Among the neuralgite of the skin and contiguous parts, frontal and occipital pain especially often appear during the menopause, also masto dynia, intercostal lumbago, neuralgia and sciatica; myalgia of the neck, back (some forms of lumbago) and limbs, and pains in the vertebral column and sacrum also occur. Thus it happens that, in the same patients who are affected at one time with certain paramthesiEe, and at another with slighter or more marked forms of hyperkinesis (among those in the internal organs are to be mentioned spasm of the glottis, nervous asthma, and cramps of the pharynx and o3sophagus, such as give rise to globus), the most peculiar conditions naturally develop, which, although they are in themselves always rather harmless, nevertheless are regarded by the patient herself as well as by her friends, as evidence of a very severe course of the menopause. I cite here a couple of examples of the multiform complications which are observed under these circum stances. Mrs. D., aged forty-six, childless, has been irregular for three years. During the past year she has violent pains in the back at night, extending down the thighs, so that she can not sleep. These disappear eight days before each period, to reappear about eight days after. She has also been troubled for years with a burning, pricking sensation in the neck, especially in the evening, to which is added a week. before her period feelings of constriction as well as a constant inclination to swallow.
Mrs. 11., aged. forty-eight, has been irregular for a year. Beside headache, vertigo, etc., she was at first troubled with violent itching between the shoulders, which has recently chimed to a fixed burning pain in the same locality. The adjacent vertebrze are painful on pressure. This pain is most severe when she is in a sitting posture. With it is constantly associated a feeling of oppression in the chest and dyspmpa, so that the patient thinks every moment that she is going to be suffocated. At the acme of this attack she always becomes as pale as a corpse. On rubbing this spot in the back, some relief is obtained.
Mrs. R., aged forty-four, a strong, healthy working woman, married at eighteen, and was pregnant sixteen times. During the past six months she has been irregular, and has had flushing vertigo, etc., together with the following symptoms: Every noon (sometimes afternoons), she has a violent burning feeling on the ulnar side of the forearm, just as if a hot iron had been drawn along it. This disappears after some minutes, but always returns. At night she has a feeling of stiffness in the knee and calf of the leg, so that every movement is painful. If she is very tired this stiff ness may last .several days. At the same time there is a pricking feeling in the legs, as if from the insertion of needles.
A good many of the pains in the back and loins at the time of the climacteric are due to excessive distension of the belly-walls through the accumulation of fat. On the other hand, we may meet with eases at this time in which the backache forms the only subject of complaint, although no denionstrable cause is present, and the individual has had previously no nervous or hysterical symptoms whatever. The following ease is
typical in this respect: Mrs. K., aged fifty-three, the mother of three children, began to be irregular at forty-nine, and ceased to menstruate at fifty-one, when she began to have slight backache, which has constantly increased during the past two years. These " drawing" pains appear, whatever posture she may assume, but are increased by the warmth of the bed, so that she cannot sleep. The sacrum is sensitive on pressure, but nothing abnormal can be found.
A phenomenon associated with the visceral hypersesthesim which occur at the menopause, is a feeling of palpitation and pulsation of the arteries, especially those of the abdomen; neuralgic affections of the heart now and then accompany them, such as transient stabbing pain, sensa tions of tearing, etc., or spasm of the heart, which, consisting mostly of parakinesiEe, " combine with parmsthesim and constitute the conjoined symptoms (symptomen complex) of angina pectoris in all its possible grades and variations" (R. Arndt, on " Hysteria "). Very often there is a sudden increase in the frequency of the pulse, and sometimes the women are constantly troubled with palpitation of the heart. If these various complicating functional disturbances are extremely violent, we may be inclined to suspect a form of heart-disease peculiar to the climac teric, described by E. Clement as " cardiopathie de la menopause."' Al though the conclusion arrived at by that author may be rather too sweeping, some of his observations have been confirmed on many sides, i.e., the beginning of palpitations while the menstruation is still regular or at the time of the first irregularities, their successive increase until they amount to regular attacks associated with vertigo, precordial pain and dyspncea, their onset during violent movements or in sleep, and, finally, a tendency to attacks of fainting, etc.; at the same time there is an irreg,ular, small pulse, but no organic heart-lesion, no catarrh of the lungs, no albumin in the urine, only there ia always striking paleness and frequently advanced anmmia. To explain this affection, Clement sup poses that there is a special predisposition, produced by the menopause, to marked change in the innervation of the sympathetic, and he affirms that the attacks described are due to reflex impulses from tbe sexual organs,. which, through irritation of the cardiac accelerator nerves, cause spasm of the vessels. Without entering any further into this subject, I would merely take occasion to refer again to the accompanying anEemia, to the presence of Which in all his cases Clement calls special attention. I believe that it is hardly possible to lay too much stress on this factor in connection with most of the disturbances of innervation at the time of the climacteric.