Symptoms and Course.—All exudative inflammations of the vagina, whether they are diphtheritic, due to sepsis, or else complications of in fectious diseases localized elsewhere, such as cholera, typhus, the acute exanthemata, erysipelas, dysentery, are associated with high fever. The local symptoms are generally slight. When the patients have not a pro fuse purulent discharge with necrosed masses, they complain of ischuria and of burning in the region of the pubes. In case of diphtheria of the vagina, Schroeder mentions pain in the pelvis, bearing down pains, vagi nismus and painful defecation, as the symptoms, and he has exceptionally noted more marked symptoms in case of more intense and extensive in flammatory swelling.
The less marked the local symptoms the less likely is the physician to make a vaginal examination whereby the diagnosis can alone lie reached. This is probably the reason why the number of clinical observations of these affections, where the anatomical changes are described, are few.
Even in case of puerperal sepsis the vagina in general practice is rarely examined with the speculum, although it is essential to seek for the source of the infection in the genital tract. The more likely hence that an exudative inflammation of the vagina, dependent on some other infec tious process, should be frequently overlooked.
The course and the prognosis of these complications may be modified, however, in cases of medium severity by appropriate treatment, and overlooking the inflammatory process may inflict much damage on the patient. When the process is left to itself, it changes into more or less
extensive ulceration, which may lead to atresia and union of the vaginal walls. Under bad local conditions the tissue may necrose, and abscesses in the pelvic cellular tissue may form, which may seriously imperil life.
The treatment of all these forms consists especially in the use of disin fectants. The more deeply the infectious agent has penetrated into the tissues, the more essential it is that the disinfection should not alone consist in occasional injections, but that agents should be used which will thoroughly change the ulcerated surfaces, and prevent the growth and the extension of the infectious agent. Strong caustics are not appropri ate, since they themselves act as strong irritants. Our results in cases of septic vaginitis lead us to favor tincture of iodine, which we either paint over the surfaces, or else in severe septic vaginitis 'pour through a specu lum. The stronger solutions of permanganate of pot,ass have also proved serviceable.
It is of advantage, especially in septic inflammations, to insuffiate iodo form in order to guard against, for as long as possible, decomposition of the secretion. As to whether one or another disinfectant is preferable in the treatment of diphtheria aud other forms, has not been as yet es tablished.