ACUTE AND CHRONIC INFLAMMATION OF THE VAGINA.

When speaking of inflammation of the vagina, reference is had to its mucous lining alone. It undoubtedly happens that structures or tissues beneath the mucous covering become involved in the inflammatory action, but this occurs so seldom that it is not of sufficient moment to make it the subject of an inquiry in a practical work.

The mucous membrane of the vagina, like all other mucous surfaces, has its natural secretion for the purpose of lubricating and keeping its surface moist. In a perfectly healthy state, the color of the vaginal mucous membrane is a pale red, this becomes scarlet red upon irritation. In girls who are not irritated or women who have not been abused by sexual excesses nor infected by disease, the normal secretion is just sufficient to preserve the moisture of its surfaces, but not in such an excess as to be noticed as a secretion or discharge outside of the vaginal canal. There is a physiological exception to this normal rule, a few days before and after the menstrual period, when the mucous membrane of the vagina sympathizes with the general congestion of the pelvic organs. The mucous secretion becomes then greatly increased, amounting to a catarrh or flow, this, however, is only transient and subsides with the cessation of the menses. This might with propriety be termed a natural or physiological catarrh.

For convenience of description and corresponding with the anatomical changes and the sources of their origin, inflammation of the mucous membrane of the vagina may be acute or chronic, simple or specific.

Acute inflammation in this instance is no different in its characteristic symptoms from inflammations elsewhere; it develops suddenly, and there is congestive swelling and pain. There is considerable heat in the parts, increased redness, and the canal is very sensitive. In the beginning the mucous membrane is dry and contracted, but after a few hours or a day, relaxation and moisture supersede. The secretion is very scant at first, but becomes more abundant as the disease progresses, its character also changes from a white, glairy mucus to a creamy, muco-purulent or yellowish discharge. The urethra may also become involved, and then the symptoms that were detailed in connection with urethritis are also present.

Acute vaginitis may arise from a great variety of causes, but the worst case that ever came under my notice was the scalding effect of a hot-water injection, given under the advice of a physician who had ordered the patient to use the water “as hot as she could stand it,” and also told her “the hotter the better.” This profoundly wise suggestion was carried out by the patient with a vengeance, for she used nearly boiling hot water, which she had tested by putting in her finger and quickly withdrawing it. The steaming fluid so scalded the vagina that a most pronounced acute inflammation of the vagina was the immediate result. I have had other cases of the chronic form come under my notice that were aggravated by similar advice, so that a word of warning against the thoughtless and indiscriminate use of hot-water injections will not be without value.

The vaginal irrigations of hot water, as a general stimulant to the mucous surfaces, or as an alterative to stimulate the absorbents to increased activity in removing old pelvic exudations, deserve a recognized place as a useful therapeutic measure, often of the greatest value, but too hot or “as hot as the patient can bear it,” is superlative nonsense and absolutely injurious.

No water injections into the vagina that are kept up any length of time should be warmer than 110 degrees Fahr. and never should vaginal injections be employed without using a thermometer to gauge the heat. When the solution is medicated, 103 degrees should be the average temperature, but it should never exceed 107 degrees Fahr. Exposure to cold and moisture especially during the menses is prominent among the causes of acute vaginitis; injury from pessaries or coition, retained putrefying secretions in the vagina, or the application of chemical preparations, or injury during confinement, will all induce this disease. Prolonged nursing causes anÆmia, which predisposes the system to catarrhs. During the child-bearing period catarrhs of the vagina are quite common, and excessive coition excites a very painful inflammation of the vaginal mucous membrane.

Gonorrhoeal infection arising from a specific contagion gives rise to a very painful and dangerous vaginitis. The character and nature of the specific virus admits of no particular description, because its infectious quality of a specific nature does not at all depend upon the physical appearance of the infectious discharge from the male. Whether it is yellow or greenish, muco-purulent or a glairy mucous discharge, establishes no criterion, but the presence of microbes, the gonococcus of Neisser; this, of course, a careful microscopic examination can alone establish. This much is true, that careful researches in Europe, by competent and reliable authorities, have established the fact, from carefully-prepared statistics, that this is a far more fruitful source of uterine diseases than was formerly dreamed of.

A specific vaginitis has a greater tendency to spread itself along the mucous tract of the genital organs of the female than a simple non-specific catarrh. In the former the womb and Fallopian tubes become successively affected, as we shall learn more definitely when we have occasion to inquire into the diseases peculiar to these organs.

Acute inflammation of the vagina has pronounced symptoms, and when any one of them is felt by the patient, she should lose no time in resorting to treatment.

The first symptom that is generally perceived by the patient is a sense of heat and burning in the vaginal canal; this is also reflected in the neck of the bladder during micturition. As the disease develops, there is a constant desire to pass water frequently, and this becomes sometimes a prominent sign. A dull aching weight is felt between the vagina and rectum. After these have lasted for some days, an offensive discharge from the vagina ushers in the second stage, excoriating the skin around the vulva, and if the disease should spread itself to the neighboring organs, there is a violent throbbing pain in the whole pelvis.

Women who are suffering with acute painful vaginitis should take to bed; all pelvic diseases of any acuteness at all are treated at a great disadvantage when the patient is running around and on her feet. The disturbance in the circulation, the exposure to cold from cold floors or damp sidewalks, and the impossibility of preserving an equable temperature of the body, when out of bed, only aggravate the malady.

The vagina is to be douched several times a day with half gallon of warm water, in which a half teaspoonful or one tablet of Femina antiseptic uterine lotion has been dissolved, and when the canal is rinsed, a Femina vaginal capsule should be introduced, but only once a day, and that is preferable at bedtime. The feet and extremities should be kept warm, and in married women total continence should be observed while the slightest irritation and soreness exists. By the non-observance of this precaution, the best directed efforts will often be frustrated and many female diseases which are readily curable in the beginning become chronic, and a moment’s reflection ought to make this clear to any person of ordinary intelligence.

If there is the slightest suspicion that the disease is of a specific nature, the treatment must be antiseptic in its nature. Your physician should be reminded of the possible nature of the disease, for doctors as a rule are ignorant of the dangers that ordinarily accompany gonorrhoeal infection.

Oppenheimer in Germany made experiments for testing the germicidal properties of various drugs on the specific germs of gonorrhoea, and he proved that a corrosive sublimate solution of 1 part to 20,000 will kill the gonococci. Corrosive sublimate is the corrosive chloride of mercury, one of the most powerful of the mineral poisons, and while it is perfectly safe in the dilutions that it is employed in, the greatest precaution must be constantly exercised to keep the drug isolated and out of the reach of children, especially the “antiseptic tablets,” of which mention will be made below, because little children and adults also might at first sight believe that they were candy.

I am accustomed to employ the corrosive sublimate much stronger than the Oppenheimer experiments demand, a practice which I base upon practical observations, while in the Berlin clinics, and that is in the proportion of 1 to 2,000. John Wyeth & Bro., of Philadelphia, and other manufacturing chemists, make compressed tablets or wafers, which are very convenient and easily handled by any person of average understanding. These are sold by the druggists in little wide-mouth bottles, properly labeled, so that the required strength, 1 to 2,000, is obtained by dissolving one or two according to their strength in a half gallon of warm water. Whenever gonorrhoea is suspected, the vagina should be thoroughly rinsed out several times a day with the corrosive solution. If the patient fears mercurial poisoning, the antiseptic irrigation can be followed by plain warm-water rinsings as a safe precaution against mercurial absorption.

CHRONIC CATARRH, LEUCORRHŒA OR WHITES.

An acute inflammation of the mucous membrane of any organ may drift into the chronic or subacute form, so that any of the causes which give rise to the acute variety are among those that are to be looked for in chronic catarrh. The general characteristics of catarrh are the same, whether acute or chronic or whether located in the nose, throat, bronchial tubes or vagina. This fact greatly simplifies the whole subject of catarrhal inflammations, so that the general reader will find no difficulty in acquiring the necessary information for successful home treatment of this very common class of diseases.

Chronic vaginal catarrh has been divided into two varieties, vaginal and uterine. The distinction depends upon its origin or complication. Vaginal catarrh has its origin in and is limited to the vaginal canal. I have already called attention to a purely physiological catarrh that accompanies the menstrual flow and which subsides with the cessation of the menses; in addition to this, there is probably no woman who goes through life without at some time during her natural existence having this disease or symptom. Often the discharge is so scant that it entirely escapes her notice, and not until it becomes annoying by its constancy and abundance do women seek assistance.

In ancient times and until quite recently, it was considered as a distinct disease, attributed to constitutional debility or an indication of impure blood; these theories are now entirely discarded. The modern school of Gynecology has given it quite a different interpretation, and considers leucorrhoea rather a symptom of some local disease than a disease itself. Experience, and careful research in, the sick chamber fully corroborate the correctness of this view, so that a simple local chronic catarrh is the exception to the rule. The exception applies oftener to children than to adults. We find it in young babies or little girls of all ages as a result of diarrhoeal discharges which are acrid and filter themselves into the vagina and by their sharp, irritating action on the mucous membrane, excite at first an acute, and afterwards a chronic catarrh of these parts. Eruptive fevers have induced a similar effect upon the mucous membrane of the child’s vagina and also upon that of the bladder; obstinate catarrhs are frequently traced to these fevers. I have known pinworms to make their way from the rectum into the vagina and by their irritating presence excite in the little child a very distressing vaginal catarrh.

The irritation or itching which the inflammation and decomposed secretion cause, makes the child involuntarily dig or scratch her vulva, which of course only aggravates the disease, and which has already been mistaken for precocious masturbation, and will undoubtedly often be so considered again by superficial observers. In later years a subacute inflammation of these parts will undoubtedly develop this pernicious practice, and I have known several cases myself where young girls became physical wrecks from a combination of chronic vaginal catarrh and self-abuse, no one ever dreaming of the real morbid condition, but attributing their decline to everything else but the right cause.

There is another complication that may arise from catarrhal inflammation in little children, and that is an adhesive inflammation of the vaginal walls; that means that the sides of the vagina may partly or completely grow together, and thus change the normal diameter of the vaginal canal. In after years this may entail frightful suffering, either by mechanically obstructing the escape of the menstrual blood or otherwise interfering with the normal function of the canal. There are many diseases from which we suffer in adult life for which the foundation was laid when we were young, through the ignorance of our parents.

The stormy symptoms that usher in the acute form are absent in the development of the subacute or chronic variety. This disease begins sometimes so insidiously that the patient may not be aware of its existence for quite a while. The secretion may not be at first changed in its character, save that it is noticed in greater abundance. In the course of time, the nature of the secretion will be greatly changed, from a white glairy discharge into a grayish opaque secretion; this will be tinged greenish some days and be of a muco-purulent aspect. In the great majority of cases it is a whitish cheesy discharge from which the names leucorrhoea or whites have been derived.

The color of the vaginal mucous membrane in chronic catarrh is of a bluish red tint, and its surface presents in places granulated patches, that bleed easily when they are touched. The vaginal walls are relaxed, so that women often complain that they have a sensation of “feeling open;” this is indeed the real state of affairs; the walls of the vagina may become so relaxed as to constitute a prolapse of the anterior portion or wall of the vagina, dragging the bladder and womb down with it.

A great many of the so-called “falling of the womb cases” are no falling of the womb at all but simply a relaxed vagina, in which the wearing of pessaries or any other mechanical uterine supporter will actually do a great deal of harm.

The treatment of vaginal catarrh is principally local, when there are no constitutional complications. Of course there are rules of conduct that apply to all catarrhal patients, whether the catarrh is of the genitalia, of the nose or throat or of the bronchial tubes; these rules constitute the hygiene of catarrh, a subject which is discussed in a separate chapter in this work to which the intelligent reader is referred.

The main feature of the treatment consists in thorough cleanliness of the vaginal canal and in the use of a soothing lotion. This object is best accomplished by the use of the Femina antiseptic lotion and in the following manner: Dissolve one tablet or half a teaspoonful in a cupful of hot water and then add this to a half gallon of warm water of a temperature of 103° F., and by means of an elastic bulb syringe, use the entire quantity at one time. If the discharge is profuse, or if any offensive odor is perceptible, then the vaginal injection should be made several times a day.

In case there is soreness and pain in the pelvis, and there generally is, a Femina vaginal capsule should be introduced into the vagina, just before retiring.

When the patient feels a dragging sensation, or such symptoms as would indicate a prolapse (falling down) of the vaginal walls from weakness or relaxation of the columns and muscular tissue which give them support, then the Femina antiseptic uterine lotion should be used, as before described, with this difference, that double the quantity should be dissolved in the cupful of hot water, and then added to the half gallon of warm water of the same temperature and used in the same manner. When the Femina antiseptic uterine lotion is used in its double strength, the remedy loses nothing in its healing effect but becomes more astringent, strengthening, and disinfectant.

Be sure that the nozzle of the syringe sweeps the entire vaginal cavity, and if the above quantity of fluid should not be sufficient to thoroughly cleanse the vagina, then use double the quantity of fluid.

With this prescription I have cured cases of leucorrhoea of twenty years’ standing which had gone through the ordeal of all the different treatments that they were capable of undergoing.

I would recommend to those patients who feel their wombs dragged down, the knee-chest posture, that means, to kneel down on the floor with the hips elevated as high as possible and the chest close down to the floor. This position rolls the abdominal organs upwards and forwards, and thus naturally draws the womb and vagina into their normal positions, much better than any mechanical appliance or operator can possibly accomplish it. It simply allows the relaxed organs, through the natural law of gravitation, to gravitate where they belong. It is necessary to retain this kneeling position for only ten or fifteen minutes, repeated twice a day, say night and morning, and the curative effect is truly wonderful.

When I speak of the curative measures of displacements in general and of falling of the womb downwards and backwards in particular, I will give a detailed description of the knee-chest position.

There should be a choice in selecting a vaginal syringe or a syringe for vaginal bathing. The “fountain syringe” has several objections that are insurmountable. In the first place, the quantity of fluid that is to be used is limited by the capacity of the reservoir, or in order to replenish it, the even tenor of the rinsing is disturbed. Another objection is, that the convenient peg upon which to hang it is not always present, or a shelf upon which to rest it not high enough; then there is not the control over the stream that is desirable, so that considerable confusion arises at times from the fluid wetting things that had better be kept dry. For these reasons I prefer a bulb syringe.