Historical perspectives| Volume 3, ISSUE 1, P1-9, March 1981

What's in a name? Some linguistic aspects of the climacteric

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      Examining such terms as climacteric or menopause and utilizing supportive historical data, an attempt is made to trace the development of these concepts, their time of inception and their spread. It is suggested that the persistance of popular terminology of the climacteric, especially in England, until late in the last century is due to the association of female popular healers with its management. In France, where medical men were long involved in this field, the terminology had been of a completely different character for over two centuries. Latin literature, as reflected in M.D. theses, goes back even further to the beginning of the 18th century.
      Only cultures which, because of their social structure and views of ageing regard the climacteric as a critical period, describe it in ominous terms. These terms in turn perpetuate the views and attitudes which spawned them. A warning is sounded against an objectification of abstract terms like the “biological menopause” which may lead to mispresentation and distortion. The objectification of symptoms, essentially means of communication, as data has already led to many difficulties in research. Finally, the confusion produced through lack of a suitable approach to minor behavioural disorders, and their consequent inclusion under the label of “menopause”, is very briefly reviewed.


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      1. When migrating to a new country, even when using the same language, doctors usually have to learn the local colloquial terms for many bodily functions. The position in early Victorian England is especially interesting for it shows a parallel gap between different social groups. Doctors starting practice were then quite ignorant of the terms used by women to describe catamenial functions or “female ills”. Castle, who edited Blundell's book (Blundell, J. (1837) Observations on some of the most important diseases of women. Editor: T. Castle. E. Cox, London) thoughtfully appended notes on the manner questions should be put to women and the terms to use when speaking to them. He explained that “the menses are, in common language, designated the ‘flowers’, ‘courses’, ‘changes’ …” (ibid. p. 233) and the cessation of menstruation is called the change of life (ibid., p. 265). The same was done for Scottish students by the Campbells (Campbell, W.; and Campbell, A.D. (1843) 2nd Edition. Introduction to the study and practice of Midwifery, p. 51, W. Whyte and Co., Edinburgh. 1st Edition by W. Campbell appeared in 1833).
      2. (E.g.)
        • Hooper R.
        A compendious medical dictionary, containing an explanation of the terms in anatomy, physiology, surgery, etc.
        1st Edition. Murray and Highley, London1798 (Appeared in successive editions. 7th Edition appeared in 1839)
        • Hoblyn R.D.
        A dictionary of the terms used in medicine and the collateral sciences.
        1st Edition. Murray and Highley, London1835 (Appeared in successive editions: 2nd Edition in 1844; 8th Edition in 1858; 9th Edition in 1869; 10th Edition in 1878; 11th Edition revised by J.A.P. Price in 1887; 12th Edition in 1892)
        • Thomson S.
        A dictionary of domestic and household surgery.
        1st Edition. Murray and Highley, London1859 (Ed. 39-1911)
      3. Climacteric is derived, via Latin, from the Greek κλιμακτηρικoς, variously derived from κλιμακτηζ rungs of a ladder (κλιμαξ), or κλιμαξo to proceed gradually (κλινω, slope The “climacteric years are certain observable years which are supposed to be attended with some considerable change in the body; as the 7th year: the 21st, made of three times seven; the 49th made of seven times seven” and so on: i.e. septennia. “Auleus Gellius tells us, that this whimsy first came from the Caledeans, from whom it is very probable to have come to Pythagoras who was very fond of the number seven, and used much to talk of it in his philosophy” (ibid., ibid.). Despite the very healthy scepticism shown by Quincy the belief in septennia persisted until this century (e.g., Encyclopedia Britannica 1960).
      4. Hooper, R. (1839) (vide [2]) under “climacteric”. Recovery was believed to be accompanied by rejuvenation: the restoration of acuity of vision and hearing, new growth of hair and even a third “climacteric teething” (ibid., ibid.; also Hoblyn, R.D. (1844) vide [2]).

      5. E.g., a reference in one bibliography to Halford, H. (1833) On the climacteric disease (In: Halford, H. (1833) 2nd Edition. Essays and orations, pp. 1–13, J. Murray, London: 1st Edition appeared in 1831) proved, for instance, to be an essay on the male climacteric. In fact Halford states: “I should observe that though this climacteric disease is sometimes equally remarkable in women as in men, yet most certainly I have not noticed it so frequently or so well characterised in females … Perhaps … the change which the female constitution undergoes at the cessation of the catamenia may render subsequent alterations less perceptible” (ibid., pp. 6–7). This is also supported by Day (Day, G.E. (1849) A practical treatise on the domestic management and most important diseases of advanced life. T. and W. Boone, London) who suggests “the change” protects women against the climacteric decay of the male and ensures longevity. Tilt, however, warns that women who partake of “Scotch breakfasts”, or drink liberal quantities of wine, may “become like men, liable to another kind of climacteric about sixty-two” (Tilt, E.J. (1882) 4th Edition. The change of life in health and disease. A clinical treatise on the diseases of the ganglionic nervous system, p. 110. J. and A. Churchill, London.
        • Hall M.
        Commentaries on some of the most important diseases of females.
        in: Rees, Orme, Brown and Green, London1827: 315
      6. The French never use the term climacteric in this sense, but a thesis sustained in Leiden (in Latin) equates the French temps critique (aetate critica) with the climacteric period (Vizévene, D. (1835) De faminarum aetate critica sive de periodo climacterica, Lugd. Batav.), echoing Hall [6] and Ashwell
      7. It includes, apart from “the change of life” for the present term climacteric, “dodging time” for the pre-menopause, and “turn of life” for the menopause. These terms, it may also be noted, are emotionally essentially neutral, especially when compared with some used in France (cf. [23]). They are, of course, not neutral in other ways. Two obviously mirror classical concepts that women in the climacteric changed her temperment from a feminine to a more masculine one. The designation “dodging time” may, on the other hand, reflect Western European women's fear of pregnancy at this time.
      8. The term “female climacteric”, as suggested by Hall [6] and Ashwell [7], was increasingly used in British literature from about the mid-1860s. Tilt utilized the term menopause in his articles from 1870 onwards (vide Wilbush, J. [19]) but it is not found in a British dictionary prior to 1887 (Hoblyn's Dictionary (1887) 11th Edition; Price, J.A.P., editor vide [2]). These terms, however, were apparently not generally current before the beginning of this century. Allbutt and Playfair's system of gynaecology, for instance, (Allbutt, T.C. and Playfair, W.S. (Editors (1896) A system of gynaecology. Macmillan and Co., London) employs neither while Blair Bell (Bell, W. Blair (1910) The principles of gynaecology, pp. 81–91. Longmans Green and Co., London, New York etc.) freely uses both. They were used much earlier in the U.S.A. (e.g., Skene, A.J.C. (1889) Treatise on the diseases of women, for the use of students and practitioners, D. Appleton and Co., New York, or the parallel composite gynaecological book to Allbutt and Playfair by Keating, J.M. and Coe, H.C. (Editors) (1895) Clinical gynaecology: medical and surgical, by eminent American teachers. J.B. Lippincott Co., Philadelphia).
        • Wilbush J.
        La ménespausie - the birth of a syndrome.
        Maturitas. 1979; 1: 145-151
        • Wilbush J.
        The female climacteric.
        D. Phil. thesis. 1980; (Oxford)
      9. Anonymous (“A Physician”) (1739) The ladies physical directory or a treatise of all the weaknesses, indispositions and diseases peculiar to the female sex from eleven years of age to fifty or upwards. London already mentions climacteric disturbances. He does not however describe the climateric as a critical time.
      10. This often applied, in as far as first contacts were concerned, even to women of the upper classes. If necessary the latter sought the advice of medical men who, like Tilt, were known to be interested in climacteric disorders. For “the secret ills” of women (cf. Allbutt, T.C. (1921) Greek medicine in Rome, the Fitzroy lectures on the history of medicine, p. 128, Macmillan, London) were, up to the 19th century in Western as in Greco-Roman medicine, attended to largely by their sisters.
      11. (Vide)
        • Donnison J.
        Midwives and medical men: history of interprofessional rivalries and women's rights.
        Heinemann Educ, London1977
      12. Cessatio menstruorum or mensium. The first references to any disturbances in the climacteric I was able to trace are 3 theses, one sustained at Halle Magdeburg and the other two at Leiden. The first, from the Saxonian University, is by Simon Daniel Titius, a native of “Vratislavia Silesius” (Bratislavia (Pressburg) in Slovakia or Wroclaw (Breslau) Poland?), and was presented in February 1710 with Dr. G.E. Stahl of the University of Magdeburg presiding (Titius, S.D. (1710) De fine mensium initiis morborum variorum opportuno. Christ. Henckel, Halae Magdeb.). The other two (Buhl, J.C. (1722) De praeservatione morborum post-plenarium mensium cessationem. Lugd. Bat. and Regemann, J.L. (1737) De morbis ex menstruis per aetatem cessatibus, Lugd. Bat.) are by Germans studying in Leiden. These are easily obtainable at the British Library, London. There are other numerous theses which deal with Suppressio menstruorum, suppression of the menses, which includes amenorrhoea at any age (vide Wilbush, J., (1980) [11] Sec. 8-2-0, 8-3-0).
      13. “Pour désigner la cessation des menstrues” de Gardanne proposed “l'emploi du mot ménespausie, de μηνηζ, règles, menstrues, et de παυζιζ, cessation”. Gardanne, C.P.L. de (1816) Avis aux femmes qui entrent dans l'âge critique, p. vi, Gabon, Paris.
        • Gardanne
        De la ménopause, ou de l'âge critique des femmes.
        2nd Edition. Méquignon-Marvis, Paris1821
      14. A thesis presented at the University of Paris in 1818 already carries the new term in its title (Maladière-Montécot, M. (1818) Considérations générales sur la ménespausie, ou cessation des mentrues, et sur les moyens à employer pour prévenir les accidents et les maladies qui peuvent l'accompagner, Paris). Another, in 1826 (Lefèvre, J.P. (1826) Considérations générales sur la ménepausie, ou cessation des menstrues, Paris) bears a name midway between de Gardanne's two appellations [16,17].
        Both Strasbourg (1827) and Paris (1832) theses, sometime later however, still carry his first one (Poirson, H.Q.F. (1827) Sur la ménespausie, Strasbourg. Maurice, P. (1832) De la ménespausie, Paris). The term ménopause became widely current by the 1840s, both Boismont, one of the most respected physiologists of his time (Boismont Brierre, A. de (1842) De la menstruation considérée dans ses rapports physiologiques et pathologiques, Ballière, Paris), and contemporaneous theses (e.g.), Poquillon, J.B.L. (1846) De la ménopause ou de l'âge dit critique chez la femme, Paris; Ripeault, C.A.D. (1848) De la ménopause, Paris; Chandelux, L. (1850) De l'âge critique de la femme (ménopause), Paris; Baron, J.S. (1851) De la ménopause, Paris) using it freely.
        • Wilbush J.
        Tilt, E.J. and the change of life (1857) - the only work on the subject in the English language.
        Maturitas. 1980; 2: 259-267
      15. I.e., a formation based on the Greek (vide [16]). This is well demonstrated by its use in the curious designation “male menopause”. “Male cessation of menstruation”, though equivalent, is, on the other hand, an impossible construction - or is it?

      16. Old crones, or “granny-women”. Gardanne, C.P.L.; de (1816) (vide [16]).

      17. The term L'âge de retour, best translated as the time of waning (presumably of physical beauty or power) may have had popular roots.
      18. This term must have had its inception in the encounter between doctors and the female patients who sought their advice in the climacteric. In the same category as grossly exaggerated extravaganzas like “l'enfer des femmes” (best translated as the torment of women. Roussel, P. (1775) Système physique et moral de la femme; ou tableau philosophique de la constitution, de l'état organique, du tempérament, des moeurs, et des fonctions propres au sexe, Vincent, Paris), it may be considered more literary than strictly “medical”. It cannot, however, be considered a popular term. Its description as a “common” (vulgaire) name (e.g., the thesis by Docé, L.H. (1831) Dissertation sur la cessation des menstrues, vulgairement appelée âge critique, et sur les moyens hygiéniques que réclame la santé de la femme à cette époque, Paris) is therefore of the same genre as “vulgo dicta” of an older thesis (Matthey, A. (1780) De morbis a cessatione menstruorum, vulgo dicta temps critique, Paris), an appellation in the vulgar, non-Latin, tongue.
      19. Many demographic (e.g., Pressart, R. (1971) Population. English translation: Atkinson, R. and Atkinson, D. (1970) 1st Edition, p. 16, Penguin Books, Baltimore, Md.), as well as “social” or “medical” events took place in France about 80 yr prior to their eventual occurrence in Britain and elsewhere.
      20. Flint, M., The menopause - reward or punishment? Psychosomatics 16, 161–163. Flint stresses ritual rather than social rewards. The latter, however, seem to be of very much greater importance.

      21. Zulu women, according to Harriet Sibisi (pers. commun. 1975) (Sisibi, N.H., is the author of body and mind in Zulu medicine, published in 1977, New York) admit to a feeling of “heat” in the climacteric but little else. As mothers of sons they are important and have no “reason” to be ill.
      22. The Palestinian Arab term bitkannin or bisir ilha Kanayin freely translated as “she becomes mother to brides”, or “acquires brides” (not “mother in law”, as Granqvist translates it, for such a term is full of associations completely absent in the Palestinian context), denotes a stage of female development, or “age”, which generally coincides with the climacteric (Granqvist, H. (1931) Marriage conditions in a Palestinian village, 1, 36–37, Akademische Buchhandlung, Helsingfors).
      23. (E.g.)
        • Rosenfeld H.
        They were peasants.
        in: Social anthropological studies on the Arab village in Israel (Hebrew). Hakibbutz Hameuchad, Israel1964
      24. Wilbush, J. (1980) 5-3-2 (vide [11]).

        • Maoz B.
        The perception of menopause in five ethnic groups in Israel.
        M.D. thesis. 1973; (Leiden)
        • Bertalanffy L.von
        Modern concepts on biological adaptation.
        in: Brooks C.Mcc. Cranefield P.F. The historical development of physiological thought. Hafner Publishing Co, New York1959: 265-286
      25. Vide Wilbush, J. (1980) [11] for fuller discussion.

        • Utian W.H.
        Clinical and metabolic effects of the menopause and the role of replacement oestrogen therapy.
        M.D. thesis. 1970; (Vide) (Capetown, quoted in many later articles)
      26. Utian is one of the best and most articulate recent exponents of the organicist point of view.
      27. The most widely used classification of menopausal symptoms is the Blatt index (vide Kupperman H.S., Wetchler B.B., Blatt M.H. (1959) Contemporary therapy of the menopausal syndrome. J. Am. Med. Ass. 171, 1627–1631). During the last few years Jaszmann (e.g., Jaszmann L. (1973) Epidemiology of climacteric and postclimacteric complaints. In: Ageing and estrogens, pp. 22–34. Editors: P.A. van Keep and C. Lauritzen, Karger, Basel) has been tireless in advocating a revision of this classification and its general adoption.
      28. This division was established in the last century. Veterinary medicine makes no such distinction but calls all findings of the attendant veterinarian “symptoms”. Unfortunately some medical men are not very discriminating either.
      29. Medicine is still not paying sufficient attention to non-verbal symptoms. These have to be distinguished from non-verbal attitudinal overlay of presentation and expression of illness [11].
        • Wilbush J.
        Symptoms in middle life and the menopause.
        Br. Med. J. 1980; 2 (Vide) (Letter to the Editor): 563-564
        • Neugarten B.L.
        • Kraines R.J.
        “Menopausal symptoms” in women of various ages.
        Psychosom. Med. 1965; 27 (A glaring example is illustrated by the research described in): 266-273
      30. E.g.: Knowing the names of the Kings of England for the history of England, or being able to name a bird for ornithology.

      31. E.g.: compare Gen. 2, 19–20 with Gen. 1, 28.

        • Rutherford R.N.
        • Rutherford J.J.
        The climacteric years in the woman, man and family.
        in: Counselling in marital and sexual problems. A physician's handbook. Williams and Wilkins, Baltimore1965: 220-226