LEUCORRHCEA 
 
 AND OTHER VARIETIES OF 
 GYNECOLOGICAL CATARRH 
 
 A TREATISE ON THE CATARRHAIv AFFECTIONS OE THE 
 
 GENITAI, CANAI. OE WOMEN ; THEIR MEDICAI. AND 
 
 SURGICAI, TREATMENT. 
 
 BY 
 
 HOMER IRVIN OSTROM, M. D. 
 
 NEW YORK 
 
 Surgeon to the Metropolitan Hospital 
 Surgeon to the Hahnemann Hospital 
 
 Senior Member of the American Institute of Homoeopathy; Member 
 of the New York State Homoeopathic society; Homoeopathic 
 Medical Society of the County of New York; Member of the 
 Academy of Pathological Science; American Obstetri- 
 cal Society; Surgical and Gynaecological Associa- 
 tion; Fellow of the Medico Chirurgical so- 
 ciety; Fellow of the British Gyneco- 
 logical Society. 
 
 AUTHOR OF 
 
 A Treatise on the Breast and Its Surgical Diseases 
 
 Epitheliofna of the Mouth 
 
 The Diseases of the Uterine Cervix 
 
 PHILADELPHIA, PA.: 
 
 BOERICKE & TAFEL 
 
 1910
 
 COPYRIGHTED BY 
 
 BOERICKE & TAFEL 
 
 1910
 
 
 PREFACE. 
 
 Many of the minor diseases peculiar to 
 women are associated with disorders of the 
 mucous membrane that lines the genital 
 canal, but we are rather inclined to disre- 
 gard these affections in favor of operative 
 gynaecology, and for the development of sur- 
 gical technique. This class of disease, how- 
 ever, merits careful consideration, not only 
 because of its primary importance, but on ac- 
 count of its significance as an etiological 
 factor in more serious maladies. 
 
 The commonly used term, leucorrhoea, sig- 
 nifies only one form of catarrh— a milk}^ 
 white flow — and is, therefore, not compre- 
 hensive enough to embrace every variety of 
 mucous discharge, while catarrh, used in the 
 same sense as when applied to other mucous 
 membranes, conveys a more accurate under- 
 standing of the pathology and clinical his- 
 tory of the gynaecic mucous membrane dis- 
 ease. 
 
 Specific catarrh is not included, for the 
 reason that it constitutes a special class of 
 disease, that requires special treatment.
 
 IV PRE^FACi:. 
 
 The classification of gynaecological ca- 
 tarrh here adopted is based upon the char- 
 acter of the discharge. Such a grouping is 
 not entirely satisfactory, but the anatomical 
 divisions of the genital canal, which in health 
 are clearly defined, become blurred in dis- 
 ease, and in consequence cannot be relied 
 upon for classification; and, moreover, no 
 form of gynaecological catarrh belongs to 
 any one period of life, and, therefore, the 
 clinical history alone cannot be relied upon 
 for this purpose. 
 
 Part IV., dealing with Therapeutic Sug- 
 gestions, includes a repertory, and is, as its 
 name implies, merely suggestive. No at- 
 tempt is made to record more than the actual 
 symptoms of catarrh, with a few concomi- 
 tants and generalizations. Because of the 
 lack of exactness in recording symptoms, it 
 has in some instances been found difficult to 
 distinguish catarrh from the discharge of a 
 malignant disease, or neoplasm, but such 
 conditions have been eliminated as much as 
 possible. 
 
 130 West ^yth Street, 
 
 New York City. 
 
 November, ipio.
 
 CONTENTS. 
 
 Preface 
 
 V 
 
 Chapter I, 
 
 Anatomy of the genital canal i 
 
 Physiology of the parts especially involved in catarrh 13 
 
 Function of the mucous membrane 16 
 
 Chapter II. 
 
 The nature of catarrh in general 18 
 
 The causes of gynaecological catarrh 20 
 
 Infection 21 
 
 Constitution 22 
 
 Mechanics 23 
 
 Exanthematous diseases 24 
 
 Chapter III. 
 
 Classification of Gynaecological Catarrh zy 
 
 Simple catarrh 28 
 
 Infants and children 30 
 
 Treatment, local 31 
 
 Adults 36 
 
 Treatment, local , 2)1 
 
 medical 42 
 
 Young girls 43 
 
 Mucopurulent catarrh (leucorrhoea) 44 
 
 Adults, children 46 
 
 Treatment, local 57 
 
 constitutional 62 
 
 medical 6S
 
 VI CONTENTS. 
 
 Purulent catarrh 7j 
 
 Senile purulent catarrh 76 
 
 Treatment, local So 
 
 operative 82 
 
 curettage 8S 
 
 trachelorrhaphy 90 
 
 constitutional 03 
 
 medical 94 
 
 Sanguineous catarrh 94 
 
 Treatment, medical 99 
 
 Senile catarrh loi 
 
 Treatment loi 
 
 Chapter IV. Part I. Suggestive therapeutics 105 
 
 Part II. Repertory 145 
 
 Index 20^
 
 LEUCORRHOEA. 
 
 CHAPTER I. 
 
 ANATOMY 01^ THK GENITAI, CANAI, PHYSI- 
 
 OIvOGY OF TPIi: PARTS i:SPi:CIAI,IvY IN- 
 VOLVED IN CATARRH — FUNCTION 
 OF THE MUCOUS MEMBRANE. 
 
 The genital canal, the part immediately in- 
 volved in gynaecological catarrh, is in the 
 form of two opposing angles, the vertical 
 line of union extending from the vulva to the 
 fundus of the uterus, the horizontal lines to 
 the fimbriated openings of the Fallopian 
 tubes. These passages are lined throughout 
 with mucous membrane, the epithelium and 
 construction of which are variously modified 
 to meet physiological uses. 
 
 The anatomical divisions of the canal, 
 with which gynaecological catarrh is con- 
 cerned, are, from without inwards, the 
 vulva, the vagina, the portio- vaginalis, the os 
 uteri, the cervix uteri, and the Fallopian 
 tubes.
 
 2 I^KUCORRHC^A. 
 
 The frame-work of the uro-genital sys- 
 tem, of which the genital canal is a part, is 
 developed from the embryonal glands — the 
 Mullerian ducts. These organs, two in nurfi- 
 ber, by fusing, the process begins in the 
 third month, and the septum thus made is 
 not completely removed until late in the 
 eighth month, form the uterus and vagina, 
 the Fallopian tubes representing the por- 
 tions of the Mullerian ducts that remain in- 
 tact. 
 
 The Mullerian ducts are developed in the 
 mesoblast, the middle or intermediate layer 
 of the blastoderm, from which they derive 
 their connective tissue and muscular super- 
 structure, but by a process of invagination 
 of the hypoblastic layer of the coelum they 
 receive a covering of mesothelial cells which 
 ultimately furnishes the entire genital canal 
 with a mucous membrane. 
 
 Beyond the fact that in some parts, not- 
 ably the corpus uteri, where the arrange- 
 ment of lining membrane is unlike that of 
 any other mucous membrane, for here the 
 glandular layer is directly adherent to the 
 subjacent muscular is, and there is an absence
 
 GOBLKT CE:i,I,S. 3 
 
 of any intervening connective tissue sub- 
 tratum or submucosa, the mucous membrane 
 of the genital canal does not differ materially 
 from mucous membranes generally. 
 
 This tissue, the use of which is to furnish 
 a protective covering for internal parts that 
 communicate with the surface of the body — 
 an internal skin — is built upon a simple plan, 
 epithelial cells and a supporting structure, 
 with epithelial invaginations that form 
 glands having a simple, rarely a racemose 
 arrangement. These glands are irregularly 
 distributed, but while they secrete mucus 
 they cannot be regarded as an essential part 
 of mucous membrane architecture; for the 
 function of mucous elaboration is also per- 
 formed by the epithelial cells — goblet cells — 
 which characteristic distinguishes them from 
 all other cell bodies. 
 
 The supporting structure or corium is 
 composed of connective tissue intermingled 
 with lymphoid tissue. Between this and the 
 epithelium is usually found a basement mem- 
 brane composed of flattened cells which fol- 
 low all the inequalities of the mucous mem- 
 brane, where it aids in the formation of the
 
 4 . I^DUCORRHC^A. 
 
 gland walls. Beneath this is a layer of thin 
 non-striated muscular tissue, which forms 
 the deepest part of the mucous membrane. 
 This, however, is not always present. 
 
 Mucous membranes are always abundant- 
 ly supplied with blood vessels. The arteries 
 and veins divide in the submucous tissue, 
 sending a network of capillaries to the 
 corium, where they lie immediately below 
 the epithelial layer. 
 
 The glands with which the genital mucosa 
 is liberally supplied, are irregular in distribu- 
 tion and arrangement, some parts of the 
 canal, for example the portio-vaginalis, be- 
 ing wholly devoid of them. The simple folli- 
 cles are lined with the same variety of epi- 
 thelium that invests the mucous membrane 
 in which they are situated, and open perpen- 
 dicularly to the surface upon which they 
 pour their peculiar secretion. When present 
 at all they are very numerous, as in the upper 
 two-thirds of the cervical canal, where it is 
 estimated there may be at least ten thousand 
 of these minute bodies. 
 
 No glandular structures exist in the 
 corpus uteri at birth, these formations are
 
 i:pithi:i,iai:, ce:i.i,s. 5 
 
 entirely post-embryonic. Nor do they ap- 
 pear as more than fissures made of the folds 
 of the mucous membrane before the general 
 change that ushers in puberty; when coinci- 
 dent with that organic evolution the fissures 
 assume a glandular form and develop in 
 great numbers, a process that is repeated and 
 passed through with each subsequent men- 
 struation and pregnancy. 
 
 On the basement membrane rests a layer 
 of epithelium. Its cells, which are derived 
 from the hypoblast of the blastoderm, are to 
 be looked upon as the essential part of all 
 mucous membranes. Like other epithelial 
 cells they are transitory, and only assume 
 their characteristic form subsequent to evo- 
 lution. 
 
 Not all the cells that make up the epithelial 
 covering of the mucosa are mucous forming 
 bodies. Squamous cells which appear more 
 abundant in the region of external openings 
 do not assume this function, but in these 
 parts mucous glands are more numerous, 
 and the protective material is supplied in 
 sufficient quantity by them. 
 
 The epithelial covering of mucous mem-
 
 6 i,i:ucorrhce:a. 
 
 brane is highly permeable, especially where 
 squamous epithelium predominates. In 
 these situations lymphoid tissue is more 
 abundant, and lymphoid elements in the form 
 of mucous corpuscles escape from the reticu- 
 lar structures. 
 
 The epithelial cells of the genital canal 
 vary in type according to location, but under 
 the demand of physiological requirements, or 
 pathological irritation, one form may assume 
 any other form, and so obliterate normal 
 structural boundaries. There are no well at- 
 tested exceptions to the teaching that "cells 
 breed true," but this law applies to the two 
 great anatomical divisions, epithelial, and 
 connective tissue — epiblastic and meso- 
 blastic. An epithelial cell may change its 
 form, indeed one of its chief offices is to 
 harmonize in this respect with local require- 
 ments, but that which distinguishes an epi- 
 thelial cell from a connective tissue cell con- 
 tinues with the integrity of the cell body. 
 
 Beginning at the border of the labia major, 
 the mucous membrane, which is here contin- 
 uous with the skin but separated from it by a 
 well marked line of structural differences.
 
 VAGINAI, MUCOUS MEMBRANE:. 7 
 
 passes over the nymphse and clitoris to be 
 prolonged into the vagina and urethra. Up 
 to the hymen, or its remains, the membrane 
 is covered with scaly epithelium derived 
 from the hypoblast, and liberally provided 
 with mucous crypts and follicles, and with 
 glands that secrete an unctuous substance. 
 Sebaceous glands are especially numerous 
 beneath the prepuce, upon the labia major 
 and outer surface of the nymphae. But few, 
 if any, mucous cells exist normally in this 
 part of the genital canal, and, therefore, the 
 substance with which the surfaces are bath- 
 ed is derived chiefly from the glands, and 
 lymphoid structures. 
 
 The vagina, extending from the hymen, or 
 urogenital diaphragm, to the ring in which 
 the portio-vaginalis of the uterus rests, is 
 lined with many layers of squamous epi- 
 thelium derived from the epiblast. The 
 mucous membrane being more ample than 
 the underneath submucosa, is thrown into 
 columns and rugae. Mucous glands are few 
 in number, save in the smoother portions of 
 the canal, the upper third of the vagina. 
 They, together with mucous cells, bathe the
 
 8 i,Kucorrhce:a. 
 
 vaginal walls in an acid secretion, but the 
 vaginal mucosa is otherwise structurally 
 quite homologous to the skin. 
 
 The mucous membrane is continued over 
 the portio-vaginalis, which comprises all 
 structures between the os externum and the 
 vaginal fornices, or ring. It is covered with 
 squamous epithelium, the cells of which se- 
 crete an abundant acid mucus. The secre- 
 tion of the portio, however, is not a true 
 glandular product, as there are no glands in 
 this region ; it results from the delequescence 
 and shedding of the superficial epithelial 
 cells, and the process by which the goblet 
 cells give up their contents probably without 
 destruction of their wall. 
 
 The stratified epithelial layer of the 
 vagina is continued with more or less dis- 
 tinctness beyond the external os into the cer- 
 vical canal, the lower third of which it lines. 
 The upper two-thirds are lined throughout 
 with a single layer of epithelial cells of cylin- 
 drical type, the surface of the membranes be- 
 ing studded throughout with the minute ori- 
 fices of numerous glands. These, for the 
 most part, simple follicles, secrete a thick,
 
 AI,KAI,INK SI:CRI:TI0N. 9 
 
 viscid alkaline mucus. Non-ciliated epithe- 
 lium lines the follicles, the cylindrical cells of 
 which undergo the mucous or calyciform 
 change which belongs to the elaboration of 
 their peculiar secretion. The characteristic 
 ''goblet cells" are fairly numerous in the 
 membrane covering this part of the cervical 
 canal. 
 
 The interior of the corpus uteri is covered 
 with a single layer of columnar cells. The 
 
 underneath membrane is much thicker than 
 
 « 
 
 the cervical membrane, its maximum thick- 
 ness being found at about the middle of the 
 cavity. Its surface is studded with an im- 
 mense number of minute depressions, the 
 openings of small tubular glands. These 
 glands also elaborate an alkaline fluid, but it 
 is devoid of the viscid properties of the cer- 
 vical secretion. The epithelial cells differ 
 from those lining the glands of the cervix, in 
 that none of them present calyciform char- 
 acters. 
 
 A very marked difference exists between 
 the time at which the glands of the corpus 
 and cervix appear. At the beginning of the 
 ninth month of gestation the epithelium of
 
 10 * i,i:ucorrhce:a. 
 
 the cervix begins to undergo mucous trans- 
 formation, indicative of secreting activity. 
 Numerous follicles also appear, and as a re- 
 sult of activity the canal at birth is filled 
 with a mucous plug, which effectually closes 
 the interior of the uterus. 
 
 Quite different is the history of the glands 
 of the corpus, for, w^hile in the sixth month 
 there are found traces of tubular involutions 
 of the cylindrical cell lining membrane, 
 which later developes into glandular struct- 
 ures, no true functionating glands are found 
 in the corpus at birth, these organs, as before 
 stated, being post-embryonic. 
 
 As puberty advances the development of 
 glandular structures and of the calyciform 
 epithelial cells progresses rapidly, and is re- 
 stimulated at each menstruation, and gesta- 
 tion, but at the climacteric obsolescence the 
 process of secretion, both from glands and 
 the mucous epithelial, begins to recede gradu- 
 ally. The endometrium is changed, its cellu- 
 lar elements disappear, and the activity that 
 marked reproductive life is folded up and 
 ceases. 
 
 The behavior of the epithelial cells that
 
 MUCOSA OF UTERUS. 11 
 
 line the utricular glands is of especial inter- 
 est in connection with the gynaecological ca- 
 tarrh of senility. These glands should in 
 health wholly disappear, and their function 
 terminate with the completion of the meno- 
 pause, but occasionally, under not always de- 
 terminable systemic and local conditions, 
 they degenerate and become pathological 
 factors of moment to the clinician. 
 
 The particulars in which the mucous mem- 
 brane lining the body of the uterus differs 
 from all other mucous coverings have gh en 
 rise to doubts as to whether this should be 
 classed among mucous membranes. As, 
 however, the epithelial cells do assume caly- 
 ciform characteristics, and the glands secrete 
 mucus, the name does not seem to be misap- 
 plied, even though there is an absence of sub- 
 mucous tissues, and the glands are directly 
 adherent to the subjacent muscular is. Pos- 
 sibly it would be more accurate anatomically 
 to consider this structure as lymphatic tissue, 
 and its glands as pseudo-glands, as merely 
 pits honey-combing the epithelial layer, but 
 its function is that of a mucous membrane, 
 and unnecessary confusion would follow a 
 change of name.
 
 12 i.e:ucorrhcea. 
 
 Perhaps more than any other epitheHal 
 cells those of the genital canal show a re- 
 markable power of repair after remo\'al or 
 injury. Curetting and operations on ihe 
 vagina and cervix are followed by very rapid 
 regeneration of epithelium. 
 
 The mucous membrane lining the Fallo- 
 pian tubes consists of columnar epithelium, 
 connective tissue, and musculature. It is 
 continuous with that of the uterus, but ac- 
 quires a submucous layer at the beginning of 
 the isthmus. The membrane is thrown into 
 longitudinal folds which become more 
 numerous in the direction of the ampulla. 
 True glands do not exist in the mucous mem- 
 brane of the Fallopian tubes. There is a 
 honey-comb arrangement of the tubal epi- 
 thelium, similar to that found in the uterus, 
 but these are no more than depressions that 
 impinge upon the submucous tissue. At the 
 border of the fimbria exists the demarcation 
 between the mucous membrane and the 
 serous structure of the peritoneum. This 
 point marks the anatomical limit of the ca- 
 tarrhal diseases of the female genital canal. 
 The physiology of the mucous membrane of
 
 gobi,i:t cDi^ivS. 13 
 
 the genital canal has been anticipated in the 
 foregoing review of its anatomy. The really 
 essential element, whether it fmictionates on 
 the lining membrane or in a gland cavity, is 
 the epithelial cell that has acquired the habit 
 of elaborating mucus. While a corium of 
 well recognized construction forms part of a 
 typical mucous membrane, this is not indis- 
 pensable, as attested in the lining of the 
 uterine corpus ; nor are glandular bodies nee- 
 essary to distinguish this tissue. 
 
 The incentive for an epithelial cell to 
 elaborate mucus can be none other than a re- 
 sponse to a physiological demand, for it is 
 not found that the columnar cells of the 
 mucous membrane differ from other col- 
 umnar cells until they undergo changes 
 which convert them into goblet cells in the 
 process of mucous secretion. Not all the cells 
 that cover a mucous membrane undergo this 
 change, for in health the larger number re- 
 main simple columnar cells, but capable of 
 becoming mucou° forming cells under the 
 stimulus of physiological requirements or 
 pathological contamination. 
 
 The elaboration of mucus within the pro-
 
 14 i,e:ucorrh<^a. 
 
 toplasm of epithelial cells converts these 
 bodies into goblet or chalice cells by the 
 enormous distention of their walls with 
 mucigen. The mucus is then discharged 
 from the end of the cell, but the subsequent 
 fate of the cell is uncertain, for it is not de- 
 termined whether after being freed of its 
 contents the cell is reconverted into an ordi- 
 nary columnar cell, or whether it remains a 
 goblet cell to be again filled wdth mucus, the 
 acquired cell form and function remaining 
 permanent. It is probable that the latter 
 cycle is that of healthy secretion, but that 
 under the incentive of disease — catarrh — the 
 process being rapid, epithelial cells have not 
 time to mature, and are cast off with the dis- 
 charge, their places being taken by newdy 
 formed bodies. Such imperfectly emptied 
 goblet cells are frequently found mingled 
 wath the mucous and lymphoid elements of 
 both acute and chronic catarrh of the genital 
 canal. 
 
 Reference has been made to the alkaline 
 reaction of the uterine secretion, and the acid 
 reaction of that of the vagina. These prop- 
 erties do not seem to depend upon a specializ-
 
 VAGlNAIv BACII^IvUS. 15 
 
 ing function of either the surface goblet epi- 
 thelium, or that lining the mucous glands 
 in loco. It is more likely that all mucus when 
 secreted is alkaline, and that it becomes acid 
 in the vagina owing to the presence of a 
 special vaginal bacillus that in health, ow4ng 
 to the cervical plug, cannot find its way into 
 the uterus. The bacillus has a protective or 
 antagonistic action upon pathogenic bacteria, 
 which, though always present, cannot de- 
 velop be3^ond the capacity of disposal as long 
 as the normal standard of acidity is main- 
 tained. Under conditions of infection, pa- 
 thologic bacteria are met at the vulva by the 
 acid secretion of the vagina, and if they 
 chance to pass this sentinel the mucous plug 
 at the OS acts as a further barrier against in- 
 vasion of the uterus. During the period of 
 lochial discharge the normal va<?inal bacilli 
 disappear. They are present during preg- 
 nancy, and reappear under healthy condi- 
 tions at the termination of the puerperium. 
 
 Inasmuch as but few pyogenic cocci can 
 live in an acid medium, this reaction of the 
 vaginal secretion is recognized as nature's 
 protection against the infection of the uterus
 
 16 i,i:ucorrhce:a. 
 
 from without. Almost any variety of micro- 
 organisms may be found in the vulva, gon- 
 ococci, staphylococci, streptococci, and even 
 tubercle bacilli, without invading the vagina, 
 immunity being insured as long as the secre- 
 tion remains acid, and the vaginal bacilli are 
 in physiological numbers and activity. The 
 normal secretion of the corpus uteri is a thin 
 colorless mucoid fluid, and is free from 
 micro-organisms. When, however, the cer- 
 vical barrier is once broken down and micro- 
 organisms enter the cavity of the uterus, 
 they multiply with great rapidity and give 
 rise to the most serious diseases of the 
 female pelvis. 
 
 The secretion of the Fallopian tubes is also 
 alkaline, and in health is free from micro- 
 organisms. 
 
 A study of the mucous membrane of the 
 genital canal brings out several salient points 
 concerning its function. In common with 
 mucous membrane generally it serves the 
 purpose of protecting the surface from the 
 invasion of micro-organisms, for mucus in 
 itself is not a favorable medium for the de- 
 velopment and growth of bacilli, but this se-
 
 in:^i:ction. 1 
 
 n 
 
 cretion offers an additional safeguard in an 
 acid reaction at the entrance of the canal, 
 and in the midway plug of mucus, such pre- 
 cautions being necessary because of the 
 direct communication with the peritoneal 
 cavity by way of the ova ducts. Too much 
 stress cannot be laid upon this, nor would 
 it be difficult to magnify the importance of 
 maintaining a healthy state of the mucous 
 membrane of the genital canal. It may with 
 safety be asserted that no infection of the 
 uterus can take place unless introduced from 
 without, and that this cannot be introduced 
 save mechanically, or by breaking down the 
 barriers that nature has constructed for de- 
 fense.
 
 CHAPTER 11. 
 
 THE NATURE OF CATARRH IN GENERAL — THE 
 CAUSES OF GYNECOLOGICAL CATARRH — 
 INFECTION CONSTITUTION — ME- 
 CHANICAL — EXANTHEMATOUS 
 DISEASES. 
 
 Catarrh is exclusively a product of mucous 
 membranes. It is a mucoid degeneration 
 that finds its physiological type in the mu- 
 cous secretion of mucous membrane and mu- 
 cous glands. 
 
 In its simplest form the degeneration 
 shows itself as an excess of function. Goblet 
 cells are developed in larger numbers, and 
 their protoplasm elaborates a surplus of 
 mucus. In this manner physiological secre- 
 tion is increased, and the first stage and sim- 
 plest variety of catarrh exists. But the 
 perverted behavior of the goblet cells is not 
 long confined to unnecessary multiplication, 
 and the excessive secretion of mucus. The 
 cell wall, being enormously distended, bursts, 
 the cell perishes, and mingles as a degenerat- 
 ed body with the catarrhal discharge.
 
 COMPOSITION 01^ CATARRH. 19 
 
 Nor is the pathological process limited to 
 these bodies, for early the cylindrical epi- 
 thelial cells that cover a large area of the 
 mucous surfaces, and that do not enter ac- 
 tively into the elaboration of mucus, begin to 
 multiply in excess of physiological require- 
 ments. These are cast off, and also go to 
 make up the catarrhal discharge. By grad- 
 ual and certain stages further degeneration 
 of tissue follows, the desquamated elements 
 mingling with the secretion. In this manner 
 a discharge, at first characterized by nothing 
 more than an excess over functional require- 
 ments, assumes a positive and well marked 
 pathology, and a process which in the begin- 
 ning involved only superficial structures, the 
 epithelial covering, progressing, attacks the 
 corium, its basement and submucous layers. 
 
 Even in the early stages of catarrh, when 
 the condition represents no more than an ex- 
 cess of functional activity, the protective ser- 
 vice of the mucous membrane is rendered 
 less effective, and the dangers of infection 
 from without are in like measure increased. 
 In more advanced stages, M^hen tissue de- 
 generation has progressed to pus formation,
 
 20 I^EUCORRHCEA. 
 
 and local destruction has involved the arter- 
 ial, and venous walls, nature's protective bar- 
 rier is entirely broken down, not only against 
 invasion from without, but the internal se- 
 cretions, losing their acidity, become gener- 
 ators of disease, and add to the dangers that 
 attend gynaecological catarrh. 
 
 All catarrhs of the genital canal have their 
 origin in local congestion and irritation. We 
 will find this a good working hypothesis. 
 The irritation, by determining more blood to 
 the parts, stimulates functional activity, and 
 results in rapid cell proliferation, consequent 
 immature cell formation, and imperfectly 
 elaborated secretion. 
 
 But when we have said this we have not 
 gone very far in sounding the etiology of 
 gynaecological catarrh; we must know the 
 causes of irritation before we can success- 
 fully grapple with the disease, either prevent 
 it or cure it when fully developed. 
 
 The local causes of the various irritations 
 that induce catarrh of the genital canal, and 
 that stand in the relation of cause and effect, 
 are always microbic, and are introduced 
 from without. I have never seen a case of
 
 MICRO-ORGANISMS. 21 
 
 established catarrh in which there was not 
 some degree of corium congestion, irritation, 
 and an examination of the discharges leaves 
 no ground to doubt that the cause always lies 
 in micro-organisms that have gained en- 
 trance through the vagina. In other words, 
 catarrh of the genital canal is a microbic 
 disease; in kind similar to any other infec- 
 tion, in degree milder than many that may 
 attack the mucosa of the uro-genital system. 
 
 Some cases, as the catarrh of a young girl, 
 or of a virgin with an almost imperforate 
 hymen, may with difficulty be fitted into this 
 hypothesis, but if we will examine such cases 
 carefully, their constitution, which may so 
 alter the character of the mucous secre- 
 tion as to reduce its protecting qualities, and 
 allow the ever-present bacteria to penetrate 
 below the epithelial lining, or inquire into 
 their conditions of life, there will be found 
 a causa sine qua non, without which the es- 
 sential mucoid degeneration could not have 
 taken place. 
 
 It may be asked why the severer varieties 
 of infection, tubercular, and septic, do not 
 more frequently develop in the genital canal ;
 
 22 ]:.e:ucorrhce:a. 
 
 why all women are not in danger? All 
 women are in danger, but not always. As 
 long as the secretion of the vagina remains 
 acid, they are immune, unless, and this is a 
 point of the utmost importance, there is a 
 mechanical abrasion, and the absorbing sur- 
 faces of the corium are laid bare. The latter 
 is unlikely to occur in virgins who have not 
 been examined vaginally; but the absence of 
 acidity in the vagina may be a part of a gen- 
 eral dyscrasia, or of errors in nutrition, so 
 frequently found in connection with the geni- 
 tal catarrh of girls and young women. Such 
 cases are among the most difficult to treat, 
 for we have no exact means to determine 
 how far the catarrhal infection extends, inas- 
 much as the vagina is a common outlet and 
 drain with the uterus. The same hindrance 
 opposes itself to exact diagnosis in all genital 
 catarrhs, but the obstacles are greater in 
 young girls and unmarried women, in whom 
 the impossibility of separating the uterine 
 from the vaginal secretion must always be 
 reckoned with. They may submit to a dig- 
 ital examination, but the use of instruments, 
 even a small speculum, will be refused, and 
 very properly unless as a last resort.
 
 CONSTITUTION. 23 
 
 The mechanical removal of the protective 
 epithelial covering is a frequent cause of 
 gynaecological catarrh. The examining 
 finger, the unskillful use of instruments, even 
 the vaginal douche, may be sufficient to 
 abrade the mucous membrane, and I have 
 been led to believe that rupturing the hymen 
 during coitus has in some instances been the 
 door through which the invasion of micro- 
 organisms took place. 
 
 A constitution under the influence of 
 which there is a vicious metabolism, a per- 
 verted function of all the secreting organs, 
 and a tendency to the development of im- 
 mature cell forms and their consequent de- 
 generation and nerosis, may lie at the found- 
 ation of many varieties of idiopathic gynae- 
 cological catarrh. Young girls of a scrofu- 
 lous diathesis suffer from catarrh of all the 
 mucous membranes, and are very subject to 
 catarrh of the genital canal. Adults who are 
 below par offer a corresponding decreased 
 resistance to microbic invasion. Women 
 who are over-worked mentally or physically, 
 women whose reparative processes are weak- 
 ened, among the rich by over-eating and dTi
 
 24 I^EUCORRHCDA. 
 
 ennervating life from luxury, among the 
 poor by insufficient nourishment and priva- 
 tion, reach the same results, derangement of 
 gland function, perverted secretions, and, 
 finally, gynaecological catarrh in one form or 
 another. Both classes become subjects of 
 uterine, ovarian and tubal diseases that are 
 only too frequently etiological factors in 
 affections of the genital mucous membrane. 
 It is a matter of frequent clinical record 
 that the exanthematous diseases, especially 
 measles and scarlet fever, leave as sequelae 
 catarrh of the throat, nose and middle ear; 
 quite as often genital catarrh may be traced 
 to the same cause, a vaginal discharge of 
 children and of young girls following an at- 
 tack of one of these diseases. Suppressed 
 exanthemata may also be followed imme- 
 diately or remotely by catarrhal affections of 
 the genital canal.
 
 CHAPTER III. 
 
 CivASSlFlCATlON O^ GyN^COI^OGICAI, Ca- 
 
 TARRH — SiMPivK Catarrh, in Ini^ants 
 AND Chii.dri:n, Tri:atm^nt, Locai. — In 
 AduIvTs, Trkatmknt, Locai,, Medical — 
 In Young Giri.s, Mucopurulent Ca- 
 tarrh (Lkucorrhgp:a), Adults, Chil- 
 dren, Treatment, Local, Constitu- 
 tional, Medical — Purulent Catarrh 
 — Senile Purulent Catarrh, Treat- 
 ment, Local, Operative, Curettage, 
 Trachelorrhaphy, Constitutional, 
 Medical — Sanguinous Catarrh, 
 Treatment, Medical — Sanguinous, 
 Senile Catarrh, Treatment. 
 
 The most practical and useful classifica- 
 tion of gynaecological catarrh is based on 
 clinical data so far as they are concerned 
 with the character of the discharge. A more 
 accurate and scientific arrangement would 
 consider the anatomical divisions of the gen- 
 ital canal from which the discharge could be 
 demonstrated to take place, as vulvar ca-
 
 26 i,e:ucorrhce:a. 
 
 tarrh, vaginal catarrh, uterine catarrh, and 
 tubal catarrh, but while it might be possible 
 to establish such distinctions in the earliest 
 stages of the disease, the fact that the mor- 
 bid action does not long remain confined to 
 the part in which it originates, resulting in 
 mixing the flow from the several regions and 
 consequent blurring of clinical features, ren- 
 ders it impracticable to allow the anatomical 
 or even functional divisions of the canal to 
 be a basis for classification. Catarrh origi- 
 nating in the vagina may soon spread to the 
 uterus, and the disease starting in the uterus, 
 if it does not actually involve the mucous 
 membrane of the outermost canal, mingles 
 its discharge with that from the healthy 
 vagina. As a matter of fact, gynaecological 
 catarrh is a composite discharge, being made 
 up of the secretions from the entire genital 
 canal, that special element predominating 
 w^hich represents the most active pathologi- 
 cal focus. 
 
 It is, therefore, obvious that the most prac- 
 tical demonstration of gynaecological catarrh 
 will consider the character of the discharge 
 according to its various modifications which
 
 CI^ASSIi^ICATlON. 27 
 
 depend upon the specific cause, length of 
 duration, extent of, and degree of tissue in- 
 volvement. 
 
 The following classification will be adopt- 
 ed: 
 
 A. SiMPLK Catarrh. 
 
 Usually involving only the mucous mem- 
 brane of the vagina and vulva, and rep- 
 resented by an increased secretion of 
 mucus that contains few cellular ele- 
 ments. 
 
 B. MucopuRuivKNT Catarrh (Leucor^ 
 
 rhc^a). 
 An outgrowth of simple catarrh, marking, 
 however, a distinct pathological pro- 
 cess, with more or less destruction of 
 tissue and an admixture of pus cells. 
 
 C. PuRUi^ENT Catarrh. 
 
 This may be the third stage of simple ca- 
 tarrh, the mucous character disappear- 
 ing in favor of the more intense bacteri- 
 cidal infection, or, though more rarely, 
 it may arise as a primary disease from 
 the direct invasion of pyogenic cocci. 
 The discharge is almost pure pus, the 
 cast off epithelial cells mingling with 
 cast off purulent exudation.
 
 28 I^^UCORRHC^A. 
 
 D. Sanguinous Catarrh. 
 
 The discharge is characterized by a pre- 
 dominating admixture of blood cells, 
 and indicates a distinct involvement of 
 the deeper structures of the mucous 
 membrane, and a degree of inflamma- 
 tion in which the integrity of the capil- 
 lary wall is attacked, allowing transuda- 
 tion of red blood corpuscles. 
 A further division into acute and chronic 
 catarrh is possible, but any one of the above 
 varieties may be either acute or chronic, and, 
 therefore, such a separation serves no well 
 defined purpose. In the matter of treatment 
 the history of the disease that has lasted over 
 a considerable length of time presupposes 
 more or less profound systemic involvement, 
 and as such will receive special treatment 
 directed to the chronic condition. 
 
 A. S1MP1.E: Gyn^coi^ogicai, Catarrh. 
 
 This occurs most frequently in children 
 and young adults. It is usually confined to 
 the vulva and vagina, rarely involving the 
 uterus. The process consists in an increase 
 of the functional activity of the mucous cells
 
 MKASIvES AND SCARI^KT Fi:vi:R. 29 
 
 and glands, resulting in an undue secretion 
 and discharge of mucus. Goblet cells, either 
 intact or ruptured, are found in the dis- 
 charge, and epithelial cells in various stages 
 of transition into mucus cells. The dis- 
 charge is a glairy transparent mucus, unless 
 the vulvar glands are involved, when it be- 
 comes mixed with secretion from the sebace- 
 ous glands of the vulva and the glands of 
 Bartholin, rendering the discharge opaque, 
 and sometimes cheesy. 
 
 Catarrh of this variety is not incompatible 
 with a feeble acid reaction of the vaginal se- 
 cretion, but a more advanced and pronounced 
 degree of simple catarrh is accompanied with 
 a neutral or alkaline reaction. Such dis- 
 charges are irritating, and frequently give 
 rise to troublesome vulvitis and vaginitis. In 
 infants this is not uncommon, for with them 
 and the new born the normal reaction is 
 neutral. This fact may explain their suscep- 
 tibility to vaginal catarrh; certain it is that 
 the absence of acidity favors the invasion of 
 micro-organisms in these cases. 
 
 The important part played by measles and 
 scarlet fever in causing genital catarrh in
 
 30 I^EUCORRHCEA. 
 
 little girls has been referred to. I believe 
 this to be more common than is generally ad- 
 mitted. The pruritus attending this variety 
 of catarrh in children is sometimes intense, 
 and may be the first symptom to attract at- 
 tention, for the discharge is not usually very 
 marked. 
 
 In simple catarrh of infants and children, 
 examination shows the vulva to be inflamed 
 and swollen, the redness extending into the 
 vagina. Urination is frequent and painful, 
 and the patient is in constant motion, rub- 
 bing the parts together, or seeking to relieve 
 the itching by scratching. The habit of 
 masturbation may have its origin in this in- 
 tense irritation of the genital organs, and 
 the means taken to obtain relief. 
 
 From the unrest caused by local irritation 
 and the erethism of erectile tissue that fol- 
 lows, the general health of these little pa- 
 tients soon suffers. They become irritable, 
 nervous and easily excited. Children who 
 have always been most even tempered, from 
 very trifling causes, fly into a violent passion. 
 They are restless at night, waking at short 
 intervals. Their digestion suffers, the
 
 ivOCAi, trkatme:nt. 31 
 
 tongue is coated, and there is obstinate con- 
 stipation. So marked are these symptoms of 
 some genital irritation that I always think 
 of catarrh when such a case is presented, and 
 by physical examination assure myself of the 
 condition of the vulva and vagina. 
 
 It is useless and a detriment to our heal- 
 ing art to attempt to cure these cases or any 
 case of gynaecological catarrh with internal 
 medicine alone. As it is a local manifestation, 
 local applications will form an indispensable 
 part of any rational treatment, even in in- 
 fants and young children. The disease has a 
 microbic origin, and these organisms must be 
 attacked in situ, removed and their multipli- 
 cation arrested, and their environment made 
 unfavorable for further development. In- 
 ternal remedies will dynamically restore the 
 health of the tissues and render them unfit 
 to harbor or generate microbic life. The 
 simple gynaecological catarrh of infants 
 seldom becomes mucopurulent unless to it is 
 added a specific infection. 
 
 The indications for the local treatment of 
 the catarrh of infants and young girls before 
 the advent of puberty — after that period
 
 32 i,Kucorrhce:a. 
 
 questions connected with the development of 
 the entire reproductive system will merit 
 consideration — are, first, to destroy the caus- 
 ative micro-organisms, and second, to allay 
 irritation, wdiich, in its turn, will control in- 
 flammation. 
 
 Tn simple genital catarrh the infection is a 
 mild one, and will usually yield to mild bac- 
 tericides. Even though it has passed the 
 acute stage and become chronic, the chron- 
 icity is not due to an increase of virulence, 
 but to a vicious habit of cell multiplication 
 and the extravagant elaboration of mucus 
 brought about by infecting bodies. As a 
 rule, the catarrhal process does not extend 
 beyond the external os. The lower segment 
 of the uterus, which is proportionally longer 
 than the fundus until puberty, remains closed 
 with its mucous plug. 
 
 Boracic acid usually suffices for a cure. 
 The method of its use, however, is import- 
 ant. A douche, or lotion, in the proportion 
 of one drachm in one pint of sterile water at 
 a temperature not above 100 meets the re- 
 quirements for a solution, but sometimes for 
 the irritation of the vulva, especially if it is
 
 VUI.VAR IRRITATION. 33 
 
 eczematous, an ointment is required. For 
 this purpose I use Boracic acid ointment, U. 
 S. P., or the Glycerite of starch; either one 
 of which will be found most soothing to the 
 irritated surface, and will reduce the 
 brawny condition of the labia. If there is 
 much swelling and denudation of epithelium 
 the following will be very efficacious : 
 
 ?. Calomel 1 gramme. 
 
 Tannin 2 grammes. 
 
 Glycerite of starch. 20 grammes. 
 
 This may be smeared over the parts, or ap- 
 plied on strips of old sterilized linen, which I 
 find very useful in gynaecological practice. 
 
 Or a pencil-shaped suppository of the fol- 
 lowing may be introduced between the labia : 
 
 19. vSalol grs. Iss. 
 
 Cocoa butter gr. xv. 
 
 M. 
 
 The use of the vaginal douche in these 
 cases becomes a matter for serious consider- 
 ation. It goes without saying that it should 
 never be used in children if it can possibly 
 be avoided, and in many cases it is not neces- 
 4
 
 34 I,EUCORRH(HA. 
 
 sary, for the pathological process when origi- 
 nating in the vulva frequently does not in- 
 vade the vagina, and can be treated by ob- 
 serving strict cleanliness, and bathing with a 
 Boracic acid lotion. The parts can be cleans- 
 ed by directing a gentle stream of Boracic 
 solution against them, going well up to the 
 hymen. It is of the utmost importance to 
 remove all discharge from every crease and 
 fold, and to bring the medication in contact 
 with the entire mucous surfaces. After dry- 
 ing, Boracic ointment or Glycerite of starch 
 may be applied if necessary. I generally give 
 the preference to the Glycerite of starch. 
 
 When the vagina is involved it may be- 
 come advisable to use a douche. With care 
 this can be done without mutilation unless 
 the hymen is almost imperforate. This con- 
 dition of the hymen by interfering with 
 drainage may intensify the local process, and 
 require to be separately dealt with. I have 
 met several such instances in little girls. 
 The opening in the hymen would scarcely 
 admit a small probe, and the pent up catar- 
 rhal discharge encouraged conditions favor- 
 able for its continuance and induced further
 
 impi^ri^orate: hyme:n. 35 
 
 mucoid degeneration. An enlargement of 
 the opening in the hymen, and a few Boracic 
 acid douches, sometimes Potassium per- 
 manganate 1/2000, will be of more service, 
 usually suffice to effect a cure. In one of the 
 instances I recall the child was eight years 
 old. The catarrh had spread from the vulva 
 into the vagina. All of the structures involv- 
 ed were in a state of intense irritation. The 
 discharge was distinctly alkaline, and very 
 offensive. The opening in the hymen was 
 difficult to find, and was finally discovered by 
 a drop of mucus that oozed into the vagina. 
 An enlargement of the opening and Boracic 
 acid douches promptly restored the mucous 
 membrane to health. 
 
 Children of this as:e, or older, should never 
 be allowed to use the douche themselves; it 
 should always be given by the mother, nurse, 
 or some adult member of the family. The 
 physician should carefully instruct the per- 
 son who is to carry out his orders, and if 
 the entire matter is treated in a perfectly 
 simple matter of fact manner the patient's 
 modesty will not be offended nor will her 
 mind dwell unduly upon the subject.
 
 36 I^EUCORRHOSA. 
 
 Simple gynsecological catarrh in adults is 
 the most frequent form of catarrh encount- 
 ered by the gynaecologist, and may vary in 
 quantity from a scarcely increased physi- 
 ological discharge to a profuse debilitating 
 flow. The character of the discharge re- 
 mains the same, but the surfaces involved are 
 most extensive, the morbid processes spread- 
 ing to the mucosa covering the portio-vagin- 
 alis, and even to the cervical endometrium. 
 This variety of gynaecological catarrh is 
 sometimes called leucorrhcea — fluors alba — 
 for it may be milky white from the admixt- 
 ure of cast off epithelial cells. 
 
 In virgins it is usually associated v/ith dis- 
 placement of the uterus, congestion of the 
 ovaries, or general pelvic congestion ; in mar- 
 ried women it may be connected with defect- 
 ive sexual hygiene, or when a part of a multi- 
 para's histor}^, with subinvolution of the 
 uterus. Any cause that induces chronic con- 
 gestion of the pelvic organs and structures 
 may be looked upon as most potent in the 
 etiology of simple gynaecological catarrh. 
 
 The treatment advocated for simple ca- 
 tarrh in infants and young girls will also be-
 
 te:chnique: o^ douche:. 37 
 
 found useful for the disease in adults. Pa- 
 thologically, there is little difference between 
 the two manifestations of catarrh. A 
 Boracic acid douche and ointment, or an 
 ointment made with the glycerite of starch 
 have for pruritus their well-defined places 
 as curative agents, but with the adult the 
 vaginal douche and direct local medication 
 necessarily fill a more prominent place than 
 in children. When the inflammation sub- 
 sides somewhat an astringent solution is of 
 service, 1 to 200 of lead acetate, or 1 in 40 
 solution of glycerite of tannin. 
 
 The method of giving a vaginal douche 
 will vary according as it is desired to retain 
 the medication for a length of time in con- 
 tact with the mucous membrane, or the ob- 
 ject is for cleansing purposes chiefly. For 
 simple uncomplicated catarrh the latter will 
 suffice, and, with this in view, the following 
 technique will be found convenient, and to 
 yield satisfactory results : 
 
 The patient will sit on a douche pan, or, 
 better still, on a commode with the thighs 
 well separated. A reclining position retains 
 the solution in the vagina, and does not per-
 
 38 I^I^UCORRHCE^A. 
 
 mit thorough cleansing of the canal. There- 
 fore, I have my patients sit while irrigating 
 the vulva and when taking a douche. 
 
 There should not be a famil}^ douche bag, 
 each patient should have her own instrument 
 reserved for her exclusive use. This must be 
 insisted upon, for the custom of having one 
 bag with several tips cannot be too strongly 
 condemned. 
 
 Before used, the bag and tips should be 
 cleansed and boiled, and, thereafter when not 
 in use, kept in a solution of boracic acid. 
 The ordinary hard rubber tip is convenient in 
 size and shape, but I prefer one made of 
 glass. Any soiling can then be easily de- 
 tected. This is not true of the hard rubber 
 tips. These, however, can be made perfectly 
 clean, and with the aid of boiling water, or 
 an alcohol flame, be moulded to any desired 
 shape. Before heating the tip in an alcohol 
 flame it should be smeared with vaseline to 
 prevent burning the rubber. Hard rubber 
 tips have one advantage over glass, they do 
 not break easily, and no risk is run of injur- 
 ing the patient while taking the douche. I 
 have known several quite severe accidents
 
 TDMPE^RATUR^ 01^ THE) DOUCHE). 39 
 
 to occur by the glass tip breaking when in the 
 vagina. 
 
 Little force is necessary for the stream of 
 water. The douche bag should be hung 
 about on a level with the patient's head. If 
 the solution when poured in the bag is 110° 
 F., it will be the proper temperature when it 
 reaches the body. I will here enter my pro- 
 test against the high temperature douche un- 
 less as a continuous irrigation in pelvic cellu- 
 litis. The temporary relief afforded by the 
 heat induces a more or less permanent relax- 
 ation of tissues, which eventually accentu- 
 ates the very conditions it is used to correct. 
 As a therapeutic agent in the treatment of 
 catarrh the vaginal douche should not be 
 above 105° F. 
 
 To minimize the danger of adding to vag- 
 inal infection the external parts should be 
 douched before the vagina. Ordinarily two 
 quarts of water will be sufficient to cleanse 
 both the vulva and the vagina, but if the ca- 
 tarrh is very tenacious it may be necessary to 
 first use a pint of bicarbonate of soda solu- 
 tion, soda one ounce, water one pint, to cut 
 the discharge, and permit the boracic acid to 
 come in contact with the mucous membrane.
 
 40 LKUCORRHC^A. 
 
 If there is sufficient vulvitis to necessitate 
 special treatment, the parts should first be 
 thoroughly dried, and then one of the gly- 
 cerites I have mentioned applied, either as a 
 smear or on pieces of linen laid between the 
 labia. 
 
 It is desirable to avoid retention of the 
 irritating discharges, and to prevent them 
 from remaining in contact with the vulva, 
 also to avoid the use of heat producing vulvar 
 pads. At the same time the catarrh may be 
 so profuse as to require a protective dress- 
 ing. The rule for dressing should be as light 
 an antiseptic pad as possible, renewed as 
 often as necessary. One or tw^o layers of 
 absorbent cotton wrapped in sterile gauze 
 wall answer the purpose, and before saturat- 
 ed it should be changed. 
 
 In case the discharge is corrosive, and this 
 will be increased by the urine passing over 
 the sensitive parts, a stiff boracic acid oint- 
 ment will afford relief. Stearate of zinc may 
 also be dusted over the vulvar pad. 
 
 I have advocated especially a boracic acid 
 douche. This has in my hands been the most 
 generally useful in the treatment of simple
 
 BORACIC ACID DOUCHK. 41 
 
 catarrh. It allays the, itching of vaginismus, 
 and at the same time furnishes the required 
 bactericide. Occasionally I add glycerine in 
 the proportion of one ounce to a quart of 
 water, or when the mucous membrane is in- 
 tensely congested I inject an ounce of sterile 
 glycerine into the vagina after the douche 
 has been given. The patient should then be 
 kept in the recumbent position to retain the 
 glycerine in the canal as long as possible. 
 An availment of the hygroscopic action of 
 glycerine will do much towards the success 
 of any subsequent local treatment that may 
 be instituted. Some cases may call for a 
 carbolic acid douche, others for bichloride 
 of mercury, still others for creoline, but in 
 my hands boracic acid has been so entirely 
 satisfactory in the treatment of simple ca- 
 tarrh that I have come to rely upon it, and to 
 reserve the more powerful germicides for 
 the severer adult cases, in whom there is 
 liable to be a mixed infection. 
 
 In the general treatment of gynaecological 
 catarrh the hygiene of the patient must be 
 carefully regulated. Digestion should re- 
 ceive especial attention, and the several func-
 
 42 ]:,e:ucorrh(i:a. 
 
 tions of elimination encouraged to their full 
 activity. Any tendency to constipation must 
 be overcome by the use of salines, in mild 
 cases preferably the phosphate of soda; in 
 more chronic cases it may be necessary to re- 
 sort to Rubinat condal, or Hunyadi water. 
 Cascara is useful for children. The estab- 
 lishment of a cathartic habit is greatly to be 
 deprecated, but it is useless to attempt to 
 cure a torpid intestinal canal with dynamic 
 medicines while it remains mechanically full. 
 Remove the accumulation, which from its 
 very presence paralyzes the muscular wall, 
 establish the habit of forcing the faecal mass 
 onward, and the cause of the trouble may be 
 reached with the indicated remedy. Consti- 
 pation in children and young girls is attended 
 if not caused by packing of the sigmoid colon 
 with fseces. The rectum also becomes filled 
 and sluggish. This operates mechanically, 
 favoring congestion of the pelvic organs, the 
 very condition it is desired to overcome. 
 
 The remedies for simple gynaecological 
 catarrh will cover a wide range of drugs, but 
 the selection will usually be made from 
 among a comparatively small number, for in
 
 sDi^ijcTioN oi^ ri:mi:die:s. 43 
 
 seeking the similimum a few symptoms will 
 serve as a basis upon which to build each 
 therapeutic structure, these are the guiding 
 symptoms of the drug, and the essential 
 symptoms of the disease. Adapting one to 
 the other makes a perfect prescription. The 
 genius of the drug fitted to the genius of the 
 malady constitutes scientific therapeutics. 
 
 In the treatment of the simple catarrh of 
 children and young girls, I have generally 
 obtained the best results from Merc. jod. 2, 
 or Sepia, Calcarea carb., or Phosphorus, the 
 latter, if there is much pruritus and local irri- 
 tation, will be thought of. The scrofulous 
 diathesis suggests Bromine or Iodine, either 
 one of which remedies will bear careful 
 study in these cases. When there is evident 
 sexual excitement, this may manifest itself 
 in a variety of ways, no remedy equals 
 Origanum. Caulophyllum is also useful 
 when the discharge is very profuse and acrid. 
 When there is reason to associate the genital 
 catarrh with suppression of exanthemata, or 
 to regard it as one of the sequelae, Phosphoric 
 acid will be of service. Baryta carb. has 
 been of service in the treatment of simple ca-
 
 44 I^IJUCORRHOeA. 
 
 tarrh in young women who are always tired. 
 Sepia when there is pronounced misplace- 
 ment of the uterus. Frequently catarrh in 
 young women is associated with some dis- 
 appointment connected with the affections, 
 disappointed love. Here Calcarea phos. will 
 render excellent service. Ambitious students 
 are often the subjects of gynaecological ca- 
 tarrh ; we will think of Gelsemium. Helonias 
 will cure many cases of simple catarrh in 
 women enervated from luxury. The pelvic 
 structures are lax and soft. Nervous ex- 
 haustion, so frequently an accompaniment of 
 genital catarrh, always suggested that great 
 tissue remedy, Kali phos. Pulsatilla, Lilium 
 tig. and a remedy usually more frequently as- 
 sociated with other forms of catarrh, Thuja, 
 I have found useful in the simple variety, 
 especially when there is much local irritation. 
 In connection with a douche of this same 
 remedy, one drachm in a quart of water, it 
 will yield most satisfactory results. 
 
 B. MucopuRUi^ENT Catarrh. 
 
 Simple catarrh may continue through all 
 phases of life, it may become chronic even
 
 utkrine catarrh. 45 
 
 before puberty, and persist without material 
 changes during menstrual life in unmarried 
 women. More frequently, however, the 
 vaginitis that is carried over into the repro- 
 ductive period becomes mucopurulent by the 
 addition of pus cells, the micro-organisms be- 
 ing pyogenic, and the vaginitis representing 
 a more profound tissue involvement. 
 
 With the functional development of the 
 upper part of the genital canal, the uterus, 
 and the Fallopian tubes, the catarrhal pro- 
 cess extends, and to the vaeinal catarrh prior 
 to puberty is added catarrh of the uterus. 
 The functional activity that attends repro- 
 ductive life, the normal increase in glandular 
 development and the consequent changes in 
 the lining epithelium of the genital canal that 
 is a part of each menstruation, introduce 
 factors until then not reckoned with, factors 
 that so dominate the gynaecological catarrh 
 of adolescence and married life as to almost 
 warrant their consideration as a separate 
 class. But the divisions according to age are 
 broken down in view of the fact that pa- 
 thologically identical gynaecological dis- 
 charges may occur at any period of life irre- 
 spective of social conditions.
 
 46 I^EUCORRHC^A. 
 
 With the advent of reproductive life there 
 is an augmented activity of the genital 
 mucosa and a corresponding increase of dis- 
 charge, this functionating continuing under 
 the regulation of physiological requirements 
 until the folding up process is completed. 
 The secretion of mucus varies greatly in in- 
 dividuals, and within limits is not incompati- 
 ble with health. That is to say, a discharge 
 considered normal during adolescence and 
 maturity would, with propriety, be looked 
 upon as abnormal if occurring in childhood, 
 a veritable catarrh even though the character 
 of the discharge continues unchanged and is 
 physiological in its constituents. When, 
 however, the simple catarrh of childhood 
 continues into menstrual life, or develops 
 after puberty, it is frequently of the muco- 
 purulent variety, and, therefore, while this 
 catarrh may occur at any period of life it is 
 the form most frequently associated wath 
 maturity. 
 
 Mucopurulent catarrh is the expression of 
 more than a simple increase of the mucus 
 forming function. It represents a true vag- 
 initis, and pathologicaly is allied to inflam-
 
 mucopuruIvE:nt catarrh. 47 
 
 mation of the deeper structures of the genital 
 canal. The portio-vaginalis is always in- 
 volved, but as long as the morbid process is 
 confined to the mucus forming epithelia, and 
 mucus predominates in the discharge, the 
 cervical canal is not invaded above the ex- 
 ternal uterine os. 
 
 Be3^ond a slight degree of congestion the 
 vulva is not usually affected unless through 
 neglect of cleanliness ; the parts are kept con- 
 stantly bathed in the discharge, which, unless 
 removed frequently, may be irritating and 
 corrosive. The vagina, however, is highly 
 congested, and the epithelial cells and glands 
 are excited to an unusual degree of activity, 
 mucus being secreted in enormous quantities. 
 
 The pus cells which give a purulent char- 
 acter to the discharge come from the portio- 
 vaginalis and the mucous membrane cover- 
 ing the external os, and are generated by 
 structural change in these parts of the canal, 
 the extent of which determines the relative 
 proportion of pus cells in the discharge. 
 
 A mucopurulent gynaecological catarrh, 
 therefore, is usually a simple mucous ca- 
 tarrh to which is added a characteristic pa-
 
 48 i,kucorrhce:a. 
 
 thology of the upper part of the vagina and 
 portio-vaginalis, the discharges from which 
 give it its characteristic features. Hence in 
 considering this variety of catarrh attention 
 will appropriately be directed more especially 
 to these parts of the genital canal. 
 
 So frequently is erosion of the uterine os, 
 and hyperplasia of its glandular structures 
 associated with mucopurulent catarrh that 
 the propriety of regarding these conditions 
 as essential parts of a whole admits of little 
 question. 
 
 Erosion of the cervix is not an ulceration. 
 There is no loss of tissue ; on the contrary we 
 find an increase of tissues, the condition be- 
 ing more accurately described as a sessile 
 adenoma. The process centers in the glands 
 of the cervix, which are normally complicat- 
 ed, and much larger than those of the body of 
 the uterus. The red patches on the cervix 
 from which pus exudes are masses of gland 
 acini, and not only occupy the surface of the 
 cervix but extend deeply into the underneath 
 tissues. The glandular construction is great- 
 ly exaggerated, with wide convolutions and 
 dilatations, the secreting parts increasing at
 
 I^CTROPIUM. 49 
 
 the expense of the stroma into which they 
 project. 
 
 The mucous membrane covering the seg- 
 ment of the uterus that projects into the 
 vagina in acute cases is highly congested, the 
 superficial vessels being only lightly covered 
 with epithelium. In chronic cases the mucosa 
 appears almost purple from blood stasis, a 
 condition that may spread to the vaginal 
 fornices. The cervical endometrium is swol- 
 len and pouting from the external os, ectro- 
 pium, and the normal rugse become accentu- 
 ated. All the structures involved are more or 
 less cedematous, the portio-vaginalis appear- 
 ing as a tumefaction that occupies the upper 
 part of the vagina. 
 
 Though the mucous membrane is extreme- 
 ly red, resembling a piece of raw meat, one is 
 surprised to find upon attempting to cleanse 
 the surface that it does not bleed readily. As 
 a matter of fact, the apparently denuded sur- 
 faces are covered with a thin layer of squam- 
 ous epithelium through which the dilated 
 vessels show distinctly. It is characteristic 
 of erosion of the cervix that the line of de- 
 marcation between the morbid and the 
 
 5
 
 so I,EUCORRH(HA. 
 
 healthy processes is very clearly defined, for 
 while there is intense congestion of the 
 portio-vaginalis where the glandular hyper- 
 plasia ends is always clearly marked. This 
 feature does not belong to any other benign 
 growth, and disappears as the pathology be- 
 comes more complex. 
 
 Save in advanced cases the uteri os is not 
 open. It remains closed with a plug of clear 
 tenacious mucus which serves to guard the 
 interior of the uterus against the invasion of 
 micro-organisms by way of the vagina. This 
 plug can be drawn out in a long string, but is 
 dislodged with difficulty. 
 
 Mucopurulent catarrh may be acute or 
 chronic, more frequently the latter, as the 
 acute condition that induces the formation 
 of pus causes a predominance of these ele- 
 ments from the outset. Mucopurulent gyn- 
 aecological catarrh, therefore, is usually a 
 chronic disease. It belongs to adult life more 
 especially, and is connected with the period 
 of sexual activity. Conditions of life are 
 mainly responsible for mucopurulent ca- 
 tarrh, for it is most frequent in married life, 
 and in those who have borne children. Elimi-
 
 E^NDOCDRVICITIS. 51 
 
 nating gonorrhoea, which for reasons already 
 stated will not be discussed here, the conse- 
 quences of child-bearing are the most pro- 
 lific causes. These are, imperfect involution 
 of the uterus, quite as important the injuries 
 of the lower segment of the uterus and of the 
 vaginal walls that are incident to parturition. 
 These injuries cannot always be considered 
 lacerations, which understanding is usually 
 reserved for tears involving the several 
 structures of the cervix and perineum, for 
 there is no doubt that in some instances in 
 which the cervix and vagina appear not to be 
 injured, indeed in which the integrity of their 
 muscular structures remains, the mucosa has 
 suffered some slight and overlooked trauma, 
 is torn, and offers an entrance for micro- 
 organisms and a point for delayed repair. 
 Endocervicitis follows. The cervical glands 
 become enlarged, their function perverted, 
 and almost as a continuation of the puer- 
 perium there is an erosion of the cervix, and 
 an infection of the vagina. When the cervix 
 is lacerated the steps to the development of 
 erosion are more rapidly taken, and the end 
 more quickly reached. There is also liable
 
 52 i,e:ucorrhcka. 
 
 to be an arrest of the process of uterine in- 
 volution as a consequence of injury, tissue 
 changes, and local interference with nutri- 
 tion. 
 
 Women who have borne children and 
 those who employ means to prevent con- 
 ception, or to arrest gestation, are also fre- 
 quent subjects of mucopurulent catarrh. 
 The exciting causes are either mechanical in- 
 jury to the cervix, or an irregular congestion 
 of the uterus without the means nature pro- 
 vides for the emptying of the surcharged 
 vessels. The results are the same, though in 
 less degree. A heavy uterus, endometritis, 
 endocervicitis, glandular hyperplasia, infec- 
 tion, and lastly the formation of pus. 
 
 But mucopurulent catarrh occurs in un- 
 married women. The pathology is similar, 
 erosion of the cervix from which pus is de- 
 rived, and excessive secretion of mucus by 
 the vaginal epithelium and glands. Such 
 cases are not usual, but we do find well de- 
 veloped erosion of the cervix in virgins, as 
 we find congenital laceration of the cervix 
 from defective fusion of the uterine seg- 
 ments. Mucopurulent catarrh in virgins is
 
 OCCUPATIONS AND CONDITIONS. S3 
 
 associated with malposition of the uterus, 
 most frequently retroflexion, and with con- 
 gestion of the pelvic organs. Retroflexion of 
 the uterus is a potent factor in causing con- 
 gestion and swelling of the cervical endo- 
 metrium and the cervical glands, thus 
 through successive stages removing the 
 natural protection against invasion of the 
 cervix by micro-organisms. 
 
 Certain occupations followed by women 
 conduce to the same end. Among these, 
 standing long hours, as until quite recently 
 required of shop girls, is most prolific in in- 
 ducing pelvic congestion, uterine displace- 
 ments and perverted function of the genital 
 mucosa. The fatigues incident to social life 
 in our large cities, and its unnatural excite- 
 ments furnish their quota to the local condi- 
 tions that favor bacterial infection of the 
 vagina and uterus. In other words, the 
 vagina being naturally a self -cleansing and 
 aseptic canal becomes through unnatural 
 conditions non-resistant to infection. The 
 uterus and pelvic organs also suffer from 
 similar unhygienic conditions, and one of the 
 results is gynaecological catarrh of the mucu- 
 purulent variety.
 
 54 I,i:uCORRHC^A. 
 
 Mucopurulent catarrh is among the most 
 common of gynsecic diseases, but because 
 women, and especially married women, are 
 accustomed to more or less vaginal dis- 
 charge, the disease has frequently become 
 quite well established before brought to the 
 specialist's attention, and even then, unless its 
 importance is almost unduly exaggerated, it 
 is difficult to impress patients with the neces- 
 sity for persistent and systematic treatment. 
 
 The discharge of mucopurulent catarrh 
 consists of mucus containing pus cells, some 
 broken down epithelial cells and incompletely 
 emptied goblet cells. Because of the altera- 
 tions that may take place in the secretion 
 from the glands, according to the length of 
 time it lies in the vagina, and also according 
 as the reaction is acid, alkaline or neutral, 
 the gross character of mucopurulent catarrh 
 will vary considerably. 
 
 Typical mucopurulent catarrh is yellow- 
 ish in appearance, with the predominance of 
 pus it assumes a creamy consistence, and 
 when the cervical canal is involved there will 
 be strings of clear, transparent mucus mixed 
 with the opaque material. Occasionally
 
 TIME O^ AGGRAVATION. 55 
 
 there is a slight tinging with blood. This 
 calls for a rigid examination, aware as we 
 are of its possible grave pathological signifi- 
 cance. Occurring as a feature of an eroded 
 cervix from which it emanates, it may mean 
 nothing more than a temporarily increased 
 local congestion, but the true state of the 
 case should be ascertained, and the source 
 and cause of the bleeding determined without 
 delay. 
 
 It is characteristic of a mucopurulent dis- 
 charge to harden upon exposure to the air; 
 we, therefore, find yellow crusts on the ex- 
 ternal parts where the matter has been allow- 
 ed to accumulate. As a rule, these crusts are 
 not difficult to remove and will not be present 
 when systematic local treatment is carried 
 out. 
 
 Mucopurulent catarrh is generally aggra- 
 vated a few days before and a few days fol- 
 lowing menstruation, the period of least dis- 
 charge being the mid-month. It is also in- 
 creased during the first months of preg- 
 nancy — if present before conception — when 
 it becomes a most annoying symptom. After 
 the third month the discharge is generally
 
 56 I^KUCORRHG^A. 
 
 reduced in quantity until just prior to con- 
 finement, when it is liable to become quite 
 profuse again. It may, however, continue 
 during the entire period of gestation. 
 
 The reaction of mucopurulent catarrh is 
 always alkaline, the vagina having lost its 
 protective acidity. When strongly alkaline 
 the discharge is corrosive and will injure any 
 fabrics with which it comes in contact. A 
 patient's linen is in this way frequently quite 
 destroyed. 
 
 The clinical picture of gynaecological 
 mucopurulent catarrh will not be complete 
 without considering the constitutional symp- 
 toms. Those that accompany this form of 
 catarrh are varied. One of the most com 
 mon is a persistent backache. This is a dull, 
 wearisome pain below the waist line. It is 
 aggravated by standing, but is never wholly 
 absent save during menstruation, vv^hen there 
 may be relief. 
 
 Digestion suffers, and the appetite is liable 
 to be fickle, almost to the unnatural cravings 
 of gestation. Constipation is always pres- 
 ent, and is due to a torpid condition of the 
 rectum. The patient complains of a dull
 
 occipital headache, with which she wakens 
 in the morning, continuing with more or less 
 severity during the day. As general nutri- 
 tion suffers the skin becomes dry and 
 ansemic, and on the face and back acne may 
 develop. The patient is always tired, she 
 becomes exhausted after slight exertion and 
 does not readily recuperate. This picture is 
 an extreme one, but in varying degree be- 
 longs to every case of mucopurulent catarrh. 
 
 The cure of mucopurulent catarrh can be 
 eff'ected only with the faithful co-operation 
 of the patient, and after persistent treat- 
 ment, which to be successful must include 
 careful individualization of symptoms and of 
 pathological conditions. The treatment is 
 naturally divided into local and constitu- 
 tional. 
 
 The local treatment will be the use of the 
 douche, the medicated tampon, direct appli- 
 cations to the eroded cervix and the vagina, 
 and cervical curettage. A lacerated cervix 
 must, of course, be repaired, for without 
 trachelorrhaphy the erosion cannot be cured. 
 Any malposition of the uterus that exists 
 will also be corrected, for until this is done
 
 58 i,e:ucorrhce:a. 
 
 the circulation of the pelvis cannot be re- 
 stored. As the infection is from pus-form- 
 ing cocci, unless in the beginning, Boracic 
 acid will not control the disease. More ac- 
 tive bactericides are necessary. 
 
 I generally make my selection from among 
 three drugs. Bichloride of mercury, Iodine 
 and Carbolic acid. My routine practice, sub- 
 ject, however, to variations, is the following: 
 At the first examination — Cusco's speculum 
 affords the best exposure — the mucous mem- 
 brane is thoroughly cleansed with a solution 
 of Bicarbonate of soda, followed by Carbolic 
 acid. For this and for all cleansing of the 
 vagina I use the selected medicament in the 
 form of a spray with compressed air. The 
 force of the spray easily reaches parts that a 
 douche cannot touch. Bicarbonate of soda 
 cuts tenacious mucus, and Carbolic acid 
 possesses a soothing as well as an antiseptic 
 action. 
 
 The eroded cervix is then lightly painted 
 with Carbolic acid 95 per cent., its action be- 
 ing antagonized with alcohol. The Carbolic 
 acid follows the sulci between the hyper- 
 trophied glands and attacking necrosed
 
 USD OF TAMPON. 59 
 
 matter dislodges it, to be subsequently mixed 
 with the discharge. The patient is directed 
 to take a Carbolic douche 1/60, each night 
 and morning, and to return for treatment at 
 the end of three days. By that time the 
 slough on the cervix caused by the acid ap- 
 plication has been cast off, and the eroded 
 surfaces are ready for further treatment. 
 The discharge will not be diminished, but it 
 will be thicker, and more creamy. The erod- 
 ed surface will be found bathed in pus, but 
 this is easily removed, and the underneath 
 structures appear more healthy. 
 
 This treatment is repeated at intervals of 
 three days, that is, two days intervene be- 
 tween the treatments, for generally about 
 two weeks, or until the first menstruation. 
 If there is much congestion of the uterus 
 with enlargement and swelling of the cer- 
 vix, it may be advisable to use a tampon sat- 
 urated with boroglyceride, but in the pres- 
 ence of a profuse discharge from the cervix 
 I avoid even this light obstruction of the 
 vagina, seeking to promote drainage rather 
 than to retard it. 
 
 If the vaginal walls are relaxed an as-
 
 60 I^EUCORRHC^A. 
 
 tringent douche will replace the Carbolic 
 acid. Powdered Sulphate of copper and 
 Alum, equal parts, of which half a teaspoon- 
 ful is added to two quarts of water, will 
 serve a useful purpose. As a rule, however, 
 in what I consider the preliminary treat- 
 ment I depend upon Carbolic acid for both 
 douche and topical application to the eroded 
 surfaces. This drug has a most beneficial 
 effect upon the mucous membrane in the 
 early stages of mucopurulent catarrh, or 
 when the case comes to us from another sur- 
 geon, and single-handed will usually prepare 
 the diseased structures for subsequent and 
 more strictly curative treatment. 
 
 Following Carbolic acid, my chief reliance 
 is placed upon Iodine. I use it for spraying 
 the vagina, and apply it to the pus secreting 
 surfaces. I prefer Churchill's tincture, for 
 in addition to the counter-irritant action of 
 Iodine there is the well known softening ac- 
 tion of Iodide of potassium on inflammatory 
 deposits and exudates. For the spray I use 
 Iodine in the proportion of one drachm in a 
 pint of water, to cleanse the cervix; this 
 should always be done. I paint the eroded
 
 gIvYCE:ridk o^ iodine:. 61 
 
 surface with the tincture. As the in- 
 ternal OS is usually closed, the Iodine may be 
 carried well into the cervical canal with little 
 fear of invading the body of the uterus. 
 
 At this stage the vaginal tampon will as- 
 sist in restoring the eroded cervix, and 
 through its hygroscopic action, glycerine will 
 greatly relieve congestion of the pelvic 
 structures. I still rely upon Iodine. Gly- 
 cerine will take up about 1.90 parts of Iodine 
 crystals, and for the purpose of medicating 
 tampons I find it convenient to keep a bottle 
 of glycerine containing iodine crystals in my 
 office. After standing twenty-four hours 
 the saturation is complete, and the glycerine 
 solution may be used with definite knowledge 
 of its strength. Half a drachm of this solu- 
 tion is added freshly to enough glycerine to 
 drench the tampon, which is then carried up 
 against the cervix. 
 
 This treatment must be repeated at first 
 twice a week, later once a week will be suffi- 
 cient. Iodine is exquisitely homoeopathic to 
 the glandular hyperplasia, it is a most effi- 
 cient bactericide, and has a marked predilec- 
 tion for necrotic tissue, inducing its separa- 
 tion without injury to the healthy structures.
 
 62 i,e:ucorrhc^a. 
 
 In mucopurulent catarrh I formerly used 
 Ichthyol tampons, but my results have been 
 more satisfactory from the Iodine treatment, 
 and the preparation of the crystals in gly- 
 cerine I prefer to that made with the tinct- 
 ure. 
 
 It may become necessary to curette the 
 cervical endometrium and to remove the 
 glandular hyperplasia of the os, and portio- 
 vaginalis, but such a requirement will be un- 
 usual for mucopurulent catarrh. When 
 curetting is necessary the case has almost 
 certainly progressed to a more decided puru- 
 lent form — purulent catarrh. Further refer- 
 ence will be made to the operative treatment 
 when discussing this variety of gynaecologi- 
 cal catarrh. 
 
 The constitutional treatment of muco- 
 purulent catarrh is a broad subject, for it 
 will embrace the entire life history of the pa- 
 tient, and may necessitate consulting a vast 
 number of remedies before the similimum is 
 found. 
 
 Every case of mucopurulent catarrh 
 should be examined vaginally, for it goes 
 without saying that the cause must be re-
 
 CONSTIPATION. 63 
 
 moved, and this can be determined only by 
 assuring ourselves of the condition of the 
 pelvic organs. The position and size of the 
 uterus are of the utmost importance. Any 
 misplacement must be corrected, and if there 
 is subinvolution the treatment will be direct- 
 ed to its cure. Any underlying dys- 
 crasia will receive careful attention, faulty 
 nutrition which is at the bottom of non- 
 resistance to the invasion of micro-organ- 
 isms will be overcome by regulating the diet 
 and promoting assimilation. 
 
 There is almost always obstinate constipa- 
 tion, a condition of torpor of the lower 
 bowels caused, as is frequently the case with 
 women, by .neglect to respond to the demand 
 to stool. It will be necessary to empty the 
 rectum, after which diet, exercise, occasional 
 Cascara and Maltine, A. S. B. tablets, or 
 Merc, dulcis if the liver seems inactive, or 
 Alumina when the rectum has lost its power, 
 may be required. A course of Rubinat con- 
 dal, or Hunyadi water, or the phosphate of 
 soda, as already suggested, may be neces- 
 sar}^ By this I mean, giving a small dose of 
 one of these salines daily until the intestinal
 
 64 i,]E:ucoRRHaeA. 
 
 canal is empty. One tablespoonful of the 
 cathartic in a glass of warm water before 
 breakfast, will, unless in very chronic cases, 
 be all that is required. No cathartic should 
 be continued too long, or until the habit of its 
 use is established. Constipation is one of the 
 most obstinate gynaecological complications 
 with which we have to deal, and may tax 
 every resource within our knowledge before 
 it is cured, but of one thing we may be cer- 
 tain, a pelvic pathology that has to do with 
 portal congestion cannot be removed as long 
 as this lasts. Not only does the impaction, 
 for such it becomes, interfere with circula- 
 tion through the pelvic vessels, but there is in 
 addition an actual toxaemia induced by ab- 
 sorption from the effete matter that is re- 
 tained in the intestines. Much of the 
 languor and exhaustion attending these 
 cases are undoubtedly due to this cause. Es- 
 tablishing a regular daily habit of going to 
 stool, even in the absence of desire, will 
 frequently accomplish a great deal towards 
 overcoming intestinal inaction, and will in- 
 duce an onward movement of the faecal mass. 
 Constipation is not as prevalent among
 
 hygiene:. 65 
 
 women in the more humble walks of life, 
 save those employed in shops and factories, 
 as it is among the well-to-do or the idle rich. 
 A large proportion of shop women suffer 
 from catarrh, usually mucopurulent, and 
 they are almost always constipated. The 
 problem of treatment and cure in these cases 
 of gynaecological catarrh is well-night insup- 
 erable. Their very circumstances relegate 
 them to dispensary care, or to dispensary 
 physicians who will attend them in the even- 
 ing. This is the only time they have for 
 recreation, and, apart from the actual cost 
 entailed, they cannot be impressed with the 
 relative importance of being cured of their 
 catarrh. As a rule, treatment will consist 
 in directing domiciliary douches, not always 
 taken with antiseptic precautions, and hy- 
 gienic prescriptions, regular hours, plain 
 food, and attention to regular evacuations 
 of the bowels. 
 
 With the idle rich, whose life is a round 
 of pernicious enjoyment, the problem of 
 treatment is only a little less difficult. They 
 will be treated— -according to their own 
 fancy — and they will take medicine, but 
 6
 
 66 I,KUCORRH(KA. 
 
 their irregular hours, rich and highly sea- 
 soned food; their immoderate use of sweets, 
 their increasing use of alcohol, without the 
 advantage that men have of out of door ex- 
 ercise to somewhat counteract its baneful 
 effects, all tend to congest the liver, and 
 induce constipation. Their entire hygiene 
 must be corrected if they would be cured. 
 Early rising, early retiring. Late suppers 
 must be prohibited, sweets save in modera- 
 tion forbidden. Tea and coffee, sparingly 
 taken, I do not object to unless there is some 
 counterindication for their use. Daily ex- 
 ercise unless the condition of the pelvic 
 organs forbids, and regular attention to the 
 bowel function. Shortly after breakfast is 
 the best time to cultivate this habit, and 
 nothing should interfere with the hour fixed 
 for going to stool. 
 
 The intelligent well to do patients furnish 
 the most promising subjects for treatment. 
 They value health more than amusement, 
 and will be willing to give up the latter with 
 the prospect of obtaining the former. The 
 principles underlying all hygienic directions 
 are, to exclude as much as possible luxuries
 
 sEjxuAi, hygie:ne:. 67 
 
 that overbuirden the eliminating organs, and 
 store up in the system the effete materials of 
 metabolism, and to inculcate, the ideas of 
 regular living. 
 
 The sexual hygiene of women may have to 
 do with constitutional conditions that predis- 
 pose to gynaecological catarrh, and with the 
 local conditions that make for its continu- 
 ance. Excessive indulgence, or unsatisfied 
 desire — more frequent in women than is 
 generally acknowledged — act equally in 
 causing congestion of the lower segment of 
 the uterus — it will be remembered that this 
 is really an erectile organ — with consequent 
 endometritis. The various means taken to 
 prevent conception, both passive and active, 
 undermine the constitution of women, and 
 predispose to the below par state that is so 
 frequently associated with mucopurulent 
 catarrh of the genital canal. I do not wish 
 to convey the impression that mucopurulent 
 catarrh is the chief symptom of such a con- 
 stitutional condition, but I do assert that it 
 is one of the symptoms, and is not conceiv- 
 ably present under conditions of well being.
 
 68 i,eucorrhce:a. 
 
 While it may be necessary to consult the 
 entire materia medica to find the similimxum 
 for a given case of mucopurulent catarrh, a 
 few remedies have proved of value. For 
 fuller indications reference may be made to 
 Part IV of this Treatise. 
 
 Pulsatilla, Sepia, Aletris, Hydrastis, the 
 latter from its certain action on the uterine 
 musculature makes it especially valuable 
 when there is subinvolution; the Potash 
 salts, especially Bichromate and Chlorate. 
 Iodine is of a very wide application, inter- 
 nally as well as locally, especially when there 
 is an underlying dyscrasia. It is especially 
 applicable to delicate women who are easily 
 exhausted, brunettes with dark, lifeless look- 
 ing skin. All the discharges are corrosive, 
 and there is a concomitant marked conges- 
 tion of the ovaries. Kreosote will be indi- 
 cated when the mucopurulent discharge is 
 offensive, and very irritating, causing swell- 
 ing, itching and excoriation of the parts with 
 v/hich it comes in contact. The portio-vagi- 
 nalis is purple and indurated, and the en- 
 larged glandular masses form ridges that 
 project beyond the surface. Sepia is of fre-
 
 the: tissue: rkmedie:s. 69 
 
 quent use in this form of catarrh, especially 
 when there is a general relaxation of the 
 pelvic structures. The uterine supports have 
 given away, the uterus is heavy and prolaps- 
 ed, the condition being one of atony, fre- 
 quently following confinement. The pa- 
 tients are feeble and debilitated, with dark 
 complexion, fine skin, and extremely sensa- 
 tive to impressions. The indications for 
 Sepia are more upon constitutional than local 
 symptoms. The general condition of the pa- 
 tient greatly influences the choice of this 
 remedy. 
 
 But while there are many old and tried 
 remedies that have done, and will continue to 
 do; yoeman's service, I have come to place 
 much reliance on the tissue remedies for the 
 treatment of mucopurulent gynaecological 
 catarrh, and frequently make my selection 
 from among them during the course of treat- 
 ment. They are indicated by the pathology, 
 the constitution, and the subjective as well 
 as the objective symptoms, and more fre- 
 quently, I think, than any other class of rem- 
 edies, cover the complete picture of the dis- 
 ease.
 
 70 LKUCORRHC^A. 
 
 The lime salts stand out prominently. 
 Calcarea phosphorica will be useful as a 
 general tonic in women who have borne chil- 
 dren too rapidly, and, who, in consequence, 
 suffer from exhausted vitality. It is also use- 
 ful in senile conditions, especially the vaginal 
 pruritus of old women. Calcarea sulphurica 
 is possibly more useful in purulent catarrh 
 than in the mucopurulent variety, but its ac- 
 tion upon glandular structures and mucous 
 membranes is so marked that it may be call- 
 ed for here. When the discharge contains 
 lumps of pus mixed with mucus, I always 
 think of Cal. sulph. Kali phosphoricum ren- 
 ders valuable aid in the treatment of muco- 
 purulent catarrh. Not, I believe, because of 
 its direct action upon the structures involved 
 in the morbid process, but as a general nerve 
 restorer. If the catarrh has existed any 
 length of time the patient suffers from nerve 
 exhaustion, and will become before long a 
 subject of some degree of neurasthenia. I 
 know of no remedy that fits these cases as 
 perfectly as Kali phos. It is the great nour- 
 isher of nerves, and, by accomplishing this, 
 aids assimilation and the reconstruction of
 
 ME:TH0D 01^ USING KAU PHOS. 71 
 
 tissues. With this object in view, I fre- 
 quently give Kali phos. in hot water before 
 eating, at the same time that I exhibit the 
 remedy that more closely suits the local 
 pathology, and its attendant symptoms. 
 I rarely now carry through a case of 
 chronic mucopurulent catarrh, or for that 
 matter any long-lasting gynaecological case 
 that has induced exhaustion, without the 
 aid of Kali phos. Kali sulphuricum exerts 
 such a powerful action upon the epithelial 
 covering of mucous membranes that we 
 naturally consider this salt in relation to 
 catarrh. I frequently use it when the 
 discharge contains large quantities of epi- 
 thelial cells — Kali sulph. causes this desqua- 
 mation — shown clinically by its creamy ap- 
 pearance. The mucous secretion is crowded 
 with cylindrical epithelial cells that have 
 been cast off from the mucosa. Or there 
 may be complete desquamation of the vagina, 
 the epithelium appearing in shreds. Kali 
 sulph. also interferes with the lymphatic sys- 
 tem, causing a diminution of the lymph 
 supply. The catarrhal discharge then be- 
 comes sticky and stringy. A slimy, yellow-
 
 72 i,]e:ucorrhce:a. 
 
 ish catarrh, containing masses of epithelial 
 cells and lumps of pus, is strongly suggestive 
 of Kali sulphuricum. 
 
 C. PuruIvKnt Catart.h. 
 
 Unless the result of mechanical denuda- 
 tion of the genital canal and acute pyogenic 
 infection, purulent catarrh is frequently a 
 continuation of the mucopurulent variety. 
 More tissues are involved, and the formation 
 of pus quite outweighs and takes the place 
 of the normal mucous secretion. The dis- 
 charge is pus, the mucous element constitut- 
 ing only an insignificant part of its volume. 
 
 We will at the outset avoid the mistake of 
 regarding any flow of pus from the genital 
 canal as a purulent catarrh. A pyosalpinx 
 that discharges through the uterus, a pelvic 
 abscess that empties itself through the 
 vagina, or a purulent uterus, cannot be class- 
 ed as catarrh, though the discharge contains 
 pus. Any one or all of these may coexist 
 with purulent catarrh, and will, then, as 
 the more serious pathology, demand spe- 
 cial treatment, but, as already pointed out, 
 catarrh does not embrace such a pathology.
 
 VUI.VITIS. Th 
 
 Gynaecological catarrh is essentially a dis- 
 ease of the mucous membranes lining the 
 genital canal, and its various phases arise 
 from the manner in which these tissues are 
 affected, and the extent of their involvement. 
 Much that has been said of mucopurulent ca- 
 tarrh may with equal propriety be told of 
 purulent catarrh, the graduations between 
 the two varieties are slow and difficult to 
 distinguish clinically. But when fully de- 
 veloped, purulent catarrh makes a picture 
 that admits of no doubt in diagnosis. 
 
 The entire genital mucosa is usually in- 
 volved in the morbid process, even the lining 
 of the Fallopian tubes may participate. 
 While functionating goblet cells may exist, 
 their physiological role is imperfectly per- 
 formed, and is entirely dominated by the 
 process that makes for an excessive desqua- 
 mation of the epithelial layer, and the ex- 
 travasation of pus degenerated leucocytes. 
 The vulva, if not a part of the primary in- 
 fection, soon becomes involved. Vulvitis is 
 present with an increased secretion from 
 Bartholin's glands, and desquamation of epi- 
 thelium. The vaginal mucous membrane is
 
 74 i,Eucorrhce:a. 
 
 congested, swollen and velvety. In places it 
 is entirely denuded of its epithelial covering, 
 these spots appearing a deeper red than the 
 surrounding tissues. Examination shows 
 them to be the principal points from which 
 the pus cells are thrown off. 
 
 There is a form of purulent catarrh al- 
 most confined to a gonorrhoeal infection, or 
 to the puerperium, that is characterized by 
 the development of granules situated in the 
 mucous membrane. These are best demon- 
 strated by the examining finger to which 
 they feel like hard bodies the size of small 
 seeds that are freely movable. I have found 
 such granules, though not in sufficient num- 
 bers to constitute a distinct pathological en- 
 tity, unconnected with gestation, and where 
 the possibility of a gonorrhoeal infection 
 could not be entertained. I, therefore, can- 
 not consider them as characteristic of either 
 of these states. Their presence does not 
 seem to be connected with the formation of 
 pus, but is more probably an expression 
 of a mixed infection. 
 
 As in mucopurulent catarrh, the portio- 
 vaginalis is actively involved in the morbid
 
 ENDOMETRITIS. 75 
 
 process. There is always an erosion of the 
 cervix, which, from the intensity of the pro- 
 cess, may extend well out towards the fornix 
 and break down into an actual ulceration 
 with loss of substance. 
 
 Nor does the morbid process stop at the 
 internal os, for as the cervical canal shares in 
 the erosion the cavity of the uterus is early 
 invaded. The endometrium is inflamed — 
 purulent endometritis — and swollen. Its 
 glands in consequence are excited to a path- 
 ological activity, and pus corpuscles are form- 
 ed in abundance to mingle with the unhealthy 
 mucous secretion. The quantity of discharge 
 is sometimes a matter of astonishment lead- 
 ing to the suspicion of some pus cavity ex- 
 isting connected with the body of the uterus 
 through which it seems to discharge. 
 
 The endometritis that forms a part of pur- 
 ulent catarrh runs a more or less chronic 
 course, similar to the process in the vagina. 
 There is almost always a laceration of the 
 cervix, and a wide open cervical canal 
 through which the infection takes place, for 
 it will be remembered that the healthy uterus 
 contains no micro-organisms, and will re-
 
 76 i.Eucorrhoe:a. 
 
 main free from them as long as the cervical 
 canal continues its sentinel duty. 
 
 In some cases desquamation of the epi- 
 thelial covering of the mucosa takes place so 
 rapidly that the vessels are not sufficiently 
 protected, and there is an oozing of blood 
 that tinges the discharge brown. At other 
 times the discharge may become green in 
 color, depending upon decomposition that 
 has taken place, and possibly the presence of 
 some special micro-organism, for purulent 
 catarrh is always a mixed infection. 
 
 There is a form of purulent catarrh occur- 
 ring in old women, associated, if not wholly 
 dependent, upon "senile endometritis," — 
 senile purulent catarrh. The condition is one 
 of senile degeneration in which connective 
 tissue is in excess of gland tissue, the mucous 
 membrane being replaced by fibrous tissue. 
 The discharge is often bloody, and offensive 
 from decomposition of the contents of the 
 uterus. In such cases the process of atrophy 
 that attacks the uterus has the effect of clos- 
 ing the cervical canal for purposes of drain- 
 age, which accounts for the decomposition of 
 the retained discharge.
 
 The vagina does not share actively in 
 these senile changes, though there may be a 
 vaginitis which I am incHned to beheve is in 
 some instances an entirely separate disease. 
 When the vagina is involved the canal feels 
 like a fibrous cone very much narrowed 
 above, at the apex of which is situated the 
 cervix uteri. There are sometimes bands of 
 contracting scar tissue encircling the vagina, 
 or a distinct diaphragm may exist through 
 which the finger must pass to reach the os. 
 The vaginal walls are smooth in places, in 
 others there are red elevated spots. The dis- 
 charge is not profuse, but is characteristic- 
 ally purulent. Care must be exercised to 
 distinguish this senile degeneration from 
 cancer of the uterus and vagina. 
 
 As the Fallopian tubes are in health also 
 free from micro-organisms, catarrh of these 
 ducts will be an extension from the uterus. 
 Salpingitis and pyosalpinx may thus become 
 parts of the clinical history of gynaecological 
 purulent catarrh, but a pus tube is a pa- 
 thological as well as a clinical entity, and is 
 only referred to here as a possible complica- 
 tion of purulent catarrh. The same is true
 
 78 I^EUCORRHOeA. 
 
 of tuberculosis of the Fallopian tubes and of 
 the lower parts of the genital canal. The 
 chief clinical symptom may be that of puru- 
 lent catarrh, but an examination of the dis- 
 charge will establish or break down the 
 diagnosis of tubercular infection. 
 
 Purulent gynaecological catarrh is a dis- 
 ease of adult life; it occurs most frequently 
 in married w^omen, and is almost invariably 
 associated with a lacerated cervix, which we 
 must look upon as the door through which 
 infection takes place. The majority of cases 
 originate in this manner, the vagina and 
 uterus being secondarily invaded. When the 
 uterus is the primary focus of disease, the 
 endometritis of purulent catarrh has passed 
 from the stage of acute infection, puerperal, 
 to the chronic form, which, because of the 
 deep-seated pathology of puerperal infec- 
 tion, will be found especially rebellious to 
 treatment. 
 
 Purulent catarrh may follow infection 
 from the use of examining instruments, or 
 even from the examining finger. Simple ca- 
 tarrh, or mucopurulent catarrh, being pres- 
 ent, the introduction through whatever
 
 kxanthe:matous dise:ase:s. 79 
 
 agency of more active pyogenic cocci is suffi- 
 cient to cause a predominance of pus, and 
 give a purulent character to the discharge. 
 It is not infrequently a result of genital 
 tuberculosis, and may be a sequela of ex- 
 anthematous diseases. 
 
 The clinical course of purulent catarrh 
 tends to a permanent tissue degeneration and 
 progressive structural involvement. There 
 is no likelihood of self-limitation. The posi- 
 tive and ever-present danger of infection of 
 the peritoneum by way of the Fallopian 
 tubes confronts us when the disease is well 
 established. The physiological current of 
 the ova ducts is towards the uterus, but dis- 
 ease so alters the ciliary epithelium that not 
 only may the morbid secretion break through 
 the fimbria, but the uterus by these chan- 
 nels may discharge its contents into the ab- 
 dominal cavity. Nature, however, frequent- 
 ly comes to our aid in this grave condition, 
 for her tendency is to close the distal open- 
 ings of the tubes by inflammatory exudate, 
 in advance of the formation of pus. 
 
 So constantly is the necessity for plastic 
 reparative work on the uterine cervix a part
 
 80 I,E:UCORRHCeA. 
 
 of the cure of gynaecological catarrh that 
 this disease may with propriety be classed 
 among surgical affections, and we may be 
 sure that any successful treatment must in- 
 clude some operative procedure. 
 
 Each case wall be individualized, but cer- 
 tain general rules apply to all, and their sys- 
 tematic observance will greatly aid the treat- 
 ment. The first indication is to render the 
 genital canal as nearly aseptic as possible, 
 and to restore the field of operation to a state 
 fitted for surgical manipulation. In other 
 w^ords, the vagina must be cleansed, its func- 
 tion of pus formation controlled, and the 
 eroded surfaces of the lacerated cervix 
 brought into a condition in which healing 
 wnll follow an operation. This will require 
 time and much patience, and we will prob- 
 ably be obliged to ring the changes on a 
 great variety of douches, and applications to 
 the hyperplastic cervical tissues. 
 
 As in mucopurulent catarrh, I am very 
 partial to the local use of Iodine. It not only 
 controls suppuration, but it assists in getting 
 rid of the necrotic tissues that so frequently 
 form in the vagina and on the portio-vagi-
 
 PRURITUS. 81 
 
 nalis. Bichloride of mercury I do not use as 
 much as formerly. If of sufficient strength 
 to be an efficient bactericide it is corrosive, 
 increasing vaginitis and sometimes setting 
 up a troublesome dermatitis. Creoline, one 
 drachm in two quarts of water, will act well 
 in the presence of much swelling, oedema and 
 cellular infiltration especially suggest its use. 
 Hydrastis, fluid extract, is useful when the 
 mucous membrane is highly congested, bleed- 
 ing easily when touched, and when the puru- 
 lent discharge contains streaks of blood, in- 
 dicating the involvement of the walls of the 
 capillary vessels. The same condition is ob- 
 served on the portio-vaginalis in even more 
 pronounced form, distended vessels being 
 plainly visible through the thin epithelial 
 layer. In such conditions Hydrastis will not 
 fail to bring about improvement. Extract of 
 Witch hazel and Hydrastis, equal parts, of 
 which one drachm is dissolved in one quart 
 of water, is a favorite douche in my practice. 
 Pruritus, especially in women past the 
 menopause, is sometimes a most trying con- 
 comitant of purulent catarrh. It may be- 
 come so intense as to demand treatment in-
 
 82 I.i:UCORRHCEA. 
 
 stituted exclusively for its relief, without re- 
 gard to the aseptic requirements of the case. 
 Sedative douches are indicated before all 
 others. A saturated solution of Boracic 
 acid, or a solution of Liq. plumbi acet., one- 
 half drachm in a pint of water, will frequent- 
 ly give relief, and enable us to use more 
 strictly aseptic douches. When the itching 
 has been intense I have obtained benefit from 
 the application of lint saturated with : 
 
 ?. Acid hydrocyan. dil ^ii. 
 
 Plumbi acetat scruple ii. 
 
 Glycerine §ii. 
 
 M. 
 
 Another useful douche when pruritus is a 
 marked symptom is Thuja tincture, one 
 drachm in one quart of water. The relief 
 following the use of this douche is sometimes 
 very prompt and permanent. 
 
 At the same time we treat the vagina we 
 must prepare the os and portio-vaginalis for 
 operation. Not much can be done in the 
 preparation of the cavity of the uterus for 
 curetting, for any intrauterine treatment will 
 require a widely open cervical canal, insuring
 
 PREPARATION 01^ CIjRVIX 1?0R CURKTTING. 83 
 
 drainage of the cavity. To dilate the canal 
 is in itself an operation, and usually forms 
 the first step of currettage. 
 
 In preparing the cervix for operation I use 
 Carbolic acid, Churchill's tincture; or 
 Chromic acid, ten grains in one ounce of 
 water, to destroy hyperplastic glands; or 
 sometimes Acetic acid, one ounce, containing 
 Carbolic acid, twenty drops; or Nitrate of 
 silver, ten grains, water, one ounce. But 
 Iodine still remains the most generally use- 
 ful application. Its persistent use will more 
 quickly condition the parts for operation 
 than any other drug with which I am 
 familiar. 
 
 The above mentioned combination of 
 Acetic acid and Carbolic acid will be of as- 
 sistance when the hypersemic, tensely 
 swollen portio-vaginalis and os uteri are 
 smooth and glassy, apparently covered with 
 a shining film. In making this application 
 care must be taken to avoid contact with 
 healthy structures. This can be prevented 
 by holding pledgets of cotton soaked with 
 the solution against the os for a few minutes, 
 the treatment being made through a glass — 
 Ferguson's speculum.
 
 84 IvEUCORRHCBA. 
 
 I do not like dusting powders for these 
 cases. Our object is to promote drainage of 
 the surcharged tissues, and powders, with 
 possibly the exception of Calomel, which I 
 occasionally use when there is well marked 
 ulceration with loss of substance, dry the 
 parts and defeat this purpose. 
 
 The use of medicated tampons is indis- 
 pensable, and when properly made and plac- 
 ed will not seriously interfere with drainage 
 from the uteurs. 
 
 First, as to the making. As commonly 
 constructed, the vaginal tampon cannot ac- 
 complish all that it should, for after it has 
 been in the vagina long enough to become 
 saturated with discharge, it is converted into 
 a shapeless mass that presses unduly upon 
 any structures against which it may lie. A 
 vaginal tampon should above all qualities 
 possess elasticity, and be so fashioned as to 
 readily adapt itself to the conformation of 
 the upper part of the vagina. This elastic 
 quality is scarcely second to that of holding 
 the medication, for it alone, without drug 
 saturation, is of conspicuous assistance in re- 
 ducing an overweight uterus, and in reliev-
 
 VAGINAI, TAMPON. 85 
 
 ing pelvic congestion by virtue of holding up 
 the heavy and prolapsed organs. 
 
 My directions for making a vaginal tam- 
 pon are the following: A thin piece of ab- 
 sorbent cotton, about four inches wide and 
 six inches long, is pulled from the roll. It 
 should not be cut, for this leaves straight 
 edges that do not blend with the body of the 
 tampon, but should be pulled away from the 
 roll. Near one end is placed a small quantity 
 of sterile wool, picked apart. On the prepa- 
 ration of this depends the elasticity of the 
 tampon. The wool should be made light and 
 fluffy. The edges of the cotton cover are 
 then turned over from side to side, and the 
 wool rolled in the cotton. An elastic cylinder 
 is thus formed entirely covered with cotton, 
 which material alone should come in contact 
 with the vaginal mucosa. A slip knot made 
 of a double thread of darning cotton is then 
 thrown around one end of the tampon, the 
 distal end when introduced into the vagina. 
 The size of the tampon will be adapted to in- 
 dividual requirements, but the principle of 
 construction will be the same, insuring elas- 
 ticity, and a body covered with cotton in such
 
 86 I,E:UCORRHCeA. 
 
 manner as to prevent the irritating wool 
 from touching the vaginal mucous mem- 
 brane. 
 
 I usually select my tampon medicament 
 from among three, always using glycerine as 
 the menstrum. Boroglyceride, Iodine and 
 Icthyol, but others may be indicated. Hy- 
 drastis, when there is a tendency to capillary 
 erosion; Sanguinaria, half a drachm of the 
 powder in one ounce of glycerine, when the 
 eroded surface is very vascular and bleeds 
 easily if touched. Balsam of Peru when sup- 
 puration is excessive from an ulcerated sur- 
 face, and the cervical endometrium protrudes 
 from the inner os, but I use these, and pos- 
 sibly others as intercurrent remedies, and 
 rely chiefly upon the first two mentioned. 
 Boroglyceride will always prove a sedative, 
 and when the case requires soothing applica- 
 tions will be indicated. I, however, generally 
 depend upon Iodine prepared in glycerine, as 
 I have already suggested, for I find it accom- 
 plishes all that can be accomplished in pre- 
 paring for an operation. In introducing the 
 tampon care should be taken to place it 
 against the eroded surface and not in the 
 fornix, where it is useless.
 
 IRRIGATION O^ UTERUS. ^7 
 
 As a part of the preliminary treatment it 
 is well to irrigate the cavity of the uterus if 
 the OS is well open, but I am chary about do- 
 ing this, knowing how readily in diseased 
 conditions of the endometrium, and of the 
 mucosa of the Fallopian tubes, fluids may 
 pass into the abdominal cavity. For an in- 
 trauterine douche I use a weak solution of 
 Iodine, one drachm in a quart of sterile 
 water. 
 
 As long as the purulent element continues 
 in the discharge, it will be impossible to ob- 
 tain satisfactory results from an operation 
 on the cervix, nor can we safely curette any 
 part of the uterus. But as soon as this is 
 controlled and the catarrh returns to the 
 mucous variety, repair of the cervix and 
 thorough removal of the diseased endo- 
 metrium must be undertaken, otherwise the 
 catarrh cannot be cured. 
 
 Curettage and trachelorrhaphy have be- 
 come such a routine procedure that there re- 
 mains little to say in the matter of operative 
 technique. Especially in country practice, al- 
 most every physician feels himself competent 
 to curette a uterus, and repair a lacerated
 
 88 i.eucorrhci:a. 
 
 cervix. The circumstance of remoteness 
 justifies them in their practice, but there is no 
 doubt that these operations are sometimes 
 followed by disastrous results, and are not 
 infrequently absolute failures. The disas- 
 trous results arise from imperfect asepsis, 
 the failure to accomplish repair from lack of 
 thoroughness in operative technique. The 
 avenues of pelvic infection are especially by 
 way of the lymphatics of the cervix, and the 
 uterus, and inattention to the smallest de- 
 tails of preparation, or work, introduce so 
 many elements of danger. The slow and 
 imperfect convalescence that occasionally 
 follows trifling gynaecological operations, 
 can unquestionably be traced to some variety 
 of infection introduced with the operatioii 
 Not all pathologic micro-organisms are pyo- 
 genic, but all when favorably placed live 
 their life cycle, in doing which they either 
 draw from or contribute to the system of 
 their host. Such withdrawing or giving 
 may be equally effective in disturbing meta- 
 bolism, in interfering with local repair, or 
 with the restoration to health. 
 
 The operative technique for curetting the
 
 technique: of curkttagi:. 89 
 
 uterus and repairing a lacerated cervix is 
 simple, as all surgery should be. After irri- 
 gating the vagina with Bichloride of mer- 
 cury, followed by normal salt solution, I 
 swab the exposed mucosa with acidulated al- 
 cohol — Acetic acid one drachm. Alcohol one 
 ounce. Acetic acid increases the bactericidal 
 properties of alcohol, and hardens the tissues 
 included in the operative field. Thorough 
 stretching of the cervical canal, without 
 trauma, is necessary before curetting. This 
 part of the operation should be done slowly, 
 and if the dilator used has bilateral blades 
 these must be brought successively in con- 
 tact with every part of the canal until it is 
 large enough to admit with ease the largest 
 curette. Only a dull curette should be 
 used to remove the endometrium of purulent 
 catarrh; a sharp instrument is no more 
 effective in its work, and possesses the posi- 
 tive danger of opening channels for infec- 
 tion. 
 
 Any plan of procedure that insures cover- 
 ing the entire interior of the uterus with the 
 curette may be adopted. Especialy is it nec- 
 essary to go well up into the cornua, a region
 
 90 i,e:ucorrhce:a. 
 
 sometimes neglected. With a well dilated 
 canal, and a definite plan of procedure, the 
 curette need not be withdrawn until the en- 
 tire surface has been gone over, and the 
 endometrium removed. The cavity is then 
 irrigated with salt solution, which tends to 
 arrest oozing, until all shreds and particles 
 have come away. It is then dried with pieces 
 of gauze carried up with the uterine dressing 
 forceps, and finally painted with Iodine tinct- 
 ure, on a swab. A few minutes will be re- 
 quired for the surplus Iodine and serum to be 
 discharged, when the cervix will be ready for 
 operation. 
 
 No hard and fast rules can be laid down 
 for trachelorrhaphy. A simple bilateral lac- 
 eration, the most frequent variety of tear, re- 
 quires an equally simple technique. Holding 
 the cervix with a volsellum, the posterior sur- 
 face of the laceration — I usually attack the 
 left side first — is denuded w4th sharp pointed, 
 strong scissors, up to and beyond the angle of 
 the tear. The incision includes the mucous 
 membrane of the portio-vaginalis, the cervi- 
 cal endometrium, and the intervening mus- 
 culature. The cut must be smooth, and suffi-
 
 VOIvSKl/IvA FOR TRACHi:i,ORRHAPHY. 91 
 
 ciently deep to remove all diseased structures, 
 and sufficiently broad to insure good surfaces 
 for union. The denuded surface must ex- 
 tend well beyond all glandular hyperplasia. 
 The same procedure is followed on the an- 
 terior lip, and then on the opposite side of 
 the cervix. By undue dragging on one lip 
 this is liable to be disproportionately elongat- 
 ed, and embarrass accurate coaptation of the 
 flaps. To avoid this, and overcome the diffi- 
 culty, I have had made a double volsella that 
 engages both anterior and posterior lips at 
 the same time, separating them as widely as 
 may be desired while they are being denuded, 
 by bringing the handles of the instrument to- 
 gether. This operation becomes more com- 
 plicated when there are several lacerations. 
 It is then usually better surgery to amputate 
 the cervix above the apex of the tears, for 
 sutures will not hold in the narrow strips of 
 cervical tissue that are left between the lac- 
 erations. 
 
 I use a short, slightly curved heavy needle, 
 and silk worm gut sutures. These cause 
 less irritation than any other material, and
 
 92 I^EUCORRHCE^A. 
 
 can be removed with ease if the loose ends 
 are tied together, the sutures for each lacera- 
 tion forming a separate bundle. 
 
 To insure healing the denuded surfaces 
 must be carefully brought together. It is a 
 common mistake to allow the mucous mem- 
 brane of the portio-vaginalis to become in- 
 verted when tying the sutures. Wherever 
 this occurs healing fails to take place be- 
 tween the edges of the laceration, and in con- 
 sequence the integrity of the cervix is not 
 restored. An extreme result of this vicious 
 union is a cervical canal of mucous mem- 
 brane only, the muscular structures having 
 been kept apart by introducing mucosa be- 
 tween the lines of union. This inversion of 
 the mucous membrane may also be caused by 
 tying the sutures unduly tight, under the 
 erroneous impression that it is necessary to 
 hold the parts in close contact. Surgical ten- 
 sion is as objectionable in trachelorrhaphy 
 as in any other operation, and is followed by 
 quite as disastrous results. The sutures 
 should hold the parts in contact, no more, and 
 allowance must be made for traumatic sv/ell- 
 ing, which is sure to take place during the
 
 CONSTITUTIONAL TREATME^NT. 93 
 
 first forty-eight hours. Silk-worm gut 
 sutures may remain in position several 
 weeks, and, if possible, should not be remov- 
 ed until the next menstrual period has 
 passed. 
 
 It must not be expected that curettage and 
 repairing the lacerated cervix will be follow- 
 ed immediately by a cure of the catarrh. It is 
 to be hoped that the purulent element will be 
 removed, if it is not both operations will 
 fail, but a mucous discharge frequently 
 remains that will require continued douch- 
 ing, and possibly the further use of medicat- 
 ed tampons. 
 
 The constitutional treatment of purulent 
 gynaecological catarrh will be on lines similar 
 to those that have been marked out for the 
 treatment of the mucopurulent variety. The 
 hygiene of the patient is of the first import- 
 ance, and must be regulated at every point 
 that touches the functions of the organs and 
 parts involved. Even more than in muco- 
 purulent catarrh the general health suffers, 
 for, in addition to the tax imposed upon the 
 reparative processes, there is a toxaemia that 
 interferes with metabolism in a very special 
 manner.
 
 94 I^DUCORRHC^A. 
 
 The tissue remedies again come promi- 
 nently to the foreground. Calcarea sulphuri- 
 ca, and Silicea, hold the most conspicuous 
 positions. Especially do I rely upon the lime 
 salt. Sulphur will be found of service as an 
 intercurrent remedy when the case is run- 
 ning a chronic course, and apparently stand- 
 ing still. Kali phosphoricum I use to meet 
 the neurasthenia always present in cases of 
 long standing. Its exhibition does not inter- 
 fere with any other remedy that may be in- 
 dicated. Much has been said in favor of 
 Echinacea for purulent diseases. I have 
 used it internally and externally with but in- 
 different results. To obtain anything from 
 its exhibition we must give it in material 
 doses : One drachm of the tincture every 
 two or three hours. Locally, I have used a 
 preparation of the tincture, one-half gly- 
 cerine. 
 
 D. Sanguine:ous Catarrh. 
 
 The propriety of considering sanguineous 
 catarrh a distinct gynecological disease rests 
 upon well defined pathological and clinical 
 data, for while any one of the preceding
 
 SKNII^E I^NDOMKTRITIS AND COIyPlTlS. 95 
 
 varieties, simple, mucopurulent and purulent 
 catarrh, may from an intensity of the process 
 contain blood, adding a sanguineous element 
 to the already established disease, sanguin- 
 eous catarrh presents a wholly different his- 
 tory which separates it from all other varie- 
 ties of gynaecological catarrh. 
 
 Sanguineous catarrh is essentially a dis- 
 ease of the uterus, though in women who 
 have passed the menopause the vagina may 
 become implicated, the entire genital mucosa 
 suffering degeneration, — senile endometritis, 
 senile colpitis. Occurring during the repro- 
 ductive period of life, sanguineous catarrh 
 represents a dift'use hyperplasia of the endo- 
 metrium, not inflammatory in character. 
 The mucosa is uniformly thickened and ex- 
 tremely vascular. There is a glandular out- 
 growth, the glands themselves assuming a 
 most complex arrangement. New vessels 
 are numerous, and in consequence of their 
 thin walls there are frequent haemorrhages 
 into the endometrium, the infiltrated blood 
 showing as dark ecchymotic spots on the sur- 
 face of the vagina. 
 
 The reverse of this hyperplastic endo-
 
 96 IvEUCORRHCEA. 
 
 metritis is found in senility, though the 
 bloody, watery catarrh is common to both 
 diseases. The glandular structures are in 
 process of degeneration, or may entirely dis- 
 appear. Only patches of epithelium remain, 
 connective tissue being greatly in excess of 
 glandular tissue. But few vessels are found, 
 and these are thickened or obliterated. In the 
 vagina the degeneration is marked by dis- 
 colorations of different size, over which the 
 epithelium is very thin or entirely absent. 
 The whole vagina is shrunken and anaemic 
 save in isolated spots from which the bloody 
 oozing takes place, and between which ad- 
 hesions of the vaginal walls are contracted. 
 Much the same condition is noted in senile 
 purulent catarrh, save that in the sanguin- 
 eous variety, even though advanced, there is 
 no pus. The essential micro-organisms de- 
 termine these differences. Thus we find that 
 sanguineous catarrh may arise from wholly 
 different conditions, according to the age of 
 the patient, hyperplasia in adult life, atrophy 
 in senility. 
 
 The etiology of sanguineous catarrh is 
 rather obscure. The hyperplastic form is
 
 HYPKRPIvASTiC AND ATROPHIC I^ORM. 97 
 
 probably due to some menstrual irregularity, 
 or more frequently is connected with sub- 
 involution of the uterus. Retroflexion may 
 also act as a predisposing cause, though it 
 must be acknowledged that any one of these 
 conditions may exist without giving rise to 
 hyperplastic degeneration of the endo- 
 metrium. 
 
 The atrophic form is due to a vicious fold- 
 ing up of the reproductive function, but why 
 this should be, save upon the basis of some 
 dyscrasia, we cannot say. Neither variety 
 can be removed from the field of micro-or- 
 ganism activity. 
 
 The clinical basis for classification is a 
 thin mucous discharge containing blood, or 
 composed mostly of blood. Prior to the men- 
 opause — hyperplastic form — the discharge is 
 never continuous, but takes place intermit- 
 tently, sometimes as an apparent prolonga- 
 tion of menstruation, but more frequently 
 for a varying period between the monthly 
 flow. The intermittent character of the dis- 
 charge in sanguineous catarrh will serve to 
 distinguish this from the bloody discharge 
 that belongs to more serious uterine dis-
 
 98 i,kucorrhce:a. 
 
 eases. Sarcoma which also attacks adult 
 life gives rise to a watery discharge contain- 
 ing blood, but this is more or less continuous, 
 and may become at times an actual haemor- 
 rhage, an extreme condition not found in 
 sanguineous catarrh, in w^hich the discharge 
 is made up of blood and mucus. Moreover 
 an examination will determine the nature of 
 the disease. 
 
 Sanguineous catarrh may occur in 3^oung 
 girls at the establishment of menstruation. 
 It is apt to follow the flow for several days, 
 or to appear during the interval. It is al- 
 ways an indication of congestion of the en- 
 dometrium, with more or less degeneration 
 of its blood vessels. The condition of the lin- 
 ing of the uterus may be associated with 
 some malposition of the uterus, more fre- 
 quent at this early age than is generally 
 recognized. 
 
 Sanguineous catarrh of senility is a con- 
 tinuous discharge, usually nothing more 
 than an oozing, that keeps the vulva moist. 
 It is inclined to be irritating and offensive, 
 but both of these conditions depend largely 
 upon the habits of the patient, and are rem-
 
 tre:atmknt. 99 
 
 edied by douching and attention to local 
 cleanliness and hygiene. In making our 
 diagnosis the suspicious character of any 
 bloody vaginal discharge after the meno- 
 pause will not be lost sight of. Reference 
 has been made to this, but its importance 
 cannot be too strongly emphasized. 
 
 The treatment of the sanguineous gynae- 
 cological catarrh of adult life is very satis- 
 factory. Occurring before marriage it can 
 almost always be cured with such remedies 
 as Calcarea carb., Sepia, Helonias, Collin- 
 sonia, Hydrastis, or Pulsatilla, without other 
 local medication than douching with Hy- 
 drastis, Iodine, Boracic acid, or Permangan- 
 ate of potash. Any malposition of the 
 uterus will be corrected, and the patient's 
 general condition will receive such attention 
 as may be required. 
 
 In pelvic conditions, especially those asso- 
 ciated with local congestion, much benefit 
 may be derived from the use of medicated 
 baths. The milder cases would not be will- 
 inp;- to submit to the inconvenience attending 
 such treatment, but a course of baths at 
 Vichy, Homburg, Kissengen, in Europe, or
 
 100 I,i:UCORRHC^A. 
 
 at Mt. Clemens, the Hot Springs or the 
 White Sulphur Springs in this country, or 
 even hot salt baths at home, will more than 
 repay the severer cases by the relief afford- 
 ed and the additional povv'er of recuperation 
 thereby established. In chronic vulvo- 
 vaginitis, and catarrh, sea baths are to be 
 recommended, or a home bath containing : 
 
 ^. Sodium chloride lb. ii. 
 
 Sodium carbonate Svi. 
 
 M. 
 
 It may become necessary to curette the 
 uterus, to remove the hyperplastic endo- 
 metrium, and treat the basement membrane 
 directly with a view to restoring the func- 
 tion of the uterine cavity. Curettement is 
 the same as under other conditions, the same 
 complete dilation of the cervix, and thor- 
 ough covering of the diseased area vvill be 
 observed. 
 
 I use chiefly two remedies for sv/abbing 
 out the uterine cavity after curettement. 
 The tincture of Iodine again comes to the 
 front, sometimes, however, I use a ten per 
 cent, solution of Argyrol. Iodine, as in most
 
 LOCAL TREATMENT. 101 
 
 intra-uterine treatment, is more frequently 
 indicated, but Argyrol will be of service 
 when the detritus removed contains much 
 granulation tissue, the same conditions that 
 elsewhere suggest the use of Silver nitrate. 
 In some chronic cases it may be necessary 
 to repeat the scraping, but an ultimate cure 
 may confidently be looked for. 
 
 The sanguineous catarrh of senility — 
 atrophic variety — does not warrant so favor- 
 able a prognosis. The structural changes 
 are a part of the degeneration of age, and 
 being in excess of the normal process, and 
 characterized by lawlessness of function, are 
 difficult to arrest, since the entire organism 
 is losing its reparative power and tending 
 to decay. 
 
 Local treatment, save in the form of 
 douches, is not generally practicable. The 
 vaginal walls are hard and unyielding, and 
 even the use of a speculum is liable to injure 
 the thinly covered mucous membrane, add- 
 ing a denuded, and ultimately an ulcerated 
 surface to an already poorly nourished 
 vagina. A douche of Hydrastis, fluid ex- 
 tract, or when an astringent is required, of
 
 102 I^EUCORRHCEA. 
 
 Zinc chloride, ten grains in one quart of 
 water, will yield good results. 
 
 For the pruritus, so frequently such an 
 annoying symptom, and one that in extreme 
 cases renders existence almost unendurable, 
 depriving the patient of rest during both day 
 and night, the treatment already suggested 
 may prove efficacious; it sometimes, how^- 
 ever, becomes necessary to cauterize the sur- 
 face with the object of destroying the cu- 
 taneous nerves. We will think of the Nitrate 
 of silver : 
 
 ^. Silver nitrate gr. xii. 
 
 Distilled w^ater 5i. 
 
 M. 
 
 Or the actual cautery may be required. 
 These measures failing, I have resorted to 
 removal of the entire external genital 
 organs, ablating the vulva, and even the 
 clitoris with its prepuce. The possibility of 
 sensory nerves becoming involved in cica- 
 tricial tissue is always to be apprehended, 
 but one case of long standing in which I per- 
 formed this operation, was entirely cured, 
 the patient, who was unmarried, subsequent-
 
 RADICAI, TRE:aTME:nT. 103 
 
 ly marrying, became the mother of several 
 children. It will, of course, be understood 
 that I do not advocate this radical treatment 
 until every other means of cure has been ex- 
 hausted.
 
 CHAPTER IV. 
 
 THERAPEUTICS. 
 
 PART I. 
 
 THERAPEUTIC SUGGESTIONS. 
 
 Actearac. Profuse mucous catarrh. Weight and 
 bearing down of the uterus. Spasms of the 
 broad Hgament. Rheumatic pains in the 
 back and through the pelvis, the pains run- 
 ning down the legs, which feel numb. Fron- 
 tal headache. Great mental depression. 
 Subinvolution of the uterus. 
 
 yEscuhis hippocastamim. Chronic muco-puru- 
 lent catarrh, dark, yellow, thick and stringy, 
 corroding. Retroversion of the uterus, which 
 is enlarged and indurated, with heat and 
 throbbing. With the discharge there is 
 marked lameness across the sacro-iliac artic- 
 ulation. Hemorrhoids, constipation, and con- 
 gestion of the portal system. Neuralgic pains 
 that fly rapidly from spot to spot. Stunning 
 pain in the head with extreme irritability. 
 Dull aching in the occiput spreading to 
 the neck and shoulders. 
 
 Agnus castus. Copious transparent (cervical) 
 catarrh which stains the linen yellow. Sex- 
 ual excitement with relaxation of the genital 
 organs. Conditions caused by ungratified 
 sexual desire, or from exhaustion following 
 excessive indulgence. Mental dullness, and 
 depression.
 
 106 i,e;ucorrhce:a. 
 
 Aloe socotrina. Sanguineous catarrh of old 
 women, the mucus appearing in jelly like 
 lumps. Pain and fullness in women past the 
 climacteric, as of approaching menses, re- 
 lieved by a sudden flow of bloody mucus. 
 Bloody mucus in the place of stool, the 
 patient thinking it would be diarrhoea. Pres- 
 sure and heaviness in the sacrum relieved by 
 walking. 
 
 Alumen. Copious muco-purulent catarrh from 
 an eroded cervix. The uterus is hard, and 
 denuded spots and granulations are found in 
 the vagina. The discharge is irritating, in- 
 ducing pruritus vaginae. There is extreme 
 sensitiveness of the vagina interfering with 
 an examination. The left ovary is enlarged, 
 sensitive, and the seat of severe pain. There 
 is constipation from dryness of the rectum, 
 the hard faeces being expelled with difficulty. 
 It is characteristic of the urine of Alumen 
 that it is covered with an oily iridescent film. 
 
 Alumina. Very profuse transparent catarrh, 
 acrid, corrosive, aggravated during the day. 
 Thin, light yellow excoriating discharge, 
 inducing inflammation and swelling of the 
 vagina. The urine passing over the parts 
 causes intense burning. Prolapsus of the 
 uterus. Deep erosions of the cervix. 
 
 Ainbra grisea. Bluish white catarrh accompan- 
 ing nymphomania. Thick mucous catarrh 
 during the night. Pruritus vulva. Soreness
 
 THERAPEUTIC SUGGESTIONS. 107 
 
 and swelling of the vulva. All the uterine 
 symptoms are aggravated by lying down. 
 Ambra grisea will be thought of for the 
 catarrh of young girls, nervous girls who 
 suffer from chlorosis, or when the catarrh 
 follows a protracted illness from which recu- 
 peration has been slow. 
 
 Ammonium carbonicmn. Acrid, watery, burning 
 catarrh causing excoriation and ulceration of 
 the vulva, with sloughing. There is conges- 
 tion and excitement of the sexual organs. 
 Hysteria, with listlessness, and lethargy. 
 Hemorrhagic diathesis from fluidity of the 
 blood. Indicated for stout women who lead 
 a sedentary life, and readily take cold in 
 winter. 
 
 Ammonium muriaticum. Catarrh resembling 
 the white of Qgg, preceded by griping pains 
 about the navel. Brown, slimy catarrh in- 
 creased after urinating. Uterus large and 
 heavy. Menstrual flow more profuse at 
 night. Obstinate constipation, stools hard 
 and crumbling. Strained feeling in the 
 groins, causing the patient to walk bent over. 
 
 Anacardium orientale. Catarrh causing soreness 
 and itching. Menses scanty but too fre- 
 quent, the catarrh continuing between the 
 periods. 
 
 Angustura. Catarrh resembling milk, becoming 
 green. Catarrh immediatel}^ before the 
 menses. Prolapsus of the uterus. Itching 
 pustules on the labia.
 
 108 I,EUCORRH<^A. 
 
 A7itimo7iium cried. Very acrid watery catarrh, 
 containing lumps of mucus, and causing 
 smarting wherever it touches. Nympho- 
 mania following checked menstruation. Very 
 sensitive to cold air. Acne of young girls. 
 Ill effects of suppressed eruptions. 
 
 A7ttinio7tiu7n tartaricum. Sanguineous catarrh, 
 worse when sitting, coming in paroxysms. 
 Pustules on the labia with violent itching. 
 Chronic metritis. Prostration and general 
 weakness out of proportion to the apparent 
 condition. 
 
 Apis. Catarrh acrid, profuse, green, with fre- 
 quent painful urination. Neuralgic pains in 
 the labia. Swelling of the right labium. 
 CEdema of the vulva. Right ovarian neu- 
 ralgia. 
 
 Argenttim iiitricmn. Bloody, corroding, yellow, 
 and profuse catarrh. The uterus is pro- 
 lapsed, and soft. Erosion of the cervix with 
 exuberant granulations, in some places there 
 are excavating ulcers which bleed easily. 
 The nervous symptoms and the pelvic symp- 
 toms recur with marked regularity. The 
 vaginal mucous membrane is dotted with 
 ecchymotic spots owing to the specific action 
 of the Nitrate of Silver on the red blood cor- 
 puscles. The patients look old for their age, 
 and suffer with nervous headaches from 
 mental causes. 
 
 Arsenicum. There is a white offensive discharge
 
 the:rapeutic sugge:stions. 109 
 
 instead of the menses. Catarrh acrid, cor- 
 rosive, thick and yellow. All the catarrhs of 
 Arsenicum cause intense burning. Sanguin- 
 eous catarrh of old women, very acrid, and 
 offensive. The keynote of Arsenicum is 
 burning. It may be internal or external, but 
 is always present. There is marked emacia- 
 tion and pallor, with blue rings around the 
 eyes. Especially adapted to youth and ado- 
 lescence. Anaemia. 
 
 Asafoetida. Catarrh profuse, greenish, and of- 
 fensive. Erosion of the cervix. Hysterical 
 women, weak and delicate, suffering from 
 oversensitiveness. Very changeable moods. 
 
 Asaruin Eiiropoen7n. Tenacious yellow catarrh 
 occurring two or three months after confine- 
 ment. Suitable for plethoric young mothers 
 who have suffered for years with headaches. 
 A dull pressure over the whole head. 
 
 Aurum metallicuni. Thick white catarrh causing 
 burning and smarting of the vulva, the labia 
 majora are red and swollen. Profuse yellow 
 corroding catarrh. Prolapsus of the uterus 
 with backache. There is a constant oozing 
 of mucus from the vagina. Extreme mental 
 depression. 
 
 Aurum muriaticinn. Light yellow catarrh, espe- 
 cially in the morning. Uterus prolapsed and 
 indurated. Chronic metritis. Vaginitis. 
 Burning, heat and itching in the vagina. 
 Sterility.
 
 no i.i:ucorrhce:a. 
 
 Baryta carbonica. Sanguineous catarrh of old 
 women, with palpitation of the heart, pain 
 in the back, weakness and fainting. Vaginal 
 discharge immediately before menstruation. 
 The patient is always tired. Catarrh during 
 the climacteric. Especially suitable for 
 dwarfish women of soft lax fibre. 
 
 Berberis. Acrid catarrh, vaginitis with intense 
 itching and burning, with sensation of raw- 
 ness of the vagina. Alone these symptoms 
 are not characteristic, but when accompanied 
 with biliousness, or inflammation of the 
 urinary organs, they may become so, and 
 should be studied for further indications. 
 
 Bo7'ax. Catarrh like the white of ^^g, with sen- 
 sation as if warm water were flowing over 
 the parts. White albuminous or scanty dis- 
 charge. Acrid catarrh between the menses. 
 Profuse clear gelatinous discharge relieving 
 all the other genital symptoms. Aphthae of 
 the vagina and vulva. 
 
 Bovista. Catarrh a few days after, or a few days 
 before menstruation, resembling the white of 
 ^^'^y aggravated while walking. Yellow, 
 green, acrid, corrosive discharge that leaves 
 green spots on the clothing. Thick, slimy, 
 tough discharge. Soreness between the 
 labia, and thighs. Tendency to moist erup- 
 tions on the skin. The mental state is one 
 of irritability, with inclination to misconstrue 
 the motives of others.
 
 Therapeutic suggestions. Ill 
 
 Bromine. Milk white catarrh with much pain in 
 the left ovary, which is hard and sensitive. 
 Vagina sore and painful. Swelling of the 
 lymphatics without suppuration, in various 
 regions of the body. Conditions remaining 
 after scarlatina. Suitable for adults with 
 blue eyes and light hair, fair papery skin. 
 Scrofulous. 
 
 Btifo7ies. Muco-purulent catarrh. Purulent 
 catarrh. Offensive. Ulceration of the cer- 
 vix uteri with burning pains. Sharp pains in 
 the uterus. 
 
 Calcarea carbonica. Catarrh like milk, with itch- 
 ing and burning before and after menstrua- 
 tion. Profuse, coming in fits and starts. 
 Aggravated after exercise, with great debil- 
 ity. Burning in the uterus. Chlorosis. 
 Pruritus with heat of the parts. Discharge 
 acrid, corroding the genitals. Varices of the 
 labia. Intense itching and soreness of the 
 vulva. Purulent catarrh with swelling of the 
 vulva, and inflammation. Menses too early 
 and last too long. The least excitement 
 causes a return of menstruation. 
 
 Calcarea phosphorica. Catarrh like the white of 
 ^^%, creamy discharge. Much aching in the 
 vagina. Throbbing and stinging in the 
 vulva. Menses too early. Great sexual ex- 
 citement, with congestion of the erectile 
 organs. Constant voluptuous sensation in 
 the external parts with pulsation as if filling
 
 112 IvI^UCORRHCHA. 
 
 with blood. Young girls who have been dis- 
 appointed in love. 
 
 Calcarea sulphurica. Profuse purulent catarrh. 
 Menstruation is delayed, but continues too 
 long. The discharge contains lumps of pus, 
 and may be bloody. Pustules develop on 
 the vulva, and other parts, which rapidly 
 pass to the stage of suppuration. 
 
 Cannabis sativa. Infantile gynaecological catarrh. 
 In the absence of other history there is 
 always the suspicion of gonorrhoea, but gen- 
 ital catarrh in children does undoubtedly 
 arise from other causes. 
 
 Cantharis. Muco-purulent catarrh containing 
 shreds of mucus, blood, and desquamated 
 epithelium. The key note of cantharides is 
 irritation. There is oversensitiveness of all 
 the sexual parts. The ovarian regions are 
 sensitive to pressure, with bearing down. 
 Vaginismus. Swelling and irritation of the 
 vulva. Portio vaginalis swollen. Irritation 
 of the bladder with the characteristic dysuria 
 of this drug. 
 
 Carbo animalis. Offensive muco-purulent catarrh 
 which stains the clothing yellow. Corrod- 
 ing, burning, aggravated when standing or 
 walking. Uterus swollen; slimy, bloody 
 catarrh. All the discharges are offensive. 
 Prostration is marked, and^ the local path- 
 ology suggests malignancy. Carbo an. will 
 be found serviceable for young women, and
 
 thkrapeutic suggestions. 113 
 
 elderly persons, especially those suffering 
 from venous plethora, with blue cheeks, and 
 blue lips. 
 
 Car bo vegetabilis. Catarrh thin, aggravated in 
 the morning on rising, scanty during the day. 
 Milky, excoriating, thin, yellow, preceding 
 or following the menses, intermitting, coming 
 and going suddenly, with rawness and sore- 
 ness of the labia. Swelling of the vulva. 
 Prurigo, varices and itching of the vulva. 
 Red sore spots on the pudenda, aphthae. 
 Lassitude and general weakness. The ca- 
 tarrh is of long standing. Acts well on old 
 persons. 
 
 Carbolic acid. Copious, fetid, greenish acrid 
 catarrh, especially following profuse men- 
 struation. The uterine cervix is hard, and 
 eroded. 
 
 Caulophyllmn tlialictroides. Acrid catarrh, very 
 weakening. Profuse, bland, mucous catarrh 
 with '* moth spots " on the forehead in young 
 girls. Profuse, mucous catarrh with conges- 
 tion of the uterus, and forcing down pains. 
 Aphthous vaginitis. Menstrual colic, uterus 
 retroverted. Hysteric convulsions during 
 dysmenorrhoea. Catarrh in little girls. 
 
 Caiisticinn. Catarrh having the same odor as 
 menstruation, at night only. Clear ropy 
 acrid catarrh with itching and smarting of 
 the vulva. Urine acrid, causing biting like 
 salt of the pudendum. Menstruation during 
 9
 
 114 I^KUCORRHC^A. 
 
 the day only. The capillaries are near the 
 surface showing as a fine net work under 
 the skin, in various parts of the body. 
 
 Cedron. Catarrh regularly every month five or 
 six days previous to the catamenia, with 
 pain in the uterus and swelling of the vulva. 
 Catarrhal discharge appearing in the place 
 of the menstrual flow. Menstrual epilepsy. 
 All the symptoms recur with clock like regu- 
 larity. Adapted more especially to women 
 of a voluptuous disposition, and of an ex- 
 citable temperament. 
 
 Chamomilla. Acrid biting watery discharge, 
 particulary after eating. Yellow smarting 
 catarrh, causing burning in the vagina as if 
 excoriated. Many menstrual symptoms 
 with intolerance of any suffering. Physical 
 and mental irritability. Excitable tempera- 
 ment. 
 
 Chelidonijim majiis. Acrid catarrh. There is 
 nothing characteristic in this symptom, but 
 when taken in connection with the well 
 known hepatic and gastric action of Cheli- 
 donium it may assist in selecting the individ- 
 ual remedy. 
 
 Cinchona officinalis. Sanguineous catarrh. Pur- 
 ulent catarrh. Acrid catarrh in the place of 
 the menses, with itching, contraction of the 
 uterus, and bearing down. Bloody catarrh 
 containing clots one week before the menses. 
 Painful induration of the vagina. Ovaritis
 
 the:rapi:utic suggestions. 115 
 
 from sexual excesses. Cinchona is suitable 
 for women who have passed the climacteric, 
 and when there is exhaustion from loss of 
 any of the fluids of the body. 
 
 Cinnabaris. Genital catarrh, the discharge of 
 which causes pressure, or labor like pain in 
 the vagina. 
 
 Cocculus. Catarrh of mucus, purulent, ichorous. 
 Discharge of bloody water, resembling the 
 washings of meat, gushing out when bend- 
 ing, or squatting. Menstruation gradually 
 more scanty until catarrh takes its place, 
 the discharge then becoming continuous. 
 There is hypersesthesia of all the senses, 
 and an exalted susceptibility to impress- 
 ions. A slight noise or unsuspected touch 
 induces starting and trembling all over 
 the body. Persistent occipital headache, 
 with a peculiar swimming sensation as of 
 seasickness. 
 
 Coffea crtida. Profuse discharge of bloody mucus 
 preceded by paroxysms of colic, voluptuous 
 itching, and sexual excitement. Mucous, or 
 milky catarrh when urinating, sensitiveness 
 of the vulva. Overexcitement of the entire 
 nervous system. Cerebral erethism. Ure- 
 thral caruncle. 
 
 Collinsonia Canadensis. Discharge of mucus — 
 simple catarrh — with obstinate constipation, 
 and dysmenorrhcea. Pruritus valva. All 
 the pelvic systems depend upon congestion
 
 116 IvEUCORRHCE^A. 
 
 of the portal vessels. There is congestion of 
 the cervix, congestion of the uterus, conges- 
 tion of the rectum, with haemorrhoids. 
 
 Colocynthis. Thick, yellow, offensive catarrh 
 between the menses. Swelling of the labia 
 with dragging pain and heat in the vagina. 
 The cramping, cutting pains of Colocynthis 
 that are made better by relieving muscular 
 tension are valuable indications. 
 
 Conium maciilatum. Discharge of mucus follow- 
 ing uterine spasm. Bloody catarrh in the 
 place of menstruation. Acrid and burning 
 catarrh, white or yellow, preceded by grip- 
 ing and pinching in the abdomen, and lame- 
 ness in the small of the back. Profuse, 
 bloody mucus, excoriating, thick, milky white 
 and acrid mucus, causing burning and smart- 
 ing. Stitches in the vulva, itching of the 
 vulva. Sero-purulent eruption on the mons 
 veneris. One of the most frequently indi- 
 cated remedies for erosion of the cervix with 
 characteristic hardness and induration. This 
 may exist quite independently of malignancy. 
 The pelvic condition calling for Conium can 
 frequently be traced to a strain, or to a fall 
 that has displaced the uterus. It is espe- 
 cially useful for old women. 
 
 Copaiva. Bloody purulent mucous discharge 
 from the uterus upon pressure. Milky, acrid 
 discharge, strangury. Throbbing pain in the 
 ovaries. This drug is more frequently indi-
 
 THDRAPKUTIC SUGGESTIONS. 117 
 
 cated in specific cases, but inasmuch as it 
 induces profuse discharges from mucous sur- 
 faces generally, it may be found useful in 
 non-specific gynaecological catarrh. 
 
 Cubeba. Profuse chronic catarrh, very acrid, 
 green, yellow and offensive. Vaginitis, ere- 
 thema on the inside of the thighs, and pruri- 
 tus of the vulva. Uterus swollen and pain- 
 ful. Catarrh takes the place of the menses. 
 The urinary symptoms of Cubeba will be 
 concomitants. Acrid catarrh of children. 
 Acts well in persons of a bilious tempera- 
 ment. 
 
 Curare. Scanty, thick, purulent foul discharge 
 in clots. The pathology of the cervix and 
 vagina indicate the tissue destruction of 
 malignancy, and may remove this remedy 
 from the class of uncomplicated gynaecologi- 
 cal catarrhs. 
 
 Cyclamen Europceum. Catarrh in blond, leuco- 
 phlegmatic subjects, with retarded scanty 
 menstruation. Chlorosis and anaemia, at- 
 tacks of fainting ; there is constant chilliness 
 of the whole body. The menses cease when 
 moving about, reappear when sitting quietly, 
 or when in bed. 
 
 Drosera rotundifolia. Genital catarrh with labor 
 like pains. This may be included in the 
 clinical picture that shows the action of 
 Drosera on the pneumogastric nerve, pro- 
 ducing a spasmodic dry cough like whooping 
 cough.
 
 118 I^KUCORRHGSA. 
 
 Dulcamara. Genital catarrh appearing, or ag- 
 gravated, in cold damp weather, with herpetic 
 eruptions on the vulva. Preceding the cate- 
 menia there is always some form of skin 
 eruption. 
 
 Erigeron. Profuse catarrh with spasmodic pains, 
 and irritation of the bladder, and rectum; 
 usually scanty menses. Chronic uterine 
 catarrh. Prominently in the pathogenesis of 
 Erigeron will be observed active congestion 
 of various organs, with a tendency to haemor- 
 rhage. It is especially indicated for small, 
 frail, delicate women. 
 
 Eucalyptus globulus. Acrid, fetid mucous ca- 
 tarrh. Urethral caruncle. The urine has 
 the odor of violets. 
 
 Eupatorium purpureum. Uterine catarrh, chronic 
 metritis. Profuse and frequent urinating, 
 with painful urging. 
 
 Ferrurn. Discharge of mucus in the place of the 
 menses. Chlorosis. Catarrh before the 
 menses. Discharge resembling watery milk, 
 smarting and corroding when it first appears, 
 becoming more bland. Dragging pains in 
 the loins, pelvis and thighs. Much itching 
 of the vulva in weakly, delicate women. 
 Face red. Menorrhagia, especially when 
 accompanied by a flushed face, and fol- 
 lowed by a very acrid catarrh. Laxness and 
 weakness of the entire musculature ; weak 
 digestion, and cold extremities. Anaemia.
 
 thi:rapi:utic suggkstions. 119 
 
 Fei^rtim iodatum. Catarrh resembling boiled 
 starch, which is discharged in strings during 
 Stool. Itching and soreness of the vulva and 
 vagina with swelling. Constant bearing 
 down ; when sitting she feels as if something 
 were being pushed up through the vagina. 
 Prolapsus of the uterus, the cervix actually 
 protruding from the vulva. 
 
 Fluoricum acidum. Acrid excoriating catarrh 
 with itching. Chronic erosion of the cervix, 
 with sharp darting pains. Coccyodynia. 
 Varicose veins. Congestion of the sexual 
 organs. 
 
 Gelsemiurn, Catarrh resembling milk with full- 
 ness of the uterus, in nervous, excitable, 
 hysterical women, old maids, and students. 
 Aching across the lower part of the back. 
 Catarrhal discharge in gushes. Neuralgic 
 pains with cramps in the uterus and legs. 
 Cramps in the utero-sacral ligaments. Pain 
 from the occiput to the forehead, as though 
 a knife were thrust through. All the symp- 
 toms are relieved by the free flow of urine. 
 Congestion, both venous and arterial, with 
 sluggish circulation, face red, and a sodden 
 expression. 
 
 Graphites. Catarrh occurring in gushes, acrid, 
 excoriating. Profuse catarrh with weakness 
 in the back and sacrum. Yellowish-white, 
 that excoriates the skin. Uterus indurated 
 and sore. Catarrh profuse and perfectly
 
 120 LEUCORRHCKA. 
 
 white, especially on rising in the morning. 
 Copious thin catarrh, causing biting and 
 smarting in the vagina. Itching, smarting 
 vesicles on the vulva. CEdema of the vulva. 
 Enlarged ovaries, becoming more tender 
 after getting the feet damp. Vagina hot and 
 painful. Swelling of the lymphatic vessels 
 and mucous follicles of the vagina. The 
 neck of the uterus is hard and swollen. 
 Catarrh in the place of the menses. Tend- 
 ency for the skin to crack and form fissures. 
 Moist eruptions, the discharged fluid being 
 excoriating. Adapted to women inclined to 
 obesity, who suffer from habitual constipa- 
 tion, and whose history is of delayed men- 
 struation. 
 
 Guarea trichilioides. Fetid catarrhal discharge 
 after the menses. 
 
 Hamamelis Virginica. Profuse purulent catarrh 
 with sensitiveness of the parts, vagina sore 
 and raw; vaginitis. Relaxation of the walls 
 of the vagina. Sanguineous catarrh with 
 excessive tenderness of the vagina. Ovaritis. 
 Marked tenderness always suggests this rem- 
 edy. Venous stagnation of the skin and 
 mucous membranes. 
 
 Helonias dioica. Catarrh with profuse flooding 
 at the menopause. Intense pruritus of the 
 vulva and vagina with curdy secretion. 
 Aphthous vaginitis. Labium and pudendum 
 hot, red and swollen, with burning and itch-
 
 the:rapi:utic sugge:stions. 121 
 
 ing. Catarrh with pains in the lower part of 
 the back, soreness and tenderness of the 
 breasts and nipples, particularly during 
 menstruation. Catarrh in old women. Pro- 
 lapsus uteri and erosion of the cervix, ca- 
 tarrhal discharge constant, dark, offensive, 
 aggravated when lifting and upon the least 
 exertion. Vaginal irritation. Profuse watery 
 catarrh in feeble women who suffer from 
 uterine displacement, face sallow. Profuse 
 menstruation is characteristic of Helonias. 
 Extreme languor for which she can find no 
 cause. Suitable for women who are ener- 
 vated by indolence and luxury. Conditions 
 developed in connection with the climac- 
 teric. 
 
 Hepar srilph. calc. Purulent, fetid catarrh. 
 Smarting of the vulva. Erosion and ulcera- 
 tion of the cervix, the discharge having the 
 odor of old cheese. The patient is ex- 
 tremely sensitive to open air, and to changes 
 of temperature. A damp east wind aggra- 
 vates all the conditions. Very sensitive to 
 contact, the patients dread to be touched, out 
 of proportion to the actual pain caused. 
 There is an offensive exhalation from the 
 body. 
 
 Hydrastis Canadensis. Uterine and vaginal ca- 
 tarrh of tough, stringy mucus. Purulent 
 catarrh. Hot watery discharge from the 
 uterus. Acrid, corroding catarrh about one 
 
 4
 
 122 I^EUCORRHC^A. 
 
 week after menstruation. Profuse discharge 
 like the white of egg immediately after men- 
 struation, lasting about two weeks; very de- 
 bilitating. Yellow tenacious catarrh in long 
 threads and pieces. Pruritus vulva. Cervix 
 swollen, indurated and eroded. Ulceration 
 of the cervix. There are almost always dis- 
 orders of digestion when Hydrastis is indi- 
 cated. 
 
 Ignatia. Purulent corrosive genital catarrh with 
 labor like pains. Chronic catarrh with sex- 
 ual excitement. Vaginismus. Pruritus of 
 young girls, with catarrh. Suppressed grief. 
 Rapidly changing moods. Melancholia. 
 Irritable and impatient, sad, concealing her 
 grief from others. 
 
 Inula. A moving about in the abdomen as at 
 the appearance of the menses, followed by 
 yellowish catarrh. Stitches in the region of 
 the uterus and genitals. Urine smells like 
 violets. 
 
 Iodi7ie. Thin, yellow catarrh in scrofulous 
 women, with induration and swelling of the 
 OS uteri and engorgement of the vagina. 
 Chronic catarrh most profuse at the time 
 of menstruation, causing soreness of the 
 thighs, and corroding the linen. Corrosive 
 catarrh in women subject to chronic menor- 
 rhagia. Hardness and swelling of the cervix. 
 Weakness and loss of breath on going up 
 stairs. Uterine catarrh alternating with 
 cough. Gradual emaciation.
 
 THE:rAPI:uTIC SUGGi:STlONS. 123 
 
 Kali bichromicum. Catarrhal discharge that can 
 be drawn out in long strings. Yellow ropy, 
 stiffening the linen. Pruritus. Subinvolu- 
 tion of the uterus. The catarrhal discharge 
 alternates with rheumatic pains in various 
 regions of the body. Suitable for fat, light 
 haired persons who are subject to catarrh of 
 all the mucous membranes. 
 
 Kali ferrocyanatiim. Purulent catarrh, profuse, 
 not irritating, that follows the menses. 
 Usually in the day time only. Pain in the 
 small of the back. Acidity and pressure at 
 the stomach after eating. Menses too fre- 
 quent and too profuse. 
 
 Kali iodatum. Catarrh watery, acrid, corrosive 
 with biting in the pudendum ; milky, white, 
 green or yellow, putrid. Discharge that re- 
 sembles the vv^ashings of meat. Subinvolu- 
 tion of the uterus. Hypertrophy and en- 
 largement of the uterus. Uterine fibroids. 
 Constant catarrh. Pain in the back — lum- 
 bago. Hard swelling of glands and infiltra- 
 tion of cellular tissue are characteristic of 
 Kali iodatum. Syphilis or mercurialization 
 will always be considered. 
 
 Kali muriaticiLin. Bland milky catarrh. Thick, 
 yellow, slimy discharge. Kali muriaticum 
 will rarely be indicated in genital catarrh 
 unless there is a concomitant pelvic exudate 
 the result of a former pelvic cellulitis. In 
 this condition the remedy is well nigh a spe- 
 cific.
 
 124 i,kucorrhce:a. 
 
 Kali phosphoricuin. Catarrh yellowish, blister- 
 ing, orange colored, scalding and acrid. In- 
 tense sexual desire after the menses. Amen- 
 orrhoea with depression of spirits, lassitude 
 and general nervous debility. Kali phos. 
 covers the entire field of nervous exhaustion. 
 
 Kali sulphuriciun. Purulent catarrh, yellow, 
 green. The vaginal lymphatics are involved, 
 and there is desquamation of the genital 
 epithelium. 
 
 Kalmia latifolia. Yellowish catarrh one week 
 after menstruation, at which time all the 
 symptoms are aggravated. This remedy 
 will be thought of when there are severe 
 pains in the region of the heart — angina pec- 
 toris. Rheumatic pains suddenly leave the 
 extremities ; stitches in the heart. Hyper- 
 trophy of the heart and valvular insuffi- 
 ciency. Articular rheumatism. 
 
 Kreosotum. Catarrh putrid, acrid, corrosive, that 
 stains the linen yellow, and stiffens it like 
 starch. White discharge having the odor of 
 green corn. A bland yellow discharge pre- 
 cedes each urination. Drawing pains from 
 the coccyx, extending into the rectum and 
 vagina. Electric like stitches in the vagina. 
 Itching in the vagina. Vaginal mucous 
 membrane swollen, burning and puffy. 
 Brownish acrid catarrh, offensive. Sanguin- 
 eous catarrh. Erosion of the cervix with 
 watery, offensive catarrh. The character-
 
 THKRAPi:uTlC SUGGi:STlONS. J 25 
 
 istic catarrh of Kreosotum is offensive and 
 excoriating. 
 
 Lachesis. Catarrh from three to eight days be- 
 fore the menses, green or thick yellow. 
 Copious, smarting, stiffening the linen, stain- 
 ing it green. Simple mucous catarrh with 
 redness and swelling of the pudenda. Uterus 
 enlarged, os open, with ectropion of the 
 endometrium. The vaginal mucosa and that 
 covering the portio vaginalis are dark blue 
 from venous stasis, with tendency to bleed 
 when touched. Purpura hemorrhagica. 
 Especially indicated at the climacteric, and 
 for affections developing after that period 
 has passed. 
 
 Lactic acid. Catarrh that stains the linen saf- 
 fron yellow. 
 
 Leptandra. Catarrh with erosion of the cervix, 
 shreds of mucus. Sometimes fetid. Irrita- 
 tion of the bladder, much dull aching in the 
 abdomen. 
 
 Lilimn tigrimim. Constant mild profuse catarrh 
 that stains the linen greenish yellow. Thin 
 acrid excoriating discharge leaving a brown 
 stain on the linen. Bright yellow catarrh, 
 excoriating the pudendum. Bearing down, 
 and distress in the pelvic region. Must hold 
 herself together. Dry mealy spots on the 
 labia, with intolerable itching. All the uter- 
 ine ligaments and supports are relaxed. 
 Offensive catarrh resembling the white of
 
 12d I^E^UCORRHC^A. 
 
 egg, with dull pain in the ovaries. Almost 
 constant bachache. Chronic ovaritis and 
 neuralgia of the ovaries. 
 
 Lycopodium. Catarrh milky, bloody, in starts, 
 corroding, aggravated before a full moon. 
 Catarrh thin, yellow, ulcers on the os uteri. 
 The catarrh alternates with dryness of the 
 vagina. There is an entire absence of the 
 normal secretion of genital mucus. The 
 skin is unhealthy, there is eczema on the 
 genitals that bleeds easily, and is covered 
 with a thick offensive secretion. When 
 Lycopodium is indicated there will always 
 be found excoriations where mucous mem- 
 brane and skin pass into each other, the 
 anus, the vulva and the mouth. 
 
 Magnesium carbonicnm. Acrid, white mucous 
 catarrh preceded by colic. Watery catarrh 
 after the menses, thin, scanty, with pinching 
 around the navel. All the pains are lancin- 
 ating, and lightning like. The muscles are 
 lax and flabby. Rheumatic affections. There 
 is a sour smell from the entire body. 
 
 Magnesium 7nuriaticum. Catarrh watery, or 
 thick, followed immediately by a discharge 
 of blood. After exercise, with every stool, 
 preceded by spasm and contraction of the 
 uterus. Uterine spasm followed by a profuse 
 discharge of mucus. A remedy of wide use- 
 fulness in many gynaecological conditions. 
 
 Magnesium sulphuricum. Catarrh thick, profuse, 
 with bruised pains in the small of the back.
 
 THKRAPi:uTlC SUGGE:STI0NS. 127 
 
 Mercurins. Muco-purulent catarrh, constant, 
 but ag-i^ravated after menstruation. Catarrh 
 containing lumps, sticky, green, bloody, 
 causing burning and intense itching. White 
 patches on the vaginal and labial mucosa, 
 which when removed leave a raw surface. 
 Labia swollen. Spasms of the vagina, vul- 
 vitis, erosion and ulceration of the cervix. 
 All the conditions of Mercurius are aggra- 
 vated in the cold air, and by cold water- 
 There is also an aggravation after becoming 
 warm in bed. Suitable for light haired per- 
 sons, with lax skin and muscles. 
 
 Mercurins corrosivus. Profuse, muco-purulent 
 catarrh, pale yellow, tinged with blood ; thin 
 mucous discharge causing intense burning 
 and heat. Inflammation of the vulva and 
 vagina. The symptoms seem to be in excess 
 of the local pathology. 
 
 Merc2irius iodatus flavus. Copious muco-puru- 
 lent catarrh, yellow catarrh particularly in 
 young girls, or children. The entire skin is 
 irritated, causing persistent itching. 
 
 Mezereiiin. Catarrh like the white of ^^^, cor- 
 roding. Mucous discharge from the vagina 
 and urethra. Erosion of the cervix. Mucous 
 catarrh tinged with blood. Smarting, burn- 
 ing, pricking in the ulcerated uterus. Thick 
 honey-comb scabs cover all the eruptions, 
 which itch intolerably and bleed easily when 
 touched.
 
 128 LEUCORRHCEA. 
 
 Murex purpurea. Watery, greenish, irritating 
 catarrh, with dragging and relaxation of the 
 perineum, pain in the hips, loins and down 
 the thighs. With the catarrhal discharge 
 the mental conditions improve. Uterus 
 swollen and cervix elongated. Soreness of 
 the cervix. There is usually disturbance of 
 the sexual function; most intense sexual ex- 
 citement. 
 
 Myrica cerifera. Excoriating, fetid, thick and 
 yellowish catarrh. Chronic catarrh. Urine 
 high colored, saturated with the coloring 
 matter of bile. 
 
 Naja tripudians. Thin, white catarrh in the 
 afternoon. Cramping pain in the left ovary, 
 ovarian congestion. 
 
 Natrum carbonicum. Profuse genital catarrh 
 after frequent attacks of colic. Frequent 
 copious urination. Thick, yellow, putrid 
 catarrh. Bearing down as if the uterus 
 would protrude. Passive congestion of the 
 uterus. Leuco-phlegmatic constitution with 
 aversion to the open air, and disinclination 
 to exertion, either mental or physical. 
 
 Natrum viuriaticum. Profuse, acrid, greenish 
 catarrh in the morning, transparent, watery, 
 greenish, particularl}^ after walking, with 
 headache ; corrosive, transparent mucus, 
 causing excoriation, irritation and itching, 
 with falling off of hair from the pubes. Pim- 
 ples on the mons veneris.
 
 ThKRAPKUTIC SUGGi:STlONS. 129 
 
 Natrum phosphoricum. Creamy, honey colored 
 catarrh. Watery, sometimes acrid catarrh. 
 Prolapsus uteri. 
 
 Natrum snip hiiri cum. Acrid corrosive catarrh. 
 Vulvitis with swelling. Vulva covered with 
 vesicles the size of lentils, filled with pus. 
 Prolapsus uteri. Purulent catarrh during 
 pregnancy. Phlegmasia alba dolens. All the 
 conditions are brought on or aggravated in 
 damp weather. 
 
 Niccolum. Profuse watery catarrh, especially 
 after urinating, and following menstruation. 
 Periodic nervous headaches, recurring every 
 two weeks. Amenorrhoea. 
 
 Nitric acid. Catarrh of ropy mucus, green 
 mucus, flesh colored, acrid, brown, offensive. 
 A sudden gush of muddy water following 
 violent pain in the abdomen. Coffee ground 
 offensive discharge from the uterus at the 
 climacteric, or after labor. Very offensive 
 urine. Pain in the small of the back with 
 burning pain running down the limbs. Vag- 
 initis with cracks and ulcers on the labia 
 minora, aggravated by cold bathing. Ero- 
 sion of the cervix, the glandular hyperplasia 
 is very marked, and bleeds easily when 
 touched. Eczema of the genitals. Suitable 
 for persons suffering from diarrhoea. There 
 is rarely constipation. 
 
 Nux moschata. Genital catarrh in the place of 
 the menses in women who always awaken 
 
 10
 
 130 LEUCORRHCEA. 
 
 with a dry tongue. Functional affections of 
 the heart, nervous palpitation of the heart. 
 Flatulent distension of the abdomen, when 
 it can be traced to some nervous disturbance. 
 Clairvoyant state of the mind. 
 
 N21X vomica. Catarrh of yellow mucus, fetid, 
 staining the clothing yellow. Swelling of 
 the vagina, with prolapsus of the uterus. 
 Corrosive itching eruption of the vulva. 
 Chronic metritis, hardness and swelling of 
 the uterus. Prolapsus of the uterus with 
 bearing down pains. A great variety of 
 pains in the back. Stiff neck, lumbago, 
 spinal irritation, convulsive spasm and twitch- 
 ing of single muscles brought on by a sud- 
 den jar, or shock. Excitable, irritable dis- 
 position, inclined to sudden anger. Tense 
 fibre, irascible temperament. Constipation. 
 Conditions associated with overindulgence 
 in alcohol, and induced by rich living. 
 
 Oleum animale. Thin white mucous catarrh. 
 Choking and constriction of the throat. 
 Itching like flea bites, disappearing suddenly, 
 or changing to burning heat. 
 
 Oleum jecoris aselli. Purulent uterine catarrh. 
 Pain in the back, lumbago. Difficult to 
 walk because of pain in the sacro-iHac syn- 
 chondrosis. Patients are always cold. 
 
 Origanum. Profuse mucous catarrh which is 
 only a concomitant symptom, depending 
 upon sexual irritation, and uncontrollable
 
 THKRAPKUTIC SUGGe:sTIONS. 131 
 
 sexual desire which leads to masturbation, 
 and the effort to overcome which induces 
 religious insanity. The presence of men ex- 
 cites the desire to masturbate, rather than 
 for sexual intercourse. Young- girls, divorced 
 women, widows, old maids, with the most 
 intense sexual excitement, driving almost to 
 despair. Itching of the vulva, with catarrh. 
 An invaluable remedy in the treatment of 
 masturbation in females. 
 
 Palladium. Yellow catarrh becoming white and 
 thick. Transparent jelly like catarrh, pre- 
 ceding and following menstruation. Affec- 
 tions of the right ovary. Pain, weight and 
 soreness in the region of the uterus making 
 walking and standing almost impossible. 
 There is a peculiar sensation of being very 
 tall when walking. 
 
 Petroleum. Burning, acrid, profuse, excoriating 
 mucous catarrh. Itching and burning in the 
 vagina and labia. Pruritus with herpetic 
 eruptions. The concomitant skin symptoms 
 will suggest this remedy. The skin is un- 
 healthy, with a tendency to crack, leaving 
 moist surfaces, or deep fissures. Itching, 
 thick scabs, from under which oozes pus. 
 The discharges are usually excoriating, and 
 aggravated in winter. 
 
 PJiosphoric acid. Profuse, yellow, thin, acrid 
 mucous catarrh, after the menses. Itching 
 of the vulva. Ulceration of the cervix, with
 
 132 LEUCORRHCKA. 
 
 bloody profuse discharge. Inflammation of 
 the uterus. Weakness, neurasthenia. Hys- 
 teria in young girls. Suppression of exan- 
 themata by cold. 
 
 Phosphorus. Milky, excoriating catarrh during 
 menses, with cold hands and feet, and cut- 
 ting in the left ovarian region. In the place 
 of the menses, a white, watery mucus; acrid 
 and excoriating catarrh, causing blisters and 
 soreness. Slimy, bloody catarrh in old 
 women. Stitches running from the vagina 
 into the pelvis. CEdema of the labia. 
 Nymphomania. Sterility from excessive sex- 
 ual feeling. The patient is very susceptible 
 to external impressions. Amenorrhoea with 
 a weeping mood. Suitable to tall, slender 
 blondes, or blondes with red hair, a quick, 
 lively disposition, and sensitive nature. 
 
 Physostigma. White milky, or bloody, scanty, 
 stringy catarrh, aggravated about four o'clock 
 in the afternoon. Dread of cold water. 
 Weakness of the muscular system. 
 
 Phytolacca. Thick, tenacious and irritating ca- 
 tarrh in women who suffer from various 
 glandular swellings, and from abscesses in 
 the breasts. Uterine catarrh, nerosis of the 
 cervix, and even ulceration. Aching and 
 soreness all over the body. Rheumatic dia- 
 thesis. 
 
 Platinum. Catarrh like white of ^^% after rising 
 from sitting. Excessive sexual desire with
 
 thKrapi^utic suggestions. 133 
 
 over-sensitiveness of the genitals, inducing 
 spasms during an examination. Premature 
 development of the sexual instinct. An arro- 
 gant over-estimation of one's self, and one's 
 importance, with haughtiness towards others. 
 She wishes to embrace every one she meets. 
 
 Podophylhiin peltatinn. Thick, transparent mu- 
 cous catarrh. Bearing down pain in the 
 small of the back during menstruation, pain 
 in both ovaries, numbness and aching pain 
 running down the thighs. Pain in the right 
 ovary involving the anterior crural nerve. 
 
 Prumis spinosa. Excoriating catarrh coloring 
 the linen yellow. Frequent urgent desire to 
 urinate, which if not attended to immedi- 
 ately causes very sharp pains in the bladder. 
 
 Psorimun. Catarrh in large lumps that have an 
 intolerable odor. Violent cramps in the sac- 
 rum and right loin. Induration of the right 
 ovary. Moist eczematous eruptions. All 
 the discharges have a carrion like odor, even 
 the perspiration is foul. 
 
 Pulsatilla. Catarrh painless, thick mucus hav- 
 ing the color of milk, especially on lying 
 down. Catarrh acrid, thin, with pruritus, 
 near the change of life, or before menstrua- 
 tion is fairly established. Thick, white 
 mucus, with backache. The menses are too 
 late, or are suppressed; menstrual colic. 
 Affections from getting the feet wet. Pro- 
 lapsus uteri. The patient is tearful and
 
 134 I.KUCORRHCSA. 
 
 easily discouraged. She is anxious. Anxiety 
 in the epigastric region. The patient is 
 moreover always chilly, but finds relief in 
 the open air. The pains of Pulsatilla appear 
 suddenly, and leave gradually; they also 
 shift rapidly from part to part. 
 
 Ranuncidtis biilbosiis. Catarrh at first mild, be- 
 coming acrid and corroding. Ovarian neu- 
 ralgia, chronic cases always excited by at- 
 mospheric changes. Vesicular eruptions, as 
 from burns. Shingles, and intercostal neu- 
 ralgia. Eruptions of blisters secreting a foul 
 smelling gluey matter. 
 
 Robinia. Yellow green, thick, acrid catarrh. 
 Purulent catarrh with tumefaction, and 
 bruised feeling in the cervix, and general 
 prostration. Ulcerative pains in the vagina, 
 with acrid yellowish catarrh having a most 
 fetid odor. Sensation as if the brain re- 
 volved; as if the head were full of boiling 
 water. 
 
 Rjita graveolejis. Corrosive catarrh after irregu- 
 lar or suppressed menstruation. Pressure to 
 urinate, though there is little urine in the 
 bladder. If the urine is retained it cannot 
 be voided. 
 
 Sabina. Yellow, ichorous, fetid catarrh, and 
 painful discharge of fetid blood every two 
 weeks, during the climacteric. Catarrh of the 
 consistence of starch, copious, milky, caus- 
 ing itching. Ropy, glairy catarrh from the
 
 thKrape:utic suggestions. 135 
 
 cervical canal, with drawing pain in the back 
 through to the pubes. Corrosive catarrh in 
 a primipara causing soreness and itching of 
 the thighs. Stitches from below upwards 
 deep in the vagina. Protracted uterine haem- 
 orrhage arising from loss of tone in the 
 vessels of the uterus, blood dark and clotted. 
 There is a tendency to abort at the third 
 month. Threatened abortion with profuse 
 mucopurulent catarrh. 
 
 Sanguinaria Canadensis. Corrosive fetid catarrh 
 at the climacteric. Ulceration of the uter- 
 ine OS, which bleeds readily. 
 
 Sarracenia purpurea. Watery or milky catarrh, 
 thick, whitish, foul smelling, with spasmodic 
 pains in the uterus. Cervix swollen and hot. 
 Miliary eruption on the vulva; heat in the 
 vulva. 
 
 Sarsaparilla. Catarrh that continues six months 
 after parturition, with labor like pains from 
 the sacrum to the crest of the ilium, heat 
 and pulsation in the sacrum. White catarrh 
 when walking or exercising, severe pain at 
 the close of urination. Eruptions that ap- 
 pear in the spring time. Eruptions of vari- 
 ous kinds that are aggravated on passing 
 from a warm room to the open air. 
 
 Secale cornutum. Green brown, offensive catarrh 
 in thin, scrawny women. Creamy catarrh 
 with weakness and venous congestion. 
 Ulcers on the pudendum which spread rap-
 
 136 I^EUCORRHC^A. 
 
 idly. A peculiar feeling- of numbness and 
 formication in the fingers as if the}^ were 
 asleep. Prickling in the fingers. This is a 
 marked concomitant symptom of Secale. It 
 is characteristic of this drug that all the 
 symptoms are aggravated at night, by touch 
 and from external warmth, and relieved from 
 cold. The skin is dry, dingy, and wrinkled. 
 Senecio. Genital catarrh in little girls preceded 
 by headache. Sleeplessness; irritable blad- 
 der, especially at night. Amenorrhoea. 
 Sepia. Gelatinous catarrh. Sensation as if the 
 uterus would fall out of the vagina, she must 
 cross her legs to prevent it from, doing so. 
 The cervix is swollen and dry, and does 
 actually protrude from between the labia. 
 The OS uteri is wide open and will admit the 
 finger, even when not lacerated. Yellow 
 catarrh most profuse before the menses. 
 Acrid catarrh before the menses, especially 
 in young women. Profuse yellowish green 
 catarrh in the place of the menses. Yellow- 
 ish green catarrh excoriating, with heat and 
 pain in the sacrum. Menses a dirty brown 
 color. Dryness of vulva and vagina, causing 
 a very disagreeable sensation of friction when 
 walking. The vaginal mucosa is a reddish 
 brown color. Catarrh bloody, slimy, yellow- 
 ish or hke milk, especially profuse after uri- 
 nating. Profuse, lumpy, fetid mucus, acrid, 
 causing soreness of the pudendum. Dis-
 
 the:rape:utic sugge:stions. 137 
 
 charge as clear as water. Yellowish, or 
 greenish watery catarrh during pregnancy, 
 and at the climacteric. Catarrhal discharge 
 coming away in starts. Thick, yellow, acrid 
 catarrh during the day only, with constant 
 pressure in the sides of the pelvis. Very 
 profuse catarrh in children. Severe pruritus. 
 Erosion and ulceration of the cervix. The 
 cervix is greatly indurated. Offensive, ex- 
 coriating catarrh during pregnancy. Pain in 
 the sacrum extending through the hips and 
 thighs to below the knees. Faintness, nau- 
 sea, exhaustion, an all gone feeling in the 
 pit of the stomach. Constipation. Herpetic 
 eruptions. Brown spots on the skin. Sad, 
 gloomy, and despondent. Suited to persons 
 with dark hair, of rigid fibre, but of a mild, 
 gentle disposition. 
 Silicea, Acrid catarrh before the menses, with 
 sensation of swelling of the vulva, and sore- 
 ness of the perineum. Watery catarrh in 
 the place of the menses. Profuse yellow, 
 excoriating, tenacious catarrh. The entire 
 genital mucosa is red, vascular, moist, and 
 exquisitely sensitive, rendering sexual inter- 
 course impossible. Chronic headache re- 
 lieved by warmth, and by having the head 
 wrapped. Profuse sour perspiration on the 
 head in the evening. Exhaustion from ere- 
 thism. Want of vital heat, not renewed by 
 exercise. Strong desire to be magnetized.
 
 138 LEUCORRHd^A. 
 
 Swelling and inflammation of glands. 
 Chronic suppuration. Especially suited to 
 youth and adolescents. 
 
 Stillingia sylvatica. Copious mucopurulent ca- 
 tarrh, with rheumatic pains, chiefly perios- 
 teal. Secondary syphilis. 
 
 Sulphur. White watery, copious catarrh, com- 
 ing in gushes, staining the linen yellow. The 
 discharge contains yellow granules like 
 crushed mustard seeds. Chronic catarrh 
 causing burning and smarting of the vulva, 
 and thighs (pathognomonic). Pudenda sore 
 and burning, milky catarrh. Smarting as 
 from salt, aggravated at night. The patient 
 must bathe with warm water, cold water 
 aggravates the soreness, and smarting. 
 Burning in the vagina, she cannot remain 
 quiet, must constantly shift her position. 
 Yellow, excoriating catarrh a fortnight be- 
 fore menses. Menstruation is too early, and 
 lasts too long. Hot flashes at the climac- 
 teric. Bearing down pains, congestion of 
 the uterus. The Sulphur patient is ver}^ 
 sensitive to the open air, and will not be 
 bathed; she takes cold easily. Affections 
 following suppressed eruptions. There is an 
 offensive odor from the skin, despite frequent 
 bathing, to which however there is an aver- 
 sion. A marked tendency to congestion of 
 the internal organs. Suppuration, the pus 
 being of foul odor. Comedones, frequently
 
 THERAPEUTIC SUGGESTIONS. 139 
 
 on the face. Acne punctata. Adapted to 
 lean persons who never stand straight, or sit 
 up straight. Stoop shouldered young girls. 
 Peevish, fretful disposition. 
 
 Sidphuric acid. Catarrh acrid and burning, 
 milky or transparent, or of bloody mucus. 
 Appearing at the climacteric, with hot 
 flashes. 
 
 Stunbtil. Catarrh of white mucus, especially 
 when sitting, with hot flashes at the climac- 
 teric. Nervous palpitation of the heart in 
 hysterical subjects at the change of life, ag- 
 gravated by thinking of how the heart is act- 
 ing. 
 
 Syphilinuni. Profuse, thick yellow catarrh, with 
 flabbiness of the vaginal mucosa. Soreness 
 of the vulva with mucopurulent catarrh in 
 children, aggravated at night. Acrid, cans, 
 ing itching, and inflammation, increased from 
 the warmth of the bed. Uterine and ovarian 
 diseases with profound nervous disorders, 
 especially in married women. Affections 
 of the left ovary. All the conditions are 
 aggravated at night, and many from the 
 heat of the bed. 
 
 Tabacimi. Simple catarrh following menstrua- 
 tion, or during the change of life. The 
 patient feels cold, and has a sense of ex- 
 cessive wretchedness. This latter condition 
 is most marked under Tabacum, as is an 
 almost constant sick headache.
 
 140 i,Kucorrhce:a. 
 
 Tarantula. Sanguineous catarrh, with constant 
 desire to urinate. Mucopurulent catarrh be- 
 fore menstruation, with intense sexual ex- 
 citement. Catarrh causing burning and 
 smarting, with painful uneasiness in the 
 cocc3^x. Enlargement of the cervix. Chronic 
 vaginitis with granulations in the vagina, 
 and on the portia vaginalis. Hyperesthesia 
 of the entire nervous system, the least ex- 
 citement irritates. Hysteria with trembling 
 of the body. Cannot remain quiet, she is 
 constantly moving the hands and feet. All 
 the nervous symptoms are aggravated by 
 music, which was formerly enjoyed, and 
 most agreeable to her. Sexual excitement, 
 even nymphomania, induced b}^ irritation of 
 the terminal nerves of the genital organs, 
 rather than by any cerebral disturbance. 
 
 TerebintJiina. Sanguineous, offensive catarrh 
 with fibroid enlargement of the uterus. 
 Burning in the uterus, pains at the crest of 
 the ilium aggravated by the least motion or 
 jar in walking or riding. Neuralgia in the 
 vagina. Burning that extends along the 
 large nerve trunks. 
 
 Thuja. Yellowish catarrh causing smarting of 
 the vagina and vulva. Bland mucous catarrh 
 from one menstrual period to another, which 
 leaves a yellowish green stain on the linen. 
 Burning and smarting in the vagina when 
 walking. Congestion of the left ovary.
 
 THKRAPKUTIC SUGGESTIONS. 141 
 
 Squeezing pain in the ovary. Erosion of 
 the OS uteri, on which there are spots Hke 
 aphthae. Uterine polypus. Warts and con- 
 d3domata, and other excrescences about the 
 vulva; these are flat v/ithout pedicles. Seedy 
 warts, pedunculated, oozing moisture which 
 has a peculiar coppery odor. Wandering 
 rheumatic pains aggravated by warmth, re- 
 lieved by cold. 
 
 Trillitun pendiihnn. Profuse yellow and thick 
 catarrh between the menstrual periods. 
 Sanguineous catarrh with great prostration. 
 A menorrhagic history, the blood being 
 bright red and coming in gushes, is an essen- 
 tial part of the Trillium gynaecological pic- 
 ture. 
 
 Urtica urens. Acrid, excoriating catarrh, with 
 stinging itching and oedema of the vulva. 
 Pricking and stinging characterizes this rem- 
 edy. Urticaria. 
 
 Ustilago. Excoriating albuminous catarrh be- 
 fore menstruation, which is too early and 
 profuse, the flow being bright red, and in 
 gushes when rising from a seat, or after hav- 
 ing been startled, or frightened. Or at 
 times the menstrual flow is dark, in clots 
 that are expelled from the vagina where 
 they form. Neuralgia of the ovaries. Tall 
 slim women with fair complexion. 
 
 Viburnum opulus. Thin, yellow white or color- 
 less catarrh except during stool, when it be-
 
 142 Iv^UCORRHCEA. 
 
 comes thick yellow, and streaked with blood. 
 Catarrh for two days following menstruation, 
 yellowish white. Dysmenorrhcea with draw- 
 ing in the anterior muscles of the thighs. 
 Pains begin in the back going around the 
 loins to the anus and to the pubic bones, like 
 labor. Membranous dysmenorrhcea. Espe- 
 cially indicated for tall slender women who 
 suffer from chronic dysmenorrhcea, spas- 
 modic, or membranous. 
 
 Xanthoxylum. Great increase of the catarrhal 
 discharge during the time when the menses 
 should appear. Dysmenorrhcea with agon- 
 izing pains driving the patient almost dis- 
 tracted. Neuralgic pain following the course 
 of the genito-crural nerve. Suitable for 
 women of spare habit, and of a delicate 
 nervous temperament. Pains that run down 
 the thighs, with scanty and retarded men- 
 strual flow. 
 
 Zincuni. Thick bloody mucus after menstrua- 
 tion, or before the flow, preceded by cutting 
 colic, causing itching of the vulva. Thick 
 mucous catarrh, especially in the morning 
 on rising. Thick and slimy discharge with 
 sensitiveness of the vagina and vulva. Acrid 
 and excoriating catarrh in the place of the 
 menses. Pruritus which leads to masturba- 
 tion, from which nymphomania develops. 
 Varicose veins of the pudendum. Ulcera- 
 tion of the uterus; there is a bloody dis-
 
 THE:rAPE:uTIC SUGGi:STlONS. 143 
 
 charge, the ulcerated surface being without 
 sensation. Left ovarian neuralgia. There 
 is great lassitude, especially upon waking in 
 the morning, even after a good night's sleep. 
 Cerebral exhaustion. Rhagades mostly be- 
 tween the fingers; painful cracking of the 
 skin. 
 Zizia. Catarrh bland and profuse, commences 
 on the second day after menstruation and 
 continues slight in quantity, at first acrid, 
 later becoming bland and copious. Acrid 
 catarrh following profuse menstruation. Sud- 
 den suppression of the menses, or they may 
 appear at the regular time but cease after 
 twelve hours.
 
 REPERTORY. 
 PART II. 
 
 VARIETIES OF CATARRH. 
 
 Albuminous. Ustilago, Borax. 
 
 Bloody. Lycop., Merc, Mez., Phos., Phos. acid., 
 Physos., Viburnum (streaked with), 
 Sabina (fetid), Sepia, Copaiva, Coffea c. 
 (mucous), Conium. 
 
 Clots. Curare. 
 
 Creamy. Secale, Calc. p., Natrum p. 
 
 Curdy. Helonias. 
 
 Egg, like the white of. Am. m.. Borax, Bovista, 
 Calc. c, Hydrastis, Lilium t., Mez., Plati- 
 num. 
 
 Gelatinous. Sepia. 
 
 Ichorous. Sabina. 
 
 Lumpy. Sepia, Ant. c. (of mucous), Aloe (like 
 jelly), Calc. c. (of pus), Psorinum. 
 
 Meat, like the washings of. Cocculus, Kali jod. 
 
 Milky. Sarrac, Phos., Puis., Sabina, Sulph. a., 
 Nat. p., Niccolum, Kali jod.. Kali m., 
 Angustura, Calc. c, Ferrum, Gelsemium, 
 Conium, Copaiva, Carbo v., Coffea c. 
 
 Mucous. Caulophyllum, Copavia, Conium, Euca- 
 lyptus, Act?ea r., Agnus c, Aurum m.. 
 Nitric a., Nux v.. Puis., Oleum a., Ori- 
 ganum, Sulphuric a. (bloody), Sumbul, 
 II
 
 146 i,e:ucorrh(Ka. 
 
 Mucous — Continued. 
 
 Thuja, Tabacum, Zincum (bloody), 
 Lachesis, Mez., Phos. a., Podophyllum. 
 
 Muco-purulent. ^Esculus h., Alumen, Bufones, 
 Canth., Carboa., Cocculus, Sabina, Merc, 
 Merc, c, Merc. iod. f., Stillingia, Syphili- 
 num, Tarantula. 
 
 Purulent. Bufones, Calc. c, Calc. s., Copaiva, 
 Curare, Ham., Hepars., Hydrastis, Igna- 
 tia, Kali ferro., Robina. 
 
 Slimy. Amm. m., Carbo a. (bloody), Phos., 
 Sepia. 
 
 Sanguineous. Arg.n., Ars., Baryta c, Calc. s., 
 Canth., Cocculus, Ham., Kreosot., Taran- 
 tula, Terebin., Trillium, Ant. t.. Aloe, 
 Amm. m. 
 
 Shreds. Canth. (of mucus), Leptandra. 
 
 Starchy. Borax, Sabina. 
 
 Stringy. Bovista, Merc, Hydrastis, Kalib., Nit. 
 
 Transparent. Alumina, Nat. m.. Palladium, Sulph. 
 a., Podophyllum, Stannum. 
 
 Thick. Mag. m., Nat. c 
 
 Thin. Anacardium, Asafoetida, Carbo v., Lyco- 
 pod.. Iodine, Lilium t., Naja t., Oleum a., 
 Phos. a.. Viburnum op. 
 
 Tough. Hydrastis (mucus). 
 
 Tenacious. Phytolacca, Silicea, Kali b. 
 
 Watery. Amm. c. Ant. c, Hydrastis, Kali jod., 
 Mag. c, Mag. m., Murex p., Nat. p., 
 Niccolum, Sarracenia, Silicea, Cham., 
 Helonias.
 
 r^pe:rtory. 147 
 
 Water. Sepia (as clear as). 
 
 THE COLOR OF THE DISCHARGE. 
 
 Bluish white. Amb. g. 
 
 Brown. Amm. m., Kreosot., Nitric a., Secale. 
 
 Coffee grounds. Nitric a. 
 
 Dark. Helonias. 
 
 Green. Apis, Asaf., Bovista, Carb. a., Cubeba, 
 Kali jod,, Kali s., Lachesis, Merc, Murex 
 p., Natr. m,, Nitric a., Secale, Graph. 
 
 Honey, the color of. Natr. p. 
 
 White. Ars., Aurum m.. Borax, Conium, Kreos., 
 Mag. c, Naja t., Oleum a.. Palladium, 
 Physostigma, Podophyllum, Robinia, Sar- 
 rac, Sarsap., Stannum, Sulph., Sumbul, 
 Syphilinum, Viburnum. 
 
 Water, like muddy. Nitric acid. 
 
 Yellow. iEsculus, Ars., Alumina, Angustura, 
 Argent, n., Asarum, Aurum m., Bovista, 
 Carbo v., Chamomilla, Colocynth, Con- 
 ium, Cubeba, Inula, Iodine, Kali b., Kali 
 jod., Kali m.. Kali s., Kalmia, Lachesis, 
 Lilium t. , Lycopodium, Merc, c, Merc. 
 jod. r., Myrica c, Natr. c, Nux v.. Palla- 
 dium, Phos. a., Robinia, Sabina, Sepia, 
 Silicea, Stannum, Sulphur, Syphilinum, 
 Thuja, Trillium, Viburnum. 
 
 THE NATURE OF DISCHARGE. 
 
 Acrid. Alumina, Apis, Amm. c, Ars., Ant. c, 
 Berberis, Borax, Calc. c, Caulophyllum,
 
 148 I^KUCORRHd^A. 
 
 Acrid — Cofituiued. 
 
 Cham., Chel., Conium, Copaiva, Cubeba, 
 Eucalyptus, Nat. m.. Fluoric acid. Graph., 
 Hydrastis, Kali jod., Kreosot., Lilium t., 
 Mag. c, Nat. p., Puis., Nat. s.. Nitric 
 acid., Ranunculus, Robinia, Sepia, Silicea, 
 Zizia (in the beginning), Sulph. a., Syphi- 
 linum, Urtica u., Zincum. 
 
 Bland. Caulophyllum, Zizia, Cyclamen, Kali 
 ferro.. Kali m., Kreosot., Lilium tig., Pul- 
 satilla, Ranunculus, Thuja. 
 
 Burning. Carbo a., Conium, Sulph. a.. Tarantula. 
 
 Corrosive. Alumina, Arg. n., Aurum m., Carbo 
 a., Carbo v., Calc. c, Ferrum, Ignatia, 
 Iodine, Kali jod., Nat. s.. Ranunculus, 
 Ruta g., Sabina, Sang., Silicea. 
 
 Excoriating. Graph., Kreosot., Merc, c, Myrica 
 c, Phos., Psorinum, Urtica u., Ustilago, 
 Zincum. 
 
 Hot. Hydrastis. 
 
 Irritating. Murex p., Phytolacca, Alumen, Alu- 
 mina. 
 
 Scalding. Sulphur. 
 
 Smarting. Ferrum, Lachesis, Lilium t.. Sulphur 
 (like salt). Tarantula. 
 
 Water, sensation of warm. Borax. 
 
 THE MANNER IN WHICH THE DISCHARGE 
 TAKES PLACE. 
 
 In gushes. Gelsemium, Graph., Lycopod., Nitric 
 acid (sudden). Sepia, Sulphur.
 
 ri:pe:rtory. 149 
 
 Fits and starts. Calc. c. 
 Paroxysms. Ant. t. 
 Intermitting. Carbo v. 
 
 GENERAL CONDITIONS AND CONCOMITANTS OF 
 THE DISCHARGE. 
 
 Abdomen, dull aching in the. Leptandra, Inula 
 
 (sensation of moving in the). 
 Angina pectoris. Kalmia. 
 Abortion, tendency to. Sabina. 
 Air, aversion to fresh. Natrum c. 
 
 sensitive to fresh. Hepars., Ant. c. 
 Back, aching in lower part of the. Gelsem., Helo- 
 nias. 
 ache, Aurum m., Baryta c, Puis., Podo- 
 phyllum. 
 in the small of. Kali ferro., Mag. s., Nitric a. 
 lameness, ^sculus, Conium. 
 lumbago. Kali jod., Nux v., Oleum jec. 
 rheumatism of the. Actsea r. 
 weakness of the. Graphites. 
 spinal irritation. Nux v. 
 drawing fro'^n the, to pubes. Sabina. 
 pain begins i7t the, extending to the loins, 
 anus and pubic bones. Viburnum. 
 \^wit\^, constipation. ^Esculus, Amm.. m., Alumen, 
 Aloes, CoUinsonia, Cubeba, Graphites, 
 Nuv v.. Sepia. 
 Bladder, irritable. Canth., Erigeron, Leptand., 
 Senecio. 
 sharp pain in the. Prunus.
 
 150 I^KUCORRHC^A. 
 
 Blood, bright red. Ustilago. 
 
 dark clots. Sabina, Ustilago. 
 
 fluid. Ant. c. 
 Bilious. Cubeba, CheL, Berb. 
 Broad ligament, spasmus of the. Actaea r. 
 Bearing down. Lilium t., Nat. c, Nux v. 
 Breasts, swelling of the, suppuration. Phyto- 
 lacca. 
 
 tenderness of the. Helonias. 
 Breath, loss of, on going up stairs. Iodine. 
 Breathing, difficult. Stannum. 
 Bathing, aversion to. Sulphur. 
 Brain, sensation as if revolving. Robinia. 
 Colic. Natrum c, Colocynth., Mag. c. 
 Coccyodinia. Fluoric a. 
 Coccyx, pain from, into the rectum and the vagina. 
 
 Kreosote. 
 Coitus, impossible because of sensitiveness of the 
 
 vagijia. Silicea. 
 Coldness of extremities. Ferrum. 
 Chilliness, relieved in the open air. Pulsatilla. 
 Chilliness. Cyclamen. 
 
 Cold, takes easily. Am. c, Sulph., Oleum jec. 
 Cough, alternates with catarrh. Iodine. 
 
 spasmodic. Cyclamen. 
 Convulsions. Caulophyllum. 
 Congestion, active. Erigeron, Gelsemium. 
 Debility. Hydrastis, Calc. c, Carb. v. 
 Emaciation. Arsenicum. 
 Epilepsy. Cedron. 
 Exertion, aversion to making any. Natr. c. , Ant. t.
 
 ri:pi:rtory. 151 
 
 Exhaustion, cerebral. Zincum. 
 Face, comedones on the. Sulphur. 
 
 acne. Sulphur. 
 
 red. Gelsemium, Ferrum. 
 
 pale. Helonias, Ars. 
 
 salloiv. Helonias. 
 Fall, bad effects of. Conium. 
 Faint, tendency to. Cyclamen. 
 Feet, cold. Phos. 
 Fingers, pricking in the. Secale. 
 
 numbness of the tips of the. Stannum. 
 
 cracks between the. Zincum. 
 Groin, strained feeling in the. Amm. m. 
 
 dragging in the. Ferrum. 
 Glands, swelling of the. Kali jod., Silicea, Phyto- 
 lacca. 
 Head, constant sick headache. Tabacum, Natr, m. 
 
 occipital ache, ^sculus, Cocculus, Gelsem- 
 ium, Silicea. 
 
 ache every two weeks. Niccotin. 
 
 sour perspiration on the. Silicea. 
 
 pressure on the. Asarum. 
 
 ache^ nervotis. Arg. n. 
 
 as if it were ftill of boiling water. Robinia. 
 Heart, valvular diseases of the. Kalmia. 
 
 palpitation of the. Sumbul, Nux m., 
 Baryta c. 
 
 hypertrophy of the. Kalmia. 
 
 functional affections of the. Nux m. 
 
 pain in the. Kalmia. 
 Hands, constant movements of the. Tarantula. 
 
 cold. Phos.
 
 152 i,i:ucorrhce:a. 
 
 Hyperesthesia of the entire nervous system. Taran- 
 tula, Cocculus. 
 Hysteria. Phos. a., Gelsemium, Asaf., Sumbul, 
 
 Tarantula. 
 Haemorrhage, tende7icy to. Erigeron. 
 Lassitude. Zincum, Carbo v. 
 Languor. Helonias. 
 Lymphatics swollen. Bromine. 
 Lips blue. Carbo a. 
 Labia, pudenda, aphthce of the. Carbo v. 
 
 biting like salt. Canth., Kali jod., Sulph. 
 
 burnijig. Ars. 
 
 cracks. Nitric a. 
 
 cervix y protruding from the. Sepia. 
 
 excoriations. Lycopodium. 
 
 eczema on the. Lycopodium. 
 
 itching. Origanum. 
 
 heat in the. Helonias. 
 
 mealy spots on the, with itching. Lilium t. 
 
 neuralgia of the. Apis. 
 
 oedema of the. Apis, Phos. 
 
 patches y white, on the. Merc. 
 
 pulsation in the. Calc. p. 
 
 rawness of the. Carbo v. 
 
 red spots on the. Carbo v., Helonias. 
 
 soreness of the. Sepia, Sulphur, Bovista, 
 Carbo v. 
 
 swollen. Amm. m., Colocynth., Helonias, 
 Lachesis, Merc. 
 
 swelling of the 7'ight. Apis. 
 
 ulcers on the. Secale.
 
 re:pe:rtory. 153 
 
 Labia — Co7i thi ued. 
 
 varices on the. Calc. c, Zincum. 
 
 voluptuous itching of the. Calc. p., Coffea c. 
 Love, disappointed in. Calc. p. 
 Mental states and symptoms. 
 
 Arrogant. Platinum. 
 
 Changeable mood. Asaf., Ignatia. 
 
 Clairvoyant. Nux m. 
 
 Mental symptoms improve with the increase 
 of the catarrh. Murex p. 
 
 Depressed. Amm. m., Agnus c, Sepia. 
 
 Despondent. Sepia. 
 
 Dullness. Agnus c. 
 
 Grief y suppressed. Ignatia. 
 
 Homesick. Ignatia. 
 
 Insanity caused by effort to control intense 
 sexual desire. Origanum. 
 
 Irritable. Bovista, Cham., Ignatia, Nux v., 
 Tarantula. 
 
 Irascible. Nux v. 
 
 Listless. Amm. c. 
 
 Melancholia. Ignatia. 
 
 Mesmerized^ strong desire to be. Silicea. 
 
 Peevish, fretful. Sulphur. 
 
 Suffering, intolerant of. Cham. 
 
 Weeping mood. Phos., Puis. 
 Masturbation, induced by itching of the genitals. 
 
 Zincum, Origanum. 
 Menstruation, catarrh in the place of. Graph., 
 Nux V,, Silicea, Sepia, Zincum, Ars., 
 Cedron, Cocculus, Cubeba, Ferrum.
 
 154 I,i:UCORRHCHA. 
 
 Menstruation — Coiitinued. 
 
 before. Zincum, Borax, Cedron, Bovista, 
 Silicea. 
 
 after. Agnus c, Tabacum, Viburnum, 
 Zizia, Bovista, Graphites. 
 early. Calc. c, Calc. p., Sulph. 
 delayed. Graphites, Calc. s.. Cyclamen, 
 
 Puis. 
 checked. Ant. c, Zizia, Niccolum, Puis., 
 
 Phos. 
 profuse. Helonias, Kali ferr., Iodine, Secale, 
 
 Ustilago, Trillium, Zizia, Ferrum, Sabina. 
 
 at night. Amm. m. 
 only at nigJit, in bed. Cyclamen. 
 ceases when rising frorn bed. Cyclamen. 
 during the day only. Causticum. 
 burning and itching before. Calc. c. 
 eruptions precede. Dulcamara. 
 painful {dysmenorrhcea) . Viburnum, Xan- 
 
 thoxylum, Caulophyllum, Collinsonia, Puis. 
 in gushes. Ustilago. 
 epilepsy dtiring. Cedron. 
 Mons veneris, blisters on the. Phos. 
 
 eruptions, sero-purulent on the. Conium. 
 hair, falling off of the. Natr. m. 
 itching of the. Natr. m. 
 pimples on the. Natr. m. 
 Muscles, iveakness of the. Ferrum, Physos. 
 twitching of the. Nux v. 
 lax. Mag. c. 
 Nervous, excitable. Gelsemium. 
 
 depressed. Leptandra, Xanthoxylum.
 
 ri:pe:rtory. 155 
 
 Neuralgia. Gelsemium, Terebinthina. 
 genito-cmral. Xanthoxylum. 
 anterior crural. Podophyllum. 
 Neurasthenia. Phos., Kali p. 
 
 Odor of the catarrh, offensive. Ars., Asaf., Bovista, 
 Garb, a., Colocynth, Cubeba, Carbolic a., 
 Eucalyptus, Kali jod., Graph., Helonias, 
 Leptandra, Lilium t., Kreosot., Lye, 
 Nitric a., Psorinum, Robinia, Sabina, 
 Sanguinaria, Sarrac, Sepia, Secale, 
 Terebinth. 
 sour. Curare. 
 of old cheese. Hepar s. 
 as of the menses. Causticum. 
 froin the body^ offensive. Hepar s., Sulph. 
 sour. Mag. c. 
 Ovaries, pressure and burning in the. Canth. 
 throbbing in the. Copaiva. 
 dull pain in the. Lilium t., Podophyllum. 
 congestion of the. Naja t., Thuja. 
 neuralgia of the. Ranunculus, Lilium t., 
 
 Ustilago, Apis. 
 ovaritis, chronic. Lil'ium t. 
 left. Syphilinum, Thuja, Ustilago, Naja, 
 
 Phos., Psorinum, Alumen, Bromium. 
 right. Apis, Palladium, Podophyllum. 
 Perineum, dragging in the, relaxed. Murex p., 
 
 Silicea (soreness). 
 Purpura hemorrhagica. Lachesis. 
 Pelvic cellulitis. Kali m. 
 Pelvis, pressure in the. Sepia.
 
 156 I.i:UCORRHCHA. 
 
 Pains appearing suddenly^ disappearing gradually. 
 Puis. 
 
 increase and decrease gradually. Stannum. 
 
 bearing dozvn. Ferrum, Caulophyllum, 
 Sepia. 
 
 flying. iEsculus. 
 
 spasmodic. Erigeron. 
 
 lancinating. Mag. c. 
 
 labor like. Ignatia. 
 
 lightning like. Mag. c. 
 
 as of a knife. Gelsemium. 
 
 change locatioji, suddenly. Puis. 
 
 squeeziiig. Thuja. 
 
 when sitting as if somethi?ig were being 
 thrust up into the vagina. Ferrum jod. 
 Pruritus. Alumen, Amb. g., Anacard., Angust., 
 Kali b., Calc. c, Puis., Sepia, Ignatia, 
 Petrol., Collinsonia, Cubeba, Helonias, 
 H3^drastis. 
 Prostration. Carboa., Trillium, Robinia. 
 
 develops rapidly. Calc. c. 
 Phlegmasia alba dolens. Natr. s. 
 Rheumatism. Stillingia, Phytolacca, Kalmia (shift- 
 ing). 
 
 alternating with catarrh. Kali b. 
 
 articular. Kalmia. 
 Sacrum, heaviness in the. Aloe. 
 
 lameness iii the. ^Esculus. 
 
 weakness in the. Graphites. 
 
 cramps in the. Psorinum. 
 
 heat i7i the. Sarsap. , Sepia.
 
 re:pe:rtory. 157 
 
 Sacrum — Continued, 
 
 pulsation in the. Sarsap. 
 
 pains from the, extending to the hips and 
 
 thighs. Sepia. 
 labor like pain from the, to iliu7n. Sarsap. 
 sacro iliac joint. Oleum j. 
 Sexual symptoms and conditions. Congestion. Amm. 
 
 m., Fluoric a. 
 exciteme7it. Agnus c, Amm. m., Calc. p., 
 
 Coffea c. 
 
 intense. Murex p., Origanum, Tarantula. 
 development premature. Platinum. 
 desire excessive. Origanum, Platinum. 
 irritation of organs. Canth. 
 nymphomania. Amb. g., iVnt. c, Phos., 
 
 Tarantula. 
 sensitiveness of the organs. Canth., Plati- 
 num. 
 ca^ises spasm during examination. Platina. 
 Skin, bleeds easily. Lycopodium, Mez. 
 crackifig of the, Zincum. 
 eczema on the genitals. Nitric a. 
 itching like flea bites. Oleum a. 
 crusts on the. Graph., Mez. 
 fssures of the. Petroleum. 
 eczematous eruptions on the, having the odor 
 
 of car ri 071. Psorinum. 
 vesicular eruptions on the. Ranunculus. 
 shingles. Ranunculus. 
 eruptions i^i the spring. Sarsap. 
 djy, zurinkled. Secale.
 
 158 i,e:ucorrhc^a. 
 
 Skin — Con tin tied. 
 
 blisters. Ranunculus. 
 
 moist eruptions on the. Graphites, Bovista. 
 
 herpes. Dulcamara, Sepia. 
 
 varicose veins. Fluoric acid. 
 
 erythema {thighs). Cubeba. 
 
 warts, having a coppery odor. Thuja. 
 
 surfaces, irritation of the. Canth. 
 
 capillaries near the stirface of the. Caust. 
 
 plethora, venous. Carbo a., Secale, Ham. 
 
 exanthemata, suppression of, front cold. 
 Phos. a. 
 
 stinging of the. Urtica u. 
 
 lax a7id hanging. Merc, Bar3'ta c. 
 Stains of the clothing caused by the discharge, green- 
 Bovista, Lilium t., Thuja. 
 
 browit. Lilium t. 
 
 yellow. Agnus c, Carbo a., Kreosot., Nux 
 v., Prunus, Sulphur. 
 
 saffron. Lactic acid. 
 
 corrodes the listen. Iodine. 
 
 stiffens the linen. Kreosote, Lachesis, Kali b. 
 Suppuration. Sulphur, Silicea. 
 Scarlet fever, sequelce of. Bromine. 
 Sterility. Amm. m., Phos. 
 Spasms. Nux v. 
 
 Stomach, gone feeling in the. Sepia. 
 Sleeplessness. Senecio. 
 Trembling of the body. Tarantula. 
 Thighs, pain in the. Murex p., Podoph3dlum. 
 
 pain r uniting down the. Xanthoxylum. 
 
 drawing in the. Viburnum.
 
 rKpKrtory. 159 
 
 Tongue, azvakens ivitJi a dry. Nux m. 
 Throat, constriction of the. Oleum a. 
 Uterus, enlarged. Lachesis, Murex p., Carbo a., 
 
 Carbo a., Iodine, Kali jod. 
 subinvoliited. Actaea r., Kali b., Kali jod., 
 
 Nux V. 
 metritis, chronic. Ant. t., Eupator. pur., 
 
 Amm. m., Merc, Phos. a. 
 indurated. Amm. m., Iodine, Nux v., 
 
 Conium. 
 retrojiexed. ^sculus. 
 retroverted. Caulophyllum. 
 prolapsed. Alumina, Angustura, Arg. n., 
 
 Amm. m., Ferrum jod., Helonias, Natr. p., 
 
 Nux v.. Puis. 
 misplaced. Conium, Helonias. 
 pain in the. Cedron, Bufones, Inula, Gel- 
 
 semium (cramps), Sarrac, Terebinth. 
 burning in the. Calc. c. , Terebinth. 
 tenderness of the. Nux v., Palladium. 
 fullness, sensation of. Gelsemium. 
 fibroids. Kali jod.. Terebinth. 
 congestion of the. Nat. s., Sulph., Caul- 
 ophyllum. 
 uterosacral ligaments relaxed. Lilium t. 
 polypus of the. Thuja. 
 sensatioji as if the, zvould fall out. Sepia. 
 Uterine cervix, portia vaginalis, os uteri, aphthcB on 
 
 the. Thuja. 
 erosions. Alumen, Arg. n., Asaf., Carbo a. 
 
 Conium, Helonias, Fluoric a., Hepar s..
 
 160 i,e:ucorrhce:a. 
 
 Uterine cervix — Contimted. 
 
 Hydrastis, Kreosote, Leptandra, Merc, 
 Mez., Nitric a., Phytolacca, Sepia, Thuja. 
 
 ulceration of the. Arg. n., Bufones, Hepar 
 s., Hydrastis, Phytolacca, Merc., Sepia, 
 Phos. a.,Sangmnaria, Lycopodium, Iodine. 
 
 granulations on the. Arg. n., Nitric a. 
 (bleeding easily). 
 
 hardness^ induration of the. Carbolic a., 
 Hydrastis, Iodine, Sepia, Conium, Graph- 
 ites. 
 
 swelling of the. Iodine, Murex p., Sarrac, 
 p.. Sepia, Canth., Graphites. 
 
 elongated (^cervix). Murex p. 
 
 engorged. Tarantula, Lachesis (dark blue). 
 
 ectropio7i of the mucosa of the. Lachesis. 
 
 burning ifi the. Bufones. 
 
 bruised feeling in the. Robinia 
 
 darting pains in the. Fluoric a. 
 
 dryness of the. Sepia. 
 Urethral caruncle. Coffea c. Eucalyptus. 
 Urine, saturated with bile. Myrica. 
 
 biting like salt. Causticum. 
 
 frequent. Nat. c, Psorinum, Eupatorium 
 pur. 
 
 cofistajtt desire to urinate. Tarantula. 
 
 painful. Aloe, Canth., Copaiva. 
 
 pain at the close of urinating. Sarsaparilla. 
 
 pressure though little urine is in tJie bladder. 
 Ruta g. 
 
 if retai^ied cannot be voided, Ruta g.
 
 RI^Pi^RTORY. 161 
 
 Urine — Con tin tied, 
 
 oily iridescerit film on the. Alum en. 
 having the odor of violets. Inula, Eucalyp- 
 tus g. 
 Vagina, aphthcE of the. Borax, Caulophyllum, 
 
 Helonias. 
 burning in the. Ars., Amm. m., Cham. 
 ecchyniotic patches on the. Arg. n. 
 engorgement of the. Iodine. 
 epithelium^ desquamation of the. Kali s. 
 dryness of the, Lycopodium, Sepia. 
 granulations on the. Alumen, Tarantula. 
 heat of the, Colocynth, Ham. (relaxed). 
 itching of the. Kreosot., Merc, Sabina, 
 
 Syphilinum, Ant. t., Berberis, Ferrumjod., 
 
 Fluoric a. 
 lymphatics of the ^ swollen. Kali s., Bromine, 
 
 Graphites. 
 inflammatio7i of the. Merc, c, Syphilinum. 
 mucosa, of the^, swollen. Alumen, Kreosot., 
 
 Ferrum jod., Nux v.. Graphites. 
 
 puffy. Kreosot. 
 
 dark red. Lachesis, Silicea. 
 
 absence of mucus. Lycopodium. 
 
 vascular. Silicea. 
 
 reddish brown. Sepia. 
 
 raw and sore. Ham., Berberis, Anacar- 
 dium. Bromine. 
 sensitive. Alumen, Silicea, Zincum, Ham. 
 smarting of the. Ant. c. Graphites, Cham., 
 
 Conium, Thuja, Xanthoxylum. 
 spasms of the, Merc. 
 
 12
 
 162 IvEUCORRHC^A. 
 
 Vagina — Con tin ued. 
 
 stitches in the, from below upwards. Kreosot. 
 
 neuralgia of the. Terebinthina. 
 
 walking, uncomfortable diyiiess iii the, whe7t. 
 Sepia. 
 Vaginismus. Canth., Ignatia. 
 
 Vaginitis. Amm. m., Berberis, Cubeba, Ham., 
 Nitric a., Tarantula. 
 
 white patches witJi. Merc. c. 
 Vulva, aching, throbbiiig in the. Calc. c. 
 
 burning. Ars., Aurum m., Sulph. 
 
 condylomata on the. Thuja. 
 
 dryness of the. Sepia. 
 
 eruptio7i, itcJiing. Nux v. 
 
 excoriation of the. Amm. c. 
 
 heat of the. Sarrac. 
 
 herpes on the. Petroleum, Dulcamara. 
 
 itching of the. Calc. c, Carbo v., Causti- 
 cum, Ferrum, Ferrum jod., Phos. a., 
 Sabina, Urtica u., Zincum. 
 
 inflam^nation of the. Merc. 
 
 fniliary eruption on the. Sarrac. 
 
 prurigo. Carbo v. 
 
 oedema of the. Apis, Urtica u. 
 
 pricking in the. Mez. 
 
 soreness of the. Syphilinum. 
 
 sensitiveness of the. Coffea c. 
 
 smarting of the. Sulphur, Thuja, Causti- 
 cum, Ferrum. 
 
 swelling of the. Calc. c, Canth., Cedron, 
 Natr. s., Silicea.
 
 REJPE^RTORY. 163 
 
 Vulva — Continued. 
 
 stitches in the. Conium. 
 
 ulceration of the. Amm. c. 
 
 vesicles 07i the. Natr. s. , Graphites. 
 
 varices on the. Carbo v. 
 
 warts on the. Thuja. 
 Weakness. Caulophyllum, Stannum. 
 y^z.itr, dread of cold. Phos., Sulphur. 
 
 AGGRAVATIONS. 
 
 Atmospheric changes, air, in the cold. Merc. 
 
 Afternoon. Naja t. 
 
 Bathing, cold. Nitric a., Sulphur. 
 
 ^t^j from the warmth of the. Syphilinum, Merc. 
 
 Bending. Cocculus. 
 
 Confinement, after. Asarum. 
 
 Day, during the. Kali ferr., Sepia. 
 
 four P. M. Physos. , Lycopod. 
 Eating, after. Cham., Kali ferr. (acidity after). 
 East wind. Hepar s. 
 Exertion, exercise. Helonias, Physos., Sarsap., 
 
 Calc. c. 
 Evening. Zincum. 
 
 Food, overindulgence in rich. Nux v. 
 Full moon. Lycopodium. 
 Fright. Ustilago. 
 
 Feet, getting, wet. Graphites, Phos. 
 Jar, sudden. Nux v., Terebinth. 
 Lifting, when. Helonias. 
 Lying down. Pulsatilla. 
 Labor, after. Nitric a., Sarsap.
 
 164 i,eucorrhce:a. 
 
 Menstruation, before. Baryta c. , Carbo v. , Ferrum, 
 
 Sulph., Tarantula, Palladium, Sepia, La- 
 
 chesis, Hydrastis. 
 between. Anacard., Colocynth., Trillium. 
 after. Hydrastis, Kali f err., Kalmia, Merc, 
 
 Niccolum, Palladium, Sepia, Phos. a., 
 
 Carbo v., Carbo a. 
 during. Iodine. 
 following suppressed. Ruta g. 
 Morning. Amm. m., Natr. m., Zincum, Graphites 
 
 (on waking). 
 Night. Secale, Sulph., Caust., Syphilinum. 
 Noise, causes trembling. Cocculus. 
 Music. Tarantula. 
 Men, presence of, causes desire to masturbate. 
 
 Origanum. 
 Pregnancy, during. Nat. s., Sepia. 
 Primipara. Sabina. 
 Riding. Terebinth. 
 Squatting position. Cocculus. 
 Spring, in the. Sarsap. 
 Shock, causes twitching. Nux v. 
 Sitting. Sumbul, Ant. t., Platinum. 
 Strain, ill effect of. Conium. 
 Standing. Carbo a. 
 Thinking of complaints. Sumbul. 
 Touch. Secale, Hepar s. 
 Urinating. Apis, Amm. m.. Sepia, Tarantula, 
 
 Niccolum. 
 before. Kreosote. 
 Uterus, from pressure on the. Copaiva.
 
 re:pe:rtory. 165 
 
 Walking. Nat. m., Sarsap., Tarantula, Thuja, 
 
 Natr. m. 
 Warm room, going from, into open air. Sarsap. 
 Warmth. Secale, Thuja. 
 
 Weather, damp. Hepar s., Natr. s., Dulc. (cold). 
 Water, cold. Merc, Sulphur. 
 Winter. Petroleum. 
 
 AMELIORATIONS. 
 
 Bathing with warm water. Sulphur. 
 
 Cold, froin. Thuja, Secale. 
 
 Catarrhal discharge, all the conditions, by. Borax, 
 
 Murex p. 
 Warmth, (^headache'). Silicea. 
 Wrapping head. Silicea. 
 
 STAGES OF LIFE, CONSTITUTION, DISPOSITION, 
 TEMPERAMENT. 
 
 Anaemia. Ars., Cyclamen, Ferrum, Amb. g., 
 
 Calc. c. 
 Blondes. Phos., Mer. c, Kali b. (fat), Ustilago, 
 
 Bromine. 
 Climacteric. Aloe, Baryta c, . Helonias, Puis., 
 
 Sabina, Lachesis, Nitric a.. Sang., Sepia, 
 
 Sulph., Sulph. a., Sumbul, Tabacum. 
 Jiot flashes at the. Sulphur, a., Sumbul, 
 
 Sulphur. 
 Catarrh, subject to. Kali b. 
 Children. Curare, Merc. jod. r., Sepia, Syphi- 
 
 linum, Caulophyllum. Old. Argentum n. 
 Dark hair. Sepia.
 
 166 L^UCORRHCE^A. 
 
 Diathesis, kce^norrhagic. Amm. m., Lachesis. 
 
 rJieumatic. Phytolacca. 
 Diarrhoea, subject to. Nitric a. 
 Dwarfish women. Baryta c. 
 Emaciation, gradual. Iodine. 
 Enervated from luxury. Helonias. 
 Excitable. Cedron, Cham. 
 Feeble women. Helonias. 
 Girls. Caulophyllum. 
 
 {little^. Calc. p., Ignatia, Phos. a., Merc, 
 jod. r., Origanum, Senecio, Silicea. 
 Hair, red. Phos., Sepia (dark). 
 Infants. Cann. s. 
 
 Leucophlegmatic. Nat. c, Cyclamen. 
 Lean persons, who never stand straight. Sulphur. 
 Married women. Syphilinum. 
 Mild gentle disposition. Sepia. 
 Mothers, j'^^^;?^^. Asarum {^plethoric). 
 Nature, sensitive. Phos. 
 Old maids. Gelsemium. 
 
 women. Aloe, Ars., Baryta c, Carbo v., 
 Carbo a., Conium, Helonias, Phos. 
 
 for tJieir age. Argent, n. 
 Obesity. Graphites, Amm. c. 
 Small, delicate women. Erigeron. 
 Scrofulous. Bromine, Iodine. 
 Students. Gelsemium. 
 Syphilis. Kali jod. 
 Stoopshouldered girls. Sulphur. 
 Thin, scrawny women. Secale. 
 Tall, slender. Viburnum. 
 
 pale. Ustilago, Helonias.
 
 RKPE^RTORY. 167 
 
 Tired, always. Baryta c. 
 
 Young women. Amb. g., Ars., Carbo a., Sepia, 
 
 Silicea. 
 Voluptuous nature. Cedron. 
 Widows. Origanum.
 
 INDEX. 
 
 A. 
 
 Abrasions, a cause of catarrh 22 
 
 Acetic acid and alcohol in the use of the preparation 
 
 for trachelorrhaphy 89 
 
 Acetic acid and carbolic acid 83 
 
 Acid reaction of simple genital catarrh 29 
 
 the normal vaginal secretion 14 
 
 Acidity, absence of, favorable to the development of 
 
 micro-organisms ^ 29 
 
 Adenoma, senile, and erosion of the os uteri 48 
 
 Adolescence, the normal vaginal discharge of 46 
 
 Alkaline reaction of normal uterine secretion 14 
 
 Alumina, the use of, for constipation 6^ 
 
 Argyrol, swabbing out the uterus with 100 
 
 Arteries, involvement of the walls of the, in genital 
 
 catarrh 20 
 
 B. 
 
 Bacillus, the vaginal 15 
 
 Backache, and muco-purulent catarrh 56 
 
 Balsam of Peru tampon 86 
 
 Bartholin, the glands of 29, 73 
 
 Basement membrane, of the mucosa 3 
 
 Baths, the medicated 99 
 
 Baths, preparation of, for house use 100 
 
 Bicarbonate of soda douche 39 
 
 Blood, significance of, in genital catarrh 55 
 
 Birth, the genital canal at 10 
 
 glandular structures at 32 
 
 Boroglyceride, the use of 59> 86
 
 I/O INDEX. 
 
 G. 
 
 Calomel, the use of, as a dusting powder 84 
 
 Calyciform cells, the character of 9, 10, 13, 18, 28 
 
 Carbolic acid douche 41, 58, 60, 83 
 
 application of, to the cervix 59 
 
 Cascara, the use of, for the constipation of children. . 42 
 
 Cascara and maltine 63 
 
 Catarrh, acute genital 28 
 
 in children 3i> 43 
 
 chronic genital 28, 32 
 
 classification of 97 
 
 constitutional symptoms of 56 
 
 curettement for the treatment of 62 
 
 gynaecological 14, 18, 42 
 
 infection, the source of 32 
 
 the local causes of 20 
 
 muco-purulent , 44, 47, 49, 50, 54, 55 
 
 constitutional treatment of . . 62 
 
 local treatment of 57 
 
 reaction of 56 
 
 symptoms pf 56 
 
 purulent 27, 62, 72, 76 
 
 blood in y6 
 
 clinical course of 79 
 
 the color of 76 
 
 source of injection of 75 
 
 origin of 78 
 
 senile 96 
 
 treatment, constitutional . . 93 
 
 local 80 
 
 sanguineous 28, 94, 96, 97 
 
 the treatment of, in adults 99 
 the treatment of senile . .96, loi 
 
 simple 18, 27, 28, 32, 36 
 
 treatment of general 41 
 
 of the uterus 45
 
 INDEX. 171 
 
 Catarrh of young girls 21 
 
 Cautery, the actual, treatment of pruritus with 102 
 
 Cells, breed true 6 
 
 calyciform 9> ^o 
 
 chalice 13 
 
 goblet 9, 10, 14 
 
 protoplasm of 18, 28 
 
 their methods of discharging mucus 14 
 
 immature, and genital catarrh 23 
 
 Cervical canal, alkaline reaction of the 8 
 
 dilatation of the 89 
 
 endometrium of the, in muco-puru- 
 
 lent catarrh 49 
 
 the lining of the 8 
 
 Cervix, erosion of the 48* 75 
 
 treatment of, with Iodine .... 64 
 
 Children, catarrh in 28, 30 
 
 treatment 43 
 
 constipation in 42 
 
 the method of using the vaginal douche for 35 
 Churchill's tincture of Iodine, the action and use of 60 
 
 Cicatricial tissue after operations 102 
 
 Constipation in adults 42 
 
 children 42 
 
 * and gynecic diseases 63, 64 
 
 the treatment of 42 
 
 Constitution and vicious metabolism 23 
 
 the relation of, to mucous secretion .... 21 
 
 Corium, a layer of mucous membrane 3 
 
 glands of the, at birth 10 
 
 Corpus uteri, the lining of the 29 
 
 secretion of the 9 
 
 Creolin, the use of, for douching 81 
 
 Curettage 62, 87, 88, 89, 100 
 
 after treatment of 93 
 
 Curette, the use of the 89
 
 172 INDEX. 
 
 D. 
 
 Diathesis, scrofulous and genital catarrh 23, 43 
 
 Discharge, the suspicious character of a bloody 99 
 
 Douche, bag and tip 38 
 
 the intra-uterine 87 
 
 Alum and Sulphate of Copper 59 
 
 Bichloride of Mercury 41 
 
 Bicarbonate of Soda 39, 58 
 
 Boracid Acid 32, 41, 99 
 
 Carbolic Acid 41, 58, 60, 83 
 
 Glycerite of Tannin 38 
 
 Hydrastis 81, 99, loi 
 
 Iodine 58, 60, 81, 99 
 
 Lead Acetate 2>7 
 
 Permang. of Potassa 99 
 
 Sulphate of Copper and Alum 39 
 
 method of giving a 37 
 
 to children 35 
 
 the temperature of a 39 
 
 Dusting powders, objection to the use of 84 
 
 E. 
 
 Ectropion of cervical mucosa 49 
 
 Eczema, ointment for 33 
 
 Endo-cervicitis 51 
 
 Endo-metritis, atrophic 97 
 
 hyperplastic 100 
 
 and purulent catarrh 75, 79 
 
 sanguineous catarrh 95 
 
 Epithelial cells, chalice 13 
 
 calyciform 9, 10 
 
 cylindrical 19 
 
 of genital canal 12 
 
 goblet 9, 10, 14
 
 INDEX. 173 
 
 Erosion of the cervix 48, 51 
 
 Exanthemata, suppressed 43 
 
 Exanthematous diseases, and genital catarrh 29 
 
 of children 29 
 
 F. 
 
 Failure, the causes of, after curettage and trachelor- 
 rhaphy 88 
 
 Fallopian tubes, catarrh of the 'j'j 
 
 epithelium, of the 12 
 
 glands of the 12 
 
 in purulent catarrh yz 
 
 reaction of the secretion of the .... 16 
 
 tuberculosis of the 78 
 
 Fluors alba 36 
 
 Ferguson's speculum 83 
 
 G. 
 
 Genital canal, development of the 2 
 
 lining of the i 
 
 mucosa of the 2 
 
 shape of the 7 
 
 Gestation, arrest of, a cause of leucorrhoea 52 
 
 appearance of mucosa during 9 
 
 changes in mucosa during 10 
 
 Glands, of Bartholin 29, 73 
 
 genital, development of the, in reproductive life 45 
 
 distribution of 4 
 
 of mucous membrane 4 
 
 utricular in health 11 
 
 Glandular hyperplasia 61, 62,83 
 
 Glycerine, the use of, in vaginitis 4^ 
 
 Glycerite of Iodine 61 
 
 starch 34 
 
 Goblet cells, 18, 28, 39 
 
 formation of 13 
 
 protoplasm of 18 
 
 secretion of 8
 
 174 INDEX. 
 
 Gonococci in the vulva i6 
 
 Gonorrhoea! infection in purulent catarrh 74 
 
 Granules in vaginal mucous membrane in purulent 
 
 catarrh 74 
 
 Gynaecological catarrh, complications of 25, 27 
 
 composition of 26 
 
 H. 
 
 Headache, a symptom of muco-purulent catarrh .... 57 
 Hot Springs, a course at, in the treatment of genital 
 
 catarrh lOO 
 
 Hydrastis, fluid extract, douche 81 
 
 tampon 86 
 
 Hygiene, necessity for regulating 65 
 
 sexual 67 
 
 Hymen, epithelial covering of the 7 
 
 imperforate 34 
 
 I. 
 
 Ichthyol vaginal tampon 62, 86 
 
 Infection, avenue of pelvic 88 
 
 conditions favorable for 17 
 
 leucorrhoea a mixed 41 
 
 immunity from 22 
 
 Iodine, bactericidal action of 61 
 
 Churchill's tincture 60 
 
 douche, vaginal 58, 60, 81, 99 
 
 douche, intra-uterine 87 
 
 and Glycerine 61 
 
 tampon 86 
 
 the use of, after curettage 90, 100 
 
 the treatment of glandular hyperplasia with 61, 80 
 
 L. 
 
 Laceration of uterine cervix, causes of vicious healing 92 
 
 congenital i 52
 
 INDEX. 175 
 
 Laceration of the uterine cervix, preparation for 
 
 operating on the . .80, 83 
 
 in purulent catarrh . .75, 78 
 
 stellate 91 
 
 Lead acetate douche 37 
 
 Leucorrhoea 36 
 
 a mixed infection 41 
 
 Lochia, vaginal bacilli normally absent from the 15 
 
 Love, effects of disappointed 43 
 
 Lymphoid elements and tissues 6 
 
 M. 
 
 Malignant growths, line of demarcation of 49 
 
 Masturbation, a cause of 30 
 
 Measles, a cause of genital catarrh 24, 29 
 
 Menopause, and sanguineous catarrh 97 
 
 Menstruation, changes in epithelial cells that attend . . 45 
 the establishment of, and sanguineous 
 
 catarrh 98 
 
 genital glands during 10 
 
 Mercurius dulcis, the use of, for constipation 63 
 
 Metabolism, and genital catarrh 23 
 
 Microbes, the cause of catarrh 20 
 
 Micro-organisms of purulent catarrh 45 
 
 determine the differences between 
 
 forms of catarrh 96 
 
 Mt. Clemens, the baths of 100 
 
 Mucous membranes, the blood supply of 4 
 
 construction of 3 
 
 epithelial covering of 6 
 
 essential elements of 13 
 
 parts of S 
 
 the formation of genital 12, 16 
 
 the glands of 34 
 
 granules developed in the 74 
 
 the treatment of congested 41 
 
 the office of 3
 
 176 INDEX. 
 
 Mucus, cells concerned in the elaboration of 3, 13 
 
 the method of being discharged from goblet 
 
 cells '14 
 
 Alullerian ducts, the development of the 2 
 
 N. 
 
 Needles, those used in trachelorrhaphy 91 
 
 Nervous exhaustion 41 
 
 Neurasthenia 70, 99 
 
 Nitrate of Silver, application of, to the uterine cervix 83 
 
 ' the treatment of pruritus with . . 102 
 
 Normal salt solution 88 
 
 Nutrition, errors in, a cause of genital catarrh 22 
 
 O. 
 
 Ointments, the method of applying 33 
 
 the use of, for genital eczema 33 
 
 for corrosive catarrh 40 
 
 Operation for pruritus 102 
 
 Ovaducts, physiological current of the 79 
 
 Ovaries, diseases of the, and catarrh 24 
 
 P. 
 
 Pad, the vulvar 40 
 
 Parturition, the relation of, to muco-purulent catarrh 51 
 
 Pelvic organs, congestion of the, in constipation .... 42 
 
 Pelvis, condition of the, in sanguineous catarrh 99 
 
 Peritoneum, infection of the 79 
 
 Phosphate of Soda, the use of, for constipation . .42, 63 
 
 Portio vaginalis, the 8 
 
 the coverings of the 8 
 
 and genital catarrh 46 
 
 purulent catarrh 74 
 
 the secretions of the 8 
 
 Potassium permang. douche 35 
 
 Puberty, development of glands at 5, 10
 
 INDEX. 177 
 
 Puerperium, the relation of, to purulent catarrh .... 74 
 
 Purulent catarrh ^2 
 
 the color of 76 
 
 in old women 'j^i 
 
 Pruritus 81 
 
 an operation for 102 
 
 the treatment of 82, 102 
 
 in young girls 50 
 
 Pus cells, relation of, to the portio vaginalis 47 
 
 Pyogenic cocci, and acid media 15 
 
 and purulent catarrh 79 
 
 R. 
 
 Reproductive life, the changes that belong to 45» 46 
 
 S. 
 
 Salines, the use of, for constipation 42, 63 
 
 Sarcoma, diagnosis from sanguineous catarrh 97 
 
 Scarlet fever, a cause of genital catarrh 24, 29 
 
 Scrofulous diathesis 43 
 
 and catarrh in young girls .... 23 
 
 Sebaceous glands, the distribution of 7 
 
 Secretion, alkaline, of the uterus 8 
 
 Secretions, internal, generators of disease 20 
 
 Senile colpitis 95 
 
 endo-metritis and purulent catarrh "76 
 
 and sanguineous catarrh, 95, 98, loi 
 
 Senility, the condition of the uterus in 96 
 
 Sexual excitement, the treatment of 43 
 
 hygiene 36, (i^ 
 
 Sigmoid colon, the, and constipation 42 
 
 Skin, the condition of, in muco-purulent catarrh .... 57 
 
 Speculum, Cusco's 58 
 
 Ferguson's 83 
 
 Spray, method of using the vaginal 58 
 
 Staphylococci in the vulva 16 
 
 13
 
 178 INDEX. 
 
 Streptococci in the vulva 16 
 
 Students, neurasthenia in 44 
 
 Sutures, those used in trachelorrhaphy 92, 93 
 
 T. 
 
 Tampon, the vaginal 59 
 
 medicated 61, 62, 86 
 
 method of making 84 
 
 Tannin, Glycerite of, douche Z7 
 
 Tenacious genital catarrh 39 
 
 Tension, surgical, necessity of avoiding, in trachelor- 
 rhaphy 92 
 
 Thuja, the use of, for douching 82 
 
 Tissue remedies, the use of, in g3'nsecological diseases 6) 
 
 Trachelorrhaphy 87, 89, 90 
 
 after treatment of 99 
 
 Tubercle bacilli in the vulva 16 
 
 Tuberculosis of the Fallopian tubes 78 
 
 a cause of purulent catarrh 79 
 
 U. 
 
 Urethra, the lining of the 7 
 
 Uro-genital system, development of the 2 
 
 Uterine diseases and genital catarrh 24 
 
 glands, time of appearance of, in corpus .... 9 
 OS, erosion of, and muco-purulent catarrh . . 47 
 
 mucus plug in the 15, 49 
 
 secretion, alkaline, reaction of the n, 45 
 
 Uterus, catarrh of the 45 
 
 an erectile organ 67 
 
 displacements of the, in simple catarrh . . 36, 44 
 
 epithelial lining of corpus 9 
 
 involution of the, and muco-purulent catarrh 51 
 
 irrigation of the 87 
 
 lower segment of the, before puberty 2>^ 
 
 mucous membrane of the 11 
 
 retroflexion of the 52, 97
 
 INDEX. 179 
 
 Uterus, secretion of the, normally free from micro- 
 organisms 16 
 
 subinvolution of the, and genital catarrh 36 
 
 Utricular glands in health and disease II 
 
 V. 
 
 Vagina, acid secretion of the 7, 14, 22 
 
 congestion of the, in muco-purulent catarrh 45, 46 
 
 catarrh of the 2J, 36 
 
 lining of the 7 
 
 mucous glands of the 7 
 
 a self-cleansing canal 53 
 
 Vaginal bacillus 15 
 
 mucosa in purulent catarrh 73 
 
 walls in senile purulent catarrh 72 
 
 Vaginitis, and muco-purulent catarrh 45, 46 
 
 simple catarrh 29 
 
 Virgins, erosion of the cervix in 52 
 
 laceration of the cervix in 52 
 
 Volsella, the authors for trachelorrhaphy 91 
 
 Vulva, in the catarrh of children 30 
 
 micro-organisms found in the 16 
 
 condition of the, in, muco-purulent catarrh... 47 
 
 Vulvitis and purulent catarrh y2> 
 
 simple catarrh, the treatment of ...,40, 41 
 
 W. 
 
 White sulphur springs, for the treatment of genital 
 
 catarrh 100 
 
 Witch Hazel and Hydrastis douche 81 
 
 Y. 
 
 Young girls, genital catarrh of 21 
 
 sanguineous catarrh of 98 
 
 Z. 
 
 Zinc chloride douche loi 
 
 stearate dusting powder 40
 
 mm'ssfm^M^-si^wm-»M 
 
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 UNIVERSITY OF CALIFORNIA LIBRARY 
 
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