16. – LEUCORRHOEA – WHITES (Fluor Albus)
DEFINITION – The term Leucorrhoea literally means a white discharge – the white as opposed to a red sanguineous one, – though it is not infrequently of a light cream colour, or yellow, or greenish – and includes a great variety of non-haemorrhagic discharges. It is a catarrh of the vagina, cervix, or uterus, the result of inflammation or irritation. In a healthy condition, the mucous lining, and the various glands which stud the vaginal orifice, secrete a fluid just sufficient to lubricate the opposed surfaces, and the other physiological purposes. In unhealthy conditions this secretion becomes increased in quantity, of an altered character and varies in colour and consistence; this is termed Leucorrhoea.
This disease or symptoms may occur at any period of life, but is most common after puberty, and previously to the cessation of the menses, when so many causes are in operation to induce free determination of blood to the utero-genital organs.
It has been observed that leucorrhoeal discharge in the mother is a potent cause of scrofula in the child. The foetus is insufficiently nourished, hence the scrofulous symptoms soon show themselves in the form of Convulsion, Hydrocephalus, or mesenteric disease; or, if the age of Puberty be reached, in Tubercular.
SYMPTOMS – Generally, a profuse mucous discharge from the utero- vaginal lining membranes of a white, cream-yellow, or greenish colour; thin and watery, or of the consistency of starch or gelatine; it may present a curdled appearance, or appear as a thick tenacious, glairy secretion; and it may be inodorous or foetid. When the discharge proceeds from the vagina it is generally a light, creamy-looking fluid, and has an acid reaction; when it is the effect of ulceration of the os uteri it is profuse and semi-purulent. That poured out by the cervical glands is a copious tenacious albuminous fluid, very much like the white of an egg, and so distinctive that it is unmistakably connected with disease of the cervical canal. It blocks up the os uteri, and hangs out of it as a string of viscid mucus which cannot be wholly removed. This form of Leucorrhoea prevents conception.
The discharge proceeding from the lining of the interior of the uterus has a alkaline reaction, is copious, and generally immediate precedes menstruation. But in most cases the discharge is much more profuse immediately after the menstrual period. In severe cases, the whole system becomes injuriously affected; the face is pale or sallow; the function of digestion are impaired; there are dull pains in the loins and abdomen; cold extremities; palpitation and dyspnoea after exertion; debility and loss of energy; partial or entire suppression of the menstrual flow. Sometimes the discharge is evidently vicarious of menstruation. Slight cases of Leucorrhoea may exist for years without giving rise to any very marked symptoms.
CAUSES – These may be constitutional or local. Any habits or disorder which debilitates the constitution or lowers the tone of health is likely to be accompanied, sooner or later, by a leucorrhoeal discharge; thus it is frequently associated with profuse menstruation prolonged lactation, and other excessive discharges; thus it is frequently associated with profuse menstruation prolonged lactation, and other excessive discharges; prolapsus uteri.
It is often met with in delicate females of a leuco-phlegmatic temperament, in whom a tendency to Phthisis exists; indeed, it is not infrequently the precursor, if not the cause, of lung disease. Cold; congestion; scrofulous constitution; defective health generally; a warm climate; the use of purgative drugs; an inactive and luxurious life, etc. In short, Leucorrhoea is likely to accompany or follow any disease that enfeebles the health. Leucorrhoea is very common in rich, indolent, luxurious and dissipated, and in those who live in crowded cities; it is less frequent in those of industrious and regular habits, and in persons living in the country, especially if the soil be dry.
Local causes are – excessive intercourse, and similar causes of sexual irritation; Polypi, little vascular mucous tumors, or other abnormal growths of the uterus; want of cleanliness, etc. Lastly, Leucorrhoea not infrequently results from irritation or disease in an adjacent part – thread-worms in the rectum (especially in children), Piles, Stone, or Catarrh of the bladder, or the introduction of any irritation substance into the vaginal passage.
EPITOME OF MEDICINAL TREATMENT –
1. Yellow or white mucous discharge – Calcarea C., China, Copav., Hydras., Iodium, Mercurius, Nat. M., Pulsatilla, Sepia, Xanth.
2. Thin, watery discharge – Alumina, Arsenicum, Ferrum, Graphites, Iodium, Sabina, Stannum
3. Thick discharge – Mez., Sepia, Zincum met.
4. Acrid discharge – Acon -N., Arsenicum, Helonias, Kreosotum, Lycopodium, Pulsatilla, Sepia
5. Milky – Calcarea carb., Ferrum, Lycopodium, Pulsatilla, Silicea
6. Offensive. – Carb.-V., Causticum, Iodium, Kreosotum, Sepia
7. Bloody – Calcarea C., China., Kreosotum, Lycopodium
8. Greenish – Carb. -V., Kreosotum, Mercurius, Sabina, Sulphur
LEADING INDICATIONS FOR THE PRINCIPAL REMEDIES.
Arsenicum – Thin, burning Leucorrhoea, from passive or atonic hyperaemia of the uterus, with too frequent and profuse Menstruation.
Calcarea Carb. – Chronic Leucorrhoea in children and in women of weak, scrofulous, and lymphatic constitution, particularly those who menstruate too frequently and too profusely; the Leucorrhoea has a milky appearance, is worse just before the menses, is often attended with itching or burning, or with pains shooting through the parts and sometimes falling of the womb.
China. – After long-continued or excessive discharge, for the consequent debility; also after other debilitating diseases which have induced Leucorrhoea.
Hamamelis – Moderate or excessive discharge, more or less taking the place of menstruation, with much pain about the groin, scalding urine, etc.
Helonias – Leucorrhoea with relaxation of the womb and its appendages. It improves the tone of the sexual organs, and at the same time corrects the co-existing general debility.
Hydrastis – Leucorrhoea with abrasion or superficial ulceration of the parts, and co-existing indigestion and debility. It should be used locally also, six drops of the extract to an ounce of water.
Iodium – In constitutions similar to those mentioned under CalcareaCarb., when there is an offensive, thin discharge; with emaciation.
Mercurius – Leucorrhoea of a yellowish character, containing matter (pus), with soreness and itching, profuse menstruation, the discharge being thin and unhealthy looking; weakness, coldness, sallow complexion, etc.
Pulsatilla – Suitable in the majority of cases, especially when occurring in girls who have not menstruated, or in Leucorrhoea during pregnancy, when the discharge is a thick white mucus, or is corrosive with itching etc. Wandering pains in the abdomen, flatulence, and the Pulsatilla temperament are further indications.
Sepia – Yellow, greenish, or foetid discharge, worse before the menses; scanty menstruation, bearing-down pains; costiveness; sensitiveness to cold; languor; delicate, unhealthy skin.
Sulphur – Chronic cases and scrofulous constitutions. It may follow, or be given in alternation with, any one or the above remedies, in the latter case, Sulphur for seven or ten days, and the other remedy selected the next seven or ten days, and continue to repeat as long as necessary.
Xanthoxylum. – LEucorrhoea with Amenorrhoea, or Dysmenorrhoea, especially in nervous persons, of a delicate organisation. This remedy we obtain from America, and according to Dr. Hale- confirmed as far as we have used it by our own experience-is of great value in diseases of the female reproductive organs.
ADDITIONAL REMEDIES – Colic (leucorrhoea, with colic and flatulent distention); Collinsonia (with piles or constipation); Stannum (watery leucorrhoea in feeble patients; Alumina (inveterate cases; profuse discharge; raised itching spots in the vagina) Kreosotum (with itching, burning and biting of the external parts.)
ADMINISTRATION – A dose three or four times daily for a week or ten days; in chronic cases, morning and night for a longer period.
ACCESSORY MEANS – There are several conditions which are absolutely essential to the successful treatment of “Whites,” – the most important of which are the following:- REST, in the horizontal posture, is sometimes necessary in the treatment of this, as it is of most other uterine disorders. Active exercise aggravates an existing Leucorrhoea, just as it does congestion, or inflammation of the womb. At the same time, moderate exercise in the open air, especially in the intervals between the attacks, short of inducing fatigue, is essential for the maintenance of the general health.
Other accessories of importance are – a…. chosen with the view to its nourishing properties, and to its ready assimilation; avoidance of all sexual excesses, indulgence in the pleasures of the table, exciting spectacles, crowded balls and parties, etc.; and lastly frequent injections of water, and daily ablutions, including the hip-bath, are necessary, in order to insure the most perfect cleanliness of the utero-genital organs.
The importance of this last point cannot be too strongly stated, for without due attention to cleanliness all other efforts may prove futile. The leucorrhoeal secretion is at best exceedingly irritating, but when it is permitted to accumulate and remain for a long time in contact with the mucous membrane, it becomes partly decomposed, foetid, and highly pernicious to the healthy condition of the parts. On this account the frequent and thorough use of local applications of tepid or cool water should be strictly carried out. The use of the enema syringe, having the vaginal tube attached, is necessary efficiently to carry out this part of the treatment. For delicate ladies we recommended.
THE VAGINAL OR UTERINE DOUCHE. – In order to insure a continuous stream of water on the lower portion of the womb, and on the vaginal mucous surfaces, without any any manual effort on the part of the patient, a self acting douche has been constructed. It consists of a japanned metal reservoir, fitted with six or more feet of tubing, to which a vaginal pipe with an ivory nipple is attached.
The reservoir has merely to be filled and suspended above the level of the hips, when a continuous stream is obtained, the force of which is easily regulated by a stop cock. The degree of pressure can be increased by a greater or less elevation of the vessel. The water for the douche should never be cold when pregnancy is supposed to exist.
17. – INFANTILE LEUCORRHOEA
DEFINITION – Catarrhal inflammation of the vulva, occurring chiefly in strumous children.
SYMPTOMS – Irritation of the vulva, occasioning a frequent desire to rub the part, sometimes slight pain in passing water, and a tin, colourless, or thick creamy discharge. In unhealthy children, of bad hygienic conditions, the Leucorrhoea may become copious and corrosive, giving rise to ulceration of the mucous membrane. The discharge is infectious, causing severe inflammation if brought in contact with the lining of the eye, or other mucous surface.
CAUSES – Sudden check of perspiration or exposure to cold; acrid urine; neglect of cleanliness; the use of infected sponges 1 (1 Mr. Copper Forster relates a case in which a woman communicated an infectious discharge to two girls by washing them with her own sponge.) worms; manual irritation, etc.
DIAGNOSIS – Girls of all ages are liable to a discharge from the vulva, quite independently of infectious matter. The remembrance of this fact may save much distress; for the occurrence of this discharge in children has often caused unfounded suspicious and anxiety.
But the absence of swelling, heat, and redness; the limitation of the discharge to the external parts, and the integrity of the hymen, tend to prove that the affection has not been communicated. In infectious discharges, the parts are inflamed and swollen, the inflammation extending high up into the vagina, and passing of urine causes pain.
MEDICINAL TREATMENT. –
Calcarea C. – Chronic whites in strumous children, the discharge being milky.
Cannabis Sativa – When the discharge is yellowish, and there is swelling, heat and redness of the parts and painful urination.
Iodium – For the leucorrhoea of strumous children; the discharge is usually thin and offensive; and there is considerable emaciation.
Mercurius Cor. – Acrid yellowish discharge with soreness, scalding urine etc.
Pulsatilla – Milky discharge in children of fair complexion, with symptoms of indigestion or catarrh.
Teucrium – Leucorrhoea from the irritation of thread worms.
For additional remedies and fuller details of symptoms, the previous Section should be consulted.
ACCESSORY MEASURES – The parts should be frequently washed with tepid or cool soft water, carefully dried, and a little finely powdered starch or violet powder applied. The diet should be good and digestible, taken regularly in three meals daily, and properly varied. Fresh air is necessary but without too much exercise at first. Salt baths, sea-air, and cod-liver-oil are often advantageous, and in strumous children essential; for the general health, which is at fault, must be corrected before a cure can be effected. When worms are the exciting cause, the treatment pointed out in the Author’s work on the “Diseases of Infants and Children’ should be carried out.
18 – CHLOROSIS – GREEN SICKNESS
DEFINITION – A condition of general-debility affecting young women at about the age of puberty (from sixteen to twenty-five years of age), due probably to nervous causes. There is anaemia or deficiency of the red corpuscles of the blood, which gives the skin a pale, yellowish, or greenish, and almost transparent hue. The greenish hue is so characteristic as to have given rise to the name – “green sickness”.
The temperature of the body is diminished, and morbidly sensitive to cold. There is generally delayed, suppressed, or imperfectly performed menstruation. Respiration, circulation, and digestion are also disturbed, and the whole organism, physical and mental, is feeble and enervated.
SYMPTOMS – In addition to those given in the preceding paragraph, the following symptoms are always more or less prominent:- loss of appetite, the patient often subsisting upon an incredibly small quantity of food; or the appetite is perverted, and such articles craved for as chalk, coal, cinders, etc. In other cases, the appetite becomes fitful, or the patient eats simply as a duty. Most patients complain of obstinate constipation, or this condition may be alternated with relaxation. Sometimes the breath is offensive, or there may be ulceration of the stomach, and persistent vomiting, or even Haematemesis. These and other gastric disturbances are attended by loss of the cellular tissues, and even wasting of the muscles.
The face becomes puffy, and the features somewhat observed; the eyes languish, the lids are oedematous, and surrounded by dark circles, which strongly contrast with the pearly translucent appearance of the white of the eyes, and the pallor of the lips. A species of dropsy, most generally affecting the ankles, is often present, and the whole surface is dry and bloodless. The hands are shriveled, and the nails brittle. Nervous affections of the heart, unattended by any structural change, are very common, with palpitation, chilly turns, with cold and often oedematous extremities. The pulse is usually, but not invariably slower, and also weaker than in health. But the most marked symptom affecting the circulation is the anaemic bruit or bruit de diable; this is a continuous humming or cooling sound heard over the precordial region, and especially over the large blood- vessels of the neck. It can also be felt, and under the finger resembles the vibrations of a musical cord. It is supposed to be due to the tenuity of the blood.
CHLOROSIS AND ANAEMIA – The table on the following page, from Dr. Ludlam’s Clinical Lectures, with enable the reader indistinguish between these diseases. Sometimes the symptoms are less clearly marked than in the table, and probably in rare cases the two diseases may co-exist.
It is very rare for Chlorosis to exit without menstrual irregularities; Amenorrhoea is the most common complication. Sometimes the monthly discharge, if it every occurred, is superseded by a copious Leucorrhoea. The co-existence of non- menstruation and gastric disturbance has sometimes given rise to a suspicion of pregnancy, and we have not infrequently been consulted from the fear which has thus been excited.
Chlorotic patients become listless lethargic, and melancholy. They lose interest in society and in the general events of life, preferring solitude and quiet repose. There is frequently paroxysmal, often regularly periodic headache, chiefly affecting one temple, greatly aggravated by over anxiety, worry and other emotional influences. In short, as the foundation of all the symptoms, the nervous system is so completely the seat of the disease that there is not an organ, or tissue, or fluid of the body that escapes.
CAUSES – The chief predisposing causes are the lymphatic temperament, and a tendency to struma. In these persons the blood-making function is liable to such disorder as results in a deteriorated quality of that fluid.
1. Is an idiopathic affection 2. Is not caused by loss of blood or other debilitating discharge. 3. May result suddenly from mental causes alone.
4. The mental and nervous symptoms are especially prominent.
5. The nervous symptoms initiate an attack.
6. Fugitive neuralgic pains in the head, the spine, the stomach, the chest, and especially in the side, are almost invariably present.
7. May be accompanied or followed hysterical spasms, Chorea, Paralysis, or Epilepsy
8. The skin is of a greenish or greenish-yellowish tint.
9. Haemorrhages are not very frequent.
10. Is very rare in male subjects. 11. Rarely happens in those who are under twelve or over thirty years old.
12. Is limited to women of tympanitic temperament.
13. Is very liable to be accompanied by suppression or retention of the menses.
14. May exist and run its course without any perceptible change in the composition of the blood.
15. The degree of change in the blood is in direct ratio with the degree of functional disease.
16. Is most common among the better classes of society.
ANAEMIA 1. Is an accident or sequel of other diseases.
2. Is frequently caused by haemorrhage, suppuration, Leucorrhoea, Diarrhoea, colliquative sweats, etc. 3. Never does. 4. Not so in Anaemia. 5. The opposite occurs in Anaemia. 6. These pains are lacking. 7. These complications and by sequelae are not incident to this affection. 8. The skin is blanched, pallid, puffy, and doughy. 9. Haemorrhages are very frequent. 10. Affects the sexes indiscriminately – men, women and children. 11. May occur at any age. 12. May happen to men and women of any temperament. 13. Is more likely to be accompanied by too frequent and copious menstruation. 14. Is always characterised by an impoverishment of the blood. 15. The impoverishment of the blood bears no necessary relation to the severity of disorder. 16. Is most common among the poorest classes.
Hence the relative diminution of the red corpuscles, and the proportionate increase in the watery part of the blood. This predisposition is fostered by hygienic conditions which tend to lower the standard of health, and to vitiate the progress of sanguinification (Ludlam).
Among the hygienic conditions, the most favourable to the production of Chlorosis are-confinement in badly ventilated or imperfectly lighted or shaded rooms-under ground kitchens and back rooms, shut in by high walls excluding the direct rays of the sun, and a free circulation of air – and deprivation of open air exercise and recreation. Some time since, the writer was requested to visit a chlorotic patient in London, in whom the symptoms were very marked. She lived in a large house thickly hemmed in by lofty buildings, and for convenience or from choice passed most of the day in a low dark room. We saw flowers in the upper rooms and remarked as we entered the patient’s room. “You have no flowers here.” Our patient quickly answered, “Oh no! they won’t grow in this room; they want more light.” But she failed to perceive that her devitalised frame and languishing nerve-power were the result of those bad hygienic conditions to which she should not even subject her plants!
Other causes are-too studious and sedentary habits; chronic inflammation of the intestinal canal; enlargement and inaction of the mesenteric glands; long-continued grief, unrequited love, anxiety, fright, or fatigue; abnormal excitation of the sexual organs; uterine or ovarian disease, innutritious food. Bread- and-butter forming the staple diet, the relish for animal food of every kind almost completely ceases. These and similar causes not merely effect gradual changes in the composition of the blood, but impair the process by which the blood itself is made.
EPITOME OF MEDICINAL TREATMENT –
1. For Cachexia. – Arsenicum, Calcarea carb., ferrum, Kal-C., Lycopodium, Natrum muriaticum, Sulphur
2. Nervous Symptoms – Aconite, Belladonna, Chamomilla, Coffea, Ignatia, Phosphorus-Ac.
3. Menstrual Irregularities – Calc-C., Chamomilla, Caulophyllum, Conium, Cyclamen, Graphites, Gelsemium, Helonias, Lep., Senec., Sepia
4. Digestive Symptoms – Lycopodium, Nux -V., Plumb., Pulsatilla
LEADING INDICATIONS FOR THE PRINCIPAL REMEDIES –
Arsenicum – OEdematous swelling of the feet, puffiness of the eyelids, distention of the abdomen morbid cravings, frequent fainting, and extreme debility.
Calcarea Carb. – In cases in which there is tendency to scrofula, or consumption, as evinced by the presence of glandular enlargements, cough etc., and in other cases attended with dropsical swellings of the feet and difficulty of breathing.
Cyclamen – The patient is pale, chilly, and languid, with nausea, loss of appetite, headache, vertigo, dimness of sight, and tendency to looseness of the bowels.
Ferrum – Fits of oppression, palpitation and anxiety, poor appetite, pale face, swelling of the face and ankles, absent, scanty, pale, or watery menstrual discharge, especially in patients of strumous constitutions and lymphatic temperament.
Graphites – Too late, scanty, painful menstruations, dull, pressive or wrenching pain in the lower part of the back, constipation, and unhealthy condition of the skin.
Helonias – Chlorosis with atonic conditions of the womb, and defective digestion and assimilation.
Ignatia – Nervousness; mental depression, or rapid emotional changes.