Page:Clinical Lectures on the Diseases of Women.djvu/41

Rh weight about the rectum or lower part of the belly, are common; and there are many other ill-defined symptoms referable either to the disease or to the constitutional disorder which sometimes it induces.

What chiefly attracts the woman's attention in most though not all cases, is an extraordinary discharge. All such discharges, when not bloody, are familiarly termed "whites" by women; but, if there is any occasion to be exact, you cannot rest satisfied with such a mere name. You must see the discharge before it has dried on a cloth, or see it in situ. Often, and even in severe cases, there is little discharge to show. In our present case, although the disease was extensive, there was little discharge; it was only to be well seen by exposing the diseased part, and observing its thick, yellow, viscid character. You cannot judge of these discharges when dried on a diaper, for then they are all very nearly alike, appearing as dirty, greyish-yellow stains. A discharge in cervical catarrh may vary from the healthy crystalline viscid mucus of the part through opalescence to yellowness or greenness. The worst kind is not viscid, but a thin yellow pus.

A milky-white discharge is scarcely to be called morbid. It is the vaginal mucus in excess, and occurs in very many weakly women after a long walk, or even without apparent cause. A glairy albuminous crystalline, or slightly opaline, discharge is also scarcely to be called morbid. It comes from the cervix. But a yellow or purulent discharge surely indicates disease.

This discharge is to be traced to its source, and this is done by using a speculum, which shows part of the catarrhal surface with the discharge flowing. The discharge may be wiped off by a mop to disclose the disease better, and often the mop sets agoing an oozing of blood. The duck-bill speculum is the best, but it is not generally used in private practice, because it requires special adjustment