The essential points of treatment to observe in the acute stage of vulvitis are rest in the recumbent posture and perfect cleanliness. The labia should be separated and the parts frequently bathed and cleaned with warm water. Various local washes or applications are of use. A warm solution of boracic acid (ʒj to a pint of water), the dilute solution of the subacetate of lead, or a solution of bichloride of mercury (1:5000) may be used. If the disease is of gonorrheal origin, the parts should be painted once or twice a day with a 2 per cent. solution of nitrate of silver, applied after the discharges have been gently washed away. As the disease subsides the inflammation may be found to persist in the crypts of the vestibule, the urinary meatus, and the ducts of Bartholin’s glands. It is very important that all remains of the inflammation, especially if it be of septic or gonorrheal origin, should be eradicated before the woman is discharged from treatment. The presence of any focus of inflammation, even though latent, is a constant source of danger to the woman; for septic organisms or material may be carried from the external genitals to the higher parts of the genital tract, as the uterus and Fallopian tubes, with the most disastrous results. Sometimes a small drop of pus will be observed escaping from one of the small glands or crypts of the vestibule, about the urinary meatus, after the inflammation has disappeared in other parts of the vulva. In this case the gland should be punctured with a fine cautery-point or a fine wooden probe or point saturated with pure carbolic acid or other caustic. If the disease persists in the external meatus or urethra, it must be treated by the local applications appropriate for urethritis. [Illustration: FIG. 16.--Appearance of the external genitals in a woman with gonorrhea: _G. m._, gonorrheal macula situated at the base of a vaginal caruncle.] =Inflammation of the Vulvo-vaginal Glands.=--The vulvo-vaginal glands are two in number. They are about the size of a bean, and are situated deeply on the inner aspect of the labia majora, where they may be felt in thin women. The duct of the gland is about one inch in length, and opens immediately in front of the hymen, about the middle of the side of the ostium vaginæ. In cases of vulvitis the duct of the gland usually becomes inflamed, and the inflammation may extend to the gland, producing abscess of the vulvo-vaginal gland. Inflammation of the duct and the gland may also occur independently of vulvitis, from direct septic or gonorrheal infection.