M. Sig.: Apply freely.
Diphtheritic Vulvitis.
There is in this form of vulvitis a true inflammatory process of infectious origin identical with that which is character ized by a deposit of exudative material or false membrane upon mucous surfaces in general (e.g., upon the pharynx, in testine, or uterus). It sometimes occurs in little children as an accompaniment of croup and diphtheria, or with the eruptive fevers. It may occur in women as an accompaniment of diphtheria, though this is rare in adults, or it may occur as one of the phenomena in puer peral septica3mia; in other words, it is a phenomenon which rarely occurs alone. It is of grave importance, for it signifies profound toxemia and a gloomy prog nosis.
The general treatment which is ad vised includes inhalation of oxygen, in ternal use of chlorine-water and general supporting measures. The local treat ment requires the greatest caution and delicacy of manipulation, and usually in volves also the treatment of a similar condition in the vagina and uterus. Cleanliness must always be most scrupu lously observed, no portion of the diph theritic membrane being allowed to soil the tissues contiguous to the vulva. In children and virgins it is desirable to avoid entering the vulva, but a pad of absorbent cotton may be kept constantly in contact with the vulva moistened with chlorine-water, or a 10-per-cent. solu tion of nitrate of silver, or a 5-per-cent. solution of hydrochloric or carbolic acid. For puerperal women and multiparr in general vaginal douches of creolin (2 per cent.) may be used, with great gentleness, twice daily, while in the in tervals the vulvar pad moistened with the 10-per-cent. solution of nitrate of silver, or 2-per-cent. solution of protar gol should he constantly applied.
Atrophy of the Vulva.
'This condition is the usual accompani ment of age, the hair of the labia bum ing sparse and straggling, the labia majora flabby or still somewhat promi nent if the supply of fat is abundant, the labia minora small and insignificant, while the vulvo-vaginal glands lose their activity and participate in the general shriveling and abolition of function. This condition may also come prema turely as the result of general failure of nutrition or in consequence of the re moval of the ovaries and the resulting premature menopause. It does not by any means occur as a customary result, however, of the early removal of the ovaries.
A rare form of atrophy is that which causes the well-nigh complete disap pearance of the labia minora. This was described by Breisky (Centralb. f. Gyniik., p: 35S, 'S5), and by him was called kraurosis. few cases of this form of atrophy have been recorded.
Hypertrophy of the Vulva.
This condition is a relatively common one. It may involve the labia majora alone, the labia minora alone, or may in clude both. In syphilis and chancroidal disease we frequently have this condi tion, the labia majora being more fre quently implicated.' The degree of en largement varies; it may be moderate, or the vulva may be four or five times its normal size. The skin is hard and board-like to the feel, a dense infiltration taking place in the skin and cellular tis sue. It is painless, without febrile move ment, and is usually self-limited; but it may persist for months, yielding as the disease yields to constitutional measures. When the tension in the skin is consider able a few linear, but shallow, incisions will bring relief by depleting the tissues. The use of a few leeches will accomplish the same result. The extensive enlarge ment of the labia known as elephantiasis arabum is not seen in this country. Its nature is the same as that which has been referred to, but it may be due to an in fectious medium other than that of venereal disease.
Hypertrophy of the labia minora is also a very common condition. Among the negroes of Africa it is said that the enlargement is sometimes enormous, the labia hanging down in great folds and masses. A very common cause for this condition is masturbation, the nymplue being very sensitive and constant fric tion and traction producing elongation and enlargement. I have never observed that such enlargements caused any par ticular annoyance, save in one instance, this occurring in a prostitute about 20 years of age, who was syphilitic and an opium-smoker. The tumors were as large as a man's fist and were a decided impediment to coitus. Some of those who saw the case believed the tumors were of syphilitic origin, others that they were simply inflammatory. They were removed with the cautery-knife, but after a few months the vagina was filled with a recurrent growth. The result is not known.