Tfie Inflammatory Affections of the Vagina

vaginal, decomposition, secretion, vaginitis, circulatory, tissue, stagnating and membrane

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By one or other of these irritants, in the last case by the passage of the pathogenic coccus into the sub-epithelial tissue at points of less resistance, reactive circulatory disturbances with increased secretion and abundant leucocytic emigration are set up. The effect is in all cases at first one and the same. The circulatory disturbances, however, soon subside, unless the source of irritation continues active.

This does seem to occur as a rule because decomposition processes go on at the primarily injured spot or in the secretions. We do not know the exact nature of the irritants which are thus produced; but we think that those of an infectious nature take the greater part in the process, penetrating into the tissue of the mucous membrane in various places, and keeping up circulatory disturbances by their presence and prolifera tion. This is proven by the fact that when decomposition processes are prevented by disinfection and the removal of the stagnating secretion, the effects of moderately severe traumata soon pass away, foreign bodies become healed in, or, as we see with pessaries, cause no catarrh; and cau terization with ferrnm candens, the most violent thermic irritant, only causes an eschar and a very temporary swelling of the neighboring tissues, just as does a localized chemical cauterization. On the other band, vagi nitis catarrhalis occurs with certainty in all these cases where the neglect of antiseptic precautions leads to the decomposition of injured portions of tissue and of the stagnating secretion& And the various decomposable foreign bodies which reach the vagina from the uterus, as well as stagnating vaginal secretions, blood-clots, etc, all lead to vaginitis, since contact with the external air offers specially favorable conditions for the reneption and proliferation of the micro organisms concerned in decomposition. Hence the frequent connection between catarrhs and menstruation and the puerperium.

As to the point of origin of the inflammatory process, the vaginal mucous membrane may be primarily affected, or it may originate from neighboring organs or tissues. The function of the vagins„ as the organ of conception, gives rise to many occasions for the action of inflammatory irritants; while its communication with the open vulva, even apart from the chances of sexual intercourse, exposes it to the influence of external irritants, which it is especially prone to react against when circulatory disturbances (stasis, status menstrualis or puerperalis, descensus) are present. Gaping of the introitus is of importance. Primary ulceration,

and disintegrating vaginal new growths, may also form the starting-points of catarrh, as may finally the various therapeutic measures which expose the vaginal mucous membrane to irritation.

The influence of neighboring organs is of much importance for the etiology of catarrhal vaginitis. From the uterus especially may come the cause of the catarrh process. Decomposing or infectious secretions may flow out of it (in endometritis, carcinoma, and cervical gonorrhcea), as may blood, lochial and menstrual discharges. Schultze has correctly claimed that the &composition of the stagnating scanty menstrual blood, mixed with vaginal mucus, which occurs behind the narrow hymenal ring in chlorotic girls, is not infrequently the cause of vaginal catarrh. Then again polypoid tumors originating from the uterus may lie partially in the vagina, and cause retention of secretion; or the uterine tumor may disintegrate superficially, and lead thus to decomposition of the secretions. Finally, inflammatory processes which were primary in the cervical canal or the portio vag. may spread to the vaginal mucosa.

In contradistinction to the last-mentioned descending catarrhs, there are others which ascend from the primarily affected vulva. The vulvo vaginitis of children, with cases of gonorrhcea of vestibule and urethra, and those due to labial exanthemata, belong here.

In the rectum also, and in the bladder, may the conditions causing vaginitis originate. The rectal contents may reach the vagina through fistuke and perineal ruptures. And without any solution of continuity, oxyurides may reach the vagina by tra,versing perineum and labia, and infiltrations of the septum recto.vaginale may set up inflammatory changes in the vaginal mucous membrane. The same is true of the blad der, though the passage of undecomposed urine through the vagina is far less irritating than the passage of rectal contents. Fistulous communica tions of the vagina with abscesses of the pelvic connective tissue, with extra-uterine fcetal sacs, with incised or punctured pelvic cysts, lead the more regularly to catarrhal vaginitis the. more putrid the secretion and the less care is bestowed upon its removal and upon vaginal disinfection.

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