The intentional traumatisms which produce vulvitis are the wounds which are inflicted by the surgeon with knife, the actual or potential cautery, also the wounds which are due to violence and brutality, kicks. rapes, violent coitus, self-inflicted injuries, and many others.
Pathology.—The pathology of trau matic inflammations of the vulva is sel dom obscure. If the lesion involves the .skin alone it will be very difficult to cleanse it and keep it clean, for it is often the seat of parasites; it is often bathed with offensive and irritating secretions, and it is frequently soiled by menstrual blood, urine, and even faeces. It is not easy to eliminate the conditions which result in infection from such a tissue.
The subcutaneous tissue—rich in fat, cellular tissue, and vessels—shows the same tendency to inflammatory reaction, which is ordinarily shown by cellular tis sue or highly-nourished erectile tissue. Wounds in this location, therefore, not infrequently suppurate, and suppuration and sloughing are not without danger, for there may be profuse luemorrhage from large venous plexuses, or general infection through opened veins and lymphatics.
The large glands on either side df the vulva which secrete the lubricating fluid for the vulvar mucous membrane may bear no unimportant share in traumatic vulvitis. They may undergo direct in jury and the duct be closed in the in flammatory condition which follows, or the inflammation of the surrounding tis sues may be communicated to them. The secreting function of the glands may be destroyed, scar-tissue taking the place of the normal glandular tissue. In other cases the obstruction of the duct may simply lead to the formation of a cyst, which will be filled with the retained glandular secretion.
Complications. — Phlebitis and lym phangitis are among the rarer complica tions of this condition, the possibility of their occurrence should constantly incite to the adoption of the utmost care and cleanliness in any plan of treatment which may be followed.
Treatment.—The treatment should be such as modern asepsis and antisepsis in- I spire in the treatment of all traumatic inflammations, the basis being cleanli ness. If pain is severe, a vulvar pad, se cured by a T-bandage and kept moist with the lead-and-opium lotion (LT. S. P.), may be used. Irrigation two or
three times daily with hot saline solution (100° to 110° F.) or with boric acid (10 per cent.), carbolic acid (2 per cent.). Thiersch's solution, or peroxide of hy drogen will favor the healing process. Extensive wounds must be cleansed, trimmed, and sutured with the same care which would be used if they occurred in other parts of the body, burns may be dressed with vaselin, carron-oil, or other approved substances, the scrum from large vesicles being carefully withdrawn, and pain relieved by hypodermics of morphine grain) and atropine sul phate (V„,, grain). Abscesses and re tention cysts must be evacuated, care being taken to avoid opening the venous plexuses on either side of the vulva. If there should be elevation of temperature (102° or higher), quinine in 10-grain doses may be given at night with especial reference to its sustaining and tonic ef fects. The bowels must be kept open, fluid extract of cascara, 1 drachm at night, or any other approved cathartic being used. The diet must be composed mainly of fluids. Rest in bed is desir able, and if these hygienic precautions are observed the active course of the dis ease may not exceed a week.
It is desirable to continue the vulvar dressings and irrigation and abstain from coitus or fatiguing work as long as any pain, swelling, or induration persist.
Infectious Vulvitis.
By far the greater number of cases of inflammation of the vulva are of infec tious origin.
This statement seems reasonable enough when we realize that the skin and mucous membrane are always the abodes of organisms which only await favoring conditions to become noxious. The vulva is also the most vulnerable location for infection by the organisms peculiar to venereal disease, and the number of cases of such disease is be yond computation. Filthy habits, un cleanliness, and carelessness are also re sponsible for many cases. The follow ing varieties are suggested:— Few forms of disease to which women are susceptible are more common than venereal vulvitis. I have chosen the sub divisions of this disease which are ac cepted in the nomenclature of venereal disease in men, though it is certainly doubtful, in many cases, whether the so called chancroids exist independently of the gonorrhoeal bacterium (gonococcus).