Eppinger has also made a series of careful investigations into the patho logical anatomy of vaginal affections, and describes as kolpitis miliaria and vesiculosa forms which belong here.
Both are characterized by the occurrence of multiple, round, sharply limited exudation masses, which in certain stages of retrogression become ulcers, and appear as grayish spots to the naked eye.' The difference consists in that in kolpitis miliaria the exudate is cellular and partly inter stitial; while in kolpitis vesiculosa it is serous, and collects between the epithelium and the sub-epithelial tissue to form a vesicle.' In both forms Eppinger noticed vertical and strongly injected vessels at the base of the inflammation, which were surrounded by a large number of proliferated cells. Eppinger did not observe that the papilhe participated much in the inflammatory changes; but for the rest his description coincides in all essentials with that of Ruge.
We may here mention the connection which Eppinger has proven be tween the sub-epithelial inflammatory infiltration and the pigmented gray spots in the vaginal mucous membrane. These latter were first described by Haller,' and have since been repeatedly supposed to be glandular struc tures.' But they are pathological in their origin, and begin as promi nent, knot-like, superficial, cellular centres of infiltration (milia, granula), whose protruded epithelial covering often gives way, and forms the well known central opening which has been so often supposed to be the duct of the gland; the surrounding pigmentary layer being supposed to depend upon circulatory disturbances. The conception of the Hallerian spots as sub-epithelial round-celled infiltrations is one which approaches the idea of.the granula being a lymphatic follicle-like body, and the process a folli cular vaginitis. This is important for our understanding of other c,ondi bons, such as the formation of gas cysts.
Etiology of Catarrhal Inflammation. As Blebs correctly claims, we must first learn to distinguish the physiological changes which the vaginal mucous membrane undergoes in menstruation and gestation, and in the puerperal period, from those which are due to catarrh. They are appar
ently alike. We must do the same with simple hypersecretion, occur ring either from mechanical disturbances of circulation (stasis) or from general disturbances of nutrition, (chronic anmnia, chlorosis, etc.) In the first set the clinical symptoms are not always sufficient for differ entiation; and we must then decide from the connection between them and certain phases of the physiological function. Simple hypersecretion has only a few characters in common with catarrhal inflammation of the vaginal canal, such as increase of secretion, swelling of the mucous mem brane, and blood stasis. So long as there is no qualitative changes in the secretion, and none of the alterations in the surface of the mucous mem brane, which are characteristic of inflammation, have occurred, we must diride the two. But both the physiological changes and the hyper-secre tion predispose to catarrh, since they seem to lead to diminish resisting power of the mucous membrane to irritants.
Bumm's observation is of. interest in this connection. He found that the puerperium caused an extremely abundant proliferation of gonococci, even in cases where the phenomena of gonorrhcea had sunk quite into the background. Bumm also ascertained the astonishing fact, that gonor rhom practically never occurs primarily in the vagina, but usually spreads thence from the cervix, or more rarely from the urethra. He claims that the stratified pavement epithelium forma so gad a protecting tissue that the gonococci cannot affect an entrance unless changes which render the more delicate layers accessible, have first occurred. On the other hand the mucous membranes covered with cjdindrical epithelium, such as that of the cervix, are not so resistant.
It may be said in general of catarrhal inflammations of the vagina, that they are all caused by irritants which either come from without, or from neighboring organs. Such are mechanical irritants (injuries, foreign bodies), thermic irritants (burns, cold), chemical irritants (cauterization), and infectious irritants (gonorrhceal contagion).