The conditions referred to here as flushing, or localized sensation of heat, and the general or localized sweating, usually appear together. They very often affect simultaneously the same portion of the body. But this is by no mes.ns always the case; on the contrary, I have frequently found that one or the other of these phenomena was entirely absent when the others were present. This is especially marked during the " post climacteric period,'' and it may, I think, furnish a useful hint as t,o how many a peculiar complaint at this time is to be regarded from the physi cian's standpoint. If one or the other of these phenomena disappears (even after it has been present), the remaining one is, just because it has been separated from its usual association, no longer regarded according to its character as a simply climacteric phenomenon, although it really is so. IIence frequently arise errors which could easily be avoided by a more careful examination of the natural processes.
As regards the hemicrania, which shows such a predilection for the female sex, it is in general true that this important expression of the neuropathic family trait appears by preference at the time of the woman's sexual activity. Appearing less often in childhood, this affection usually begins with puberty, persists throughout the period of sexual maturity to a greater or less degree, and disappears after the individual has entered upon the menopause. There is no doubt that we can, as a rule, reckon pretty certainly upon the cessation, or at least an essential improvement, even in the most severe attacks, at the time of the climacteric. I have seen this proved in many cases; in some of these, which were quite severe, a decided improvement began even before the first menstrual irregulari ties, as I would like to illustrate. Ott the other hand, there may be an aggravation of this condition while these irregularities continue, as well as after the establishment of the menopause. Mrs. B., aged forty-eight, from a nervous family, has been irregular for nine months. For twelve years she has had migraine just before her periods, which has increased greatly during the past two years, until now she is obliged to avcid any exposure to cold air.
Miss L., aged forty-three, had migraine before every period. For some months she has had symptoms of the approach of the menopause, and the headache now appears every two or three days, instead of only once a month as before. Mrs. G., aged fifty-six, ceased to menstruate at fifty. Now she has migraine every week instead of at longer int,ervals.
In the realm of the higher sense-organs, we frequently encounter during the menopause certain hyperaesthesia3, parsesthesise, idiosyncrasies, also anassthesia3, which are simply comparable to the same conditions in ordinary hysteria. As the chlorotic disposition -that is, a hypoplastic
condition of the blood—if we look for it, is not absent in the marked cases of hysteria, " even when the patient complains of plethora, palpitation, pulsation in the abdomen, and fullness of the head and breast' (Rudolf Arndt), so, in my own, we shall not go amiss if we connect those func tional disturbances at the climacteric also with defective nutrition of the nervous system. The nervous system may at other times indeed be im properly nourished, just as here and there in hysteria every chlorotic or ancemic cause can be excluded. Excessive sensitiveness towards a bright light, increase in the intensity of sound-impressions, or odors of every form, is a phenomenon frequently noted, and it may persist for years after the menopause. One of my patients began, about six months after the last appearance of her periods, to be so irritable that she was always seized with nausea if a light was suddenly brought into the room in the evening, or any one•addressed her in a loud tone. I met with very peculiar in stances of abnormality in the sense of smell in tho following cases: Mrs. A., since the time when her menses began to be irregular, has not been free from the idea that a number of objects smelt like strong fat, or like " brass, that had been cleaned with vinegar; " this cig-ar seemed to her t,o be " burnt," that soup to be " rancid," the smell of the coffee reminded her of .dish-water, etc. Mrs. N.., ever since she began to be irregular, experiences with the return of each flow a peculiar odor of burning (" like burning fat "), which continues for four or five days, is most marked in the evening, and only disappears on using petroleum, after the removal of which it at once returns; it is also to be noted that this was an odor to which the patient was previously so accustomed that she described it as formerly agreeable to her.
Mrs. G., who reached the menopause seven years ago, is likewise troubled with the sensation that everything smells of " strong fat,'' etc. In the two former women there were well-marked symptoms of anEemia.
There is very often a vague complaint about a bad taste, although of no pronounced type. The variable character of this phenomenon is characteristic. Ringing in the ears, a low humming or loud buzzing in the ears, appears temporarily in nearly every case, but it may now and then become extremely painful by reason of both its permanence and its intensity. Transient hardness of hearing is often associated with it. Allusion should also be made to the dimness of vision. which so very often occasione uneasiness at this time.