Hildebrandt describes a peculiarly interesting case in a puerpera, where on the right labium majus there existed a tumor the size of an apple made up of condylomata. Small remnants of condylomata were at the lower part of the vulva. The tumor disappeared without treatment at the end of eight weeks.
The experiments v. hich have been made by Kranz and by Gfintz to transplant condylomata in order to determine if they were specific were not conclusive. It is not denied that these growths are especially fre quent in cases of gonorrhea. Where this disease is present such a condyloma may appear. How many virulent cells were transplanted with these condylomata no one can say. The experiments would only be of value when carefully disinfected condylomata should cause the growth of other similar excrescences. Further, many of the transplantation experi ments were entirely negative.
That condylomata have nothing in common with syphilis is granted, although it has been proved that papillomata may spring from syphilitic soil. The tertiary syphilitic papillomata, which grow at the vaginal entrance, have generally a different appearance. Their surface is not so much divided up like the mulberry as is that of the condyloma.
As to whether true condylomata may exist in the absence of specific infection will shortly be determined by careful search for the gonococcus. To-day it is probable that condylomata may exceptionally exist without such a specific cause. Vulvitis of a simple nature may result in their growth. Pregnancy predisposes to their formation in that during its course there is usually present a profuse and lasting leucorrhea. The congestion customary to the gravid state is a further cause. Recurrence in after pregnancies prove these assertions to be true.
Condylomata rarely produce symptoms. If they are large, however, they may even imperil life. I had a patient with a large number of con dylomata on the left labium minus. During labor there occurred a tear of the vagina which extended into these masses, and caused a profuse hemorrhage difficult to check. In the puerperal period these condylo mata degenerated, resulting in pelvic abscess and death from puerperal fever.
I believe the correct practice to be to remove condylomata, seeing that this may be accomplished without pain or risk. Cleanliness and injections
will cause the accompanying factors to disappear. Isolated patches may be treated by the milder caustics, or else they may be cut off. Removal by the scissors is certainly more radical, but if the site be not cauterized the growths will recur. After excision the base should be touched with nitric acid, and then lead compresses applied. Levy of Munich has thus entirely cured these excrescences. Formerly, powdering with alum or sugar of lead was recommended, as also cauterization with creosote, sublimate, strong sulphuric acid, chromic acid, Fowler's solution. The creosote is used pure; the sublimate in solution of alcohol or collodion, 1 to 8; chromic acid, 5 parts to 8; Plenk's solution, consists of bi-chloride of mercury 3 ss., dissolved in i. each of alcohol and concentrated acetic acid, to which is added camphor, alum, lead; each gr. xxx. The solu tion is not to be filtered.
Elephantiasis or Pachyderma Vulvoe.—Under these terms is included hyperplasia of the skin with consecutive increase in the sub-cutaneous cellular tissue leading to enormous enlargement and thickening. The disease affects, in particular, the lower extremities (ninety-five per cent.), and from the enormous swelling of the leg and the obliteration of the ankle crease, the disease resembles an elephant's foot, and therefore its name. The disease affects, in addition, the genitals, the scrotum more frequently than the vulva, the mamma] and the anus.
The essence of elephantiasis is great thickening of the skin. The surface is smooth and shiny (elephantiasis glabra), or else with elevations (elephantiasis verrucosa), or else covered with hypertrophied papillae (ele phantiasis papillomatosa). Other distinctions are into elephantiasis diire and mollis. In the one case section through the diseased skin reveals a mass of dense fibrous tissue, and pressure with the finger leaves no im pression; in the soft forms there is succulency and pitting, even as in edema. From the section there flows considerable watery matter like lymph from the dilated vessels, which are more readily distended than normally (elephantiasis lymphiectatica).