Fluor muliebris , by abbreviation for flueurs blanches, λευκόῤῥοια, fluor muliebris, fluor albus. This name is commonly given to any discharge, any efflux, that take place by the path of the menstrual fluids, of matter different from blood and pus.

It is the relationship found between the origin, the issue of diseased fluid and that of the period , of which the term fluor is one of the synonyms, which gave occasion for the application of this name to this disease. It is from this relationship, combined with the color that usually distinguishes the humours of this abnormal discharge, that, to distinguish it, the name fluor muliebris was formed. It is also given the name perte blanche [white discharge] to express the fact that the evacuation in this case is absolutely a lesion of function, by which are ejected outside the body humours which ought to be retained therein; that it is a true lesion with respect to the vessels from which this effusion comes, which should, except in times of menstruation, exude nothing of what they contain.

One can consequently consider fluor muliebris as a sort of diarrhea of the womb and the vagina, especially since the matter of this discharge has in common with that of diarrhea properly so called that it is of as different qualities in the former as the matter of the latter, with respect to animal humours rendered in the flux from the stomach. Indeed, the humour which is shed in fluor muliebris is sometimes simply serous or lymphatic: sometimes it is lymphatic, or mucous and slimy; sometimes it is bilious, with more or less intensity, and even sometimes corrupt; whence it follows that this humour can present under different colors. When the first qualities dominate, it is limpid and more or less clear and colorless; with the second qualities it is more or less whitish, much like milk or barley cream; it has more or less consistency. With the last of the mentioned qualities, it appears yellowish, or more or less dark green; in the first of these different cases, it has little or no acrimony or bad odor; in the last, it is almost always acrid, irritating, even chafing, and more or less fetid.

The fluor muliebris sometimes forms a continual discharge, rarely very abundant; sometimes it ceases by irregular or periodical intervals; it often precedes each ordinary evacuation of the menses, and subsists for some time after it has ended.

Knowledge of the causes of the menstrual flow is absolutely necessary to judge those of the fluor muliebris ( see Menses). It will suffice here to give a summary for the understanding of the different symptoms and different circumstances of this disease.

The blood that flows out periodically from the reproductive organs in persons of the female sex is an effect of the general and particular plethora, of the overabundance of humours which form in the body when they have reached the age where it has almost ceased to grow. The nutritious juices which were employed for this purpose remain in the mass of the blood, increasing its volume, and by the laws of equilibrium in the solids of the human body cause this excess, which is first distributed in all the vessels to be carried by the general resistance they oppose to being dilated subsequently, into those where that resistance is lesser. See Equilibrium ( Animal economy ). Such are the uterine vessels, by the disposition which is theirs in the natural state. See Womb. They are therefore in a situation to yield more and more, in proportion to the augmentation of the plethora, but they yield only to the point where the tightness of their walls becomes a cause of necessary reaction to make it cease; otherwise they would absolutely lose their force. Then, the excess of blood continuing to be carried there, forces the orifices of the lymphatic vessels, and enters and stays in them, fills them to excess, as well as the sinuses that correspond to them, so that all these latter vessels, having yielded to the point where they could not yield more without breaking, are also stimulated to react, to empty themselves of the excess of fluids which they contain. The ulterior divisions of these vessels are forced to receive this excess, and dilating to that point where the collaterals that join in the cavity of the womb and the vagina, which allow there, except for the time of the period, only a small quantity of lymphatic humour to seep, as salivary, to moisten and lubricate those cavities, and which serve in time of pregnancy to establish communication between the substance of the womb and the placenta ( see Reproduction), are dilated in such a way as to let pass at once a larger quantity of this humour, and then the column of blood which there finds a way out. Thus this last fluid flows until the surplus which had caused the overabundance of humour throughout the body, and in the womb in particular, is evacuated, and allows all the vessels to exercise their ordinary systolic force, so that this discharge diminishes and ends as it began. The lymphatic vessels slowly shrink to the point of no longer receiving red globules, and even of allowing only less and less lymph to pass, until things return to the state where they were when the uterine vessels, both blood and lymphatic, began to be forced to receive more fluids than ordinary.

That assumed in general concerning the manner in which the discharge of menstrual blood occurs, it is natural now to observe that it is therefore preceded and followed by a flow of lymphatic matter which one can regard as fluor mulieris , which naturally appears before and after the red flow; but as the former subsists very little in a healthy state, it is not distinguished from the period itself so long as the discharge of white humour is slight in its quantity and duration after that of the red humour. Thus in the opposite case, where the plethora is not only rather considerable and subsists enough to give rise to the menses, but also to prevent, after it is over, the lymphatic vessels from closing enough right away so as to allow nothing which they contain to pass, the flux of white humours which follows the blood flow, not being as brief as ordinarily, and subsisting beyond, in proportion to the quantity of overabundant fluid which gives rise to the effort, to the contranitence  [1] of all the other vessels of the body not to absorb it, and to force it to go into the part that resists the least, and be voided through the conduits that favor the voiding.

But this discharge, being excessive with respect to what takes place in health, must then in this regard be placed among the lesions of functions: this is the disease of fluor mulieris . If the cause that produces it, in other words the overabundance of humours, is continually renewed to a sufficient degree to keep the uterine lymphatic vessels constantly too dilated, the fluor mulieris will be continual; if it is only accidental, its effect will soon cease with it; if it occurs often by intervals, the fluor muliebris will recur also from time to time, and will dispose the part where the often forced vessels gradually lose their resilience, to make the discharge more frequent and then continual through the habit which the humours contract to go there, as into the weakest part of the body.

Consequently, this discharge should be attributed to the vice of the solids alone, to the excessive relaxation of the uterine vessels, since in this case one can conceive that the fluor muliebris can occur without being preceded by any plethora, and that the ordinary portion of the fluids distributed to these vessels suffices to furnish the matter for it, given that they lack retentive force; whence it follows that the decrease in the mass of humours which takes place by that path is sufficient to remove the overabundance as it forms, which means blood does not collect in the substance of the womb, and that for want of the matter for the menses, they do not occur, and is complemented by the fluor muliebris with respect to the decrease in the volume of humours.

But if the vice of the solids of this part is combined with a dissolution of fluids in general, the fluor muliebris will be much more abundant, given that in this case the lack of consistency of the humours will make the evacuation even easier; it will become truly colliquative, and will be followed by all the ill effects which one can easily imagine. It is for this reason that, following the observation of Eugalenus, scorbutic women do not have periods, but instead have fluor muliebris , usually quite abundant. [2]

The different dominant qualities of the matter of this unnatural flow must be imputed first to the mass of humours that supply it; but it also contracts particular qualities through the more or less long time it stays in the cavities of the parts where the flow is created; thus the warmth of these cavities disposes that retained matter to become corrupt by a sort of putrefaction that makes it all the more astringent, yellow, and fetid, as it was bilious coming out of the uterine vessels. From this acrimony follows the disposition to procure erosions and ulcerations to the walls of those cavities; the fewer new qualities it contracts, the less is it disposed to start giving off bad odor and procuring the symptoms that have just been mentioned.

These imperfect qualities of the matter of fluor muliebris are therefore only accidental; they must not make it be considered excremental, in keeping with the idea that the Ancients had of it. This matter does not belong more to the kind of humours of that last quality than the menstrual blood itself. See Menses. There is however an exception to make concerning another sort of discharge, unnatural without being virulent, the difference and the very existence of which have scarcely been noted, which one could regard as false fluor muliebris , insofar as it resembles fluor muliebris without having the same source, or like a benign gonorrhea, since it is nothing but an overabundant excretion of the prostatic humour of the mucus of the gaps in the vagina, a sort of catarrh of the organs serving to separate the excremental humour destined for the lubrication of this canal.

Anything that can increase the general plethora in women, and above all that of the womb in particular, by attracting and determining a greater arrival of humours, anything that can weaken the elasticity of the vessels of this part, must be placed among the procatarctic causes of fluor muliebris , such as a sedentary life, followed by too little dissipation, overeating, fine food, followed by too abundant a confection of good blood; perspiration, or any other ordinary evacuation, suppressed, whence results an overabundance of fluids; a sensuous temperament, strong passions, effects of love; overly frequent coitus, or any other irritation of the genital parts, which, by the spasmodic tensions they cause there, impede the return of blood, hold it in the uterine vessels, cause their too frequent forced dilatation, whence their loss of elasticity and other effects mentioned in speaking of the immediate causes of the disease in question; multiple pregnancies, repeated miscarriages, which also contribute considerably, especially in cachectic persons, to directing toward the womb too great a quantity of humours, to weakening the elasticity of those vessels, and consequently to establishing the disposition to fluor muliebris , etc.

It follows from all that has just been said of the different causes of this disease that all persons of the female sex, in whatever condition they live, married or not, young or old, are susceptible to contracting the different abnormalities that establish the cause of fluor muliebris . Fernel says he has seen girls of seven to eight years old affected by this disease; [3] common observation also tells us that some women are subject to it during pregnancy, and others at a more advanced age; thus it can happen during a period, which it sometimes precedes, but it most often occurs only after the disposition of the menstrual flow is well established, and it rather commonly succeeds the suppression of that flow, either because the flow occurs through disease or is natural by the effect of age. Fluor muliebris is often a supplement to the menses, necessary and even salutary; but in both cases exercise, a laborious life, as is seen with respect to women in the countryside, dispense most of them who are even more usefully employed in it from most of these inconveniences throughout their lives.

The discharge of any humour that is not pus, especially when it is whitish, suffices to characterize the disease of fluor muliebris in persons with respect to whom there is no reason to suspect any venereal disease. The only virulent cause then is gonorrhea, in other words, the clap [ chaudepisse ] properly so called, or the prostatic flow with which it can be confused; but besides the fact that this sort of variolous flow is ordinarily still much less abundant than the least considerable discharge from fluor muliebris , there is a means of distinguishing them surely, proposed by Baglivi, Praxi medica, book II, chap. viii, sect. 3, [4] which was not unknown to Ambroise Paré, although the intermediate authors make no mention of him. See the works of Ambroise Paré, book XXIV, chap. lxiii . [5] This method consists in observing whether the equivocal discharge seems to continue during periods, or not; cessation is a proof that it is nothing other than fluor muliebris , and its continuation assures that it is gonorrhea. The reason for this is evident: gonorrhea depends on a source (in other words the prostate glands, or the mucus gaps in the vagina, or ulcers formed in the channel of the urethra, glands, and neighboring parts) independent of the menstrual flow, whereas the matter of fluor muliebris is furnished by the same vessels as that of menses.

But it is not so easy to distinguish the catarrhous discharge from the vagina mentioned earlier under the name false fluor mulieris , in other words simple gonorrhea, which also has nothing in common with menses, from that which is produced by a virulent cause; one can hardly be sure not to be mistaken in this respect when dealing with persons of uncertain virtue, whose confession can almost always be suspected; however if one can observe the matter of the discharge at its source or on linen, one can also apply to it the manner of distinguishing between a virulent gonorrhea, with respect to men, and what is only a flow of the prostatic humour. See Gonorrhea.

One can judge the intensity of the causes that gave rise to fluor muliebris by that of the symptoms that accompany or follow this affection; thus in that which is only an extension of lymphatic flow, ordinarily, and after the period, an extension that consists in lasting long enough to be made quite noticeable for a day or two, no significant lesion of functions follows. It is often in this case, as we have said, an advantageous supplement to the failure of natural evacuation of the overabundant blood, or at least it can last longer, a whole lifetime, without causing, in a manner of speaking, any inconvenience, when the subject is otherwise of good temperament.

In cachetic subjects, periodic fluor muliebris of this sort, and seeming to constitute part of the menstrual flow, betokens the inconsistency of the mass of humours, overabundant serosity, ill-constituted blood; which is most often an effect of abnormalities contracted in the digestive tract for want of digestive juices of good quality, through a sequel of obstructions of the liver, the spleen, etc., in a word through bad digestion.

When the fluor muliebris is continual, or returns, often irregularly, it is accompanied by symptoms of cachexia, pale face, sometimes a swelling in that part, especially in the eyelids, loss of appetite, failure of strength; because this disease is itself a symptom of the abnormality dominating in the solids and the fluids, in other words of the relaxation of atonia in the former, and of cacochimia in the latter. See Debility, Equilibrium, Fiber, Cachexia, Cacochymia, Chlorosis.

When the matter of fluor muliebris is quite serous, and constantly soaks the womb and vagina, it ordinarily renders women sterile, because it extinguishes and drowns, so to speak, the seminal liquor, according to the judicious verdict of Hippocrates, Aphorism xlii, sect. 5. So considerable a relaxation of the walls of this channel very often also follows, such that the weight of the womb that tends to make it slip towards the exterior orifice of the genital parts, makes that channel turn back on itself, and establishes the malady we call uterine prolapse , prolapsus uteri . See Womb.

If the matter of the fluor muliebris flows less abundantly, is of bilious quality, and remains in the cavity of the womb, it becomes astringent and gnawing; it causes ulcerations in the paths it follows, whence often follow real ulcerations of poor quality, susceptible of becoming chancrous and destroying the whole substance of the womb after causing hemorrhages of the uterine vessels, both abundant and difficult to stanch, etc.

Nevertheless, fluor muliebris is rarely dangerous in itself unless it comes from some morbific cause common to the whole body; when it is recent, produced by a topical abnormality and in young, well-constituted subjects, it yields easily to the assistance of the art placed in conformity with the true indications. In all persons of poor constitution, especially if they are advanced in age, it is most often incurable; but it can be prevented from bringing on death in the short term provided its progress is halted, the corruption of the flowing humours resisted, as well as the impression they impose on the solids they moisten, to prevent hemorrhages and ulcers from arising, and chancres from resulting, baleful effects to which the womb is much predisposed.

The treatment of fluor muliebris requires, to be attempted and conducted appropriately, that the cause be well known and that the dominant vice be well characterized. The slightest error in this regard can be of the greatest consequence. Thus, when the plethora alone causes this disease, bloodletting can be useful, even without other measures, to make both of them cease.

But this remedy would be very contrary in any cachetic disposition or affection, which would give rise to fluor muliebris , which is the most ordinary case: hydragogic purgatives, ferruginous mineral waters, diuretics, sudorifics, associated according to the art with the use of tonic, corroborative, and especially martial medications; as well as astringents, such as rhubarb, quinine, and simarouba, can be used with success in this last circumstance, and according to Boerhaave’s observation, Elementa chimica. proc. lvii usus . [6] Tinctures of lacquer and myrrh, produce just as great effects.

These different remedies placed and administered with method are sufficient to satisfy the principal indications that ask to be addressed, insofar as they are able to evacuate the maleficent yeasts of the digestive tract, which, passing into the secondary tracts, would contribute to furnishing the matter of the unnatural discharge; insofar as they are at the same time very effective for restoring digestion to order, restoring elasticity to organs that contribute to the operation of this important function, to reestablish those of blood formation, circulation, and secretions, also reviving and fortifying the action of solids, which are the principal instruments of these principal operations in the animal economy.

However, if the disease does not yield to these different means, a tincture of Spanish fly, given in a strong concoction of gaïac, can compensate for their insufficiency, especially if the fluor muliebris is not inveterate; in the case where it has lasted a long time, and has eluded the effect of all the remedies proposed so far, the thing to do is try mercurials, which have sometimes obtained great successes. These last two pieces of advice come from Dr. Morgan, Medical Practice , cited on this subject in Vol. IV of the Observations of Edinburgh , 1742. [7]

But the use of these various medications, in order to operate advantageously, needs to be supported by diet, distraction of the mind, and especially exercise of the body in proportion to strength, and slowly increased; moreover, for a greater detail of the means of assisting the correction of the dominant abnormalities in this disease, considered as a symptom of cachexia, see Debility and Fiber.

But in cases where there is no reason to think that fluor muliebris results from any abnormality that relates to the kind that has just been mentioned, that on the contrary the subject affected seems to be of robust and bilious temper with an acutely sensitive nervous apparatus, and that the uterine illness is caused only by a not absolute but relative weakness of the vessels of the womb which are forced to yield to the excessive contranitence of all the other solids, then one must take a very different approach from the one that has just been traced: soothing, moistening, and antispasmodic preparations fulfill, after the general remedies, the principal indications which are then presented. One can thus have blood drawn to decrease the volume of humours and the pressure in the vessels; use emetics and purgatives to cleanse the digestive tract and prevent it from supplying too much alkalescent recrementum to the blood; divert the humours tending towards the womb; whey and diluted milk can be used to correct the dominant acrimony; domestic baths, to relax bodily habit, without having that effect on the genital organs, which can be protected from it by covering them with aromatic and fortifying fomentations to promote perspiration and injecting distemper into the blood by this means, and by a great use of emulsified tisanes. It is also appropriate to use in this case, according to the rule, the various preparations of poppy, opium, castoreum, gutete powder, etc. to lessen the eretism and the irritability of the nerves that press the humours from the circumference to the center and steer them toward the weak part, toward the womb. But one must above all principally urge abstinence from raw and bitter foods, from anything that can heat the body and the imagination in different circumstances, especially when the disease is at an early stage.

There is no need, in fluor muliebris , for many external remedies. It is simply important to keep the parts clean through which the discharge occurs, and to prevent the vented humours from remaining there and stagnating. When this effect has not been anticipated, or the acrimony of the humours and what follows from it, this vice can be corrected with soothing lotions made from warm milk, barley and honey water, etc.

When these humours come from very limp organs, without irritation, one can use for lotions warm water spiked with alcohol and alcohol scented with mineral water as desiccants. One can also make use of white wine with honey as detersive and tonic, and all these different medications as injections or fomentations. Red wine would constrict too much; it would suit only the cases of a prolapsed womb, where it would even be necessary to make it astringent.

But no remedy having this last property must be used with the intention of halting the discharge of fluor muliebris unless one is sure the abnormality that sustains it is only topical, only the debility of the vessels of that part, and that none of it remains in the humours; otherwise you expose yourself, by preventing the excretion of those which are corrupt, which feed the womb, to enclosing , as they say popularly, the wolf in the fold , whence follow harmful deposits in the substance of that organ, inflammatory swellings, which are quite likely to result in gangrene; or they turn to skirrhe, which easily becomes cancerous; or they form abscesses, ulcers, or cankers, which are a source of ills, violent and durable pain, which death alone can calm; or metastases occur in distant organs, in the lungs, for example, from which phthisis can follow; in the liver, which can be followed by silent suppurations of that viscera; in the kidneys, from which can follow, according to Baillon’s observation ( Ballonii opera, book I, consil. 59) a dangerous kind of diabetes.  [8]

Thus astringents must be used with great caution, and in general this condition is very necessary in the administration of remedies for the cure of fluor muliebris . Whatever the quality of the vice that causes it, it is always very difficult to destroy, because of the structure and the particular situation of the affected organ, the nature of the humours distributed there, and the respective slowness of the movement of these humours. One must therefore, for the honor of the art and of him who practices it, and to prepare persons affected by this disease for anything, take care not to make them expect a sure, and even less a quick, cure. See Womb (diseases of the).

1. Contranitence : “(of contra and niter to endeavour), striving or resisting against; Opposition.” Egbert Buys, A New and Complete Dictionary of Terms of Art (Amsterdam, 1768-1769), 1:374.

2. Severinus Eugalenus (1535–after 1599), De morbo scorbuto (ca. 1550; the link is to a revised edition published in Amsterdam in 1720).

3. Jean Fernel (ca. 1506–1558), best known for Universa medicina (1557; the link is to an edition published in Paris in 1567).

4. Giorgio Baglivi (1668–1707), De praxi medica ad priscam observandi rationem revocanda (Lyon, 1699).

5. Ambroise Paré (1510–1590), Les Œuvres de M. Ambroise Paré (Paris, 1575). This subject is treated in chapters lxviii-lxvv in an edition published in Paris in 1598, pp. 988-90.

6. Herman Boerhaave (1668–1738), Elementa chemiae (1724; link is to an edition published in Leiden in 1732).

7. Essais et Observations de Médecine de la Société d’Édimbourg , French translation of Medical Essays and Observations published in various forms since 1731.

8. Guillaume de Baillou, called Ballonius (1538–1616), treated the subject of fluore muliebri in “Consiliorum medicinalium, book 1, consil. LVI,” in his Opera omnia medica, 4 vols. (Venice, 1734-36), 2:231-32. D’Aumont may have consulted a different edition with different numbering, or he may have transcribed the number (59 rather than 56) incorrectly.