In case of catarrhal vaginitis the use of tampons covered with one or another ointment is favored by many. Hildebrandt Eidvocates, in case of chronic catarrh, tampons covered with an ointment composed of five parts of alum and thirty parts of lard, and also the glycerin tampon; Terillon and Auvard inject directly a salve composed of vaseline, 150 parts, starch, 150 parts, tannin, 30 parts. Suppositories are also recom mended, generally made from butyr-cacao mixed with equal parts of ung. emolliens to render them less brittle. Iodoform is used in capsules with a few drops of glycerin. Where salves and suppositories are not held in situ by tampons, they readily fall out and necessitate rest on the part of the patient. They are especially valuable where the tampon and irri gation cannot be used, as where the introitus is very narrow and sensitive (in children and in virgins.) While we have spoken of the disinfecting methods which are of the greatest value in the treatment of vaginal catarrh, we have often noticed the therapeutic effect on the tissues, whereby, in a measure, disinfection is accomplished through changes in the abode of.the carriers of infection. Aside from this latter action, it may be necessary to expedite the cure by applications which lead to regeneration of the epithelium, which increase the muscular tone, and which control the circulatory and secretory dis turbances. Local changes in the mucous membrane affected by chronic catarrh require such treatment. Thus papillary excrescences can not always be caused to disappear without excision and cauterization, although they often yield to the dry treatment, thus also do erosions of great ex tent heal more quickly by applications of wood vinegar, which, as Hoff meier has pointed out in case of erosions of the cervix, favors the regener ation of the epithelium; further still; astringents of various sorts, when not used too long, unquestionably exert a good effect on the relaxation and hypersecretion of the mucous membrane.
Thus then, if we do not at the outset grant that these agents combined with the former have au anti-bacterial action, do we pass from the disin fectants to the astringents.
Vaginitis Exfoliativa. —In connection with the catarrhal inflammations we will speak of the rare affection. vaginitis exfoliativa, where, periodi cally, accompanied by dysmenorrhtea, epithelial membranes are cast from the vagina. Since Arthur Farre recorded the first instance of this affec tion, many writers have noted the simultaneous expulsion of dysmenor rhseal membranes from the uterus. In the last recorded ease, the membrane wa,s also expelled at longer or shorter intervals in the inter menstrtial periods, although most frequently coincidently with menstru ation. (Tyler Smith.) The vaginal inucous membrane generally shows catarrhal changes, such as congestion, loosening, and hypersecretion, which, true enough, cannot always be differentiated from similar menstrual phenomena. Cohnstein witnessed an instance, and, from a study of the literature, came to the conclusion that exfoliative vaginitia was etiologically connected with uterine membranous dysmonorrluea, and found that both processes were generally excited by general, rather than by local, disturbances, that is to say, by hysteria. Since local treatment
is unavailing, Cohnstein recommended agents directed towards hysteria, in particular, the bromide of potass. In regard to diagnosis, we must differentiate from epithelial membranes the result of sloughing not infre quently following the use of alum. Other superficial sloughs, like those caused by nitrate of silver, sesquichloride of iron, etc., may be more readily distinguished.
I have never had an opportunity to see a case of exfoliative vaginitis, but I can prove the causal connection between hysteria and severe vascular disturbances in the mucous membrane, which Cohnstein claims is the factor in vaginitis exfoliativa, by the relation of the following case: Since 3878, that is to say, for seven years, I have known a woman, of middle age, who from childhood up has been subject to varied hysterical manifestations. Since her last delivery, the fourth, she has suffered from leucorrhcea and profuse menstruation. The hysterical symptoms were more marked, and she complained in addition of nervous dyspepsia, cardialgia, and supra-orbital neuralgia. She was inclined to corpulency, was antemic, and had a tendency to diarrhcea. The thoracic and abdomi nal organs were sound, the kidneys, as well. The uterus was slightly enlarged. relaxed, rctroposed and anteflexed, movable; the anterior lip of the cervix was hypertrophic. On the vaginal surface reaching to the external os, was an atonic, sharply-demarcated; grayish-white erosion, and tbe cervix secreted a profuse white mucus. The vagina and the pos terior lip of the cervix, beyond slight injection, were normal. The uterine adnexa were not enlarged. The erosion did not yield to the orlinary method of treatment. In 1879 I excised the eroded lip and closed the wound with silver sutures. Union by first intention occurred, and for awhile the general symptoms were bettered. But soon the erosion recurred on the posterior lip, and although it was immediat,ely excised, the former result was not obtained. Dr. Wilhelm Fischel examined the excised portion and pronounced it to be an ordinary ulcer. The erosion thence quickly spread over the posterior vaginal wall, and in addition there were present isolated, sharply circ,umscribed white spots on the mucous mem brane, very vascular. These spots were dry and smooth; they felt soft, and their neighborhood was no more swollen or injected than the rest of the vaginal mucous membrane. There existed profuse secretion and great hypertesthesii on examination. Menstruation was more profuse and irregular, and the anEemia was, in consequence, intensified. The appe tite failed, the diarrhoea increased, the spasms recurred more frequently. The woman suffered from attacks of oppression and from fainting fits, from great muscular weakness; later the ingainal glands enlarged and became painful, and a crop of furuncles broke out. Frequently ephemeral fever was noted, which was not always associated with the appearance of the furuncles.