This complaint, commonly called _fluor albus_, or _whites_, to which
women are peculiarly subject, must form an important object of
attention, since it is always attended with disagreeable symptoms; and,
when aggravated, soon spoils the beauty of a fine face, weakens the
digestive powers, produces a general bad habit, and occasions sterility.
_Symptoms._
An irregular discharge from the passage leading to the womb, of a fluid,
which, in different women, varies much in colour, being of a white,
green, yellow, or brown hue. In the beginning it is, however, most
usually white and pellucid, and, in progress of the complaint, acquires
the various discolourations and different degrees of acrimony, whence
proceed a slight smarting on making water. Besides the discharge, the
patient is frequently afflicted with severe and constant pains in the
back and loins, indigestion, paleness of the face, chilliness, and
languor. In process of time, every symptom becomes highly aggravated,
the feet and ankles swell, palpitations, and a difficulty of respiration
are experienced, the menstrual discharge is rendered irregular, the
urine is turbid, the mind is dejected, and either consumption or dropsy
supervenes, and terminates a miserable existence.
In some languid habits, the fluor albus returns periodically, instead of
the proper menstrual evacuation, until the patient’s constitution is
duly invigorated.
_Causes._
It may be produced by any cause which either weakens or irritates the
womb and its appendages. It may arise from general debility of the
constitution, but it is especially caused by circumstances impairing the
power of the womb itself, as, for instance, a severe labour, a
miscarriage, or profuse menstruation.
In some instances it appears to depend on a full and irritable habit of
body, and, in other cases, of local irritation, such as disorders of the
womb, or of the urinary organs, or a collection in the gut, of the small
thready worms called ascarides.
Upon the high authority of Dr. Hamilton, this disease is most frequently
first brought on by some imprudence in respect to diet and clothing, or
exposure to cold or fatigue, or neglect of the bowels about the time
when menstruation begins.
_Treatment._
In the treatment of this complaint regard must be had to the apparent
cause, and to the state of the patient. The discharge is too often
considered by the sex as the effects of general weakness in their habit,
and, therefore, they are led to the indiscriminate use of heating
medicines, as port wine, balsam copaibæ, &c., without paying attention
to the habit of the body, or cause of the disease.
A milk diet, change of air, and the partial cold bath, as sponging the
loins and thighs with cold water every morning, with attention to
cleanliness and proper exercise, are often sufficient to arrest the
disease, if early adopted.
In addition to this plan of treatment, if the patient be of a full
habit, a disposition to fever from slight causes, attended with a sense
of heat about the passage to the womb, it will be necessary to have
recourse to the lancet, cooling cathartics, and febrifuge medicines, and
to inject, several times a day, flax-seed tea or milk and water, into
the passage of the womb. In the great majority of cases, the complaint
arises from general debility or laxity of the vessels of the parts, and
in such cases the indications of cure are to increase the vital heat,
promote the digestion, and restrain the preternatural discharge. In
order to which, recourse must be had to such of the tonic medicines as
will be found to agree best with the patient. Of these, the bark and
elixir vitriol, the tonic powders or pills, the rust or tincture of
steel, and lime-water have usually been employed, and often with good
effects. In some instances, however, I have known these medicines to
fail, when the nitric acid, diluted, in doses of a wineglassful, three
or four times a day, wonderfully succeeded.
Previously to the exhibition of tonic medicines, it is advisable to give
a dose of ipecacuanha or antimonial wine. Gentle emetics are supposed to
be of singular utility in this complaint, not only by cleansing the
stomach and bowels, and making a revulsion of the humors from the
inferior part of the body, but likewise by their exciting all the powers
of the constitution to a more vigorous action.
The bowels must be kept in a regular state by conjoining a few grains of
rhubarb with some of the tonic medicines, or by taking occasionally, at
bedtime, one of the aloetic, or aperient or diaphoretic pills; or, in
the morning, a teaspoonful of Epsom salts dissolved in a tumbler of
water.
If there be a fulness of the stomach after eating, the tincture of
rhubarb in small doses will excite digestion. In obstinate cases, it is
often expedient to produce a change in the system, by giving a grain or
two of calomel, or one of the mercurial pills at bedtime, until the gums
become slightly affected, and then the cure may be completed by
strengthening medicines, together with the shower bath.
Besides tonics, stimulating medicines, such as commonly determine to the
urinary passages, have very frequently been employed with great benefit.
Of these, rosin in doses of ten grains in the yolk of an egg, or a
spoonful of molasses, or balsam copaibæ in doses of a teaspoonful, or
tincture of cantharides in doses of twenty or thirty drops in some
mucilaginous drink, and taken three or four times a day, will be found
most salutary.
These means strike at the cause of the complaint; but if it do not
remove the effect very soon, we are not to trust to them alone. For once
a morbid secretion being excited, it is very apt to continue, although
the exciting cause cease to operate.
On this account, we ought, without delay, to have recourse to astringent
injections, such as a strong decoction of red oak bark, with the
addition of a little alum or a solution of alum in water. Half an ounce
of the former to be dissolved in a bottle of water; which should be
thrown into the vagina by means of a female syringe, two or three times
a day. The celebrated Dr. Burns says, after many trials, he satisfied
himself, that although assistance may be derived from internal medicines
and the cold bath, yet the chief dependence is to be placed on
astringent applications to the seat of the discharge; and these, where
there is no fulness of the general system, nor any affection of the womb
itself, are perfectly safe, and seldom fail in producing a cure.
It will be prudent, when this disease occurs as an early symptom of
pregnancy, not to check the discharge suddenly, lest miscarriage be the
consequence; but it may be moderated by injections of water, with the
addition of a little vinegar, or an infusion of green tea. Neither
should the discharge be suddenly suppressed when it has been of long
standing, and acquired a considerable degree of acrimony, with an
offensive smell. For if it be unseasonably checked, the belly swells,
and a train of the most disagreeable symptoms occurs. In such cases,
soap suds, or an infusion of chamomile flowers or hops, should be
frequently thrown up the vagina; and, as soon as the blood is freed of
its impurities, by suitable medicines, and has recovered, in some
measure, its soft and balmy quality of which it has been deprived, the
astringent injections may be employed with perfect safety.
The application of a blister to the sacrum, has, in some obstinate
cases, been attended with advantage.
When the fluor albus proceeds from worms, purgatives and bitter clysters
are the proper remedies.
Pain in the back and loins is often mitigated by the application of a
large adhesive or strengthening plaster, and by avoiding a standing
posture of long continuance, much walking, dancing, or any other violent
exertion.
Women should carefully avoid all the remote causes of the disease: they
should pay diligent attention to cleanliness, by washing the parts
frequently with cold water; and when there are excoriations, milk and
water, or lead water, may be employed as a wash.
_Regimen._
The diet should be light, cordial, and nourishing, consisting of
isinglass dissolved in milk by boiling it, jellies, custards, rice,
milk, soft-boiled eggs, gelatinous broths, and light meats, together
with a prudent use of genuine wine, particularly claret or port.
Women, affected with this disease, should by no means indulge in the use
of tea and other warm slops of a relaxing nature; but should lie on a
mattress in preference to a feather bed; and they should rise early, and
take such daily exercise as their strength will admit, particularly on
horseback. When there is much languor, with chilliness, friction with
the flesh-brush, and wearing flannel next the skin, must not be omitted.