CANCROID AND CARCINOMA.
These growths are also rarely primary in the vagina, but quite fre quently secondary, in particular by extension of carcinotna from the uterus to the fornix vaginre, and next from that of the rectum, vulva, urethra, less frequently from the bladder, and further as metastases from distant carcinomatous foci. Mister has given us the latest collection of cases of primary carcinoma of the vagina, and after the exclusion of a number of cases which seemed doubtful to him, he has obtained twenty two instances, to which number Olshausen has added two. Primary car cinoma of the vagina is met with in two forms: the first and most fre quent is the papillary cancroid, and the second is the c,arcinomatous infiltration. The first is generally seen as a circumscribed broad-based excrescence, generally on the posterior vaginal wall, and the second as a substitution for the normal tissue of medullary or schirrous masses. Of nine instances of this variety (without differentiating the carcinoma form), in four the entire length of the vagina was affected. The posterior wall was affected nine times, the left posterior once, the right once, both lateral walls once, the anterior wall twice.
In regard to etiology the reported cases give us meagre information. The same rule holds as regards age as in carcinoma of the uterus. The majority of the cases occurred between thirty-one and forty years of age, nine cases; four cases occurred between forty and sixty years. Excep tionally the disease occurs at an earlier age. Kfister records two cases from fifteen t,o twenty, and two from twenty to thirty. In the Strassburg pathological museum there are four specimens of primary c,arcinoma of the vagina, and one is a broad-based glandular carcinoma, which was removed from the posterior fornix vaginre of a nine year old child. In a single case reported by Hegar, traumatism was the etiological factor, and he removed two cancroidal nodules in a woman fifty years old, caused by the pressure of a closed Hodge pessary against the ascending ramus of the pubes.
All forms of carcinoma vaginre lead to rapid destructive ulcemtion, with peripheral and deep extension into the neighboring tissues. As the growth breaks down there re-sults an elevated cancerous ulcer which may eat its way into the adjoining organs, and owing to the frequent seat on the posterior vaginal wall, a recto-vaginal fistula is often established. Ex
tension by the lymphatics into the glands of the pelvic cellular tissue occurs, as also into the inguinal glands in case of the deep-seated form. The usual symptoms are hemorrhage, suppuration and pain; occasionally there are mechanical symptoms, during cohabitation and delivery, the result of stenosis and obstruction of the lumen of the vagina; further there are symptoms from the side of the adherent neighboring organs. The most important and never-failing symptoms are the anomalies in secretion, the watery, bloody, and purulent discharges. These depend partially on the form and the vascularization of the carcinoma, partially on the stage of the growth. Coitus and other mechanical insult, such as distension of the recto-vaginal septum by constipation, are causes of hem orrhage, as is proved by the recorded histories. Bodwin's case of " erectile cancroid" is an instance of unusual vascularization. It concerns a woman of thirty-one, whose father and grandfather had died of cancer, and who was suddenly seized with profuse hemorrhage from the genitals. Bod win found a vascular tumor the size of a walnut, on the anterior vaginal wall near the urethra, from the centre of which an artery the size of a needle spouted. The hemorrhage was checked by the local use of a so lution of sesquichloride of iron, tampons, and rest in bed. In a few days it recurred. On the seventh day the tumor was ligated, it fell off in a few days, and left an apparently healthy granulating surface. Soon a foul dark discharge set in, and after fourteen days a large cauliflower-like growth was present. The hemorrhage did not recur, but the discharge became more profuse and foul, depreciated the woman's strength, and she died six weeks after the first hemorrhage. At autopsy a number of large, soft, carcinomatous masses were found on the posterior vaginal wall, dis tending the vagina; the rest of the mucous membrane was injected and thickened. The organs so far as they were examined, were normal. As a general thing, the discharges, the suppuration, and the inflammatory and septic complications only lead to death after wide extension of the d isease.