LEUCORRHCEA.
The term " leucorrheea," or " whites," is often applied indiscriminately to every form of vaginal discharge not sanguineous in character. A little observation shows that these discharges fall naturally into the following groups, differing markedly in etiology and treatment: r. A true leucorrlicea, or white discharge, varying in consistence from a thin milky fluid to curdy semi-solid masses, and consisting mainly of shed epithelial cells from the vagina in a watery albuminous medium. This is found often in anaemic young women living amid poor hygienic surround ings, and should be combated by better hygiene as regards food, fresh air, clothing and rest, and by drugs directed to the relief of anaemia. Local measures should be avoided if possible, but if the discharge persists in spite of general treatment a vaginal douche should be given. It is well to get a nurse to show the patient how to use the douche, which should be of the fountain type with a strong glass nozzle. 2 to 4 quarts of warm saline solution (drachm to the pint) may be used every evening before retiring to bed. If this is ineffectual the following may be tried: Boric Acid or Borax (dr. j. to 0. j.), Zinc Sulphate (dr. j. to 0, ij.), Tr. Iod F (IRxxx. to 0. j.), Cupri Sulph. (gr. x. to 0. j.). The practitioner should be on the watch for threadworms and the possibility of masturbation 32 should not be lost sight of. A very soothing and useful form of douche in all cases of vaginal discharge is the following: R 01. Menth. Pip. 3iss.
Acid. Garbo!. 3iij.
Alum. Pulv. Sj.
Acid. Boracici Siv. M. ft. pulv.
Signa.—" A teaspoonful in a quart of hot water to be used as douche." A curdy white discharge associated with intolerable itch is fowl( sometimes in pregnant women. It may be treated by douches as suggestec above. Again, a thin milky secretion is found in some women at th( time of the menopause, and is due to the condition of atrophy of th( vaginal mucous membrane associated with superficial loss of epithelium known as " senile vaginitis." This condition may also be treated b; douches, and if intractable by painting the reddened patches in the vagiru through a speculum with Nitrate of Silver solution (gr. xx. to Sj.), or witl pure Phenol.
2. A sero-purulent discharge, yellowish or greenish in colour, an consisting of an albuminous fluid containing numerous leucocytes and she epithelial cells. This discharge is usually produced by the gonococcus
commonly accompanied by a secondary infection of staphylococci o streptococci. This complaint is often very difficult to cure completely The douches already mentioned may be tried first, repeated twice a day It is well to supplement douching by swabbing out the cervix, which i affected in most cases, with pure carbolic acid, saturated solution of picri acid in alcohol, 4o per cent. formalin solution, or Tr. Iodi. The vagina i: troublesome cases may be swabbed out with 2 per cent. solution AgNQ or with a saturated solution of Picric Acid. Tampons soaked in Bore glyceride, Subitol (to per cent. in glycerin) or Iodine (i per cent. i: glycerin) may be inserted overnight once or twice a week. In cases whic resist these methods ionisation with a zinc salt may be tried. A purulen discharge may also be found in patients who are wearing a pessary wit neglect of the usual precautions to insure cleanliness, or who have becom infected through the introduction of septic matter in the course of a examination or operation. Such a discharge usually disappears on th removal of the pessary, and the institution of regular douches. ] persistent, swabbing with the Nitrate of Silver solution just mentione will quickly cure it.
3. A watery or serous discharge, often foul-smelling and stained blackis or brownish. Such a discharge is very suspicious, and instant measur( should be taken to ascertain whether the patient is suffering from cane( of the cervix or body of the uterus. A similar discharge is sometim( noted in the case of a sloughing fibroid, and in cases of a foreign bod retained in the vagina or uterus. The treatment is, of course, the removi of the tumour causing the discharge (see under Cancer of Uterus and Uterine Fibroids).
4. A clear mucoid discharge like white of egg. This is almost pathogno monic of the condition commonly known as " erosion of the cervix." The treatment is the removal of the erosion by cauterisation, or better by shaving off the affected part as described under llysmenorrhcea.
5. A mum-purulent discharge, consisting of stringy mucus, yellowish or whitish in colour. This is pathognomonic of inflammation of the cervical or uterine mucous membrane. The treatment is that of the inflammation (see under Endometritis, p. 267).—R. J. J.