A Text-book of Diseases of Women

by Charles B. Penrose

The most conspicuous symptom of cervical catarrh is the leucorrhea—the discharge from the cervical glands. As has already been said, in its physical properties it is characteristic. It is a thick, opaque, tenacious mucus. The quantity is often so great that the clothes of the woman are soiled and she is obliged to wear a napkin.

There may be present slight backache and a feeling of vague discomfort or pain in the pelvis as a result of the inflammation of the cervix. It is difficult, however, to separate symptoms referable distinctly to the cervical inflammation from those due to the primary trouble, to which the cervical inflammation is also to be attributed. The only one distinct symptom of cervical inflammation is the leucorrhea.

Digital examination in a case of cervical catarrh usually reveals an altered condition of the cervix. The vaginal cervix may be somewhat enlarged and soft in the early stages of the disease, or cystic and sclerotic in the later stages. The external os is usually enlarged, often admitting the tip of the index finger even in those who have not suffered with laceration of the cervix. The prolapsed mucous membrane is present, and the erosion may be readily felt around the external os, being easily distinguished from the smooth, less velvety squamous mucous membrane of the vaginal aspect.

Speculum examination shows a congested vaginal cervix and a patulous external os around which is the red erosion already described. Escaping from the external os is seen the thick cervical mucus, which is often so tenacious that it may be lifted from the cervical canal with forceps.

The diagnosis of cervical catarrh is usually very easily made from a consideration of the signs described. The important thing in any case is to determine the cause of the inflammation of the cervical mucous membrane, in order that the proper treatment may be directed to it.

Treatment.—As has been said, cervical catarrh is always secondary to some local or general condition, except in the case of direct gonorrheal infection. The gonorrheal cases must be determined by the history of the disease and by the distinctive signs of gonorrheal infection which will be described later.

In every case of cervical catarrh a thorough examination to determine the local cause of the disorder must be made. If, as will usually be the case, such a local cause is discovered, the treatment should be applied to it, and the inflammation of the mucous membrane may be disregarded, with confidence that it will disappear when the exciting cause is removed. Many cases are treated by local applications, the whole attention of the physician being wrongly directed to the secondary condition, while the exciting lesion, such as laceration of the cervix, subinvolution, or a flexion or version, is neglected. Such treatment, of course, results in but temporary benefit.

Besides such cases of chronic local inflammation dependent upon a distinct local lesion, there are many others in which the catarrh is but a local manifestation of a general state of depressed or poor health, or of a distinct dyscrasia like tuberculosis, syphilis, or scrofula. Local treatment in such cases, to the neglect of the general health, is wrong.

If the advice here given—to seek for the primary cause of the cervical catarrh and to cure it—is followed, it will be found that there are but very few cases that depend for cure upon local applications. Simple local treatment by douches, etc. may, however, be valuable aids in hastening the cure of the disease after the exciting cause has been removed.

The treatment may be considered under two heads, the general and the local treatment.