its many causes may be mentioned: 1. Conditions in which the freedom of the pelvic circula tion is impaired; e.g., pregnancy, new growths, and inflammatory conditions within the pelvis. 2. A relaxed and ca tarrhal condition of the mucous mem branes in general; e.g., anmmia, fatigue, and the catarrhal diathesis. 3. Excessive function; e.g., frequent coitus.
Treatment. — The treatment consists first in cleanliness, the discharge being received upon absorbent-cotton pads as soon as voided; next in relieving, as far as possible, the conditions which have caused it; and, finally, in the use of astringent douches, such as have fre quently been referred to, to remove, as far as possible, the local conditions which favor its continuance.
The vaginal secretion having an acid reaction led to the conclusion that this acid possessed bactericidal properties; experiments showed that profuse and fcetid leueorrluca under irrigation with a 3-per-cent. solution of lactic acid disap peared in a very short time. Sneguireff (Thinchener med. Wocb., S. 66, 1900).
Except in a few instances, Duch as specific and septic infections, leueorrhma is almost always secondary.
Speaking broadly, the discharge can have its origin in one of three places: (1) the vagina, (2) the cervix, and (3) the endometrium of the body of the uterus.
When a patient presents herself coin plaining of leticorrlicea, the first thing to do is to determine the cause, if possible. Any local treatment would be worse than useless, unless the source of the trouble be removed at the same time.
It has been personal custom to treat by the use of tonics for the general health, astringent douches of alum and zinc sulphate, and the occasional use of a solution of silver nitrate, 10-20 grains to 1 ounce. This latter is applied by insert ing a cylindrical speculum, filling it full of the solution, and then slowly with drawing the instrument, thus making sure that the solution reaches every part of the vaginal wall. This is more satis factory than the use of a swab. This treatment, combined with douches of corrosive sublimate 1 to 4000. is the one which, in gonorrhoea, has given perfect results.
Cervical leucorrhcea, always excluding a vonorrhceal infection, is usually due to a catarrhal inflammation of the cervical endometrium, usually secondary to some other condition. The discharge here is very thick and copious. It is often ac companied by erosions of the cervix. This erosion, when not due to laceration, is produced by swelling and prolapse of the cervical endometrium. When such an endoinetritis exists, it usually in volves the corporeal endometrium as well, so that the condition may often be cured entirely, or at least form a much better foundation for satisfactory after-treat ment, by a thorough curettement. Non operative treatment consists in hot as tringent douches, painting the vaginal vault with Churchill's tincture of iodine, and the use of boroglyeeride tampons three times a week, the whole combined with a general tonic treatment. Tonics are generally indicated. The only pre caution taken is not to prescribe iron in cases where there is a tendency to uter ine hemorrhage.
When this treatment has not the de sired effect, protargol bougics may be used.
Leucorrhwa from the uterine body is nearly always associated with an endo metritis. The treatment should lie curettement to remove the hypertrophied masses: then tonic treatment with intra uterine medication of one of the new silver salts in the form of bougics. Bar ton Cooke Hirst (Tiler. Caz., Oct. 15, 1900).
Atrophy of the Vagina.
This condition is the natural result of age and the decay of function; it is a diseased condition when it occurs prema turely, or as the result of other diseased conditions. It occurs after the removal of the ovaries and the premature pro duction of the menopause; sometimes in connection with excessive obesity and wasting diseases, which cause atrophy of all the genital organs. The lumen of the vagina, under these conditions, is con tracted, the mucous membrane is pale, and it fails to respond to those stimuli to which the healthy mucous membrane ordinarily reacts. In a word, its vitality as a functionating organ is practically abolished. No particular treatment is indicated, its work as an organ being ac complished.