Second, it is a catarrh, presenting all the usual appearances of this diseased condition. The mucous membrane is swollen, red, is easily made to bleed, and secretes a mucopurulent fluid or simple pus. In the part of the cervix that can be seen, the mucous membrane has often a punctated appearance, which is called granular. This arises from epithelial denudation or so-called ulceration, laying bare or making visible the papillæ, which are specially injected, and whose vessels are easily ruptured, and bleed. Our patient complains greatly of losing blood: so much, indeed, as to be called by her (not by us) flooding.
Third, it is an affection of the neck of the womb. This part, you must always remember, is physiologically and pathologically, as well as anatomically, quite distinct from the real womb, or body of the womb. The latter is the organ of menstrual excretion and of pregnancy. A neck of a bottle is much less a distinct part from the bottle proper than is the neck of the womb from its body. The cervix uteri is a large open gland, and very liable to catarrhal inflammation. This, then, is the disease, chronic catarrh of the neck of the womb.
This disease is of considerable importance on account of its frequency, not on account of its nature. It is in every respect an important disease, yet it is not to be classed with fevers, degenerations, with rheumatism, or gout. If a classification of diseases were made, according to their gravity, I daresay this disease would not be placed higher than the third rank. Many women—but far from all—who suffer from it, pay no attention to it, and can scarcely be said to be patients in any ordinary sense. In some women it is important from the alarm it causes; in our patient in Martha ward, it was supposed to be a malignant rodent ulcer. In all it deserves attention, and demands treatment at your hands.
It is generally said to be the commonest disease pecu-
