THE REPRODUCTIVE ORGANS OF THE FEMALE. 663 



and submucosa may die and become gangrenous, and thus deep and ex- 

 tensive ulcers be formed. 



Suppurative Inflammation of the fibromuscular coat of the vagina may 

 occur after injuries or in pregnant and puerperal women. Abscesses 

 may be formed which penetrate into the labia or into the pelvic connec- 

 tive tissue. In other cases the intense phlegmonous inflammation may 

 lead to the death and casting-off of portions of the vaginal wall, or even 

 of the entire wall. 



Gangrene of the vagina may occur as a result of croupous or intense 

 suppurative or syphilitic inflammation, or from unknown causes. In 

 the form of noma it may be very extensive and rapidly destructive. 



Tuberculous and Syphilitic Inflammation, usually leading to more or 

 less extensive ulceration, may occur in any part of the vagina. Tuber- 

 culous inflammation is usually secondary to tuberculosis of other parts. 

 Syphilitic ulcers may heal, sometimes leaving marked cicatrices, and 

 sometimes not. 



TUMORS. 



Fibroma, nbro-myoma, sarcoma, myoma Isevicellulare, are of occasional 

 occurrence in the vagina. Myoma striocellulare is of rare occurrence. A 

 teratoma has been described and a few cases of endothelioma, 1 



Papillomata are of frequent occurrence as a result of chronic inflam- 

 mation. Carcinoma of the vagina is usually secondary to cancer of the 

 uterus. It may be primary as a circumscribed nodular tumor, or more 

 frequently it occurs in a papillary and ulcerating form and often spreads 

 to neighboring parts. 



Cysts. These are not very common and may be small or as large as 

 a hen's egg. They may be lined with flattened epithelium, and contain 

 serous or viscid, dark-colored or transparent fluid. 4 



PARASITES. 



Among the animal parasites Oxyuris and Trichomonas vaginalis are of oc- 

 casional occurrence. Among the vegetable forms Oidium albicans and Lep- 

 tothrix are occasionally seen, while various forms of bacteria are common. 

 Staphylococcus and Streptococcus pyogenes have been found many times 

 in the normal vagina. While these and other bacteria may be harmless 

 in the normal vagina, should conditions favoring their growth or an in- 

 crease in their virulence occur, as after delivery for example, serious 

 infectious processes may follow. The role of the gonococcus as an ex- 

 citant of catarrhal inflammation is well established. 



The Uterus. 



Congenital Malformations. 



The uterus, tubes, and vagina may be entirely absent, with or without absence of 

 the external genitals. Or the uterus alone, or the upper part of the vagina also, may 

 be absent. 



1 See RascTikes, Cbl. f. Path., Bd. xiv., 1903, p. 657. 



2 Consult Stokes, Johns Hopkins Hospital Reports, vol. vii. , p. 109, bibliography. 



