CHRONIC ENDOMETRITIS, LEUCORRHOEA, OR UTERINE CATARRH.
In this chronic from of inflammation, into which the acute inflammation of the mucous lining membranes of the uterus is most apt to subside, the symptoms are less violent of and less strongly marked. Nor in fact would its presence be suspected in all cases, were it not for the accompanying discharge. In chronic uterine leucorrhoea, the discharge is usually less profuse than in that which attends the first onset of the acute inflammation. And as the acute catarrhal inflammation is the form which principally attack the young, especially the unmarried, so the chronic form chronic appears in those who are older, who are married, who are bearing, or who have borne children, or who have passed the change of life.
The uterine catarrh, which forms have principal symptomatic indication, as it is the chief consequence of chronic endometritis, varies in quantity in different persons, and at different times in the same individual. Like vaginal leucorrhoea, it may be so scanty as scarcely to become perceptible externally, or it may be so profuse as to require the application of several napkins daily. The discharge varies also in color, character and general appearance and effects. It may be colorless and semi- transparent; or it may assume a greenish-brown or even darker hue, as if, in the severer forms, it were mixed with blood. In the same manner its character and quality may be very different in different persons, or in the same individual at different times. Thus it may be mild, bland and unirritating, or it may be acrid and so cause excoriation of the labia or even of the skin of the surrounding parts. So also in its direct effects, it may vary in a remarkable manner. When very profuse it becomes rapidly exhausting. And while in the first instance due to some dyscrasia, some morbid influence or diseased condition of the system, it still further aggravates the general ill-health by the profusness of its flow as well as by the important functional derangements, which sooner of later allow in its course.
The causes of Uterine Leucorrhoea may be divided into two classes. The first may be grouped under the head of constitutional predisposition. And in this class also we include all those cases which result from the influence of other forms of constitutional or functional disorders, such for example as menstrual irregularities or organic displacements. From causes and morbid influences of this nature, arise the great majority of the cases of uterine leucorrhoea, which appear either in the young or in older, unmarried females.
The second class of cause of chronic endometritis, we may term the provoking or special causes. These are most numerous in the married state, as arising from the great excitements and sudden and extensive organic changes to which the uterus and its appendages are constantly liable.
The constitutional predisposing causes are in general similar to those which result in chronic leucorrhoea. They are such as are implied in the terms leucophlegmatic temperament or scrofulous diathesis. Persons who come under this description of may be thin or quite fleshy. In either cause such person s are remarkably prone to suffer from the least exposure to cold damp weather; and the immediate consequence of such suffering and exposure, appears in the form of some blennorrhoea. These two circumstances of sensitiveness to the cold dampness, and blennorrhagic discharge in consequence of it, are characteristics of this particular temperature. This constitutional predisposition is the one which most frequently leads to leucorrhoea, whether vaginal or uterine, or both, in young girls.
But after the accession of puberty, the same constitutional influences may, and indeed constantly do, induce leucorrhoeas, but in a less direct manner. The principal diagnostic characteristic of uterine leucorrhoea, is its relation to menstruation. Those forms of leucorrhoea which appear to be unaffected by the menstrual function, being supposed to be purely vaginal, while those which are greatly aggravated either immediately before, or during, or immediately after the menses or menstrual period, are considered to belong more especially to the uterus.
And there are several varieties of uterine leucorrhoea considered with reference to the menstrual function. Thus in young females of a delicate, constitution, the accession of the catamenia may be preceded by two or three monthly attacked of leucorrhoeal discharge. This may be considered as a forerunner, and truly uterine, if not a vicarious secretion. Again in many cases of suppressed menses the proper menstrual flow is replaced by a leucorrhoeal which appears regularly at the proper monthly periods, continues the usual number of days and perhaps discharges about the quantity which would correspond to the natural menstruation of the female. Where the menses themselves are normal and regular, a leucorrhoea may appear in the intervals, which will greatly increase in quantity immediately before the appearance, or immediately after the subsidence of the menses. In some of these cases the leucorrhoea encroaches more and more upon the menstrual flow, until it finally supersedes it altogether. And in the severer forms of this leucorrhoea, it may produce menorrhagia, or true uterine hemorrhage, which like the former variety of leucorrhoea just mentioned, may also occupy the intervals and increase just before and just after the monthly periods. Again, as at the accession of the menses, so also about the time of the cessation of the menses, the few last periods are often marked by the occurrence of leucorrhoeal discharges either alternating with, or appearing in the place of the usual menstrual flow. In many persons of a chlorotic temperament, leucorrhoea replaces the menses entirely. And finally after child-bearing, or after abortion, a white, inodorous discharge will sometimes makes its appearance and continue for months. In the case of spontaneous abortions this discharge will either tend to prevent subsequent conception, or where that takes places, it will predispose to successive abortions. But this result will not be so much due to the discharge itself, although apparently its immediate cause, as to the morbid condition of the womb which produces the discharges.
Those forms of leucorrhoea, which appear under the above- mentioned conditions, may be considered as arising from the uterus; although in the great majority of cases, the uterine leucorrhoea is complicated with a similar discharge from the vagina. And those disorder of the vaginal mucous membrane, which thus induce uterine leucorrhoea, may also be included among its constitutional causes. And the same may also be said of the leucorrhoea of the uterus which result from displacements of this organ.
Among the special or provoking causes of chronic endometritis and uterine leucorrhoea, are to be ranked principally those influences which are incidental to the married state. Of these, excessive sexual intercourse is perhaps the most frequent and efficient. Similar in effect are the cold water and other injections, resorted to by many for particular purposes. Child- bearing, abortions, and in fact all other influences capable of producing acute inflammation of the mucous coat of the womb and consequent acute catarrhal discharge, are also to be classed as causes of similar chronic disorders. And this is equally true whether we consider the less violent and longer continued action of such influences to have resulted in a chronic inflammation, or whether this latter form of disease be but the continuation of the acute inflammation itself. And in general, all those influences, mechanical, functional or sympathetic; which disturb the womb, without exciting inflammation of its deeper tissues, may result in this subacute mucous inflammation, of which the leucorrhoeal discharge is at once the evidence and the consequence.
Aconite is the only remedy in those forms of this disease, where there is much irritability of the system with fever and fear, thirst and vertigo in rising or setting up.
Aesculus hippo. Leucorrhoea with lameness in the back, across the sacro iliac articulations, and great fatigue from walking, because that part of the back gives out in walking even but a little way.
Alumina. Where the leucorrhoea occurs either before or after the menses; it is acrid and profuse. Relieved by cold washes. Transparent and mucous, running down to the heels in large quantities.
Ambra grisea. Leucorrhoea only at night. Stitches in the vagina before the discharge. Leucorrhoea of bluish white mucus.
Ammo. c. Violent acrid leucorrhoea, sometimes burning watery discharges from the uterus.
Ammo. mur. Leucorrhoea with distention of the abdomen. Leucorrhoea like the white of egg after a pinching pain around the navel. Brown slimy leucorrhoea, after every discharge of urine.
Anacardium o. Great loss of memory. Leucorrhoea with thing and soreness.
Anti. crud. Discharge of an acrid water from the vagina which causes a sensation of biting down along the thighs.
