of the vagina are rare. It has been said that they sometimes result from a thrombus, but a thrombus in a vaginal vessel fol lowed by a rupture and blood-tumor, while conceivable perhaps as an accident of labor, is at least improbable. As a result of pressure or bruising or violence with instruments during labor it is quite possible, but I do not remember to have seen such an accident nor the record of such.
Accidents of other kinds are ac countable for this condition, such as violent coitus, masturbation with wooden or metallic substances, falls astride a fence or a chair, or thrust with any hard substance or thing in a violent manner. It is possible also as an accompaniment of purpura hmmorrhagica. No age is ex empt from such a tumor. It may be little more than an ecchymosis or slightly elevated effusion, or it may occupy a large portion of the vaginal tube. The htemorrhage which causes such a tumor is usually self-limited, the pressure of the surrounding tissues being sufficient to check it.
Treatment.—There is little to be done in the way of treatment; the fluid con tents of the tumor are usually absorbed if they are not disturbed. Should puru lent degeneration take place, the tumor would be converted into an abscess, and would require to be treated as abscesses in other locations are treated. Rest in bed will favor absorption and may pre vent degenerative changes.
NO GROWTHS.—Benign neo plasms of this class are most frequently fibroids or outgrowths from the mucous membrane. Lipomata have been re ported, but they must be exceedingly rare. Fibroids may be either sessile or pedunculated. They are always sessile in their early history. They may be projected into the vagina from the uterus or they may originate within the vagina. They are seldom larger than a walnut or a small egg, and are not painful. They may be pure connective-tissue growths or they may contain muscle-elements. Little is known as to the causation of such growths.
The mucous-membrane growths are always pedunculated; they may be single or multiple, are always painless, but may give rise to haemorrhage and a mucoid or muco-purulent discharge: they are seldom larger than a pea. The treat ment consists in ligation and cxsection of the polypi; incision and enucleation of the spcsilo fnmnrc Fungous growths of the vagina have been described, but must be exceedingly rare. Garrigues ("Diseases of Women,"
p. 319, '97) describes two forms of these growths which usually occur among pregnant women. They are known as Leptothrix vaginalis and Oidium albi cans. Their principal symptom is itch ing, this being especially the case with Oidium albicans. The vaginal mucous membrane with this disease is red and inflamed, and studded with small, whit ish growths similar to those which are seen in the mouths of children afflicted with the same fungus. The distinguish ing characteristics of the two fungous growths are to be determined, of course, with the microscope.
Treatment. — For treatment the ni trate-of-silver solution (10 per cent.) or a 10- or 15-per-cent. solution of sulphate of copper or of acetate of lead may be swabbed freely over the vaginal mucous membrane, daily until the latter has re gained its normal condition and ap pearance.
Foreign Bodies.
Of course, these are not really tumors, but they may become fixed in the vagina and be more or less surrounded by new tissue and so become essentially tumors. They may consist of hair-pins, pieces of glass, pessaries long neglected and over looked, and a great variety of other sub stances. They are often introduced for the purpose of masturbation, and some times from mere perversity on the part of the patient. They may excite intense inflammation. In some cases they form a focus from which malignant disease develops. They may cause intense pain, and their removal may be very difficult. In some cases they may be removed with forceps; in others they must be removed by dissection.
There are three hundred and sixty-four eases on record in which deleterious re sults have followed retention of vaginal pessaries. In many cases the instru ments have grown into the vagina or have become incrusted or produced per foration and have been removed with difficulty. The use of Gig]i's wire saw is suggested in the removal of such re tained pessaries. An aneurism needle threaded with silk is carried about the pessary, the saw is tied to the silk, by means of which it is then drawn around the pessary. Max Madlener (Centralb. 1. Gyniik., Oct. 1, TS).