Kraurosis vulvæ : a disease of chronic inflammatory nature and characterized by cutaneous atrophy, with marked shrinking and contraction of the vaginal orifice / by J.M. Baldy and H.L. Williams.

  • Baldy, J. M. (John Montgomery), 1860-1934.
Date:
[1899]
Catalogue details

Licence: Public Domain Mark

Credit: Kraurosis vulvæ : a disease of chronic inflammatory nature and characterized by cutaneous atrophy, with marked shrinking and contraction of the vaginal orifice / by J.M. Baldy and H.L. Williams. Source: Wellcome Collection.

    3/18 (page 529)
    gradually disappear, fusing with the labia majora, and the skin becomes shiny and drawn smoothly over the shrunken clitoris, which has appar¬ ently retracted behind the skin, and is now only indicated by a small de¬ pression instead of a prominence. Underlying vessels are frequently seen through the transparent epidermis, and cracks appear on the dry sur¬ face, which extend often into the corium. A sensation of drawing and shrinking of the vulva is usually experienced, and the vaginal orifice becomes gradually narrower and more and more contracted, until fre¬ quently the little finger can scarcely be introduced, and all sexual inter¬ course becomes a physical impossibility. When this condition has been reached the pathological process is arrested, the subjective sensation of shrinking passes away, and the symptoms of pruritus, usually prominent only in the earlier stages of the disease, are no longer experienced. But the shrunken and contracted vaginal orifice still persists, and is never spontaneously restored. That the disease occurs but rarely is shown by the fact that Fleisch- man,5 who was especially on the watch for this condition in Breisky’s clinic, in Prague, found only 8 cases in 1550 patients. On the other hand, Lewin, at the Charite, observed no case among 70,000 to 80,000 patients. The pathological examinations of Breisky’s cases, made by Fischels, form the foundation of our present knowledge. These researches showed the papillae of the skin transformed into scar-like masses, the connective tissues of which were almost homogeneous, partly sclerotic, and without wavy fibres. The papillse were, for the most part, low and varying in size, while the rete Malpighii was in places exceedingly thin. Sebaceous glands had disappeared altogether, and sweat glands were found to be almost entirely wanting. The microscopical examina¬ tions of Orthmann11 in Martin’s cases added still further to our knowl¬ edge of the pathology of the subject. He found some portions in a hyper¬ trophic condition and other parts in a condition of atrophy. Under a thin horny layer the rete Malpighii was markedly narrow, some places showing but slight remains, the greater part of it having disappeared. The tissue of the corium had entirely lost its warty appearance, and was stretched and sclerotic. Here and there areas of small round-cell infil¬ tration could be seen. The stratum Malpighii, outside the part of the true skin which was in a condition of hypertrophy, was atrophied. In other portions the horny layer was much wider, the cells being in strata of many layers upon a much-widened rete. The papilke were much dragged out in width, and, like the corium, were more or less infiltrated with small round cells. Degenerative nerve processes were sought for, but not found, and, likewise, bacteriological examination proved negative. Up to this time, as Sanger points out, only the secondary stages of the dis¬ ease had been described. The observations of Peters'6 are of especial