TREATMENT.—The measures I have found efficacious consist in drying the skin and mucous membrane with ab sorbent cotton, tamponing the vagina with cotton-wool soaked with a paste of glycerin and subnitrate of bismuth, and covering the skin with a thick layer of the same. This should be repeated daily and will usually bring relief.
As to skin parasites, these are the ordi nary Pediculi pubis, which adhere tena ciously to the roots of the hair of the vulva. Mercurial ointment rubbed into the skin a few days in succession will destroy them.
As regards irritation of cutaneous nerve-endings of central origin the cu taneous nerves are irritated, in all these conditions, but in this variety the source. of the trouble is not local.
Diabetes may produce this condition,. though the irritant, in some cases at least, is the urine, which has been allowed to soil the skin. The treatment will con sist, first, as in all cases, of cleanliness, then the application of the glycerin-and bismuth paste or of vaselin or zinc oint ment with which a sufficient quantity of cocaine or carbolic acid (15 grains to the ounce will usually suffice) has been com bined. The causative disease must, of course, receive proper treatment at the same time.
Ichthyol is rationally and logically indicated in all cases of vulvar pruritus. used either as a 10-per-cent. ointment, plaster, or lotion (aqueous). Doizy (Bull. Mad., xii, p. 904, '93).
(Edema.
(Edema of the external genitals, the lower and upper extremities, may prop erly be considered together, for it in all cases results from the same cause,— namely: interference with the venous circulation,—the first being more fre quent than the other two.
(Edema of the vulva is very common.
the tissue becoming quite dark, some times almost black. The veins may be
greatly enlarged and the swelling of the tissues so extensive as to be painful and make locomotion difficult. The treat ment consists in the application of cool ing and astringent lotions—e.g., the lead and-opium wash—and rest in bed the greater portion of the time. This and the other two conditions are accompaniments of the later months of pregnancy when the weight and pressure of the heavy womb impair the freedom of circulation of the blood-current. (Edema of the lower extremities is especially apt to oc cur with those who suffer with varicose veins of the legs, with cooks and washer women, and others whose duties compel them to be standing from morning until night.
TREATMENT.—This is the same as for oedema of the vulva, rest in the hori zontal position being all-important. Bandaging the feet and legs, the band age being carried well above the knees, will often give comfort and enable the patient to go about in the pursuit of her ordinary duties.
(Edema of the upper extremities I have never seen. It would indicate a very bad condition of the circulation and a prob able lesion of the heart. In addition to appropriate treatment of the central cause, rest in bed is imperative, and the limbs should be lightly bandaged from hand to shoulder if the swelling is con siderable.
Haemorrhoids.
This condition is often a source of great annoyance, especially in the later months of pregnancy. It may be re garded as similar in its causation with oedema of the vulva, and, indeed, may accompany it. It is more frequent with those who have suffered with the same trouble prior to pregnancy than with others, it is common with those who suffer with constipation, and is a source of great pain when the bowels are moved.