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In chronic catarrh there are certain symptoms which show the long continuance the affection, and especially the following The swelling and relaxation for a long period time has caused an increase in the mass the mucous membrane, in consequence which the relaxed wall folded upon itself, with furrows containing the pathological secretion between the folds. The mucosa no longer evenly injected.

Upon the grayish pigmented surface there appear circumscribed, red, vascular areas and spots, corresponding the apices the rugosities and here and there will The papillae are no longer diffusely swollen, though a greater degree than in acute catarrh.

But especially in chronic gonorrhoeal catarrh that the hypertrophy the papillae becomes very marked, even in non-pregnant women. It seen in three forms.

There may be papillary hypertrophy over large areas, giving the mucous membrane an even sandy appearance a pale grayish color or the papillae may grow in circumscribed spots form papillomata and pointed condylomata or finally there may a moderate and general papillary hypertrophy, giving rise club-shaped protrusions, each one which corresponds a group hypertrophic and swollen papilla?. These papillary granule cannot microscopically distinguished from the granulae which will describe further in which the papillae are not involved.

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Only the extent and the evidences other changes enable decide as the The secretion in chronic vaginal catarrh may vary very much.

Some Compare esp. Bumm. The or dumb-bell figure the gonococcus Neisser, which Bumm compares two coffee-beans with their flat sides in opposition, not itself sufficiently characteristic a number similar diplococci are present in the secretion, some which are not pathogenic at all, and others which are indeed pathogenic, but are both in their relations and their actions upon the mucous membrane entirely different from the gonococcus. We must able demonstrate that they are mainly located upon the pus cells, into the otoplasm which they apparently penetrate and there must also be the heaps cocci upon which Neisser has laid much stress.

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Bumm recommends the following as a convenient method examining the secretion for gonococci the method employed at the Wurtzburg Clinic, and takes but minutes. The secretion spread out thinly upon an object-glass with the blade a knife, dried in the flame, exposed for from a half one minute a concentrated watery solution uchsin, washed, again dried in the flame, and examined at once, pay someone to write a paper for me without cover-glass, in oil, with a homogeneous immersion lens.

times abundant, cheesy, or purulent university assignment writing services at other times grayish white and mucoid.

Even in the latter case may contain many gonococci.

The amount epithelium present in the fluid usually very great there are leucocytes in varying quantity in fact acute and chronic catarrh contain the same formed elements, their amount and relative proportion varying with the help in writing an essay consistency and color the secretion. In the cheesy yellow secretion chronic coursework writing help catarrh, not infrequently find the trichomonas vaginalis which Donne has described, and Kolliker and Scanzoni have investigated but not know that the occurrence this infusorium bears any relation the composition the secretion, Follicular Vaginitis. In exceptional cases chronic catarrh find as the most striking change the mucous dissertation writer membrane the development of those round granula or noduli, whose origin still a matter dispute. Some Authorities consider them lymphatic follicles Birch-Hirschfeld, Winckel others, mucous glands Thomas, Heitzmann others again, papillary structures Rokitansky, Bois Loury, Costilhes, Kiwisch, Ruge and still others, circumscribed sub-epithelial inflammatory foci Eppinger, Ruge. Clinically must separate this form from the catarrhs accompanied the usual papillary changes. Deville first characterized as vaginite granuleuse but has been known as vaginitis granulans, follicularis, miliaris, psorelytrie, etc. For the affection shows a number peculiar and characteristic symptoms. It occurs most frequently during gravidity, and often disappears spontaneously during the puerperium, even during pregnancy if antisepsis thoroughly carried out. It has only been observed in non-pregnant women in extremely rare cases, far as I know, and then solely in persons middle or advanced life.

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