very useful, both for strengthening the whole system, and for taking off the determination of the blood to the internal parts.

983.] The remedies mentioned in these two last paragraphs, may be employed in all cases of menorrhagia, from whatever cause it may have proceeded, if the disease shall have already induced a considerable degree of debility in the body.

CHAPTER VII.

OF THE LEUCORRHEA, FLUOR ALBUS, OR

WHITES.

984.] VERY serous or puriform discharge from the vagina, may be, and has been comprehended under one or other of the appellations I have prefixed to this chapter. Such discharges, however may be various; and may proceed from various sources, not yet well ascertained; but I confine myself here to treat of that discharge alone which may be presumed to proceed from the same vessels, which, in their natural state, pour out the menses.

985.] I conclude a discharge from the vagina to be of this kind;* 1. From its happening to women who are subject to an immoderate flow of the menses, and liable to this from causes weakening the vessels of the uterus. 2. From its appearing chiefly, and often only, a little before, as well as immediately after, the flow of the menses. 3. From the flow of the menses being diminished, in proportion as the leucorrhoea is increased. 4. From the leucorrhoea continuing after the menses have entirely ceased, and with some appearance of its observing a periodical recurrence. 5. From the leucorrhoea being accompanied with the effects of the menorrhagia (971-972.) 6. From the discharge having been neither preceded by, nor accompanied with, symptoms of any topical affections of the uterus. 7. From the leucorrhoea not having appeared soon after communication with a person who might be suspected of communi

Extract. Glychrrh. aa 3ss.

Mucilag. gum. Arab. q. s.
M. f. Elect.

The dose is half a drachin or two scruples twice a-day.

The young practitioner ought to pay great attention to the diagnostics of the leucorrhoea delivered in this article.

cating infection, and from the first appearance of the disease not being accompanied with any inflammatory affection of the pudenda.*

986.] The appearance of the matter discharged in the leucorrhoea, is very various with repect to consistence and color; but from these appearances, it is not always possible to determine concerning its nature, orthe particular source from whence it proceeds.

987.] The leucorrhoea, of which I am to treat, as ascertained by the several circumstances (985.) seems to proceed from the same causes as that species of menorrhagia which I suppose to arise from the laxity of the extreme vessels of the uterus. It accordingly often follows or accompanies such a menorrhagia; ; but though the leucorrhoea depends chiefly upon the laxity mentioned, it may have proceeded from irritations inducing that laxity, and seems to be always increased by any irritations applied to the uterus.

988.] Some authors have alleged, that a variety of circumstances in other parts of the body may have a share in bringing on and in continuing this affection of the uterus now under consideration; but I cannot discover the reality of those causes; and it seems to me, that this leucorrhoea, excepting in so far as it depends upon a general debility of the system, is always primarily an affection of the uterus; and the affections of other parts of the body which may happen to accompany it, are for the most part to be considered as effects, rather than as causes.

989.] The effects of the leucorrhoea are much the same with those of menorrhagia; inducing a general debility, and in particular, a debility in the functions of the stomach. If, however, the leucorrhoea be moderate, and be not accompanied with any considerable degree of menorrhagia, it may often continue long without inducing any great degree of debility, and it is only when the discharge has been very copious as well as constant, that its effects in that . are very remarkable.

way

990.] But, even when its effects upon the whole body are not very considerable, it may stillbe supposed to weaken the

*Nothing is more frequent with ignorant practitioners than to mistake a gonorrhea for a leucorrhoea. Women in general give the name of whites to a gonorrhoea, and therefore the unwary practitioner may the more easily be misled. The distinguishing characteristic of gonorrhoea is, as the Author says, an inflammatory affection of the pudenda; but, as few women will suffer an inspection of the parts, we must pay some attention to the concomitant symptoms. The running in a gonorrhoea is constant, and only in small quantities; in a leucorrhoea the discharge is inconstant, and in large quantities. The other distinguishing marks of a gonorrhoea are, smarting in making water, itching of the pudenda, increased inclination for venery, a sweiling of the labia and of the glands about the groin. Some authors mention the color of the discharg ed matter as a distinguishing mark; this, however, is inconstant.

genital system; and it seems sufficiently probable that this discharge may often have a share in occasioning barrenness. 991.] The matter discharged in the leucorrhoea, is at first generally mild; but after some continuance of the disease, it sometimes becomes acrid ;* and by irritating, or perhaps eroding, the surfaces over which it passes, induces various painful disorders.

992.] As I have supposed that the leucorrhoea proceeds from the same causes as that species of menorrhagia which is chiefly owing to a laxity of the uterine vessels, it must be treated, and the cure attempted, by the same means as delivered in 981, for the cure of menorrhagia, and with less reserve in respect to the use of astringents.+

993.] As the leucorrhoea generally depends upon a great loss of tone in the vessels of the uterus, the disease has been relieved, and sometimes cured by certain stimulant medicines, which are commonly determined to the urinary passages, and from the vicinity of these are often communicated to the uterus. Such, for example, are cantharides, turpentine, and other balsams of a similar nature.‡

The young practitioner must not conclude too hastily that an ulcer exists in the uterus when the matter discharged is acrid. Practice has afforded many instances where the matter has excoriated the pudenda, and yet no ulcer existed.

+ The electuary mentioned at the end of the last note on article 982. has been found efficacious in some cases of leucorrhoea. Its dose may be increased to a drachm thrice a-day, either swallowed as a bolus, or dissolved in an ounce of pure water, and half an ounce of simple cin

namon water.

The chalybeate waters are useful in this, as well as in the former disease; and they may be used in the manner above mentioned.

Practitioners recommend, in these cases, a nutritive but not a heating diet, as mucilaginous broths made with rice, especially veal-broth, jellies of all kinds, except those that are high-seasoned. Port wine must be prescribed in a moderate quantity, according to the habits of the patient.

The practice here recommended is not without danger, and must not be followed exceptwith great caution and circumspection. When the other means fail producing relief, we may then have recourse to these balsamics, or join them to the tonic astringents, as,

R. Gum. oliban.

Terebinth. venet.
Alum.

Terr. Japonic. aa. 3i.

Sal. martis 3ss.

M. f. massa. in pilulas æquales No. 60. dividend.

Two or three of these pills may be given twice a day or oftener.

Some practitioners have strongly recommended the following emulsion.

R. Balsam. copaivi. 3i,

Vitel. ovi No. 1.

Tere in mortar. marmor. et adde gradatim,
Aq. font. žvii.

Syr. Simpl. 3i.

M. f. Emuls.

The dose of this emulsion is two or three spoonfuls three or four times a day.

CHAPTER VIII.

OF THE AMENORRHEA, OR INTERRUPTION OF THE MENSTRUAL FLUX.

994.] WHATEVER, in a system of methodical no

sology, may be the fittest place for the amenorrhoea, it cannot be improper to treat of it here as an object of practice, immediately after having considered the menorrhagia.

995.] The interruption of the menstrual flux is to be considered as of two different kinds; the one being when the menses do not begin to flow at that period of life at which they usually appear; and the other being that when, after they have repeatedly taken place for some time, they do, from other causes than conception, cease to return at their usual periods: The former of these cases is named the retention, and the latter the suppression, of the menses. 996.] As the flowing of the menses depends upon the force of the uterine arteries impelling the blood into their extremities, and opening these so as to pour out red blood; so the interruption of the menstrual flux must depend, either upon the want of due force in the action of the uterine arteries, or upon some preternatural resistance in their extremities. The former I suppose to be the most usual cause of retention, the latter the most common cause of suppression; and of each of these I shall now treat more particularly..

997.] The retention of the menses, the emansio mensium of Latin writers, is not to be considered as a disease merely from the menses not flowing at that period which is usual with most other women. This period is so different in different women, that no time can be precisely assigned as proper to the sex in general.-In this climate, the menses usually appear about the age of fourteen, but in many they appear more early, and in many not till the sixteenth in which last case it is often without any disorder being thereby occasioned. It is not therefore from the age of the person that the retention is to be considered as a disease and it is only to be considered as such, when about the time the menses usually appear, some disorders arise in other parts of the body which may be imputed to their retention;

year:

e;

being such as, when arising at this period, are known from experience to be removed by the flowing of the menses.

998.] These disorders are, a sluggishness, and frequent sense of lassitude and debility, with various symptoms of despepsia; and sometimes with a preternatural appetite.* At the same time the face loses its vivid color, becomes pale, and sometimes of a yellowish hue; the whole body becomes pale and flaccid; and the feet, and perhaps also a great part of the body, become affected with oedematous swellings. The breathing is hurried by any quick or laborious motion of the body, and the heart is liable to palpitation and syncope. A headach sometimes occurs; but more certainly pains of the back, loins, and haunches.+

999.] These symptoms, when occurring in a high de gree, constitute the chlorosis of authors, hardly ever appearing separate from the retention of the menses; and, attending to these symptoms, the cause of this retention may, I think, be perceived.

These symptoms manifestly show a considerable laxity and flaccidity of the whole system; and therefore give reason to conclude, that the retention of the menses accompanying them, is owing to a weaker action of the vessels of the uterus; which therefore do not impel the blood into their extremities with a force sufficient to open these, and pour out blood by them.

1000.] How it happens that at a certain period of life a flaccidity of the system arises in young women not originally affected with any such weakness or laxity, and of which but a little time before, they had given no indication, may be difficult to explain; but I would attempt it in this

way.

As a certain state of the ovaria in females, prepares and disposes them to the exercise of venery, about the very pe riod at which the menses first appear, it is to be presumed, that the state of the ovaria and that of the uterine vessels are in some measure connected together; and as generally symptoms of a change in the state of the former appear before those of the latter, it may be inferred that the state of the ovaria has a great share in exciting the action of the uterine vessels and producing the menstrual flux. But ana

*This is a very extraordinary symptom, which has not hitherto been explained. It sometimes accompanies every cessation of the uterine discharge, but frequently appears in the most violent degree, in pregnancy. In young women, the appetite for chalk, lime-rubbish, charcoal, and various absorbents, is the most prevalent. Stahl, and his followers, made great use of this circumstance in supporting their favorite opinion of the vis medicatrix naturæ,

These pains are not properly symptoms of the disease, but prognostics of the efforts nature makes to remove the disease: They are symptoms of the vis medicatrix.