Diagnosis.—Vulvitis is a very common derangement amongst- the chil dren of the poor, but may be found in any condition of life. Knowing its frequency, we must be on our guard against accepting any suggestion (such as some mothers are very ready to make) that their child has been tampered with by a person of the opposite sex. If this have really taken place, we should expect to find ecchymosis and recent abrasions of the external genitals. The hymen is rarely ruptured, on account of the small ness of the passage.
The aphthous spots are distinguished from mucous patches by the ab sence of all signs of constitutional symptoms in the child. The ulcers are distinguished from venereal sores by the absence of any hardening at the base. Moreover, the latter are never grouped or confluent, as is almost invariably the case with the aphthous ulcers.
Treatment. —The utmost cleanliness must be observed. The parts should be bathed frequently or syringed with warm water, and afterwards a little pledget of cotton-wool, soaked in a mild lead lotion, should be passed between the labia. If the catarrhal inflammation seem to have ex tended into the vagina, the lotion may be injected with a syringe. If there be great irritation of the parts, a weak solution of perchloride of mercury (one grain to eight ounces of water) may be used instead of 'the lead. If the case be obstinate, the parts should be well dabbed with
a weak solution of nitrate of silver (gr. vj.–x. to the ounce of distilled water).
Dr. Gaillard Thomas recommends for all obstinate cases the careful syringing of the vagina with warm water, and the use afterwards of a lotion composed of one ounce of black wash to the pint of water. The lotion must be injected with a syringe twice a clay, and on each occasion the pas sage must be previously cleansed by careful injection of warm water. Dr. Thomas attributes the chronic course of many of these cases to the imperfect application of remedies. He urges the importance of instructing the mother in the use of the syringe, directing her to introduce the nozzle of the instru ment well into the vagina, so that the upper part of the passage is reached by the fluid. In all instances where the child is ancemic or of scrofulous aspect, iron wine and cod-liver oil should be given internally. Care must also be taken that the bowels are regularly relieved, and that objectionable habits are no longer continued.
In the aphthous form of vulvitis, Parrot recommends the use of the powder of iodoform once a day thoroughly after careful washing. He then applies a covering of lint. Parrot states that this application quickly cures the sores, and prevents the occurrence of gangrene.