Among the inflammatory affections we must refer to the formation of furuncles on the labia majora. These furuncles result from inflamma tion of the glands. Retention of secretion in the ducts lead to the form ation of ache pustules and of small abscesses. According to Verneuil the sweat glands may also develop into large abscesses.
Finally there occur on the external surface of the labia majors, all the various diseases of the skin, and in particular eczema of the skin over the mons veneris, giving rise to pruritus.
Under the term follicular vulvitis Huguier describes a special inflam matory affection which is characterized by the presence of little elevations, at the centre of each of which is a hair.
We must refer somewhat at length to gonorrheal vulvitis, since this is certainly caused by infection of the female with gonorrheal virus. For years it has been suspected that this disease was dependent on a specific virus, the gonorrheal, and to-day its specific nature has been proved to reside in Neisser's gonococcus. Donne's opinion that the cause of the infection is the presence of the trichomonas vaginalis has long since been rejected.
Gonorrheal inflammation varies in degree. Certain women are af fected without special symptoms, others are seriously sick. We explain such variations to-day by the intensity of the virus associated with the greater or less receptivity of the individual. If the inflammatory process spreads from the vestibule, then the urethra is also affected and the patient complains of the characteristic burning on micturition. If the vagina is diseased then there is present a great amount of creamy discharge; if the uterus is the seat then we have an acute metritis. The most frequent site is, at least at the outset, the vulva, and then are superadded excoria tions of the labia majora and of the nymphs. In one instance which we saw, and where the source of the infection was clearly traceable, the papillae were so enlarged that the mucous membrane resembled gmnula tions. The woman complained of intense itching night and day, and I elicited from the husband the fact that he was suffering from gonorrhea.
In addition to the excoriation, the process extending through the lymphatics to the glands, there are present buboes, which, however, rarely turn into abscess. Further, boils and abscesses in the labia majora may be present. A vnlvar catarrh of this nature is very prone to recur, and there is always a slight discharge and danger of renewed infection. The source of the slight discharge is generally to be sought in the duct of the gland of Bartholin.
The diagnosis of the different inflammatory affections is not at all difficult. All forms on the external surface of the genitals assume the appearance of analogous forms on other portions of the body. Virulent catarrh in the acute stage is so characteristic that it is recognized at a glance, and the form will often be differentiated by the history of burning micturition. If the inguinal glands are enlarged, which enlargement disappears soon after the cessation of the catarrh, then the diagnosis is certain.
The prognosis is in all these forms good. The inflammation, of course, as in other regions of the body, may become phlegmonous. Ver. neuil has reported an instance where a fatal affection followed on an ab scess in the right labium majus. The patient was pregnant. The ab
scess was opened, and as the hemorrhage was profuse the cavity was packed with charpie. Miscarriage ensued, and sixteen days later death. Post-mortem an extension of the inflammatory process from the abscess cavity to the peritoneum was established.
As for the treatment, in acute cases in extensive inflammatory processes it consists in rest in bed. Leeches in vulvitis do no good, although they are useful in metritis. Cold compresses, cleanliness, as regards the ex ternal parts, and lukewarm injections, to which may be added disinfec tants or narcotics for the vagina, such are the therapeutic indications.
The nitrate of silver, in solution of greater or less strength, has been much used. Since the discovery of the gonococcus, we ought from the standpoint of practical research, and theoretically as well, to resort above all to this agent, even though it has the disadvantage of staining the linen. In case of acute vulvar gonorrheal catarrh we should either paint the surfaces with a solution of nitrate of silver or else lay cloths dipped in the solution over the parts. The strength of the solution should be from two per cent.. to ten per cent. Stronger solutions cauterize and smart, so that we can but rarely resort to them. Two per cent. solutions soothe the pain and are also deadly to the gonococci. All other astringents and disinfectants must yield place to the nitrate of silver. Before the ap plication of the silver solution the external genitals must be washed or irrigated. If the vulvar catarrh tends to recur, then it is necessary to attack the duct of the Bartholinian gland. This may be injected through a fine needle with a two per cent. to five per cent. solution of nitrate of silver, but the procedure is a difficult one and uncertain. The same remark applies to the insertion of the point of lunar caustic. I prefer to take a knife similar to the one which ophthalmologists use for slitting the duct of the lachrymal gland, and inserting it into the Bartholinian duct to lay it open. Then we may use the silver solution to advantage.
In case of follicular vulviti treatment may be begun with a warm sitz-bath and then the parts are to be poulticed. The boils and abscesses are to be treated according to routine rules.
In the treatment of dermatitis cleanliness is of prime importance, and then a piece of cotton saturated in a five per cent. solution of tannin will speedily effect a cure. Other agents than tannin may of course be used, such as lead wash, or Goulard solution, etc. To-day it is no longer the custom to use ointments, as formerly was the rule.
In case of vulvo-vaginitis in children, the two per cent. nitrate of silver solution is again the best remedy. IL Pott has latterly recommended iodoform in the shape of pencils or suppositories, or else by instiffiation through a speculum. If the hymen interferes with treatment it must be stretched with the little finger. J. Cheron recommends daily salt baths, laxatives, and injection of a dessertspoonful of the following solo tion in a half glass of lukewarm water, morning and evening. a Glycerin 5 iv., alum ust. gr. xlv., tr. opii. 3 as.