We would mention here, finally, not as a therapeutic measure, al though it has been utilized once by Fehleisen, that erysipelas has a marked influence over elephantiasis, and a number of observations exist where recovery from this disease followed on an attack of erysipelas.
Fibroids.—These tumors grow generally on the labia majors, although they are also found on the perineum and on the nymph. They may be enucleated, and they contain, according to Klob, interstitial tissue and muscular fibres. Kiwisch says that these tumors may further arise from the interstitial tissue of the labia majors, from the pelvic fascia, from the periosteum of the bones.
Fibroids of the labia attain great size, become pediculated, and may reach to the knees. Scanzoni removed one the size of a man's fist, I myself one the size of a child's head, which in the erect position extended to the middle of the thigh. We would record also a case cited by Klob from Voigtel of an instance seen by Fahner where a tumor weighing twelve pounds and soft in consistence sprang from the left labium. In certain instances superficial excoriations appear on the skin, which may eventuate in purulent degeneration and elimination of the fibroid. (Scanzoni.) Ordinarily, fibroids are of slow growth, although they increase rapidly under the influence of pregnancy, to decrease, however, even as do uterine fibroids, at the end of the puerperium. (Scanzoni.) Even as in the uterus, also, these fibroids may, according to Scanzoni, be of the nature of fibro-cysts.
When the fibroids are seated only in the subcutaneous cellular tissue, the tissue underneath often increases rapidly, the tumor is pushed above the surface and is pediculated (fibroma pendulum). In case the growth is very soft it is called a fibroma molluscum. Such tumors vary in size from that of a poppy-head to a man's head. Here belongs that case re ported by Hildebrandt and referred to under elephantiasis, where the growth on the vulva was the result of rough manipulation on the part of the husband.
As to the etiology of these tumors we know as little as in regard to similar growths on other parts of the body. It is interesting to note that Scanzoni deems it probable that occasionally non-resorbed blood extra vasations may be a cause. The symptoms are the same as in elephantiasis.
They are uncomfortable on account of their weight and traction; they hinder walking and coitus, interfere with the stream of urine, and they lead to ulceration, dermatitis and smarting The treatment is similar to that of elephantiasis.
Lipoma. —This form develops from the fatty layer in the sub-cutane ous cellular tissue of the mons veneris or the labia majors. Its char acteristics are in many respects similar to those of elephantiasis. The size, the covering of skin, the softness, are alike in both affections. Section through the tumor, however, reveals only connective tissue, in the interstices of which is a large amount of fat. The largest tumor of this kind was seen and operated upon by Stiegele. It developed from the left labium, being sessile, and measuring twenty-five inches in length, 5t in breadth, five in thickness, and weighing ten pounds. The epidermis was greatly hypertrophied, and nodular in places and depressed in others. On section the meshes of the sub-cutaneous cellular tissue were greatly distended and filled with fat, firm towards the surface, softer in the depths, and mixed with serum. In Bruntzel's case the rapid increase during la bor and the decrease after a spontaneous hemorrhage were noteworthy. The patient was operated upon and cured.
Enchondroma.—Seimeevogt has reported a case of enchondroma of the clitoris, the size of a fist, which was united to the clitoris by a pedicle trifle over one inch in length. The woman was aged fifty-six, married but sterile, and suffered from prolapsus uteri. The surface was nodular, was hard to the touch, and on section it was found to be chondroid in tex ture, and in places calcified. (Hildebrandt.) Likely enough Beiges cases of ossification of the clitoris belongs here.
The first is cited from Bartholin, where a Venetian prostitute had such a greatly ossified clitoris that the men who had intercourse with her were injured. Bellamy showed before the London Pathological Society a spec imen from a woman seventy years old. It was a horny growth from un derneath the prepuce of the clitoris, which in form and in size resembled a tiger's claw.