an melancholia is the most it. .1 itrt f mental disease that at the Int ittl ause. it would be a tt ntlositql that a much larger ir tit n t.f ca-ts of this form would • -ur at this period. The exact per •t tasis between the ages of 45 • -tit Ntas for men. 20 ;; women, 21'h,; r ractit.ally thLre was no difference in st xt s. refore, outside of the nar r...‘ lin itations named there is no sufli . tut experience to warrant the ;nttit ti of a distinct class of insani tits as due to a normal ending of an aLimal function that is universal. J. B.
.al .Phila. Aled. Jour., Aug. 25, 'Out .
Complications. — The complications •r d,,La-.,es incident to the time of life x‘hi the menopause occurs are, in aal;ty, the factors that have caused the hanfze of life to be dreaded and to be • .nr i:td upon as a serious crisis.
In cases in which a patient comes ..ntler the care of the physician at this rwrhar.s more than at others, it is 7-17ortant to ascertain that the heart and kidneys are free from organic This is the period when these tr...fan= are apt to fail. in either sex.
Attention called to the frequency of u•ero-evarian irritation at the time of the menorause as a factor in the causa ticn PI' rheumatoid arthritis. W. Arm strong Cyn. -Tour., xliv, 49C, '96).
Follett\ ing the cessation of the meno p..ise the modification of the menstrual flow can cause a congestion of the kid Leys, varying, in its intensity. The symp Trn.,-bserved have been oliguria, albu minuria. and hTmaturia, often aceom p•nied with lumbar pains, nausea, and headache. local bleeding and mild di uretics recommended. Le Gendre (Afed i-o-Surg. Bull., July 25, 'OS).
Of the diseases more closely connected with the genital system, first in impor tance, first in gravity, and most serious if neglected, is cancer of the uterus or of the vagina. In all cases of undue or irregular bleeding frorn the genital tract it is imperative to niake a thorough local examination, since in a large pro portion of cases the cause will be found to be a cancer. In this matter the knowledge and care of this generation of physicians must undo the mischief that has been wrought by the false teach ing of previous generations, that irregu lar luemorrhages were natural to the change of life. The truth is that the menopause is an evil period, when can cers are liable to develop.
"Ulceration of the uterus" was also— and is still—too often diagnostieated in cases of uterine cancer attended by in tractable bleeding and only recognized when the disease is far advanced and the patients have lost their only chance of rescue.
Certain axioms should guide the mod ern practitioner in this connection:— 1. All irregular or profuse hmmor rhages about the period of the change of life are suspicious; they therefore re quire immediate, thorough, and com petent examination.
Analysis of the eomplieations of meno pause in 500 women. Out of this num ber. the flow of blood returned a year or more. after the menopause had beeorne established. in 1S3 eases. Of these over one-half, or 54 per cent., were found to be suffering from uterine cancer. Neu mann (Alonats. f. Geburts. und Orynak., B. 1, H. 2, '95).
Diagnosis between benign and malig nant bleeding after menopause. Menor rhagia of the menopause appears as a sudden and very free diseharge of blood following distinet cessation of the cata menia for two or three months. The dis charge oeeasionally recurs. The bleeding . of cancer is insidious. irregular in ehar acter, and very frequently appears in the interval of the period during the last year or two of menstruation. Doletis (Bull. et M6m. de la Soc. Obstet., etc., Paris, No. 7, '97).
2. .A.11 eases of incipient cancer of the uterus are easily diagnosticated by care ful examination, aided by the curette and microscope in doubtful cases, but nsually by the presence and character of an ulcer.
3. All cases of cancer of the uterus in the early stages are susceptible of plete removal by total hysterectomy, with less than 2 per cent. of mortality in competent hands. There is, in fact, no organ of the body where cancer can be so totally and widely removed as in cancer of the uterus.
4. A large proportion, probably a large majority, of cases in which total tion of the uterus, for cancer, is per formed quite early, never have relapse or recurrence in the scar or elsewhere, and they enjoy, not only life, but the best of health.
Next in frequency, after cancer, when luemorrhage occurs after menopause are intra-uterine or intramural fibroids. There may also be polypoid growths in the uterine cavity of the ordinary cous and glandular type. All these may give rise to frequent hmrnorrhages that tend greatly to reduce the strength of the patient.