VULVOVAGINITIS OF OTHER ETIOLOGY Epstein describes a catarrh of the female genitals in the newborn which is part of a desquamation process, which occurs in all the mucous membranes and upon their apertures. This catarrh is present in fcutal life and continues energetically after birth in consequence of the changed conditions of life and the new external impressions which affect the new born. The catarrhal process is demonstrated by an abundant secretion from the vulva. In the beginning it contains viscous hyaline masses, but later on these may become more liquid as a result of the increase of microorganisms, and the secretion may a.ssunie the aspect of a blen norrha. This process which Epstein calls desquamation catarrh may be accompanied by a catarrhal vulvovaginitis from inattention to cleanliness of the genitals.
In the secretion are found epithelium, leucocytes, and microorgan isms of the most varied types, but never the gonococci, which latter fact enables us to make the diagnosis.
Von Hansemann describes a very early form of catarrh of the female genitals due to spreading of morphological particles from the vagina of the mother. This catarrh never becomes chronic.
A phtleous vulvitis is the name given by Parrot to an affection, occurring in infants, which consists in the formation of eircular white and grayish white plaques, from 1-4 mm. in size, on the labia majora and minora, but which may spread to the adjacent parts in the median line or to the posterior portion of the genital region, and sometimes to the genitocrural and inguinal folds. After from two to three days there appear elevations with yellowish coating and a red areola, which cause itching and swelling of the surrounding parts. A serious but very rare complication is gangrene. The disorder seems especially prone to de velop after the infectious diseases, particularly measles, and less fre quently it occurs idiopathieally. Dusting with icaloform promotes healing and prevents gangrene.
An impetiginous form of volvitis is described, characterized by the formation of blisters and pustules, beginning with redness, and with a reactive inflammation and catarrh. This affection is an unusual locali
zation of the eommon impetigo contagiosa. In making the differential diagnosis we have to exclude syphilis, herpes, and gonorrhcea. Treat ment consists in the use of 10 per cent. solution of hydrogen peroxide.
Vaginal catarrh may also result from herpes and from the localiza tion of syphilitic lesions, and from vaccine pusiides. The diagnosis is generally to be made by a careful examination. Furthermore there appears in scarlet fever, in measles, and in smallpox during the acute stage, a vulvitis, which Henoch considers to be an extension of the skin inflammation over the vulva. General clyscrasice are also regarded as eauses of vulvovaginitis in infancy, and we speak sometimes of " vul vovaginitis cachectica and scrofulosa." It is hardly necessary to emphasize the fact that infection due to foreign bodies introduced into the vagina, may also produce vulvo vaginitis.
In comparison with gonorthcea, the above causes of inflamma tion of the genitals are rare. Cleanliness and antiseptic washes will effect a cure in most cases.
There still remains to be mentioned a disagreeable complication of the various forms of inflammation which We have been describing, and that is the phlegmon of the vulva and vagina, which is attended by considerable swelling, severe pain, crdema of the surrounding parts, and serious febrile reaction.
Treatment consists in poult,iees of acetic alum, sitz baths, and the early evacuation of the pus. In the most serious cases, gangrene of the labia with the formation of violet colored, rapidly softening, and ill smelling spots, may develop from the phlegmon, or from an added erysipelas. This gangrene may appear apparently primarily, without any phlegmon, in the course of infectious diseases, which are attended by a marked cachexia. Henoch compares it to the 110111a of the cheek. Treatment consists in early incisions and the bold use of the cautery. The general strength must be maintained by a concentrated diet and stimulants.