At the period of the menopause the vulva is apt to become affected with local hypersthesia, which is a symptom of many conditions. It may be due to a pure neurosis; to reflex cause, such as early carcinoma cervicis; to mucous polypus or prolapsed ovary; or to krau rosis, local rashes, dirt, parasites, vaginal or uterine discharges; irritating urine, as in cases of acidity, gout, or diabetes. Amand Routh (West London Medico Chin Soc.; Univ. Med. Jour., Mar., '97).
Neuroses seen at the time of the meno pause show many gradations from nerv ous irritability with efTects on the char acter and temper to fully-developed in sanity, which has a tendency in a large proportion of cases to melancholia, a de lusional insanity, less frequently to mental weakness, and rarely to general paralysis. The change in the reproduc tive organs leads in some to a morbid querulousness, in others to a jealousy. Sexual excitement sometimes is developed which exceeds all control, depraved and ViCiOUS habits may show themselves, and dangerous accusations be made. Drunk enness and the drug-habit are especially noted at the climacteric. Charles Luke (West London Medico-Chir. Soc.; Univ. Med. Jour., Mar., '97).
Attention called to dyspareunia at this period. Cases occur where the introitus is small; the mucous membrane of the vulva has already acquired that smooth and glazed appearance characteristic of senility, and around the ostium vaginw are certain red, well defined circumscribed spots, extending forward and involving the meatus urinarius and the urethral canal. These are exquisitely tender and bathed in a muco-purulent discharge. Manse11-Moullin (West London Medico Chin Soc.; Univ. Med. Jour., Mar., '97).
While the cilia of the uterine and cer ieal epithelitnn grow scanty in sickly women near the menopause, they some times remain perfect in women over 60 here the uterine muscular tissue has undergone degenerative changes percep tible to the naked eye. Parviainen ("Mith. aus der gynlik. Klinik der Prof. Engstein," vol. i, Part II, '97).
H ea da che, nervousness. hysterical manifestations of all kinds, depression of spirits, change of temperament always for the worse, even real melancholy and insanity; such are the woes which are added to the unpleasant conditions in separable from this age, and referred to in the beginning of this article.
Attention called to the very intimate relation which exists between the meno pause and the pathological conditions of the uterus and exoplithalmic goitre. In this relationship the latter is placed in the position of an effect or consequence, and not the cause, of the uterine condi tion. An improvement in the local con dition is always followed by the appear ance of the general disease. Jouin (Nouv. Arch. d'Obstet. et de Gynec., No. 6, '95).
Investigation of one hundred eases of insanity occurring during menopause. The forms were present as follows: Mel ancholia in 67 per cent.; mania, 24 per cent.; dementia, 4 per cent.; epileptic insanity, 3 per cent.; general paralysis, 2 per cent. The prognosis is usually favorable, 40 per cent. recovering. The duration of the attack varies from three months to three years, after which time the outlook is hopeless. Henry Sutlier land (Univ. AIed. Jour., Mar., '97).
During the past few years a number of women have been received in the Penn sylvania Hospital for the Insane who had been operated upon for the removal of the sexual organs, the majority of whom subsequently had melancholia with many of the usual symptoms attending the menopause, which had been anticipated by surgical interference, showing; that, wilether the grand climacteric is brought on in the course of nature or by the methods of science, the mental results are quite similar when any have ap peared.
It bas been observed that many NN 0111011 who have been melaneholy, or threatened with insanity at the menopause, have at the age of puberty also had serious neurot ic or mental symptoms. This eir ennistance has been cited on w hid] IA) predicate a probable recurronee at the menopause. The sta tistics the Penn sylvania Hospital show that between the ages of 15 and 20, embracing the be ginning of the menstrual life in women and the age of pubei ty men, 2S1 men, and 276 women were admil ed. Ilet the ages of 45 and 55, covering the usual period of the noompooqe, 975 own and • • N%1 It 0111 it 111t0 the same ir tilts, data it N\ 01111.1 1111 , • far as indicate anything, •. t f tl e ptriods named more • •ati NN (1 k 11 ht.( me insane. If the • . .11‘ Ilt Vul, strions and im r . fat.ttr in ti.e production of in - t it %%i•tild appear in the tables.