In those exceptional instances where the eruption is in the introitus vagina or in the anal crease, and where in consequence it is not possible to poultice, the French physicians are in the habit of touching the vesicles with a solution or the solid stick of nitrate of silver. Hebra, however, is opposed to the use of this agent as well as to that of cold compresses, even though patients ask for them for the relief of the burning, since the compresses cause maceration of the vesicles, and the corium is entirely laid bare. Ho is in favor of the dry treatment and powdering with starch.
Prurigo.—The characteristic of this affection is intense itching and the formation of little papules of the same color as the skin or else a trifle redder. The name has been wrongly applied to cases where there existed no alteration of the skin but only itching, and a variety has been made of those cases where there is pruritus from the presence of body lice, but when the characteristic papules are not to be seen the term prurigo is not applicable. The etiology is not known. We can only say that this disease of the.skin is most frequently met with in poorly nourished young persons. Hebra states that prurigo is not curable. There exists a very small drop of fluid under a relatively thick epidermal layer. According to Blebs there are present in the swollen papillae ectasic lymph-vessels, by which the sensitive nerves of the skin are irritated. From the pre sence of these papules the skin has the appearance and feel of goose-flesh.
The disease has absolutely nothing to do with syphilis. As the result of examination of sections Klob found " an enormous increase in the cells, even as in case of tubercle, as the basis of the formation of the papules." The prognosis as regards health is very poor. The treatment can only aim at relieving the itching, and this will be accomplished by any means which will secure speedy removal of the epidermis, such as baths, soap, ointments, etc. Whatever is used must be employed energetically and
for a long time. We must mention in particular the use of preparations of tar. The diseased portions must be rubbed with tar or with Wilkinson's ointment, and then the patient should be placed in a bath and remain there for hours. Wilkinson's salve, according to Hebra, consists of, Flores sulph., olei cadini, vi., saponis viridis, axungite porci, as 3 xvi.
eretie iv.
Diphtheria of the Vulva.—When the surface of the mucous tears at the ostium vaginae, which occur during labor become covered with a grayish deposit, they are known as puerperal ulcers, and when the deposit spreads the name diphtheria is applied. Beyond this quantitative explanation of the difference no one has ventured. No one has as yet claimed that this diphtheria is specifically contagious, as is true diphtheria. It has never as yet been noted that such a diphtheria of the vagina and vulva can produce a case of pharyngeal diphtheria. Since new gangrenous patches may become covered with a similar gray deposit it is clear that the name diph theria is wrongfully applied. Wo are simply dealing with gangrene of tho mucous membrane, the result of traumatism during labor, and during the puerperium the disposition to wound-infection is great, seeing that there is no absence of septic germs. It is not surprising that as a result of this diphtheria of the vulva there should be present large ulcerated surfaces, and that after the healing process cicatricial contraction of the vagina should ensue. On the other hand, during epidemics of pharyngeal diphtheria, the coexistence of the same disease on the vulva has often been noted, and here no one will deny the probability of direct extension of the contagion. Here, however, the vulvar diphtheria is purely an unfortunate accompaniment, and the danger does not lie in it, but in the original seat of the disease.