TUBERCULOSIS OF THE VAGINA.
Tuberculosis of the vagina is of peculiar interest, not so much on ac count of its rarity as bee,ause of the fact that it has been usually noted as secondary to advanced tubercular processes elsewhere. I find but a single brief reported case (II. Thompson) in which the reporter found cheesy masses in the vagina, which he considered the starting-point of general tuberculosis. Although I do not consider the fact proved in the case, it is still worthy of record: A previously healthy girl of 15, who had never menstruated, died of an obscure affection of five days' duration, charac terized by elevation of temperature, anxiety, livid coloration. At the autopsy miliary nodules were found in the lungs, on the diaphragm, and in the capsule of the liver. In the liver, spleen, and kidneys were large nodules, partially caseous, and the same at the base of the bladder and in the fossa sylvii. The hymen entirely closed the vagina, which was dilated into a sack in which was about 1* pounds of semi-fluid, grumous, foul substance, consisting of retained, decomposed menstrual blood. The
cervix and the os uteri were covered with numerous miliary tubercles.
Tuberculosis of the vagina is not always, as Klebs Ims claimed, the result of extension of tubercle from the uterus. In Virchow's, Weigert's, Klob's, and Kasewarowa's cases the uterus was not affected. In such in stances tuberculosis of some other of the pelvic organs is never lacking; the urinary organs, the intestines, the peritoneum, are more or less af fected. In a case of cheesy degeneration of an ovarian cyst in au old woman, I personally saw a tubercular ulcer on the posterior wall of the vagina in the fornix. Tubercles in the vagina appear as small gray nodules arranged in groups on a reddened base, thickest in the middle of the vagina and in the fornices (Virchow), or else as larger elevated patches with cheesy, eaten-out base and steep edges (Weigert). In all the cases since Koch's discovery the tubercle bacilli were found.
In so far as treatment is to be effective further observations must show. Iodoform should at the present head the list of agents.
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