TREATMENT.—This is far from satisfactory in many cases. Thomas speaks most discouragingly concerning it, and states that "the treatment of this condition is most unsatisfactory."
The author has at this time a patient with hyperæsthesia of the vulva who has been treated by him for many months, and up to the time of this writing has obtained no relief. Thomas recommends sending the patient "away from home, where, in addition to enjoying changes of air, scene, and surroundings, she would live absque marito."
In this, as in all disorders which depend on or are associated with the hysterical diathesis, galvanism and massage are, as a rule, of decided benefit. In addition, general tonics, such as arsenic, strychnia, quinia, and iron, should be prescribed. If any local affection exist, such as vulvitis or urethral vegetations, it should be cured first. Warm fomentations, the frequent use of warm water, sedative lotions, and ointments consisting of opium or its salts, carbolic acid, chloroform, and iodoform, are useful topical remedies. Much benefit may be derived by the application of a 4 per cent. solution of hydrochlorate of cocoaine by means of a spray or soft brush. Strong solutions of alum and tannin have sometimes proved beneficial.
No good results have been derived from the use of the knife or caustics in cases where they have been used.
Tumors of the Vulva.
Under this head will be included any enlargement, neoplasm, or adventitious growth which has the vulva for its site. The most common are the following, which will be considered in the order named: viz. Cysts, Hydrocele, Hernia, Hypertrophy, Elephantiasis, Hæmatoma, Cancer, and Urethral Caruncle. There are other growths of the vulva, such as fibroma, lipoma, sarcoma, lupus, etc., but they are of such rare occurrence that their discussion is necessarily omitted.
Cysts and Inflammation of the Vulvo-Vaginal Glands.
The frequent concomitance of cysts and abscesses in these glands has caused the author to consider them here under the same caption.
The most frequent cysts of the vulva are those springing either from the ducts or glands of Bartholini, or, as more commonly known, the vulvo-vaginal glands, situated near the lower part of the labia. Cysts having their origin in the ducts are single and are invariably of an oval form; such also is the more common shape of those springing from the gland, yet sometimes they are lobulated, of an irregular form, and comprise one or more in number. Inasmuch as this same locality is sometimes the site of hernia, and cysts of the labia often of a similar form, the physician should be positive that the tumor is a cyst before having recourse to any active mode of treatment.