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or Viilvitis

aphthous, labia, vulvitis, seen, red, membrane and little

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VIILVITIS, or vulvo-vaginitis (for the catarrhal inflammation of the mucous membrane often penetrates for some distance into the vaginal canal), is very common in little girls. The complaint may be seen at a very early age, even during the first few months of life ; but is more common in children of five years of age and upwards. M. Parrot has described a variety of the derangement which he calls "aphthous vulvitis," and states that it is met with most frequently in children between the second and fourth year.

Causation.—Catarrhal vulvitis is especially common in children of scrofulous constitution, and appears to be excited by want of cleanliness and insanitary conditions generally ; also by local irritation in the neigh bourhood, as by ascarides in the rectum. In very rare cases it may be the consequence of sexual violence. Certain forms of the complaint appear to be contagious and capable of being communicated from one child to an other by sponges or towels ; and Dr. Atkinson, of Baltimore, has stated his belief that the discharges from a purulent ophthalmia may be conveyed to the vulva, and set up a similar inflammation in that situation.

Vulvitis is sometimes a secondary disease. Thus, it may come on after some of the acute specific diseases. Parrot has seen aphthous vulvitis succeed most commonly to measles, next to whooping-cough. He has also met with it after varicella, erysipelas, pneumonia, and diphtheria. In only a few cases was it apparently a primary derangement.

Symptoms.—Ill catarrhal vulvitis a purulent discharge may be noticed to issue from the vulva. At first it is scanty, and is seen on the child's body linen. On inspection of the parts the mucous membrane is found to be red, and the larger labia to be a little swollen. The discharge is yel lowish or greenish in colour. It is usually fetid, and in many cases is very profuse. In hospital out-patients, who are often neglected in the matter of cleanliness, the opening of the vagina is often found bathed with a thickish, yellow, offensive matter. If the catarrh is not quickly cured, it may lead to considerable swelling of the labia, and the mucous membrane may become excoriated. In these cases there may be some pain in walk ing ; and if the catarrh extends to the orifice of the urethra, there may be smarting in micturition. There is not usually any enlargement of the in

guinal glands ; but in bad cases, occurring in unhealthy, neglected chil dren, irritable sores may form on the inner surface of the labia, and the glands may then become slightly swollen, and a little tender. I have never seen suppuration of these glands. If left untreated, spontaneous recovery may take place, or the discharge may become chronic, and per sist for months or even years. The swelling in these cases subsides, but thin purulent matter, small in quantity, continues to be secreted. I have thought, in some of these chronic cases, that irritation has been kept up by a habit of masturbation.

Aph,thous vutvitis, according to Parrot, attacks the labia majora, and sometimes the smaller lips and the clitoris. From these parts the aphthous inflammation may spread to the genito-crural folds, the groins, the peri nacum, and the borders of the anus. It begins by an eruption of small, rounded, or semi-spheroidal elevations of the epidermis, of a grayish-white colour, and often depressed in the centre. The little patches closely re semble the aphthous spots on the buccal mucous membrane, and are sur rounded by a red, slightly-swollen ring. In number they are five or six to fifteen, and may be placed singly or in groups ; sometimes they are confluent. After a period varying from thirty-six hours to three days, the patches give place to ulcers which have a gray or yellowish base, and a red border. They cause considerable irritation, which it is difficult to prevent the patient from relieving by the use of the fingers. At the height of the disease the edges of the sores are raised, and the parts around, especially the minor labia and the clitoris, are swollen and bright red. Under suita ble treatment the swelling soon subsides, and the ulcers heal ; but in un healthy subjects the lesion may take on a gangrenous process. When this occurs the constitutional symptoms are severe, and the gangrene may spread extensively, and present all the features described elsewhere (see Gangrene of the Vulva, page 170).

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