The effects on the character of this 'grand climacteric' are often marked. Not unfrequently the woman becomes more masculine in thought and habit, as has been admirably described by Dr. Tilt:--'There are almost always while the change is progressing various forms of nervous irritability and some amount of confusion and bewilderment, which seem to deprive women of the mental endowments to which they had acquired a good title by forty years' enjoyment. They often lose confidence in themselves, are unable to manage domestic or other business, and are more likely to be imposed on either within or without the family circle. When the change is effected, the mind emerges from the clouds in which it has seemed lost. Thankful that they have escaped from real sufferings, women cease to torture themselves with imaginary woes, and as they feel the ground grow steadier underfoot, they are less dependent on others--for, like the body, the mental faculties then assume a masculine character. The change of life does not give talents, but it often imparts a firmness of purpose to bring out effectively those that are possessed, whether it be to govern a household, to preside in a drawing-room, or to thread and unravel political entanglements. When women are no longer hampered by a bodily infirmity periodically returning, they have more time at their disposal, and for obvious reasons they are less subject to be led astray by a too ardent imagination, or by wild flights of passion.' Changes in the moral character also frequently show themselves, and for a time astonish friends and relatives. These shades of moral insanity all disappear in a little while, if there be no family tendency to insanity to prolong and intensify them. THOSE WHO SUFFER MOST. Those women especially may anticipate serious trouble at this epoch in whom the change at puberty was accompanied by distressful and obstinate disorders,--those in whom the menstrual periods have usually been attended with considerable pain and prostration, and those in whose married life several abortions or several tedious and unnatural labors have occurred; also those who from some temporary cause are reduced in health and strength,--as from repeated attacks of intermittent fever, or disorders of the liver and digestive organs. Still more predisposed are they who are subject to some of those displacements or local ulcerations which we have mentioned in our chapter on Health in Marriage. It becomes of great consequence, that any such deviation from the healthy standard shall be corrected before a woman reaches this trying passage in her career.