SPECIAL DIVISION. PART I. DISEASES OF THE VULVA. CHAPTER I. MALFORMATIONS.1 1. Absence of Vulva.-By an arrest of development in the first onth of fetal life the external genitals and the anus may be absent, e skin covering the region uninterruptedly. (See p. 32.) This ondition is almost always combined with arrest of development in ther organs, and is only found in non-viable fetuses. If the anus is formed, life may be continued without external genials, the urine being evacuated through the navel. Such a case is on record, and was cured by the formation of an artificial urethra and closure of the opening of the urachus at the umbilicus. 2. Hypospadias.-In consequence of an insufficient closure in the median line the lower wall of the urethra may be split more or less deeply (Fig. 199). If the defect extends very deeply, so as to divide the different sphincters of the urethra (p. 76), the patient cannot retain her urine. A small degree of hypospadias is, by far, not so important in woman as in man, and will hardly call for treatment. The complete congenital hypospadias has been successfully treated by paring and uniting the surrounding mucous membrane to such an extent as to form an artificial urethra, the relations of which to the bladder were much like those of a spout to a teapot.2 'In this chapter I have to some extent used my article on this subject in American System of Gynecology, edited by Mann, Philadelphia, 1887, vol. i. pp. 235-282. 2 For details the reader is referred to T. A. Emmet's Gynecology, 2d ed., pp. 649-654. help. The patient should, if possible, be sent to a warm dry climate or high up in the mountains, but at the same time pleasant company should be provided. A cold and damp dwelling must be exchanged for a dry and sunny one. Different kinds of baths (p. 187) are to be recommended: warm hip-baths, tepid general baths, Turkish or Russian baths, are especially indicated where there is a rheumatic diathesis. Otherwise, it is better to strengthen the nerves and harden the skin by means of towel-, sheet-, or sponge-baths, shower-baths, hydrotherapy, or sea-baths. In many cases of idiopathic leucorrhea a treatment carried out on these lines will suffice to effect a cure. This ought especially to be tried in intact girls, so that even a physical examination may be avoided. In most cases, however, recourse to local treatment is an imperative addition to the general treatment. Applications of tincture of iodine, solution of nitrate of silver, carbolic acid, chloride of iron, chloride of zinc (20 to 50 per cent.), etc. are made to the affected parts (p. 170). If there is no free drainage from the uterus, the cervical canal should be dilated (p. 155). Vaginal injections with hot water or astringents are beneficial in most cases (p. 170). It may become necessary to remove granulations from the cervix or fungoid growths from the inside of the corpus and fundus, or to scrape the endometrium with the curette (p. 154), or to burn the cervical canal with the thermocautery (p. 182) or by means of thermic or chemical galvano-cauterization (pp. 235 and 231). The mucous membrane of the cervix may also be cut away. As to the special indications to be met in regard to underlying general or local diseases, the reader is referred to works on the practice of medicine and to later chapters of this manual. Some internal remedies, such as aletris (cordial, 3j t. i. d.), hydrastis (fluid extract, gtt. xx, t. i. d.), cimicifuga (fluid extract, 5ss to 5j), inula (a decoction of the root, 3iij to water q. s. ad 3iv, to be taken every morning), seem to have the special virtue of checking leucorrhea. In phthisical patients the leucorrheal flow is by some regarded as a kind of issue, to dry up which would precipitate the destruction of the lung. The local treatment should, indeed, be of the mildest or may be dispensed with altogether, but all the internal remedies recommended, such as cod-liver oil, terraline, hydroleine, etc., only strengthen the whole constitution, and thus benefit the lungs indirectly, and the leucorrhea, if abundant, being in itself a drain on the physical strength, can hardly fail to have a bad influence on the pulmonary affection. 1 Terraline is a product gained from petroleum. Hydroleine is a mixture of cod-liver oil, boracic acid, and other substances. Both of these medicines have seemed to me to have so decided an effect in wasting diseases that I do not hesitate to mention them here. |