NON-VIRULENT CATARRH OF THE^AGINA. 173 



flaccid. The membrane is m*>re bluish red and its surface more fre- 

 quently granular than in the acute variety ; the secretion is some- 

 times more milky, sometimes more yellow and thick. Not unfre- 

 quently the relaxation of the vagina induces prolapse, particularly 

 of the anterior wall. 



SYMPTOMS AND COURSE. In non-virulent catarrh also, if it begin 

 acutely, the patient complains of prickling and burning in the pri- 

 vate parts ; but, as the mucous membrane of the urethra is unaffect- 

 ed, she has no pain on urination. In chronic catarrh the discharge 

 of the abnormal secretion, the leucorrhoea (fluor albus vaginalis), is 

 often the only symptom of the disease. The chief means of decid- 

 ing whether the discharge be from the vagina or uterus is by exam- 

 ination with the speculum. Many women bear the drain without 

 any injury ; in others it induces anaemia, pallidity, weakness, and 

 emaciation. 



TREATMENT. In treating non-virulent vaginal catarrh, just as 

 in uterine catarrh, we must first attend to the causal indications. 

 But we cannot often cure the disease without accompanying local 

 treatment. We would chiefly recommend the hip-baths and injec- 

 tibns mentioned in the last chapter ; in obstinate cases, the introduc- 

 tion of a tampon sprinkled with alum, and even the application of 

 solid nitrate of silver. 



CHAPTER III. 



CROUPOUS AND DIPHTHERITIC INFLAMMATION OF THE VAGINA. 



CROUPOUS and diphtheritic inflammations of the vaginal mucous 

 membrane are common during puerperal fever, but are rare except 

 in the puerperal state. They either depend on local irritation or on 

 constitutional disease. Thus, the discharge from a sloughing can- 

 cer of the uterus, the urine constantly flowing through a vesico-vag- 

 inal fistula, a bad pessary, or a large uterine polypus projecting into 

 the -vagina, may induce croupous or diphtheritic inflammation of the 

 vaginal mucous membrane ; while the disease is also often observed 

 in the later stages, of typhus, cholera, measles, and small-pox, and 

 accompanying similar affections of other mucous membranes. 

 Usually only certain spots of the vagina are covered with croup- 

 membrane, or changed to diphtheritic sloughs. In the vicinity of 

 these spots the mucous membrane is dark red ; after the slough has 

 been thrown off, irregular losses of substance remain ; these are 

 sometimes superficial, at others deep. Our attention is called to 

 the disease by severe pain in the parts, and by a fetid, often bloody 



