This may be diluted with water a drachm to the ounce, or may be used with equal parts of glycerin, painted on the skin or in the form of an ointment, a drachm or two to the ounce. Tobacco, used as an infusion, two or three drachms to the pint, is often efficacious, especially in pruritus vulvæ. The fluid extract of conium, applied with a brush, and iodoform in ethereal solution, applied as a spray, may likewise be resorted to where the disease involves this region. Camphor and borax may be mentioned as being sometimes of service, as in the following formula:
| Rx. | Sodii boratis, | drachm ij; |
| Glycerinæ, | fluidrachm iv; | |
| Spts. camphoræ, | fluidounce ss; | |
| Aquæ rosæ, | ounce v. M. |
Another lotion, containing borax and morphia, may be given:
| Rx. | Sodii boratis, | drachm iv; |
| Morphiæ sulph., | gr. xv; | |
| Glycerinæ, | fluidounce ss; | |
| Aquæ, q. s. ad | fluidounce viij. M. |
In some cases ointments prove more acceptable than lotions. Tar, carbolic acid, thymol, and the mercurials are all valuable used in this form, varying in strength with the locality and amount of surface to be treated. The smaller the area, as a rule, the stronger the remedy. Chloroform, chloral, and camphor also may be used in the form of ointments. About one drachm each of chloral and camphor to the ounce constitutes a good antipruritic remedy; the active ingredients are to be rubbed together and then added to the ointment.
In pruritus of the anus one of the most valuable and neatest remedies is carbolic acid with glycerin or olive oil, in the strength of from fifteen to forty grains to the ounce. Very hot water applied with a soft linen compress or sponge will usually afford temporary ease, and may be employed from time to time in connection with other more active remedies. In some cases we have had rapid and good results from an ointment of balsam of Peru, a drachm and a half to the ounce. Equal parts of belladonna ointment and mercurial ointment, and a solution of corrosive sublimate, about a quarter of a grain to the ounce, may also be mentioned; and where there are fissures occasional pencilling with a solution of nitrate of silver will afford relief, the latter application, made with a piece of sponge fastened on a stick, being also useful in pruritus vulvæ.
A long list of formulæ have been vaunted for the relief of pruritus of the female genitalia, a few of which may be given. In addition to the remedies already mentioned the following formulæ will sometimes prove valuable. The fluid preparations may be used as vaginal injections or may be applied by means of a brush, tampon or cloth, according to their nature. Hyposulphite of sodium, a drachm to the ounce; sulphurous acid, sufficiently diluted; alum, sulphate of zinc, tannic acid, acetic acid, borax, and boric acid, may all be made use of in the form of injections. In this variety of the disease, as well as in pruritus of the anus, a 6 per cent. solution of cocaine, applied with a brush, or the oleate used as an ointment in the same strength, may be prescribed.
The prognosis should in all cases be guarded, the ability to relieve the disorder depending mainly upon the nature of the cause. The majority of cases, due to no evident cause, prove obstinate. But in all instances the patient should be encouraged to persevere in the treatment, and the hope of an ultimate cure extended to him.
PRURITUS HIEMALIS.—This is a peculiar form of pruritus, characterized by a somewhat harsh and dry state of the skin, accompanied with smarting and burning, unattended primarily by structural change, dependent upon atmospheric influences, and occurring chiefly in winter. It makes its appearance usually in the late autumn, becoming worse with the colder weather, and disappearing in the spring. The disease manifests predilection for certain regions, notably the extremities, especially the inner surfaces of the thighs, the popliteal spaces, and the calves; but in a less degree it may also invade other localities. In its milder form it is a common affection in cold climates. At times the itching is severe, leading to scratching and excoriations, while in other cases it merely amounts to an annoyance. It possesses the peculiarity of manifesting itself chiefly at night, coming on during the evening or shortly after bed is entered. The symptoms usually vary with the weather, being better and worse as the temperature is mild or cold. The affection in most instances repeats itself each year, and may thus continue indefinitely or it may partly or wholly disappear. As stated, the disorder is due to atmospheric influences, but is aggravated by irritating underwear and scratching. It occurs in both sexes, at all ages after puberty, and in those who bathe freely as well as in those who make sparing use of water. It does not seem to be influenced by the state of the general health, nor does internal treatment affect it favorably. Among the various external remedies, preparations containing glycerin, the petroleum ointment, carbolic acid and tar in the form of ointments and lotions, as in eczema, and alkaline lotions and baths,—may be mentioned as being most useful. The simple vapor bath is also in some cases beneficial.