Parasitic Vulvitis.
Symptoms and Etiology.—Various de grees of inflammatory disturbance are excited by parasites which infest the vulva. In children, worms (lumbrici, ascarides) whose habitat is the rectum, sometimes migrate to the vulva and cause much uneasiness and more or less inflammation.
Pediculi pubis are very common among those who have attained puberty, the hair-follicles upon the labia and Mons veneris being attacked. Intense itching, with consequent scratching and rubbing, results. The inflammatory re action is very decided, the vulva being sometimes converted into a mass of sup purating sores.
Treatment. — The treatment involves cleanliness and great gentleness of ma nipulation. Irrigation with a 2-per-cent. solution of creolin should be practiced twice daily. The hair of the vulva should all be carefully clipped away, and the entire surface freely anointed with mercurial ointment (unguentum hy drargyri). After the parasites have been destroyed the inflamed surface may be kept constantly covered with the officinal zinc ointment until complete healing has occurred.
Eczematous Vulvitis.
Symptoms and Etiology.—Tbis condi tion occurs more frequently among those who have passed the menopause than at earlier periods; indeed, I have seldom seen it in those who have not reached the change of life. It is usually associ ated with a vaginitis in which there is an acrid discharge soiling the vulva and producing irritation especially during cold weather and at night when the pa tient is in bed. The itching in such cases becomes almost intolerable, this being the well-known pruritus vuluce. Scratching and rubbing cause great dis turbance in the skin, which may become dry and hard, like parchment, or may exude a serum which excoriates the skin and adds to the discomfort. It is not improbable that poisonous germs from dirty finger-nails are frequently com municated in this disease, thus compli cating the condition. The suffering may be so great as to cause hysteria or even insanity.
Treatment.—The treatment consists, first of all, in cleanliness and abstinence from scratching. The entire inflamed surface should be covered with a paste made from subnitrate of bismuth rubbed up with glycerin (sufficient glycerin be ing combined with sufficient bismuth to make a rather thick paste, which will ad here readily to the skin, but will not run), this being applied freely and fre quently, and the vagina plugged with cotton-wool moistened with the same mixture. This treatment, in addition to vaginal douches sufficiently astringent (tannic acid, alum or hydrastis combined with hot water), and cathartics at night (compound cathartic pills, 1 or 2; or fluid extract of cascara, 1 drachm) will usually bring the disease under control and must be continued as long as any symptoms remain. Of course, much will depend upon the care and skill with which the local treatment is adminis tered and the persistence with which it is continued.
Tuberculous Vulvitis.
form of disease— manifested by tubercular sores, not the so-called tubercular eruption of syphilis, but that in which there is a true tuber cular process developed by tubercle ba cilli—is of occasional, but not frequent, occurrence. It is characterized by a painless ulcerative eruption of the labia, especially the labia majora, which shows the usual features of tubercular proc esses: sloughing, want of tendency to heal readily, and scarring and contrac tion after healing. It is probably iden tical with lupus of the vulva, which has been described by many writers, but not always with the same pathological idea in view.
treatment should be a general tonic one, with the adminis tration of iron, codliver-oil, strychnine, and an abundance of wholesome food; locally cleanliness is to be scrupulously observed and the use of astringent oint ments. The following formula is sug ..
1 Creasoti, V., drachm. Iehthyol., drachm. Ting. zinci ox., 1 ounce.