Varieties.—­l.  Catarrhal or simple 2. granular; 3. gonorrheal; 4. diphtheritic, and 5. senile.

1.  Catarrhal or simple form.—­This is the most usual form.  There is a general redness of the membrane with swelling and increased secretion.

2.  Granular.—­This is an advanced stage of the simple type, and is due to long continued or repeated attacks.

3.  Gonorrheal form.—­Is due to infection by the gonococcus of Neisser (due to gonorrhea).  This form is hardest to cure and may continue for years or life, The infection may extend to the womb, fallopian tubes and peritoneal cavity and produce inflammation of the womb (endometritis) pus in the tubes, (pyosalpinx) and peritoneal cavity.  This is more common than even some physicians realize.

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4.  Diphtheritic—­Due to diphtheria, not frequent.

5.  Senile type.—­This comes only after the change of life.

Symptoms.—­There is pain in the lower abdomen.  Passing of urine is frequent and is attended with smarting and burning pain.  There is a feeling of heat and burning in the vagina, and a copious discharge of mucus and pus.  In the gonorrheal variety the urinary disturbances are most marked.

In gonorrheal variety the symptoms date from a distinct onset, last longer, do not yield so rapidly to treatment, and complications, such as enlarged glands in the groin and in the vulva and vagina, inflammation of the lining of the womb and fallopian tubes, inflammation of the bladder, often make their appearance early.

Treatment (in acute cases).—­Rest in bed and prolonged vaginal injections of a solution of corrosive sublimate (1 to 4000 strength) three times a day.  If the gonorrheal poison is present in the pus, the walls of the vagina, cervix and cervical canal should be dried and thoroughly painted with a twenty per cent solution of nitrate of silver.  The patient should be in the knee-chest position for this treatment.

In chronic cases the gonorrhea poison (gonococcus) is found most frequently just behind the posterior lip of the cervix and here the silver solution should be applied very thoroughly.

Vaginismus.—­This is a painful reflex muscular contraction of the vaginal orifice, and is most often observed in patients of a nervous and sensitive temperament.  Treatment.—­Any local cause of irritation should be removed.  If there is no local irritation, the opening should be dilated under an anesthetic.  Tonics, exercise, and a complete change of scene are beneficial.

DISEASES OF THE CERVIX.

Tear of the cervix (Laceration).—­This is a tear in the lower part of the cervix.  There may be one or more.  The left one-sided tear is the usual form.  Next comes the tear on both sides (bilateral).  Tears on front and behind are not frequent.  Tears are found in about thirty per cent of women who have had children.