tion of constitutional
causes. Ulcers are generally symptoms of other morbid conditions.

Ulcers may form in the _mouth_ or _neck_ of the uterus, and, omitting
cancerous ulcers and those of a syphilitic character, which are
considered elsewhere, may be classified as _Granular_ and _Follicular_.

[Illustration: Fig. 15.
The Ferguson Speculum.]

GRANULAR ULCER. This variety of ulcerative degeneration is the most
frequent, and may exist for some time without exciting any suspicion in
the mind of the patient that she is afflicted with any such morbid
condition. There is local inflammation, and the mouth of the uterus is
uneven, rough, and granular. If an examination be made with the
speculum, the mouth of the uterus is often found in the condition
represented in Fig. 22, Colored Plate IV.

Figs 15 and 16 represent two different forms of specula. The one
represented by Fig. 15 consists of a tube of glass coated with
quicksilver and covered with India rubber, which is thoroughly
varnished. That represented by Fig. 18 is made of metal and plated. By
using one of these instruments, the condition of the mouth of the womb
can be distinctly seen.

[Illustration: Fig. 16.
An Expanding Uterine Speculum.]

FOLLICULAR ULCER. When the mucous follicles of the neck of the uterus
are inflamed they enlarge and become filled with a fluid having the
color and consistency of honey, presenting the appearance illustrated by
Fig. 25, Colored Plato IV. This secretion, because of the presence of
the Inflammation, is not discharged. The follicles, therefore, continue
to enlarge until they burst, and we then see in their place the red,
elevated, angry-looking eminence, which is called a _follicular ulcer_.

SYMPTOMS. The severity of the symptoms depends upon the character of the
ulceration. It may be simple or associated with purulent leucorrhea and
hemorrhage. If ulceration be slight and local, few symptoms will be
present; but if it be associated with uterine debility, congestion and
inflammation of the mucous membrane of the uterus, the discharge will be
profuse, and there will be fixed pain in the back and loins, a
bearing-down sensation, and great difficulty in walking. The discharge
is weakening, as it impoverishes the blood, and thus reduces the
strength.

CAUSES. Ulceration may be induced by any thing that excites inflammation
of the lining membrane of the mouth and neck of the uterus. The use of
pessaries, excessive sexual indulg