TFIE INFLAMMATORY AFFECTIONS OF THE VAGINA.
Various circumstances, which have been, and still are, active, suffice to explain our slow rate of progress in this field. Even the minuter structure of the healthy vagina, and the occurrence of glands and lymphatic follicles in it, are subjects which yet occupy anatomical investigation. In addition to this, suitable material is difficult to obtain, and portions of tissue excised during life, such as C. Ruge used so much and so successfully, are at the disposal of but very few investigators. Hence but very few anatomists have worked upon this sub ject; and all the more recent and exhaustive work in it has been done by C. Ruge and H. Eppinger.
Since their time, however, our knowledge of several infectious diseases has been much extended by Neisser, Fehleisen, and others upon the basis of Koch's method; and histological investigation has been enriched by many technical discoveries. Hence the task of the anatomical inves tigation of vaginal diseases has been enlarged, and the material at our disposal needs revision in more than one respect. For one of the most important of the infectious diseases of the female vagina, gonorrhalal catarrh, this has been done by E. Bumm in his studies upon the gonococcus. H. Chiari also has investigated the relations of vaginal air-cysts with the improved methods, and has reached new results. But a number of very important questions still remain unanswered in this field; and we are not in the possession of an undisputed anatomical basis for inflammatory and infectious vaginal diseases. Therefore in their description and classifica tion we will for the present adopt a clinical standard, and consider the pathologico-anatomical data separately.
The inflammatory diseases of the vagina usually affect the mucous membrane (vaginitis), the deeper layers of the vaginal walls being but infrequently and subordinately involved. In exceptional cases they chiefly affect the peri-vaginal connective-tissue layers (peri-vaginitis.) Vaginitis most commonly appears' as a catarrhal inflammation. It is seen in various forms according to its cause, to the extent and duration of the process, and to the condition of the vaginal mucous membrane as regards evolution or involution (gravidity, puerperium, senility); but it may also be exudative, croupous, diphtheritic, etc.
Since Rokitansky' this has been the usual division of vaginal inflamma tions. It is not quite an accurate one, since transition-forms occur, and there is an etiological relationship between the two. But we have retained it because it enables us to classify the different forms of iffflammation, and because there are clinically a number of important differences between the groups.
In general the first includes the milder, and the second the severer in flammations. In catarrhal vaginitis we do not have the coagulable exu dation and the superficial tissue necrosis which is the rule in the exudative form. The latter are regularly the more severe, and are usually found conjointly with infective diseases springing from other organs. The exudative inflammations much more commonly than the catarrhal lead to ulceration, and the ulceration may affect an extent of surface and reach a depth such as is never seen in the catarrhal forms.
The catarrhal inflammations include all those forms in which there is aecreted a pathological, pus-containing mucoid fluid, and in which the inflammatory tissue changes (small-celled infiltration and proliferation) aro confined to the superficial layer of the mucous membrane (the papil lary bodies and their neighborhood, with the glands and follicles). Thus not only do the simple and virulent catarrhs in sensu strictori, but also the forms described as vaginitis glandularis, follicularis, miliaris, and papillaris, belong here.
Remarks.—In several recent treatises upon vaginal inflammations there is no mention made of catarrh, but only of the changes of vaginitis. (Ruge, Schroeder.) Much stress is laid upon the similarity in structure of the vaginal mucous membrane and the integument; it being claimed that from its want of glandular structures, its papillary surface, and its layers of epithelium, it resembles the skin much more than the mucous membranes. Bumm has lately reached the same conclusion, aa have Eppinger and Fritsch. I hold that in spite of this analogy, we cannot clinically dispense with the idea of catarrh. It marks, as Virchow in an other connection has again reminded us,' as its etymology (xarat;cw) shows, the chief symptom, the flow, and enables us to group together the various forms of inflammation known as vaginal leucorrhoea, blenorrhcea, and pyorrhwa.