Pruritus is a frequent symptom of diabetes, and is caused by the spores which are deposited on the genitals from the sugar-laden urine. Spores of various nature are, however, found on the mucous membrane of the vestibule, and yet the woman may not complain of pruritus; and again in case of diabetes itching may be a prominent symptom without there being a discernible lesion. In many instances the secretion from a carcinoma causes pruritus through its acidity. Kaposi states that he has often noted pruritus precede for a number of years the development of carcinoma of the uterus. Chronic gonorrhoeal catarrh, and, accord ing to Hewitt, non-specific catarrh, especially in the aged, are causes of pruritus. It is well known what excessive itching accompanies all dis eases of the skin, such as the intertrigo of stout women, herpes, eczema, follicular and furuncular eruptions. The majority of these affections only cause itching during the period of subsidence.. The pruritus be comes chronic and constant when the patients have scratched and con stantly laid bare the superficies. Many women state that pruritus inva riably sets in after the scratching. In addition to these eruptions in the course of which pruritus may develop, we must mention prurigo proper, where the itching is the essential factor. We have already spoken of the pruritus which may affect pregnant women, and which Hildebrandt explains on the theory of congestion, as well as the itching of the external genitals, which is at times met with in case of ovarian tumors, retroflexions, hypertrophies and chronic inflammatory affections of the uterus, with out there being present any appreciable change in the external parts. We think that such an explanation is at best only plausible.
Since now there exist so many possible causes of pruritus, it seems unnecessary to seek for central purely hypothetical causes. Cases which are purely dependent on some central affection of the nervous system have not as yet been seen.
The diagnosis of pruritus vulvr depends, of course, on the determi nation of the cause. The prognosis will depend on the cause, the patho• logical alterations due to friction and to scratching, and especially as to whether the patient has acquired the habit of masturbation or not.
It is apparent that no definite rules can be laid down for the treat ment of a disease of such variable etiology. In many instances the ap parent changes are unimportant, but the affection is by no means so. The causes of pruritus are so manifold that, as Graily Hewitt expresses it, " we must treat everything whether it be a cause or a follower of the disease." Regulation of the diet, of the manner of life, of the bowels, must be strictly attended to. Vegetable diet, the avoidance of heating drinks, regular washing of the genitals and injections of the vagina, such are general means. Of local medicaments there have been recommended:
applications of dilute solutions of nitric acid, especially where the sensa tiou is rather of burning than of itching: compresses of black wash between the labia, as long as the inflammation is acute; belladonna and lead oint ment; bromide of potass. where masturbation is the habit, cannabis where there is sleeplessness, which drug Hildebrandt ranks above bella donna, opium, morphine or chloral.
Authorities differ greatly in the means which they recommend for cure, which proves that there are many means of reaching the desired end, and that in certain instances, all means are devoid of benefit.
Scanzoni advocates smearing the affected parts with chloroform lini ment (chloroform gr. xxv to S j olive oil). West recommends a mixture of hydrocyanic acid, gr. 100 (!) with aqua goulardi, iii, but he prefers a lotion of borax and morphia (borate of soda, 5 ss, muriate of morphia, gr. 7, rose water 5 x, ft. lotio.) Internally he gave in case of intense pruritus, three grains of quinine every six hours, and belladonna and camphor pills, pushed until the system was well under the effect. Ex ternally he applied an ointment composed of extract of belladonna gr. iv. and spermaceti ointment and glycerin equal parts, S se.
In case of intense pruritus in a pregnant woman accompanied by at tacks of neuralgia, Page used washes of borax, opium and glycerine with out effect. Chloral hydrate was more effective, associated with washes of an emulsion of bitter almonds. On the tenth day of the puerperium the itching disappeared.
Other physicians make daily applications of carbolic acid solution to the cervix, and administer it internally as well. These applications are based on the belief that the cause of the pruritus lies in hyper-secretion of the cervical glands. Still others recommend an ointment composed of carbolic acid, glycerin and citrine ointment, or else applications of corro sive sublimate (1:1000). In intractable cases Braiiii uses equal parts of carbolic acid and alcohol, painted on the affected parts for eight to four teen days, together with lead ointment. Schroder prefers carbolic acid, 3 to 10 per cent., together with sits baths, above all other remedies. Scanzoni used chloroform oil (3:30) and alum, from which drug Schroder states he has never obtained any effect. West and Martin alcoholic solu tions of tar (4:30) or with glycerin; Wiltshire 3 per cent. solutions of borax alone, or in combination with hydrocyanic acid, veratria, morphia, or chloral. Latterly I have been using solutions of cocaine with good results. In case of cutaneous pruritus, or very chronic cases, resort to Carlsbad is to be recommended. Cold water or ice applications are also of value.