Tuberculous Vaginitis.
Symptoms.—The character of the dis ease is that which is peculiar to miliary tubercle upon mucous membranes in general, the tubercle being a localized lenticular mass varying in size from a pin's head to a pea, slightly raised above the surface, grayish in color, quickly breaking down and forming a ragged ulcer with infiltrated walls, neighboring ulcers frequently coalescing and showing slight tendency to heal. There may be only a small number of tubercles or the vagina may be studded with them. They are painful to the touch, secrete a sani ous discharge, which excoriates tissues with which it is brought in contact, and should be differentiated from the ulcer ative lesions of venereal vaginitis. Acute local symptoms are usually wanting. The many avenues for transmission of the tubercle bacillus from the vagina to other parts must not be forgotten, nor the ease with which general infection may follow the local one in the vagina.
Etiology.—This is one of the rarest forms of tubercular disease, lint its existence is affirmed by competent au thority. It is rarely an isolated process, being usually an element in dissemi nated tubercular infection. It may be communicated during coitus from a tuberculous ulceration of the penis.
Treatment.—The treatment must be both constitutional and local, the former embracing such means as are usually ad ministered in tuberculosis, iron, oxygen, creasote, codliver-oil, alcohol, and an abundance of nourishing• food; the lat ter consisting in cleanliness, creolin douches (1 or 2 per cent.) twice daily, and local applications of a 10-per-cent. solution of nitrate of silver or of the mineral acids in moderate strength. The object of the local applications, it must be remembered, is to stimulate the tis sues to healthy activity, and to prevent spreading of the ulcerative process, not to cauterize the tissues.
Diphtheritic Vaginitis.
Symptoms and Etiology.—This condi tion implies the deposit of an exudate and the formation of a fibrinous false membrane, as in the similar process upon a mucous membrane in any other part of the body. This membrane
is a grayish, sloughy formation similar to that which is so frequently seen in the pharynx. Its development is attended with the usual symptoms of acute inflam mation, and forcible treatment of it will be attended with pain and haemorrhage. It may occur either in children or in adults. It has been observed in connec tion with pharyngeal diphtheria, with the eruptive fevers, and with puerperal septicemia. It is a symptom of grave importance whatever its associations may be, for it indicates a septic condi tion which is usually profound and gen eral.
constitutional treat ment must be that of the disease of which the vaginitis forms but a part. It must be supporting and tonic, and may include iron in an assimilable form (Blaud's pills, the peptomanganate, tincture of the chloride, etc.), strych nine, quinine (the elixir of iron, quinine, and strychnine is a useful combination), milk, and nourishing broths. Alcohol (whisky, port, sherry, or champagne) is usually indicated, both for its stimu lating and its antiseptic effects. The value of alcohol in these depressing, toxic conditions can hardly be overesti mated. For local treatment little should be attempted beyond perfect cleanliness. When the membrane begins to disin tegrate or exfoliate, it should be gently removed with dressing-forceps, and hot antiseptic douches (creolin, 2 per cent., at a temperature of about 100° F.) should be given twice daily as the con ditions warrant.
Puerperal Vaginitis.
Symptoms and Etiology.—This condi tion, which forms a part of the diseased puerperal condition formerly known as puerperal fever, may include the condi tion which has previously been described, though puerperal vaginitis is not neces sarily—indeed, is not usually—diphthe ritic.
It may occur to puerperal women of any age or social grade, to rich or poor. In surroundings which are manifestly dirty and with doctors or midwives who are plainly careless or neglectful it is most frequently encountered, but it sometimes occurs when the precautions on the part of doctor and nurse have been most rigid and complete.