INFLAMMATIONS OF THE EXTERNAL GENITAL ORGANS.
Inflammation of the deeper part of the labia majora ordinarily arises from an affection of the glands of Bartholin.
Inflammation of the mucous membrane is catarrhal and may be either acute or chronic.
In the acute form the mucous membrane swells, becomes a deeper red and tender, and is covered by a slimy purulent secretion. The swelling and redness affect particularly the nymph. Chronic catarrh is rarer than in case of other mucous membrane, for the reason that here there occurs no retention of secretion.
Even in small children it is not uncommon for the smegma between the labia to remain, and, in case of lack of cleanliness and from irritation by the urine, this smegma degenerates and produces erythema, excori ations, intertrigo, which may eventuate in extensive and sub-acute in flammatory affections, and cause the child pain. In childhood the oxy uris vermicularis may progress from the rectum into the vagina, and produce at the outset pruritus, and then from frequent scratching exco riations and inflammatory processes. Rape only exceptionally sets up an acute inflammatory process, but although abrasions, redness, swelling and pain exist, there is no discharge.
The most frequent cause of acute catarrh of these regions is infection by gonorrheal virus.
An inflammatory process may also be present, although not catarrhal, when the external genitals are abraded from contact with the urine. The mucous membrane is similarly reddened, is excoriated, is covered super ficially with flat, painful, nodules, and the sub-mucous tissue is densely infiltrated. A rarer cause than irritation from the urine is the result of discharge from necrosed cancer.
Inflammation of the external surface of the labia majora is very fre quently met with, and, in general, is not of much consequence. The process begins in the crease between the thigh and the labium. The secretion here stagnates, and under the influence of moisture and warmth acts as an irritant. Movements and walking increase the pain and cause the affection to spread. The process affects in particular corpulent indi viduals. As a result of the inflammatory process the sebaceous follicles secrete profusely, and the discharge affects the parts adjoining the site of inception. Thus, in very corpulent women, the discharge may run down the thigh and the inflammatory process affect the lower limb. As the
result of motion and attrition, the inner surface of the legs becomes ex coriated, so that movement becomes painful, and such a dermatitis may be the cause of excessive pain.
Acute dermatitis, however, is also a sequels of typhus, and the acute exanthemata. The etiological cause is probably the same as we saw held above.
Corpulent women suffer greatly from these simple inflammatory pro cesses, and in the vast majority we find the skin in these special localities greatly reddened and moist. Only through extreme cleanliness can this affection be cured.
Phlegmonous inflammation of the external genitals may result from the above-described catarrh and dermatitis. The source of abscesses of the external genitals is often to be sought in the pelvis, as for instance caries of the pelvic bones, parametritic and para-vaginal abscesses. Erysipelas may also affect the labia majora and pursue its customary course.
J. E. Atkinson has described a contagious form of vulvitis in chil dren, where it would seem as though gonorrheal virus was the etiological cause. In a young girls' school where nineteen children from six to twelve years were educated, and who slept in one hall, six of the children were attacked almost simultaneously by edematous swelling of the labia, painful micturition, and purulent discharge from the genitals. These children were in the habit of sleeping together. The cause was supposed to be gonorrheal virus, because one year and a half previously there had occurred in the same school a contagious ophthalmia. R. Pott also be lieves that the frequent occurrence of vulvo-vaginitis in children is due to a specific, gonorrheal virus. Where a discharge persists for a long time the chances are it is specific. The virus is acquired from the older members of the family, through, possibly, unclean linen or bed-clothing. Pott is further inclined to think that a very persistent discharge is evi dence of syphylis. Certainly, however, there exist forms of vulvo-vaginal catarrh which are not infectious, and which may, I believe, result from decomposition of the smegma, etc. I have myself seen this form in children where there was no suspicion of either syphilis or of gonor rhea.