DLSEASES OF THE VULVA AND OF THE VAGINA.
Pruritus Vu/vo3.
This disease, although not peculiar to pregnant women, sometimes as sumes especial intensity with them. By the term is understood a severe itching of the external genitals, which sometimes extends to the introitus vaginx, and amounts to real torture. Generally, there is no visible lesion. In other cases, the women produce erosions, superficial fissures, and some times redness by scratching and thus augment their sufferings. Hardy has seen some superficial ulcerations in these cases, from which serum exudes, as in eczema. Cazeaux has quoted a case in which the itching was such that the woman was in a state of general irritation almost pro ducing convulsions. In anther case the friction had been so often re peated that it had caused swelling and inflammation of the labia majora and minors, one of which was of twice its natural age. Although devoid of gravity, pruritus vulvre gives so much suffering that it claims active treatment, which is often inefficacious. Rest, alkaline baths, separation of the inflamed surfaces, and lotions of vegetable and mineral waters some times succeeds, as do solutions of borax, chlorate of potassium and weak carbolized water. Meigs recommends ablutions of the parts with soap and water, and then the application, thrice daily, of the following solu tion: [In any case o-f pruritus v-ulvte, a very common cause must be borne in mind, and this is endocervical catarrh, and the resulting erosion of the external os. The diagnosis is readily made by the finger—patency of the external os and cervical canal, velvety softness of the external os, and these signs are confirmed by the examination through Sims's speculum, which reveals the eroded cervix and the gaping os. As for treatment, applica tions to the canal and the os, by means of cotton wrapped applicators, of a solution of nitrate of silver, 30 to 60 grains to the ounce, are the most effective, and if made gently, will not induce miscarriage. In case of vaginitis a similar solution should be swabbed over the entire vaginal mucous membrane. The most effective of all means for the relief of the symptom—pruritus—is painting the external organs,the skin of the thighs, nates, etc., with a solution of silver nitrat,e, gr. x— j.—Ed.] Dubois recommended cauterization with nitrate of silver, which we have, never employed. We have seen one case of marked pruritus, the patient being a young woman, at the beginning of her second pregnancy, which resisted all treatment, and ended at two months and a half by an abor tion. During a third pregnancy, the pruritus reappeared during the first two weeks of the second month, but yielded to astringent lotions, (Goulard's extra,ct) and to separation of the surfaces. The pregnancy pursued its regular course to full term.
Leucorrhcea.
Almost all pregnant women have leucorrhcea. Generally it is mild, but sometimes is severe, being then connected with granular vaginitis. A mass of granulations develop in the vagina, particularly during the latter half of pregnancy, forming a rough surface and coexisting with erosions and with superficial ulcerations of the cervix. In this case the discharge
becomes very abundant, yellow or greenish, and, producing painful inflam mation and superficial ulceration of the external genitals, and of the inner aspect of the thighs, e,auses great suffering. The best means of relief consists in separation of the surfaces with bits of fine linen dipped in a solution of sub-acetate of lead, in careful injections, in alkaline baths, and particularly, in tampons of cotton. These tampons enclose equal parts of alum and sub-nitrate of bismuth, and are tied by a thread, which is allowed to hang between the legs, and serves to withdraw the tampon. We leave the tampon in place three days, at the end of which time the patient withdraws it, takes an alkaline bath, and during her bath, injects some of the alkaLine water. A new tampon is then inserted, and so on.
Generally after three or four tampons, notable relief ensues, if not a complete cure. We have never seen accidents due to the tampons. [Owing to the well-known property of the tampon, of exciting uterine contractions, we should not care to resort to it here. The means above described by us, for the relief of pruritus, will answer for the symptom leucorrhma.—Ed.] Vegetations.
These are common in pregnant women (Fig. 8). These vegetations, for a long time considered syphilitic, are not due to syphilis and are de veloped by pregnancy, as Thibierge has so well shown. Cullerier, Boys de Loury, Costilhes and Ricord, noted the coincidence of pregnancy and vegetations. They appear at all stages of pregnancy, in the shape of tufts, pediculated at the attachment and swollen like cauliflower. They are roseate, pale, red, brown or livid. Sometimes they are isolated, and some fillies aggregated into large masses. We have seen one case in which they were almost as large as a child's head. They have an odoriferous dis charge, and occasion sharp pains and pruritus. Their favorite seat is the mucous membrane of the vulva, the borders of the labia majora and the space between these and the labia minora, which their growth sepa rates, and through which they protrude between the thighs, partly obli terating the vulva. They may extend into the vagina and up to the eel" vix uteri. Again, they may extend to the furrow between the buttocks, to the anus and the groin. Although they constitute a source of great annoyance, they fire not serious, and generally resist all treatment up to the time of labor, when they wither and fall off. In two cases, however, in one of which they were as large as an apple, we have seen them disap pear during pregnancy, owing to separation of the surfaces and the use of compresses, dipped in Labarraque's solution. We consider more energetic measures useless,and strongly disapprove of all radical operations (excision, crushing, etc.).