea for six weeks, cancer of cervix, prolapse 12 years ago. 52. W.P.M. 52 Mar. 2ch. youngest 26 yrs. 45 Ovarian cystoma with purulent contents, acute peritonitis. 53. C.E.'O. 49 Sing. No ch. No ab. 48 3 mos. Neurasthenia, retrover- sion, under observation 3 years. 54. M. S. 44 Mar. 6ch. youngest h\ yrs. 43 Incontinence of urine, diz- ziness, dislocation of urethra downwards. 55. E.J.S. 51 Mar. 4ch. youngest 25 yrs. 50 49! 6 mos. Headaches, flowing, retro- version, endometritis. 56. N. H. 43 Mar. No ch. Noab. 43 42 1 yr. Hot flashes for first 6 months of dodging time, subinvolution. 608 THE MENOPAUSE AND OLD AGE THE MENOPAUSE. — {Continued.) 6 o5 <v d .1-2 •d d 5 a > TO 0) > fl TO «4-l Leading symptoms and fc < 02 n o OS'S O <-<£} trt M <» a v diagnosis. 57. M. E. 50 Mar. 2ch. voungest "30 yrs. 45 Hot flashes, rheumatism, . vaginitis, uterus atro- phic. 58. S. M. 57 Mar. 7ch. •youngest 17 yrs. 54 Sense of prolapse, subin- volution, vaginitis. 59. J. P. 59 Mar. 5ch. youngest 24 yrs. 50 Flowing at menopause, headaches before, pain in abdomen, lacerated cervix and perineum. 60. J.A.A. 46 Mar. 4ch. youngest 20 yrs. 45 i yr- Rheumatism, procidentia, lacerated cervix and per- ineum, ovaries normal at operation. Flowing for six months, 61. C. B. 48 Mar. 14 ch. 42 Colored youngest 17 yrs. cancer of cervix, ad- vanced. 62. M. B. 58 Mar. 5ch. youngest 28 yrs. 53 Flowing for one month, multilocular papillary cystoma of ovaries. 63. M. B. 49 Mar. 6ch. youngest 18 yrs. 48 48 4 mos. Headaches, retroversion, lacerated cervix and per- ineum, pyosalpinx, ova- ries normal at operation. 64. M.C. 58 Mar. 7ch. youngest 20 yrs. 40 Rheumatism, rectocele, cystocele, atrophic va- gina. 65. M. C. 45 Mar. 2ch. youngest 10 yrs. 37 Occasional hot flashes, ure- thral caruncle. 66. M. C. 48 Mar. 5ch. youngest 8 yrs. 44 " Falling of womb " eight years, prolapse. 67. J. D. 52 Mar. 6ch. youngest 20 yrs. 42 Unable to control bowels, lacerated perineum through sphincter, pol- yp, urethral caruncle. 68. S.J. 50 Mar. 2ch. 50 48^ 2iyrs. Tubo-ovaritis, uterus atrophied at operation, ovaries and tubes not, according to pathologist. 69. M.J. 59 Mar. lch. 31 yrs. 50 43 7 yrs. Flowing during dodging time, abdominal tumor, lacerated cervix. 70. B. L. 53 Mar. 10 ch. m Painful micturition, ure- thritis, urethral caruncle. 71. C. L. 49 Mar. 3ch. youngest 22. V yrs. 45 42 3 yrs. Scalding at vulva, eczema of vulva. 72. A. L. 53 Sing. No ch. Noab. 49 4 yrs. Painful defecation, hem- orrhoids, partial atrophy of uterus. THE MENOPAUSE THE MENOPAUSE. — (Continued.) 609 d d a d d 1-1 -h +» d <D GO • t MB > a v> !i?d O feo ^.2 d Leading symptoms and fc <3 < o O ^ !h o> o d£-^ < ^ 0 ^ diagnosis. 73. F.J.M. 57 Mar. No ch. 1 ab. 48 47 1 yr. Hot flashes and headaches during dodging time, cystitis, proctitis, retro- flexion. 74. E.M.D. 42 Sing. No ch. No ab. 42 3 mos. Hysteria, hot flashes, retro- version, adherent pre- puce, masturbation. 75. M. M. 49 Mar. lch. 14 yrs. 44 Flowing for one year, ab- dominal cancer, lacer- ated cervix and peri- neum. 76. A. F. 50 Sing. No ch. No ab. 47 None Nervous headaches since menopause, hemorrhoids. 77. A. F. 49 Mar. No ch. No ab. 42 Tumor in abdomen for twelve years, dermoid ovarian cystoma. 78. E.F. 56 Mar. 4ch. youngest 22 yrs. 46 Yellow leucorrhea for one and a half years. Tuber- culosis of endometrium, ovaries and tubes atro- phic at operation. 79. S. G. 47 Sing. No ch. No ab. 46 44 2 yrs. Flowing two months, ma- lignant adenoma of uter- us, cervix and vagina atrophic. 80. L.G. 48 Mar. 6ch. youngest 14 yrs. 45 Flowing, polyp, subinvo- lution, lacerated cervix and perineum, cardiac disease. 81. F.H. 46 Mar. 6ch. 441 None Flowing for six months, uterine polyp. 82. M. H. 53 Mar 10 ch. 52 Pain in pelvis, dizziness, urethritis, cystitis, va- ginitis. 83. H.J. 45 Sing. No ch. No ab. 45 Flowing, fungous endo- metritis. 84. J. M. 49 Mar. No ch. 1 ab. 47 2 yrs. Flowing for two years, hyperplastic endometri- tis. Painful and bloody mictu- 85. M. M. 52 Mar. lch. 42 25 yrs. rition, stone in bladder, prolapse. 86. M. M. 42 Mar. 2ch. youngest 6 yrs. 40 Frequent micturition and bearing down, polyp, lacerated cervix and perineum. 87. J.P.M. 52 Mar. No ch. No ab. 50 Flowing for two years, ad- eno-carcinoma of cervix. 88. M. M. 55 Mar. 9ch. 49i Sense of prolapse, pro- lapse. 89. D. 0. 52 Mar. 12 ch. youngest 19 yrs. 44 No symptoms at meno- pause, retroversion, tu- mor of pelvis. 39 610 THE MENOPAUSE AND OLD AGE THE MENOPAUSE. — {Continued.) o B <u d ■33 A C g O c3 O > rt w Leading symptoms and & < o o . <D O £^C3 o>2 £ <1 3-g-I diagnosis. 90. M.L.P. 55 Mar. No ch. No ab. 50 48 2 yrs. Indigestion, frequency of micturition, atrophic uterus. 91. M. P. 58 Mar. 2ch. 50 49 1 yr. Incontinence of urine, tu- mor of vagina six months, malignant ade- noma of vagina. 92. A. R. 49 Mar. 6ch. 44 Painful micturition, lacer- ated cervix and peri- neum, uterus atrophic at ether examination. 93. H. D. 50 Mar. 7ch. 6ab. 48 Flowing for one and a half years, subinvolution, endometritis. 94. J. G. S. 52 Mar. 1 ch. 20 yrs. 50 48 2 yrs. Hot flashes for four or five years, lacerated peri- neum, intestinal catarrh. 95. L. S. 45 Mar. 2ch. youngest 10 yrs. 44 * • • None Hot flashes, urethritis, dislocation of urethra downward. 96. L. S. 48 Mar. 7ch. youngest 15 yrs. 47 1 yr. Dizziness, pain in left side, subinvolution, lacerated cervix, endometritis. 97. F.L.S. 49 Mar. 3ch. youngest 16 yrs. 48 1 yr. Frequent micturition, sub- involution, urethritis, cystitis. 98. E. S. 47 Mar. lch. 27 yrs. 45 2 yrs. Flowing, subinvolution, polyp. 99. J. W. 46 Sing. No ch. Noab. 441 H yrs. Leucorrhea, headaches, re- troversion, vaginitis, old pelvic inflammation. 100. L. R. 52 Mar. 3ch. youngest 15 yrs. 50 Flowing for three weeks, lacerated, cervix and per- ineum, polyp, fistula in 101. M.E.L. 52 Mar. 3ch. 51 ano. Prolapse, lacerated cervix and perineum. 102. B.C. 56 Mar. 1 ch. 20 yrs. 51 Flowing for six months, cancer of body of uterus. 103. M. C. 50 Mar. 9ch.