When extensive ulceration is known to exist in the vagina, the case should be examined from time to time until the ulcers have healed, so that the exact condition can be determined and the proper steps taken, if necessary, to pre vent stenosis. When caustics are to be used in the vagina, the healthy portion of the mucous membrane should be pro tected by vaselin, only cauterizing that portion which is absolutely in need of it. When a tumor has been removed from the vagina, or other operation done, where a section has been removed, the case should be examined after healing is complete, to ascertain the condition and extent of the cicatricial tissue. Lacerations of the vagina occurring dur ing labor should be closed immediately, if possible. F. D. Thompson (Hot Springs Med. Jour., Jan. 15, '96).
Infectious Vaginitis.
If the inflammatory condition has an infectious origin, the causes may be varied and distinct. There are few germs or microbes which normally find their habitat in the vagina. An acid mucus, the normal secretion of its mu cous membrane, acts as an effectual septic barrier, in many cases, to the at tacks of microbes; otherwise the mor bidity of this organ would be even much greater than it is. The following varie ties of infections vaginitis are well recog nized:— Gonorrhoeal.
1. Venereal Chancroidal. { Syphilitic.
2. Tuberculous.
3. Diphtheritic.
4. Puerperal.
5. Eczematous. This classification, it will be observed, is not very dissimilar to that hereinafter suggested for infectious vulvitis. Venereal Vaginitis.
Symptoms and Etiology.—Gonorrhmal infection of the vagina has been care fully investigated since Niiggerath pub lished his epoch-making paper in 1869, and the subsequent discovery, by Neis ser, of the gonococcus. The infection is seldom limited to the vagina, the dis turbance being shared by the vulva and uterus, and not infrequently by the uter ine appendages and the peritoneum. It may be acute or chronic, and repeated acute attacks are not unusual. The symptoms may begin within twenty-four hours of the reception of the infectious material, or they may be deferred for five or six days. The disease is usually the result of coitus, but it is sometimes clue to soiled towels, instruments, or fingers. No age is exempt from it, but it is most common with women from twenty to thirty years of age, when the tissues have their greatest activity and vitality. It rapidly spreads from the point of infection to the contiguous epi thelium, until the entire vagina may be involved. There may be infiltration of the subepithelial structures, but the epi thelium and the superficial vessels are chiefly involved. Congestion, pain, and swelling are noteworthy, but there may be little constitutional disturbance. The mucous membrane is dry for two or three days and bleeds readily; then there is a purulent discharge for several clays and the severe symptoms gradually subside.
Treatment.—Rest in bed and alkaline diuretics, as:— Soda; benzoat., .5 drachms. Fl. ext. buchu, 4 drachms.
Tinct. hvoscvami, .5 drachms.
Aq. gaultherife, ad 4 ounces.
M. Sig.: Teaspoonful in water after meals.
Saline cathartics (Congress water, fInnyadi, or Pubinat, a glass before breakfast) are also indicated.
Local applications are very painful, and should be deferred until the dis charge begins to flow. A well-lubricated speculum should then be carefully intro duced into the vagina and opened as freely as the painful condition will per mit. The entire mucous membrane may then be gently swabbed with a 10-per cent. solution of nitrate of silver or a 2-per-cent. solution of protargol. This should be repeated daily as long as the discharge persists. Excessive or meddle some treatment will intensify the symp toms, and it is better to wait for the sub sidence of the acute stage than be over zealous and inflict great pain. It is hardly necessary to say that the instru ments and the hands of the physician must be rigorously cleansed after treat ing such a case. Chancroidal and syph ilitic vaginitis usually mean the charac teristic sores or ulcers upon the vaginal mucous membrane. It may be difficult to differentiate them, as there may be only a mucous patch or superficial ulcer, which will often be found near the en trance of the vagina. Whether the dis ease is local or constitutional will usually be determined by other symptoms. Nothing better can be suggested than cleanliness and the use of nitrate-of-sil ver solution for the healing of these sores, but the walls of the vagina can be kept apart with a tampon of cotton wool moistened with a 2-per-cent. solu tion of ichthyol in glycerin. Pouches with hot creolin solution (1 or 2 per cent.) may also be used morning and evening.
Protargol recommended as a local rem edy for vulvo-vaginitis in children. The strength of solution indicated depends on the degree of inflammation and other cir cumstanees, but 2 per cent, in gonorrhoeal cases and I per cent. in others represent good guides as to dilution. For very sen sitive mucous membranes a weaker solu tion may be necessary. The pus is first wiped from the orifice of the vagina, which is then gently syringed with a 5-per-cent. solution of sodium bicarbonate until no more pus can he washed out. From to 1 ounce of the protargol so lution is then introduced by means of a syringe and soft-rubber catheter, and is retained in the vagina about five min utes. This process is repeated from three to five times daily. H. B. Sheffield (N. Y. Med. Jour., lxxii, p. 189, 1900).