Far more infrequent than the catarrhal are the exudative inflamma tions of the vagina.
Paginate Diphtheritica.—Croupous and diphtheritic changes in the vaginal mucous membrane have been frequently noticed since Rokitansky called attention to them, although the identity of the process with that in the pharynx and the larynx, has only been settled in the minority of case& Klebs, who admits the occurrence of true croup in intense inflammations of the vaginal mucous membrane, describes further, as diphtheritic, the changes which are Been in lacerations at the introitus in puerperre; the dirty yellow, adherent layer, which frequently remains unchanged for some time, and again is said to give way to purulent and granulation changes, or else becomes the seat of suppuration. In secondary diphthe ria, which developes in the course of acute infectious diseases, cholera, variola, scarlatina, measles, the vaginal mucous membrane, according to Klebs, is reddened, ecchymosed, and on its surface there are generally, in groups, small elevations, grayish-yellow in color; the supeAcial layer necroses, and is shed in patches, or later in large pieces, and is then usu ally described as croup. Schroeder calls attention to the fact, that in addition to the extensive croupous and diphtheritic processes seen in puerperal women, and also after gonorrhce,a and in the course of acute infectious diseases, we often find whitish, more or less adherent layers as the result of some local traumatism (irritation by purulent secretion, fistulaz, etc.) In case of the general diphtheria accompanying acute in fectious diseases, the swelling in the vagina attains the highest grade, so that, as in a case seen by Schroeder, the recto-vaginal septum may form a thick tumor, and the vaginal folds and the cervix may be so swollen that the finger cannot reach beyond the -cervix. On the mucous membrane are found white and green diphtheritic membranes, and there exists a foul, purulent discharge. Occasionally the cervix is implicated, extension taking place to the cervical mucous membrane which is greatly swollen.
Vaginitis Dysenterica..—Klebs describes similar dysenteric changes as occur in chronic dysentery. Eppinger, Lster, examined twelve c,ases, and described the affection as a dysentery of the vagina (kolpitis dysen terica). In all the cases there existed dysentery of the large intestine, and the process was supposed to extend into the vagina owing to patency of its orifice, or narrowness of the perineum.
The microscopic changes were most marked at the introitns, that is to say, at the end of the ant. and post. columna. Flat, or irregularly formed ulcers, or spots of superficial necrosis with greatly injected base are found in various places. Loose, flocculent masses of exudation are on the ulcers. Spread out over the folds small yellowish spots are found which are par tially adherent, and, again, may readily be removed. Eppinger considers these spots as the beginning of the disease, the catarrhal stage, and in the further development they change into necrotic patches, grayish-yellow. in color, of varying depth, with sharp hemorrhagic demarcation. Through partial shedding of the slough there results loss of substance, extensive ulcers. between which are islets of mucous membrane. Microscopically, the patches are seen to consist of broken-down portions of the epithelial layer. Between the patches are colonies of micrococci in connection with similar ones in the sub-epithelial layer. It regularly happens that large portions of the epithelium in their entire thickness are lifted up by these masses of cocci, and there remain ulcerated patches entirely de prived of epithelium, from the base of which the denuded papillre pro ject, which are also covered with micrococci. In certain parts Eppinger was also able to detect the extension of the micrococci deeply down along the papillte. These micrococci were not carefully examined by culture experiments; but Eppinger states that they were never grouped together in cylinders, but were irregularly distributed, and that they were larger and paler than septic cocci, single individuals possessing the power of motion.