as to resemble the strictly vaginal mucus; and its source has thus been attributed to the vagina instead of to the cervix uteri. Mr. Whitehead is of opinion that the acid mucus of the vagina is intended to prevent the coagulation of the catamenial fluid in this canal; but I believe that in addition to this, the different chemical conditions of the surface of the os uteri and of the canal of the cervix play an important part in the pathology of these structures. During the catamenial flow, the acid vaginal mucus probably has the effect attributed to it by Mr. Whitehead, that of preserving the fluidity of the catamenial discharge, a small quantity of this mucus having the effect of preventing its coagulation even out of the body. The immediate effect of the acid mucus upon the secretion of the cervix uteri is, to cause its coagulation in the way already pointed out.

The import of leucorrhoea is not only explained by its constitutional causes, but by the fact of its being often brought on by emotion, violent altercations, or anger, which causing metrorrhagia in some, will give rise to leucorrhoea in others. It is sometimes caused by strong sexual desires, and the ecstatic trances of many holy, loving women have found a crisis in an increased mucous flow from the vagina. A more extensive view of a natural phenomenon is not uncalled for at the present time, when those who are without experience in uterine pathology are placed between extreme opinions; for while, on the one hand, they are told that, "in nineteen cases out of twenty, when a woman seeks professional advice for leucorrhoea, she will be found, on examination, to be suffering from some inflammatory disease of the uterine cervix," they are informed, on the other, that uterine ulceration seldom or never exists; while a third party says, "Yes, inflammation and ulceration are frequent, but do not originate the increased vaginal discharges. Ulceration of the womb, its induration, amenorrhoea, dysmenorrhoea, menorrhagia, sterility, and abortion are all excited by the passing of mucus from the neck over the lips of the womb." There is some exaggeration in the first statement, pitiable blindness in the second, and the third is only true of a very limited number of cases; for, as Mr. Whitehead has stated, the acid secretions of the vagina are generally sufficient to annul the

injurious effects of the alkaline mucus descending from the cervix uteri. The just view of such cases in the nineteenth century is that entertained by the first medical authority after the divine old man, Hippocrates, Galen, who called this disease a rheum of the womb, the slight hypersecretion of the vaginal mucous surface having no more alarming import than that of the mucous membrane which lines the nostrils; and to this slight affection should the term leucorrhoea be given. When, however, the discharge, instead of being white and unaccompanied by pain, is yellow or green, and attended by much pain in the back and thighs, and if it has been allowed to continue long enough seriously to disturb the functions of the mucous surface, the case alters, for in addition to the constitutional employment of steel, iodine, or mercury, local applications may be necessary—a fact only to be determined by an accurate examination.

THERAPEUTICAL INDICATIONS.

1. When the ailment is slight, and unattended by severe spinal neuralgia, some diaphoretic drinks at night, additional clothing, and the avoidance of cold and damp air, will remove it.

2. When the discharge is considerable, and attended by much pain, a digital examination will intimate, by the increase of temperature and the pain, whether the vagina be acutely inflamed; and it is then desirable to relieve this morbid state by emollient injections, tepid baths, cooling medicines, and repose.

3. Should an increased amount of vaginal discharge and spinal neuralgia persist after the cure or the alleviation of vaginitis, then it is to be supposed that the disease is in the womb itself, and a specular examination becomes necessary, to ascertain whether it depends upon a state of hypersecretion of the numberless mucous follicles lining the internal cavity of the neck of the womb, or upon ulceration of the os uteri, in which case surgical treatment is required. To detail this treatment, it would be necessary to repeat much of what the reader will find fully explained in the second part of this work.

CHAPTER X.

"L'attention a besoin d'être éveillée pour apperçevoir même les choses les plus ordinaires."-DUPUYTREN.

ON THE GASTRO-INTESTINAL MUCOUS DISCHARGES OF

MENSTRUATION.

Ir will be remembered that in those morbid functions of vegetative life called fevers, the impelling force frequently diverts, at the same time, a critical discharge from more than one surface of the body. Thus, while the urinary deposits are sometimes critical, there may also be a critical diarrhœa or perspiration; or, in other words, the ganglionic nervous system has the whole vascular system under command, and may cause it to concur more or less for the purpose of expelling what would be injurious. So it is with that form or portion of ganglionic nervous power which we call the ovarian nisus, which, while separating from the generative intestine a muco-sanguineous discharge, often impels the gastro-intestinal surface to an increased exhalation of mucus. The reciprocal influence of the womb and of the menstrual function on the stomach is proverbial; but when, some years ago, I asserted that menstruation was always more or less accompanied by diarrhoea, many midwifery practitioners denied the statement. When, however, one reflects that the organs of reproduction, as well as the intestines, are principally animated by the ganglionic nerves, that the spinal nerves of the womb and of the intestines arise from the same part of the spinal cord, that the veins of the uterus communicate mediately with the portal system, and that the last portions of both canals are contiguous, these being relieved by the same vessels, and supplied by nerves either derived from the same ganglionic nervous plexuses, or from the same portion of the spinal cord, it is not surprising, that when the uterine discharge is arrested, the nervous energy, and the sanguineous current which used thereby to find vent, should deviate to the intestinal surface.

N

Such being the anatomical connexions of the intestinal and reproductive organs, I am prepared to understand that every portion of the nutritive may sympathize with the generative intestine. Thus, like Siebold and Churchill, I have seen cases in which, the menstrual flow being absent, there was profuse salivation, lasting for several days. I have noted salivation as a symptom of morbid menstruation and of uterine disease, and such exceptional cases remind one of the occurrence of the same symptom during pregnancy. In most women the tongue is more or less furred, the breath fœtid, the taste perverted. Nausea marks the hyperæsthesia of the glosso-pharyngeal nerve. Many cases of dysphagia are recorded in this work, where menstruation was accompanied by the expulsion of a large quantity of ropy mucus secreted in the pharynx and œsophagus. All these are rare cases deserving to be noticed as instances of the symmetry of all the performances of nature; but it is not so with vomiting and diarrhoea, which deserve careful study on account of their frequency whenever the reproductive organs are in a state of great activity.

VOMITING.

The frequency of this symptom during pregnancy is well known, and need only be mentioned; it is likewise very frequent during menstruation. E. A. was always dreadfully sick the day before menstruation; with M. H. the sickness lasted three days; with B. S. eight, ceasing when the flow appeared; with F. N. the sickness lasted eight days before, and until the second day of the flow. In all these cases nothing was brought up but mucus; whereas in J. B., a chlorotic widow of twenty-eight, menstruation was regular, but scanty, accompanied by epigastric pain, and followed by two days of vomiting, bile being brought up. These symptoms occur generally in the first part of the monthly crisis, and when carried to a great extent, and prolonged beyond the usual time, chlorosis, in one of its numerous forms, almost inevitably follows. Flatulency, vomiting, and fancies after unusual articles of food, were noticed by B. de Boismont in 64 out of 360 cases. The same gastric symptoms, only greatly exaggerated, frequently constitute the prodomata of first menstrua

tion, lasting for a long time, and often seem to be the means of bringing about the chlorotic deterioration of the blood. The same gastric symptoms, carried to an extreme, constitute a large portion of the sufferings of women at the cessation of menstruation. Dr. Butler Lane has justly remarked :"Nothing can be more common than to find severe biliary derangement occurring at or about the period of menstrual secession and looking at the great physiological change which then takes place in connexion with hepatic development, it is naturally to be expected. A woman will complain of being bilious-viz., there may be a bitter, oily taste in the mouth, a sensation of burning in the throat, frontal headache, nausea, and even vomiting, the urine highly coloured, the bile abounding in the alvine dejections, and perhaps causing a heat and a stinging sensation in the rectum, the tongue furred, a biliary tinge pervading the cutaneous surface." G. N. had never been troubled with bile, but since cessation she has had repeated attacks of jaundice. P. K. is a stronglybuilt woman, of a sanguine temperament. The menstrual flow has been dodging her for the last eight months. Up to that time she had enjoyed good health; but since, in spite of purgatives, alteratives, and tonics, I have not been able to set right the gastro-intestinal functions, or to improve the appearance of the tongue, which is permanently coated with a yellow fur. A patient who has been singularly prone to sickness from childhood has slight ulceration of the os uteri, and I cannot touch it without causing retching, which always occurs whenever connexion takes place. She has had several children, and this tendency to sickness has been the bane of her life.

Many shades of sickness frequently attend diseases of the womb and ovaries, and it constitutes the most distressing symptom of some cases of inflammation of the body of the womb. I might dilate on this subject; but I shall refer the reader to the third volume of the Transactions of the Obstetrical Society, in which I have more fully discussed it.

DIARRHEA.

The ovarian nisus frequently determines diarrhoea, or constipation, or both, at different periods of the menstrual func