662 THE REPRODUCTIVE ORGANS OF THE FEMALE. 



ually becomes larger, pushes forward the posterior wall of the vagina, inverts and fills 

 up that canal, and finally projects through the vulva. It may drag with it the poste- 

 rior wall of the vagina and the uterus. 



RECTOCELE VAGINALIS. A sac is formed by the projection of the anterior wall of 

 the rectum and the posterior w r all of the vagina. This lesion is of rare occurrence and 

 does not reach a large size. 



When the vagina is prolapsed there is usually inflammation of the lining membrane 

 or a thickening of the epidermis. 



WOUNDS PERFORATIONS. 



Wounds of the vagina are made by penetrating instruments, by for- 

 ceps and other obstetrical weapons, by the foetus during delivery or may 

 result from coitus. Such wounds may heal, or give rise to large haemor- 

 rhages, or suppurate, and lead to abscesses in the surrounding tissue, or 

 leave fistulous openings into the vagina or they may by cicatricial con- 

 traction in healing lead to constriction or obliteration of its canal. 



Vesico-vaginal Fistulae are usually produced by injuries from instru- 

 ments or from, the foetus during delivery ; less frequently by ulceratiou 

 of the vagina, bladder, or adjacent connective tissue, or by abscess in 

 the surrounding parts. The fistulae form an opening between either the 

 bladder or the urethra and the vagina. They allow the urine to pass 

 into the vagina. Spontaneous cure does not take place. 



Recto-vaginal Fistulas are formed in the same way as the last-men- 

 tioned. They allow the passage of gas or faeces into the vagina. They 

 sometimes heal spontaneously. 



INFLAMMATION. (Vaginitis.) 



Catarrhal Inflammation of the vaginal mucous membrane may be acute 

 or chronic. It is most frequently induced by the gonococcus, but may be 

 due to local irritation or accompany active infectious processes. It not 

 infrequently occurs in the new-born. In the acute form the mucous 

 membrane is swollen and frequently covered with a muco-puruleut or a 

 purulent exudation. In the chronic form the mucous membrane may be 

 swollen, covered with a purulent exudation ; there may be an exfoliation 

 of epithelium, shallow or deep erosions, or ulcers. 



Sometimes large shreds or membranes are cast off from the vagina 

 which consist wholly of exfoliated, flat epithelium. ' In other cases the 

 mucous membrane is thickened, dense, and sometimes pignieuted, or 

 it may be roughened, covered with papillae, or it may be relaxed and 

 prolapsed. 



Croupous Inflammation may occur after parturition, in dysentery, in 

 typhus and typhoid fevers, diphtheria, scarlatina, measles, and other 

 infectious diseases. The mucous membrane is swollen and covered with 

 a grayish layer of fibrin and pus. The mucosa and submucosa may be 

 infiltrated with fibrin and pus. The infiltrated portions of the mucosa 

 'Consult McFarland, Proc. Philadelphia Path. Soc., March 1st, 1899. 



