We shall see that this common disease has such well-defined anatomical and clinical features that it quite suffices to designate it by the term epithelioma, and that the addition of the title cauliflower growth has only produced confusion. If one says, as is now customary, epithelioma or cauliflower growth (papilloma) of the uterus, the latter name is superflu ous and may be dropped.
Nevertheless, it seems proper, in accordance with the good, original observations of Clarke, Gooch and others, to apply the title cauliflower growth (papilloma) to a peculiar form of cervical neoplasm in order to emphasize the characteristic peculiarities of the same. It is certain that papillary tumors of the portio vaginalis are encountered, although very infrequently, which doubtless belong to the class of carcinomatous growths, ' but which are, for a long time, not cancers and do not possess the anatomical or the clinical features of the latter. These papillomata pro bably invariably become cancers, if left to themselves, but they are certainly not cancers for a long time and do not recur if removed during the period in question.
Clarke, and afterward Gooch, accurately described the tumors called, from their external appearance, cauliflower-growths of the uterus, as neoplasmata proceeding from the lips of the os, especially from their outer surface. They consist of isolated villi, which impart a wart-like appear ance to their surface, so that, in reality, no term so well describes their aspect as that in question. The color of the tumors is either light or dark red unless the surface be gangrenous, which is not often the case.
Even Clarke pointed out the vascularity of these tumors and compared them, in this particular, with the placenta. He also showed that, after removal of the tumor, it completely collapsed, owing to emptying of the vessels, and was found to consist of a small quantity of solid tissue. The later histological researches of Simpson, Virchow and others proved that these tumors consist of proliferation of the papillse into the mucous mem brane of the portio vaginalis. The papillse are, according to Mob's perfect description,' either simple or compound. They usually ter minate in fine points and are covered with a thin epithelial layer. In these slender papillse, often consisting, as it seems, of embryonic connective tissue, are situated large capillary plexuses or single vascular loops with remarkably thin walls. None of these cases are characterized by ingrow
ing of the epithelium into the papilla', by isolated epithelial proliferations, or, in fact, by any microscopical features of epithelioma. The clinical his tory of the new growths at first corresponds to their structure. The tumors occasion no pain, and their growth appears to essentially depend on the expansibility of the vaginal walls.
Even J. Clarke called attention to the fact that in nulliparse whose vaginw are narrow and rigid, the growth of papillomata is much slower than in multiparm, the walls of whose vaginm are always relaxed. Spon taneous superficial necrosis and gangrene of the tumors are, moreover, rare. The ever-present symptoms which early direct the attention of patient and physician to the new growths, are the profuse watery secretion and the unusually profuse hemorrhages. After the preceding description of the structure of these tumors, the above-mentioned symptoms are easily comprehensible.
The attenuated walls of the widely dilated vessels, and the thin layer of connective tissue and epithelium which separate the vessels from the surfaces, render an abundant serous secretion and the profuse hemor rhages almost unavoidable. The serous, watery, usually odorless dis charge takes place continually, in almost incredible quantities. Rams botham (lac. cit.) mentions a case in, which the patient used twenty dozen towels weekly to catch th3 discharge; all the towels were completely saturated.
The violent hemorrhages are due, at first, to accidental causes resulting in laceration of the tumors. At a later period they occur spontaneously. All observers have been struck with the comparative immunity of patients affected with these tumors from constitutional symptoms. The fact that new growths, such as those described, do not recur if carefully removed from a healthy portio vaginalis, harmonizes with the characteristic just alluded to. Such operations are followed by a complete cure. Simpson (loc. cit.) found that one of his patients was quite well six years after the removal of such a tumor, and that she had borne three children since the operation. Colombat found no traces of a recurrence two years after the operation, and Boivin and Duparque (quoted by Simpson) none in two cases, after four years.