(3) In the case of irregular or too profuse menstruation, the patient should under no circumstances wait for the bleeding to stop before consulting her doctor ; for, in the presence of cancer, these lixmorrhages frequently continue until stopped by medical means. The patient should at once have herself examined.
(4) Discharges and hemorrhages occurring in young persons may, of course, be due to other causes than cancer. For the sake of the patient's peace of mind, however, an exact diagnosis should at once he made by the physician, so that appropriate and timely treatment may be had.
(5) Profuse menstrual hemorrhages, especially during the change of life, require immediate medical treatment. They are always due to affections of the womb, frequently to incipient cancer. It is particularly important to remember that haemorrhages which occur after menstruation had ceased for some time are always to he regarded as possibly due to cancer.
(6) Simple inflammations of the mucous membrane of the womb in young women require careful, usually local, treatment, as these inflammations may give rise to cancer at a later period.
Catarrh of the Womb (Leucorrhcea).—A disease due to inflammation or proliferation of the mucous membrane of the uterus, chiefly of the neck, or cervix. It is characterised by the discharge of a muco-purulent fluid, and frequently also by increased menstrual flow. Catarrh of the cervix is a very frequent affection, and is brought about by all those causes which give rise to chronic inflammation of the womb (which see). It may be due also to general disturbances of nutrition, as Nye!! as to uncleanliness during menstruation, when the blood adhering to the external genitals is allowed to pass into a state of putrefaction, this infecting the womb. It follows that leucorrhcea occurs frequently in virgins. In the more marked degrees of the affection the patients may become considerably run down.
If a regulation, according to hygienic principles, of the entire mode of living has been without results, local treatment must be resorted to. This consists in cauterisation of the affected part of the mucous membrane, or in scraping the womb. The latter operation is quite harmless ; and the diseased parts of the membrane, which are removed, are soon replaced by a growth of new, healthy tissue. The parts removed should be microscopically
examined, in order to determine whether the affection was a simple catarrhal inflammation or the beginning of a cancerous growth. The naked eye is unable to recognise the differences.
Displacement of the Womb.•—The correct position of the womb is about as follows : When the bladder is empty, the uterus of a standing woman lies almost horizontally in the pelvis, its fundus, or end, forward, and the vaginal portion posteriorly. The uterus is also bent slightly forward (sec Fig. 442). When the bladder is full, the fundus is pushed backward and upward, whereas the vaginal portion advances forward and downward. This change of position should be taken into consideration by a sick woman, in so far as she should discharge her urine before submitting to a gynecological examination.
If the last-named position of the uterus persists also when the bladder is empty, a backward inclination of the womb is present. If, as is often the case, this position is accompanied by a backward curvature, retroversion or inflection of the womb is the result (see Fig. 443). This is a displacement which occurs in about 20 per cent. of female diseases. It may be congenital, or acquired during early childhood, as by a fall. In the latter case, the condition frequently gives rise to violent pains resembling those accompanying peritonitis or appendicitis. Moreover, an inflammation of the appendix may, on account of the adhesions it causes, be the direct cause of retroversion of the womb. This faulty position of the womb is very often produced in childbed, either by a deficient involution of the ligaments of the womb, which are no longer capable of drawing the fundus of the uterus forward after it has been displaced by the filled bladder, or by inflam matory adhesions of the ovaries or tubes with the posterior wall of the pelvis. It is obvious that, independent of childbirth, all causes leading to inflammation of the ovaries and of the pelvic peritoneum(gonorrhcea, for instance), may give rise to a backward displacement of the womb.