The white flux, the whites, eluvies, cachexia uterina, leucorrhta, leucorrhois, etc. is a flow of matter from the vagina, of different colours and consistencies, but generally of a pale or whitish colour. Astruc distinguishes, by an useless refinement, this discharge into the lymphatic, semilacteous, and lacteous. In Dr. Cullen's Nosology it is the monorrhagia alba; the fifth variety of his menorrhagia. He defines it "a serous menorrhagy, without any local injury in women not pregnant."he places it under this head, because the leucorrhoea is usually joined with menorrhagia, or soon follows it; and because it is highly probable that the serum flows from the vessels which supply the menses. The causes of leucorrhoea also are often the same as those of menorrhagia.
The seat of this disorder seems to be in the uterus, near the os internum, though principally in the vagina. Astruc thinks its seat to be in the glands, situated on the third or internal tunic of the uterus, and that they are vesicular bodies about the fundus uteri; these glands he calls colatoria lactea, and adds that this disease consists in a preternatural discharge from them. The uterine exhaling vessels, according to Hoffman, "become blood vessels at the menstrual period, and when emptied they contract to their former dimension and tone; but if by immoderate evacuations, or other causes of debility, their power is weakened, they separate the serous part of the blood, which, by stagnation, or from a particular state of the body, acquires various degrees of acrimony and consistence."as pregnant women are liable to this complaint, it does not appear that in them the discharge proceeds from the uterus, except from about the os internum; for the spongy chorion firmly adheres to its inner surface in almost every part. Some women have, indeed, a return of the menses in every month of pregnancy, which, though deficient both in quantity and quality, confirms Hoffman's opinion, as well as that the vagina may be a principal seat of the discharge.
Women who abound with serum, with lax fibres, or at the decline of life, and girls at the approach of the menses, are most subject to this disorder; though it sometimes occurs from infancy to old age. Hoffman observes, that women who are subject to a mucous de-fluxion at the nose are, on a suppression of the menses, affected with a fluor albus.
That the immediate cause of a fluor albus is debility of the vessels from which the menstrual discharges flow, or a retarded circulation of the blood through them, appears from some women having always a leucorrhoea whenever their menses are detained. In languid habits the disease returns periodically, instead of the proper menstrual evacuation, until the .patient's constitution is sufficiently invigorated; and in many instances it is manifest only during the absence of the menses.
The more remote causes are, cold moist air, a sedentary life, poor diet, excessive menstrual discharges, abortions, violent extraction of the placenta; indeed, every circumstance which weakens the constitution in general, or these vessels in particular.
From Hippocrates' description, it appears to have a great affinity to a cachexy. He says, "that the matter discharged resembles the white urine of an ass; white swellings appear in the patient's face, the part below the eyes swells, the eyes are disordered, and appear as if the patient was dropsical; the colour of the skin is whitish, and the lower part of the belly tumid; in the legs appear tumours so lax and so soft, as to retain the impressions of the finger; a biting pain is perceived in the stomach, and a sensation of an acid water lodged in it, either when the patient is fasting or happens to vomit; when she goes up a steep place, she is seized with short breathing; her legs are cold, her knees feeble, her uterus preternaturally opened, with a sense of weight at its mouth. This discharge is sometimes daily, and occasionally it appears two or three times in a month, and continues, each time, only a few days; the humour is serous and limpid in some, and in others more viscid: sometimes it is acrid, and occasions an itching, pricking, or even an excoriation; in its greater degrees of virulence, it appears of different shades, from the slightest yellow to a green or even a blackish green colour, and it is then more or less fetid. When the case is mild, it is often not regarded; but when more violent, a cachexy is the consequence. There is in that case a pain and sense of weight in the loins, turbid urine, longings and loathings, indigestion, swelling of the face in the night and of the feet in the day, palpitation of the heart, fainting, symptoms ending fatally in dropsy, or a consumption."
This disorder should be distinguished from a cachexy, a gonorrhoea, pale and ill coloured menses, and from ulceration, abscesses, and cancers in the parts of generation.
Leucorrhoea is often a symptom of cachexy, and the treatment is the same, so that distinction is not necessary. It is frequently mistaken for gonorrhoea; and in turn the latter is styled the whites. Leucorrhoea, when violent, is attended with a discharge as thin, as discoloured, and as acrid as gonorrhoea; and the character of the woman or her husband will, at times, be the only means of distinguishing the complaint. This similarity is, however, advantageous in another view, as it enables the practitioner to preserve the peace of a family, by giving a safer name to the effects of imprudence. If a woman is regular, it will be found that, during the discharge of the menses, the whites disappear; but the matter of a gonorrhoea is found combined with the blood; and except in very old women, whom we cannot suspect of gonorrhoea, the discharge is seldom so acrid as to occasion pain in making water.
Ulceration and abscesses in these parts have been usually preceded by inflammation, or may be traced to some violence; and the discharge of cancers is attended by the violent lancinating pains at the bottom of the belly. The discharge from cancers also, we believe, is the only fluid from those organs, which discolours bright silver.
If this disorder is moderate, it is supported a long time without much inconvenience; but if considerable, it soon spoils the beauty, weakens the digestive powers and the whole system, occasions sterility, and more frequently a disposition to miscarry. If the flux is unseasonably checked, the belly is said to swell, a hectic fever to come on, and a train of the most disagreeable symptoms to follow. We suspect, however, that to check it quickly is no easy task.
The indications of cure are, to promote digestion, increase the strength, and restrain the preternatural discharge. The diet should be light, cordial, and nourishing; isinglass dissolved in milk is useful, with moderate quantities of red port.
Leucorrhoea is with great difficulty removed. If it proceeds from partial debility of the vessels of the womb and vagina, from frequent births or miscarriages, remedies can scarcely be brought to act on such remote organs; and to remove partial debility by general remedies is a tedious, and often an unsuccessful, task.
Avoiding irritation of body and mind is highly necessary; and it is equally so to guard against topical irritation. The bowels must therefore be kept free, and every excitement of the uterine system avoided. Moderate exercise in cool air, cool rooms, and light clothing, food nourishing, but not highly spiced, or flatulent, are useful. The most scrupulous cleanliness is essential; and injections of milk and water, or green tea, should be frequently thrown up, cold.
Tonic medicines are principally employed; and the chief of these is cold bathing. The chalybeate mineral waters are remedies of considerable importance, among which the Cheltenham and Tunbridge springs are most useful. The bark is often employed, and is frequently salutary; but the more powerful astringents are said by Hoffman to be injurious. The humoral pathologists, in almost every disease, suspected acrimony; and this idea has led to the use of absorbents and of alteratives and mercurials, in leucorrhoea. The former are at least innocent; and as, in such circumstances, acids often abound in the stomach, they may be useful. Mercurials are, we believe, injurious, if we proceed beyond the slightest doses, to give a general tone to the arterial system. For the same purpose chalybeates are generally and freely employed. They have been used also for injections; and smiths' forge water has been recommended. This fluid, however, soils the linen, and as a powerful astringent may be injurious.
The alteratives employed have been the Lisbon diet drink, antimonials, and sarsaparilla. They have been supposed useful when the discharge is highly acrimonious; but we have seldom employed them, and scarcely in any instance found them effectual. The disease is peculiarly obstinate, and to relieve it our almost only chance.
See Cullen's First Lines, vol. iii. p. 24, 31. Hamilton's Midwifery, edit. 2, p. 119, 137, 140. Hoffman's Dissertation on the Fluor Albus. Leake's Medical Instructions, edit. 5.