ERYSIPELAS OF THE VULVA.
When the disease invades the system, it does not enter through the uninjured skin or mucous membrane, but we al ways seek for some entrance site for the infection. In the new-born this site is at the umbilicus or the eroded nates, genitals, etc. Both general and local erysipelas are highly dangerous, in the latter instance not so much on account of the affection of the genitals as from the accompani ment of peritonitis and septic1emia.
Prophylaxis is here again the chief factor in treatment. The umbili cal site should be carefully watched after fall of the cord; the site should be kept antiseptic by sprinkling with iodoform when the surface does not heal quickly or the child is weak. The same rules are applicable to super ficial abrasions of the skin. Where the wound-surface is deep it should be sprinkled with iodoform. In childhood the disease affects scrofulous and unclean children. In these the infection site is to be sought at the eroded introitus vaginae. At puberty and later, erysipelas of the genitals appears at the time of menstruation, to disappear with the menstrual flow, and to reappear at the next period. The affection is characterized by burning and pain in these regions and with fever. Here the process is similar to what has been noted in recurrent nasal erysipelas, there are places of deposit whence at each injection there comes recurrence.
Finally, erysipelas may proceed from the moistened and eroded labia. To the dermatitis, which we have seen exists here, there is superadded erysipelas.
The treatment is similar to that of erysipelas elsewhere, although where the disease is local, only local treatment is called for. The methods most used are powdering the parts with starch, lyeopodium, or starch and flowers of sulphur, etc. The use of oil, fat, vaseline, relieves the burning sensations. For a number of years Hfiter's method of the sub-cutaneous injection of carbolic has yielded good results, although it is questionable if the method be not rather of value to abort the affection than of utility when it has developed. At the beginning Hitter recommends the injec tion of one to two syringesful of a two per cent. solution, and later of a three per cent. The injections are made in a number of places into the healthy skin around the eryispelas patches. Bockel, who has often used
the method, and considers it relatively as the best at our disposal, injects at the beginning of the affection, twice daily, five to six syringesful of a five per cent. solution, about I of an inch from the infected zone.
The rubbing with turpentine, advocated by Dicke, is also to be used in case of erysipelas of the external genitals.
chronic form usually affects the female external genital organs. In the male organs we also see the acute form, and the eruption with the burning sensation appears so quickly that frequently in a few hours the disease is in full force. The first symptom is intense burning of the labia, followed by redness and swelling, and the appearance of small vesicles the size of the head of a pin. These vesicles contain a clear fluid, and are best seen by side illumination. When the vesicles break, there remains a moist excoriated site, over which, through drying of the exuda tion, there forms a scab. Generally the physician sees the disease in this stage. Slight fever and gastric disturbance accompany the acute form, and after three to four days the redness, swelling, and pain disappear and the scab forms. The acute form yields to treatment in from one to two weeks, but in order that this may happen the eruption must not be in terfered with by rubbing or scratching. In the chronic form the disease may spread extensively over the mons veneris on to the abdominal wall, and downward along the thighs. On account of the swelling of the labia the rima pudendi is wide open, and there is present a purulent vaginal discharge. Hence, since the nympha3 are also swollen and sensitive, the presence of gonorrhea is suggested, if we have not seen the disease at its inception. The chronic eczema is often the overlooked cause of a pruritus vulvae. Hebra says that in the majority of instances eczema is an ac companiment of menstrual disorders, (sixty-two times out of 101 affected women). Since the same thing has been remarked in case of herpes of the vulva (Lagneau) it would seem as though the two affections were often mistaken the one for the other. Diabetes mellitus is often the cause of eczema of the skin of the thighs and of the external genitals.