The infecting material may be re ceived in the vagina itself or in the vulva or uterus, the infection extending to the vagina. It may be the streptococcus or the mixed streptococcus and staphylo coccus, or organisms of lower virulence. The local vaginal symptoms may not be acute, for the disease is seldom limited to the vagina, or there may be the symp toms of an ordinary infectious vaginitis which have been noted in the foregoing pages.
treatment is such as would be appropriate with diphtheritic vaginitis, and need not be repeated. Cleanliness and antiseptic douches are the chief measures for reliance. Apart from these, the vitality of the patient will determine whether the progress of the disease and its outcome will be favor able or unfavorable.
Eczematous Vaginitis.
Symptoms.—It runs no well-defined course, its most noteworthy symptom being an acrid watery discharge, which excoriates the skin of the external geni tals, causing great distress and annoy ance from persistent itching. The itch ing may extend to the vulva and peri neum; the vaginal mucous membrane may be swollen, sensitive, and congested. and attempts to relieve it by friction often intensify the irritation. Constant rubbing will sometimes produce great annoyance from the provoking of sexual feeling, and this is the more regrettable because of its inappropriateness in those who are of mature or advanced years.
The discharge and irritation may ex tend to the mucous membrane of the uterine canal, in which case the treat ment must include that organ.
Etiology.—Eczematous vaginitis rarely occurs except in women who have passed the menopause. It has often been de scribed under the nomenclature of senile vaginitis. It is almost invariably asso ciated with eczema of the vulva. which is hereinafter considered.
The cause. so far as I can ascertain, has not yet been detected, though it is probably a vegetable germ. In my ex perience it is quite a common disease and has been observed the more fre quently among those who are not over particular in their personal habits.
Treatment.—Treatment should consist in careful cleansing of the vagina with 10-per-cent. solution of nitrate of silver applied upon a swab of absorbent cotton to every portion of the mucous membrane.
An ample tampon of cotton-wool moist ened with the paste of glycerin and bis muth (mentioned in connection with dis eases of the vulva) should then be placed in the vagina, the relief being almost al ways definite and satisfactory. The ap plications must be made daily until the congestion and discharge have entirely ceased, and sedative and astringent douches should be used daily before the tampon is renewed. In case the consti tutional symptoms in a given case are severe it would, of course, be inappro priate to carry out the local treatment with regularity. Common sense must be the guide, and, if the disturbances caused by local interference were likely to be greater than the advantages to be gained, the former should stand aside for the time.
Leucorrhcea.
• There is scarcely any morbid condi tion from which women suffer which is more common than leucorrhcea. By this term is meant the fluid discharge, more or less sticky, more or less purulent, milk-like in appearance, variable in quantity, and sometimes offensive in odor, which may occur at any age and in any social condition. The vaginal discharges from those forms of inflam mation which have been described are excluded. The condition which causes the discharge is not an inflammatory one, in the broadest sense of the term, but an irritative one, in which there is excess of secretion from the vaginal epithelium, and probably transudation of scrum and corpuscles from the vaginal blood vessels, at least in some cases. The dis charge is the more profuse as the tension in the blood-current is increased: there fore just before and just after the men strual flow.
Symptoms. — While it must be ad mitted that leucorrhcea is a symptom, it is also the direct expression of a diseased condition, and it produces a variety of unpleasant results. The daily discharge may amount to several ounces, and the removal of this volume of fluid, especially in those who are already debilitated, may add materially to the existing condition of weakness. It may also produce an intense irritation of the skin which it soils, causing itching and pain, which may become almost unbearable.