We will speak further on of disease and of cysts of the glands of Bar thol in.
Myonia.—Myoms of the labia has been described by Blasius under the name of collonema. A tumor removed by Iloogeweg had a thin pedicle, and was made up of grape-like cysts. Virchow pronounced it a tumor of this nature.
Angionza.—Only two instances of a growth of this nature have been recorded. Hennig saw a vascular nevus one and three-quarter inches thick in a two year old child, and Sanger found in a ten weeks' old baby an angioma or cock's-comb-like tumor on the right labium, which was .39 inches high, 3 indh broad. and .39 inches thick. At delivery it was only the size of a cent, but grew rapidly. It was excised and did not recur.
Melamma.—Instances have been recorded by C. J. Muller from A. Mar tin's practice. The one was a melanomatous sarcoma of the clitoris, the size of a goose-egg; the second developed from the right labium majus and was the size of a walnut. The first patient died of cachexia, the second was cured.
Carcinoma of the Vult.a.—Under this heading we include all malig nant growths, that is to say epithelioma or cancroid, medullary carcinoma, where there exists increase in the stroma and swelling and proliferation of the epithelium (glandular cancer), atrophic carcinoma, called schirrhus by the older writers, and finally sarcoma.
Although each of the above forms has been found on the external genitals, still they are rare when compared to the frequency of occur rence in the uterus. From the statistics of Virchow, Louis Mayer, Marc d'Espine, and Tanchon, it is shown that to thirty-five or forty cases of uterine cancer there occurs only one malignant growth on the external genitals.
According to L Mayer the frequency on the special organs is: Uterus, mammte, ovaries, vagina, vulva. In 16,637 patients with tumors, Gurlt found 11,140 females, and of this number 7,479 had carcinoma, and 72 or 10 per cent. wore on the vulva. From the gynecological clinic at Basle, Winner found .5 per cent. cases of carcinoma of the vulva in 5 per cent, of the disease of the female genitals. Of the above forms the cancroidal excels the others in frequency. (Scanzoni and West.) In 9 cases of malignant growths of the external genitals, L. Mayer found 4 certainly and 2 obscurely cancroidal in nature. Hildebrandt in 6 cases of malignant tumor found 3 microscopically to be cancroid.
Cancroid.—Its site is ordinarily the lower and inner surface of the labium mains, in the sulcus interlabialis—that is to say, between the ex ternal skin and the mucous membrane. In only one instance was the • clitoris the origin. (Rokitansky.) At the beginning of the disease there appear small nodules, which raise up the skin and are united to it. These nodules are always covered more or less with thick layers of epithelium. L. Mayer has reported two cases where this epidermal thickening formed extensive callosities, and he found the same appearance on the vulva of young and old women not suffering from cancroid, but from pruritus. Still, that cancroid may develop from such callosities a case reported by Mayer conclusively proves. The growth may spread deeply and exten sively before it attacks the surface.
The ulceration begins by the loss of the superficial epithelial cells from the nodules. The nodules are teen more readily recognized, and this is what speaks for cancroid. The carcinomatous ulcerations are charac terized at the outset by the discoloration and elevation of the superficies of the skin, and by the livid borders. The secretion has a great tendency to become purulent. Where, however, as on the external genitals, there is no stagnation of the secretion, the ulcerations may spread extensively before the secretion becomes foul. In later stages the cancroid is charac terized by its fissured base, whence papillre often project. The ulceration then resembles a raspberry. The tumor soon, however, spreads and as Burnes an oval shape, and has a marked tendency to spread, usually towards the mucous membrane of the vestibule. Hildebrandt remarked that a spreading of the ulcerated cancroid to the opposite labium majus ordinarily does not occur. He reports a personal case, however, where the probability was that such an extension had occurred. It concerned a cancroid of the left labium mains, which had the size of a twenty-five cent piece, while on the corresponding side of the right labium there ex isted a cancroid-like tumor the size of a cent, covered with thick granula tions, and with indurated base. It was removed at the same time as the other, but microscopic examination did not prove it to be certainly a cancroid.