It is not necessarily accompanied by an erup tion, though it is the companion and effect of such a disease as eczema, referred to on the preceding page ; but it may exist, to begin with, without any eruption or any appearance of change in the skin whatever. But as a result of the scratching, from which the patient cannot refrain, though it is painful, cracks, scratches, &c., are produced, which bleed, and with the continual scratching may become themselves painful, and lead to the formation of scabs, crusts, &c. This, however, is not the cause but the result of the itching, in this par ticular instance.
Treatment.—Such itching as has been de scribed is not to be regarded as a disease in itself. It is to be looked on rather as a sign of disease, and its true- cause must be searched for and found, if it is to be satisfactorily treated. • A common cause is 'diabetes (p. 407). The writer has seen several cases of this most annoying itching in elderly women, for which no washes or local applications afforded more than a temporary relief, and which had existed more or less for months, and in one case a couple of years, the cause of which showed itself at once on an examination of the urine, and which disappeared very soon after diabetic treatment (p. 408) was resorted to.
The presence of a constant irritation is another frequent cause. The irritation may, however, be of many varied kinds. It may arise from a discharge of whites or other discharge from the womb or genital passage, or the watery dis charge of cancer ; it may be due to some condi tion of the urine, excessive acidity, the presence of oxalates (p. 407), stone in the bladder, or worms in the bowel, or, and this is not to be overlooked, it may be the result of the work of the particular kind of louse found in this region (p. 433).
A variety of other conditions may occasion it —a gouty or rheumatic state of body, various unhealthy states of the womb, &c. &c. Besides all these, it would appear sometimes to be due simply to a condition of over-sensi tiveness of nerves of the part.
Each cause has its own appropriate method of treatment, and it will usually require the skill and patience of an educated medical man to determine what that cause is, and what the proper treatment ought to be. Without such advice, the patient should try the effect of frequent bathing, and syringing with tepid water, to which a pinch of common baking soda may be added, the parts being dried after the bathing, and then lightly dusted with white oxide of zinc powder. A lotion made of 60 grains of the acetate of lead to 2 ounces of water is very soothing, or a lotion of 1 grain of bichloride of mercury to 1 ounce of water may be tried. The latter is very poison ous, and the bottle containing it should be carefully labelled and kept out of the way, lest accidents happen from mistaking it for some thing else.
Inflammation round the external opening is called Vulvitis. It is not seldom met with in infants and young children. Want of clean liness may be the cause, or injury, and it is not necessary to suspect contagion from the child being ill treated, though, of course, such might be the cause. The parts are red, swollen, pain ful, itching, and from them flows a mattery discharge. If there is much pain and redness, soothing poultices should be applied, warm bread poultices or warm poultices of boiled mashed turnips. If the parts are not acutely inflamed bathe first with lukewarm water, and then with a lotion made of 20 grains of sul phate of zinc to 10 ounces of water. A gentle purgative of calcined magnesia or effervescing citrated magnesia is useful, and good nourish ing food must be given.
Bolls and Abscesses form in this region. Soothing poultices must be applied, and any matter present must be removed. This re quires a surgeon. Proper advice is all the more necessary, as a rupture (hernia, p. 267) occurs here in female children, and must not be mis taken for an abscess.