324 
PATHOLOGY. 
vix uteri, of abfcefs of the womb, or abfcefs in fome part 
of the vagina. Lnftly a watery difcharge, according to 
Dr. Clarke, accompanies the cauliflower excrefcence of 
the os uteri, hydatids of the womb, and the oozing ex¬ 
crefcence of the labia. There are three fpecies. 
i. Leucorrhcea communis, Ample inflammation of the 
mucous membrane of the vagina, is charafterifed by a dif¬ 
charge of a tranfparent mucus of a gelatinous nature, 
which does not render water turbid, and which, when it 
arrives at the external labia, acquires from friftion with 
the air a white colour. This difcharge may be pro¬ 
duced by two different kinds of affion in the mucous 
membrane, which bear a clofe analogy to two difeafes of 
a flmilar but diftant drudfure ; viz. acute and chronic 
bronchitis. Thus in one inftance this difcharge is caufed 
by cold, full living, and idlenefs ; attacks robufland above 
all corpulent peri'ons, u'ho for the mod part menftruate 
in great quantities; is attended with much diforder of 
the hepatic functions ; with vertigo, mufci-volitantes, and 
other fymptoms of undue circulation in the head, and 
with a full pulfe. In a word, all the fymptoms of ple¬ 
thora are fufficiently manifeft. The treatment is in this 
cafe fufficiently obvious. It conflftsin removing the ge¬ 
neral plethora by bleeding from the arm, and .the local 
fulnefs by leeches orcupping. The bilious diforder is to 
be remedied by regular doles of calomel; the bowels kept 
open by brifk faline, but not dradic, cathartics ; and a 
low diet enjoined. At the fame time, the difcharge, as 
it is a confequence of plethora, and as it tends to cure 
more violent maladies, as haemorrhage and apoplexy (to 
which the patients under confideration are very liable), 
mull not be fuddenly redrained. At fird indeed the 
•warm bath and the frequent injeftion of warm water 
into the vagina will be proper, not only to cleanfe the 
acrimonious difcharge, but to make it flow more freely ; 
and it will not be till iome time after the plethoric, bili¬ 
ary, and indeed all unpleafant fymptoms except the dif¬ 
charge, are gone, that we may venture to order an adrin- 
gent application. This may be a weak folution of ful- 
.phate of zinc, or of fuper-acetate of lead. 
But the other form of the complaint which, as we be¬ 
fore dated, depends on the relaxation of the mufcular 
drudlure of the vagina, and fo connedled with adtual de¬ 
bility, attacks weak and dyfpeptic patients, thofe who 
live in a moid atmofphere (hence its frequency in Hol¬ 
land), thofe who keep bad hours, inhabit hot rooms, and 
lie long and late in bed, or u’ho fuclcle their children for 
too long a time. Pallor, and a yellowifli exanguious date 
of the lkin, with a doughy feel, and in the feet and legs 
flight cedematous fwellings of the integuments, mark the 
patients of this malady. The pulfe, final] and fometimes 
quick, is liable to acceleration from occafional nervous 
palpitations. Anorexia, flatulence, coflivenefs, and irre¬ 
gularity in the fecretion of bile, pave the way to a more 
or lefs marked degree of hedtic fever, which eventually 
leads tootherand more eventful maladies. 
The treatment of thefe fort of cafes mud of courfe be 
different from that before defcribed. The removal to a 
drier atmofphere, the interdidfion of late hours, the fub- 
ditution of a daily nap on the fofa for late indulgence 
in bed, are the fird and mod obvious meafures. Paf- 
Ave exercife mud be ufed in the early dages of the ma¬ 
lady; and aftive mufcular motion mud be referved for 
cafes in which the fydem has recovered, or has not lod, a 
certain degree of vigour. The food mud be at fird light, 
and requiring little power in the domach to diged it; as 
foups, jellies, &c. but thefe mud be fucceeded by folid 
animal food before the vigour of conditution will be 
quite redored. The bowels mud be kept open by mild 
laxatives ; the liver, if inactive, mud be operated on by a 
few grains of blue pill every other night. Gentian and 
carbonate of ammonia will tend, in conjunction with 
proper diet and a free date of the bowels, to excite the 
powers of the fydem in a very falutary manner. As foon 
as fome material amendment has taken place in the gene¬ 
ral health, and not till then, fhould we turn our atten¬ 
tion to the redraining of the difcharge. For this pur- 
pofe the gentian and ammonia may be advantageoufly 
changed for the exhibition of fome preparation of iron, 
combined with an alkali, and occaflonally with myrrh. 
Cold bathing and adringent injections may now be ufed. 
For the latter, folution of alum or fulphate of zinc are 
the mod proper, their drength being, as in other cafes, 
gradually increafed. 
2. Leucorrhcea nabothi, labour-fhow': flimy, and for 
the mod part tinged with blood. Secreted by the glan¬ 
dular nabothi fituate on the mouth of the uterus ; and 
chiefly on the beginning of labour. 
The fame parts are how'ever liable to another difcharge, 
coming at a different time, and poffeffing characters quite 
different from the above defcription. In fome cafes of 
of vaginal difcharge, the fluid feems to come from the 
fuperior parts; and hence, though probably mixed with 
the common mucus of the vagina itfelf, exhibits charac¬ 
ters fomewhat different. It is defcribed by Mr. Clarke, 
who calls it the white mucous difcharge, as being “ opake, 
of a perfeCt white colour, and refembling in confidence a 
mixture of darch and water made without heat, or thin 
cream.” This difcharge is eafily walked from the finger 
after an examination ; and it is capable of being difrufed 
through water, rendering it turbid. Mr. Clarke is of 
opinion, that “ a morbid date of the glands in the cer¬ 
vix of the uterus probably gives rife to this difcharge; 
at lead, the cafes in which it comes away are thofe in 
which the fymptoms are referred to this part; and, when 
preffure is made upon the cervix uteri under fuch circutn- 
dances, the woman complains of confiderable pain.” 
It feems from the caufgs and fymptoms of thefe dif¬ 
eafes, and from the nature of the curative agents found 
mod ufeful in its treatment, that the above morbid date 
of the cervix uteri is chronic inflammation. Witlf re¬ 
gard to the pathognomonic fign, tendernefs of the os ute¬ 
ri, this of courfe is only known by introducing the finger 
into the vagina. In doing this, little irritation is excited 
in the vagina itfelf; but, as foon as the os uteri is 
touched, a great degree of uneafinefs is felt. The feme 
fenfation is alfo felt during the paffage of an evacuation* 
along the reClum. The cervix uteri feels poliflied and 
fmooth ; and this didinguifhes the difeafe from carcico- 
ma, in which hardnefs is felt; and from ulceration, in 
which of courfe fome breach of furface is felt. In this 
afredtion few' fymptoms are prefent. The patient com¬ 
plains of uneafinefs in the back, and lower part of the 
abdomen, which gradually becomes adfual pain. Riding, 
or other motion tending to induce preffure, increafe this 
pain in fome degree ; but the draining required to evacu¬ 
ate indurated faeces renders it very acute. The fame at¬ 
tempt often fqueezes from the vagina the mucous fecre¬ 
tion, which is always accumulated there in a greater or 
lefs quantity in this difeafe; and, as it falls down on tlie 
motion, is apt to lead perfons to fufpedl that fome difeafe 
in the redlum has given rife to the difcharge. A certain 
degree of dranguryalfo is generally prefent; and fome¬ 
times cydic tumors in the vagina have been met with, 
when they have probably been caufed by the fame inflam¬ 
matory adtion which gives rife to the tendernefs of the os 
uteri. The prefence of a mucous difcharge, the abfence 
of pain when the lower part of the belly is prefled on, and 
the abfence alfo of periodical exacerbations of pain, dif- 
tinguilh this difeafe from hyfleritis, or inflammation of 
the fubdance of the womb. 
The treatment differs little from thatlaid down for leu¬ 
corrhcea dependant on inflammatory adtion. Local blood¬ 
letting, by cupping or leeching the back or groins, re¬ 
peated according to circumdances, forms the balls of the 
treatment; and, where fymptomatic fever prefents itfelf, 
venefedtion is proper, though feldom neceflary. The 
hip-bath is a ufeful remedy, and the patient may fit in it 
twice a-day, at the temperature of 90°. Where this lad 
cannot be procured, fomentations to the back or abdo- 
i men 
