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.
Gonorrhœal 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
gonorrhœal infection.
Oppenheimer in Germany made experiments for testing the germicidal
properties of various drugs on the specific germs of gonorrhœa, 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 gonorrhœa 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 leucorrhœa 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 diarrhœal
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 _leucorrhœa_ 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 leucorrhœa 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.