As regards the intestine in particular, we observe that women during the climacteric years very often suffer from chronic meteorism. Whether this is partly referable to abnormal collections of air, or especially to simultaneous digestive disturbances, which, as has been said, are very common at this time of life, the principal cause of the phenomenon in question is a relaxation of the muscular coat of the intestine, in conse• quence of which the gut is unable to force its contents forward. With out doubt this condition is due to a change in the innervation and not to any permanent organic change, for sooner or later improvement almost invariably occurs. From a diagnostic standpoint it is of course impor tant to bear in mind at all times the frequency of this condition, as well as of an accumulation of fat in the abdominal wall, during the climacteric. It happens quite often that on account of the excessive size of the abdo men some serious affection is supposed to exist, where none whatever is present. An exact diagnosis of the condition of the abdomen is certainly very often rendered difficult by the existence of both of these two states. In connection with the distension referred to, I cite only a single case, which seems to me to be quitf instructive. Mrs. N., of M., age fifty three, the mother of four children (she ceased to menstruate two years ago), gives at the first glance decidedly the impression of a person who is seriously ill. She is poorly nourished, of a yellow hue, extremely ner vous, and has a very large abdomen. It is at once supposed that a serious abdominal trouble is present, and it actually happens that the patient is considered as having a diseased liver and spleen, etc. On the contrary, an examination shows that this is only a case of excessive meteorism; the organs being all normal. The simultaneous extreme distension of the stomach was t,o be referred to a pre-existing chronic catarrh, whence also the depraved nutrition. The distension of the abdomen seems to have begun at the time of the menopause. The combined nervOus troubles also recall well-known pictures of the climacteric. The yellow hue must have existed before.
The relaxed condition of the intestine leads on the other hand to chronic constipation, one of the most frequent conditions at the meno pause, which is generally absent in cases in which the intestinal activity was previously perfectly regulated. Less frequently (in this the observa tions in this direction generally agree) persistent diarrhwa is present. However, I should not hesitate to regard the latter in certain cases as a rare climacteric phenomenon, that is, as a condition due to the clima,c• teric changes; these attacks are sometimes so very characteristic in their duration, course, and recurrence, and are in their entire extent connected in such a striking manner with the climacteric period.' A point in con nection with intestinal activity which I would not omit is the following: I have several times observed that where the intestines have previously been sluggish and ill-regulated, with the beginning of the menopause an entire change occurs, so that from this time forward for years their func tion is perfect. At other times when there were frequent atta,cks of diar rhcea, these increased at the climacteric, or, on the other hand, ceased more or less entirely, or even gave place to a persistent tendency t,o con stipation. Still again, where the intestinal activity was previously normal, now it becomes in some way irregular, usually (as was remarked above) by a change to obstinate constipation And finally, in a few cases where the intestinal activity was normal before, as well as during, the climac teric, there was, however, here in every instance a marked change noticed from the commencement of the menopause, somewhat easier or more diffi cult, somewhat more frequent and less copious evacuations, etc. Although,
as before said, it is most common to have more or less of a tendency to con stipation, as is particularly noted during the menopause, I believe that I can assert with considerable positiveness that in all the other cases also, in which this phenomenon does not occur, there is some change to be noted in the intestinal activity, which is to a certain extent opposed to the previous condition in the given case.
We observe very peculiar variations with regard to sexual desire dur ing the climacteric period. Not seldom the sexual passion disappears more or less completely from this time; more frequently it persists through out the entire menopause, or finally it very often increases in intensity at this time, and may become positively distressing. We may, perhaps, consider the first-mentioned phenomenon as really the normal condition, agreeing as it does, with the cessation of the sexual functions in general. In fact, I have also often been able to show that increased sexual desire at the menopause was due to some abnormal condition of the genitals, as fibromata, flexions, etc. However that may be the increase of the passion in question, as long as it does not exceed a certain measure, is to be regarded as one of the symptoms of the visceral hypertestheske which develop at this period. In the excessive forms, which may sometimes be associated even with general convulsions, we shall in every case at once recognize, with Romberg, a neuralgic condition of the spermatic plexus. Patients during the critical years complain especially of the presence of this condition before the beginning of an actual or expected period, which has frequently begun just at the commencement of the first irregularities.
How long this disturbance may continue after the actual menopause, I saw in the case of a Mrs. G., who, after a childless marriage, began to be irregular in her menstruation at fifty, and reached the menopause at fifty-four. From about the fiftieth year are dated. the initial symptoms of an abdominal tumor (pressure on the bladder, bearing-down feeling, pain on movement, etc.), which I am now, in the patient's fifty-fifth year, able to recognize as au interstitial uterine fibroid, the uterus corresponding in size to that of the gravid organ at the fourth month. While in this cage some of the other climacteric phenomena began to disappear between the fifty-sixth and seventh years, the sexual passion (and another symptom assoeiated with it, i.e., nervous cardiac palpitation) reached its height to wards the sixtieth year. As long as the menses continued to reappear after the beginning of the irregularities, the patient experienced no es sential difference in regard to the degree of her sexual excitability. The latter persisted as before, and at the most, somewhat increased irritability was noticed before the end of some periods, which was diminished after these had ceased. Since her menses stopped entirely, however, she' has had regular paroxysms of sexual excitement, so that at night she would be unable to sleep, or would be distressed by erotic dreams. This condi tion increased until she reached her sixtieth year, when she began to improve.