Pathological Anatomy.—While most authorities ag,ree in their descrip tion of the anatomy of the catarrhal changes in the vagina as regards their macroscopic relations, and the clinical pictures correspond, there are but few and those varying reports as to the microscopic findings. We will refer at length to C. Ruge's important work, which is the first detailed anatomical investigation of vaginal inflammation.
Ruge divides vaginal inflammation into three forms: 1. Kolpitis granularis, which he takes as the type of vaginal inflamma tion; 2, simple kolpitis; and, 3, the lcolpitis of old women. The first two vary as they occur as acute or as chronic processes. Ruge thus describes the development of the changes of kolpitis granularis In consequence of the irritant which causes the inflammation, the entire epithelial layer is thickened, the increase being especially marked in the deeper layers. The proliferating layer, which in carmine stained sections colors more deeply than does the older tissue, may equal half the entire thickness of the stratum, and more. The papilla are enlarged. the broader and higher ones often reaching up almost to the surface. In the epithelium there form pretty distinctly limited groups of small-celled elements, which wedge themselves in between' the straight ascending ves sels. This gives the tissue an adenoid appearance. Over these inflamma tory infiltrations of the sub-papillary tissue, the epithelium is thinned out. Two processes can be noted in the papilla: 1. At one place the papilla are larger and broader, and approach nearer the surface, and the epithelial processes which originally separated them become thinner. The papilla themselves become thicker, but less promi nent; finally, the papilla3 coalesce, and the granulum consists only of a thin epithelial coating with inflammatory and infiltrated tissue lying below it.
2. As the tissue stretches the papilla3 become larger and broader; the epithelial processes do not disappear; but they become thin and look like arcades supporting the epithelial layer. The epithelium over the granu lum is changed also. The larger epithelial cells become smaller, the thin epithelial covering over the granula looks like granulation tissue, and can hardly be distinguished from the structures lying beneath it. The ves sels of the subjacent tissues are turgid with blood, and are increased in number. The appearance of follicle formation is deceptive; kolpitis granularis is not k. follicularis, nor papillaris. There is simply a sub
papillary, or sub-epidermoidal inflammation, accompanied by change in the epithelium and the papillEe.
A similar state of things prevails in the chronic form of kolpitis granu laris, in a case which occurred from the long-continued wearing of a pessary. There were the same alterations, but the epithelium over the granular layer was less changed and thinned, and the tissue below it con tained comparatively few nuclei. The thickened stratum of epithelium between the projections was pigmented, and of a sepia color in its lower strata.
During the healing process the changes occur in the reverse order. As the swelling of the sub-epithelial tissue and the inflammatory infiltration disappear, the epithelial processes grow larger and broader, until papilke and processes attain their original size.
In simple kolpitis the surface of the layer of pavement epithelium is smooth, but it is irregularly thick in various places. Where it is thinner the papillEe are enlarged, and the tissue beneath it shows a small-celled infiltration. The proliferation is confined to the epithelial layer, and thus kolpitis granularis is only distinguished from kolpitis simplex by the extent of the process.
In the chronic form the proliferation is small in amount, and there is pigmentation of the lowest layers. Here again there is no question of follicular or papillary kolpitis, nor of erosions, ulcerations, etc.
In the vaginal inflammation of old women there are seen larger or smaller confluent spots, which often project above the surface. There occur many transitional forms, from simple ecchymoses to flat elevations, which often contain a central softened, eroded, or ulcerated defect. The color of the spots is never so vivid as in kolpitisgranularis; there are often adhesions of the vaginal walls, which, however, are easily broken through with the finger. The entire epithelial layer is thinned out. The spots correspond to circumscribed and often extensive and deep cellular infiltra tions, which appear to lie directly on the surface. There is no trace of epithelium. Leaving out the changes incidental to old age, this corre sponds in general to the a,natomy of kolpitis granularis, save as to the great tendency to adhesion, and even to obliteration of the vagina.