days will be necessary. Excessive menstruation in young unmarried women and girls is usually owing to debility; attention to the general health, the use of iron, and the other means for improving the general condition recommended for the treatment of painful menstruation (p. 345) will usually suffice, with rest in bed for a day or two.

In other cases of undue loss of blood, during the monthly period in married women, an examination by a competent physician is always desirable after menstruation has ceased, to determine the cause and by this means take steps to remedy the trouble. Women, while lax about attending to unusual flow of blood at their regular periods, are even more careless and culpable in neglecting flowing from the womb at other times, because such hemorrhage is often a sign of grave trouble which demands the immediate attention of a physician. Especially true is this of flowing after the change of life" is passed, as it is sometimes the first symptom to call our attention to cancer, which may be cured by early operation. Also the fibroid tumor, which is seen usually in women over thirty-five, first makes itself known by long periods of flowing varied by intervals of immunity. Fibroid tumor of the womb does not always require removal, but operations are done with almost invariable success in the early stages.

66

Hemorrhage following an abortion is usually a sign that a part of the afterbirth has remained in the

womb, and necessitates its immediate removal by a physician to avoid the dangers of possible blood poisoning. Irregular bleeding from the womb in young married women, especially if accompanied by any signs or symptoms of pregnancy, as morning nausea and vomiting, soreness and enlargement of the breasts, and absence of the regular periods, with perhaps pain in the lower part of the belly, should cause the patient to seek a physician's advice at the earliest moment, because sometimes such a condition is found when pregnancy exists in a tube instead of in the womb. In these cases an operation is imperative to avoid rupture of the tube, as the child grows, a condition which results fatally in many instances. Operations for this condition are also almost invariably successful.

The most common cause of flowing during pregnancy is threatened abortion, when the patient should immediately take to bed, lie there quietly, take fifteen drops of laudanum 1 in water or a tablespoonful of paregoric, and secure a physician as soon as possible. Rarely women continue to flow at their regular periods throughout pregnancy, and still more rarely at irregular periods, without its being significant of any abnormal state which is discoverable. Flowing during the latter months of pregnancy, even if slight and occasional, is suggestive of a faulty position of the afterbirth in the womb, and the fact should be immediately brought to the notice of a physician in order that he 1 Caution. Take only on a physician's order.

may take steps to avert what might be a dangerous hemorrhage at childbirth.

Treatment. It is rare that the flowing is so excessive during the monthly periods that it becomes dangerous or requires special treatment to stop it. We will here describe the general methods which may be used with ease and safety by the patient or attendants to arrest undue flowing from the womb, whether at the monthly periods or at other times, and without regard to the cause.

Rest in bed with the head low, and the foot of the bed raised some six inches from the floor, is of the greatest importance. The patient must keep as quiet as possible and take twenty drops of fluid extract of ergot every hour for three or four doses if the flowing does not cease, except during pregnancy, when the ergot should be omitted. The use of injections of six quarts of water as hot as the hand can bear, with the patient lying as directed flat on the back on a bed, or douche pan, are most valuable. The injections may be best given with a fountain syringe into the front passage, and should be repeated once in four hours. A teaspoonful of alum added to the last quart of water in the syringe may increase the action of the injection in stopping the flow.

In order to stop dangerous flowing which cannot be arrested by the means we have described, it is necessary to fill and stuff the cavity of the front passage or vagina, and sometimes the womb, with clean cheese

cloth or gauze, but this cannot be attempted except by a physician.

Usually the simpler methods we have noted will suffice to arrest flowing until medical assistance can be obtained. The most severe flowing is apt to occur directly after childbirth, and this may be best controlled by firm pressure on the lower part of the belly over the womb, grasping it if possible between the thumb and fingers and keeping up steady pressure for half an hour or more regardless of the moderate suffering it may cause the patient (see Childbirth, p. 370).

The bowels should always be kept regular as a means of avoiding flowing. Sexual intercourse is not permissible during periods of excessive hemorrhage from the womb.

LEUCORRHŒA; A DISCHARGE FROM THE FRONT PASSAGE OR VAGINA OF WOMEN.— Leucorrhoea is not a disease in itself, but rather a sign of disorder of the female sexual organs, or of the whole system. When it occurs for a few days before and after the monthly periods, during the change of life, and accompanying pregnancy, it may be regarded as a natural occurrence if not associated with any other trouble suggestive of disorder of the sexual organs or of the body as a whole. In the ordinary conditions of health there should, however, be no perceptible discharge from the vagina in women, and if such occurs, with the exceptions just noted, it should be regarded as a symptom of local or general disorder. The dis

charge is not by any means always white, as the common term "whites" would suggest, but yellow, brown, reddish if mixed with blood, or colorless like the white of an egg. It varies greatly in color, consistency, and

amount.

Among general disorders causing a discharge from the front passage are: debility, anæmia (a condition caused by poverty of the blood and accompanied by paleness and weakness), malaria, tuberculosis, and acute diseases, as scarlet fever, measles, diphtheria, and typhoid fever. Exposure to heat, dampness, and emotional excitement may cause leucorrhoea. The discharge is usually white or watery when the trouble follows a disturbance of the general system, and not thick and yellow like matter from a wound.

"Whites" is one of the most frequent symptoms of inflammation of any part of the sexual organs-the womb, tubes, ovaries, and neighboring structures; also of tumors and injuries of these organs, as following tears occasioned by childbirth. It is also produced by faulty positions of the womb, by irritating injections, by too frequent sexual intercourse, etc. In all these conditions of local disease of the sexual organs there are usually present other symptoms, such as pain in the lower part of the abdomen and back or in the front passage, frequency and perhaps pain in urination, and the discharge is more apt to be thick and yellow like that coming from a boil. Such conditions should not be neglected, since sometimes serious disease