Malignant Growths.
Of malignant growths of the vagina sarcoma is very rare. It consists in an infiltration of the vaginal wall, is very painful, and its presence can only be de termined by excision of a portion and its examination by the microscope.
Carcinoma is also, for the most part, an infiltration process. It may be an ex tension from carcinoma of the uterus; in fact, the disease rarely originates in the vagina. The tissues involved may be hard or soft, and they bleed readily and profusely. This condition is times caused by the irritation of a sary or some other foreign body in the vagina.
Primary cancer of the vagina is not so rare as supposed, upward of one hundred and thirty eases having been recorded. The circumscribed, papillary variety otters the best prospects for operative interference, and is situated most fre quently on the posterior wall. Fried! (Wiener klin. Woch., No. 3. '00).
live personal cases of primary eaneer of the vagina. (July 0.43 per cent. of all sneers in women are of vaginal origin. Some foreign authorities make the per centage as low as 0.38 or as high as 1.0. The earliest ago at the onset. of the dis ease was 17, for in .1(diannovsky's pa tient, aged 9, the growth was evidently sarcomatous, and in thiersa nes. it child only 3 years of age, the nature of the tumor remains doubtful. Cancer of the has eommeneed to develop after 70. In 70 eases where the age was at eurately given the onset of the di,wase occurred thus: Third decade (20 to 30), 12 cases; fourth. 14 cases; fifth, 12 cases: sixth, 22 eases; seventh, 14 eases; and eighth, 2 eases. 'thus most cases arise long after the menopause, and hence it may be inferred that the origin of the disease has no direct connection with the incidents of reproductive life. Roger Williams (Medical Record, Nov. 30, 1001).
treatment for both these diseases consists in early and tensive removal with knife, scissors, or actual cautery. In some cases the dis eased tissue can be removed only by scraping with the sharp curette. Recur rence is almost certain to take place less the entire growth is removed in its incipiency.
Absence and Defects of Structure.
The vagina may be congenitally ab sent or it may be entirely occluded as the result of disease or surgical opera tion. Congenital absence is rare; it signifies arrest in the development of 11I filler's ducts during embryonic life from causes of which we know very little. It may co-exist with perfect development of all the other genital organs.
Twenty-six cases with rudimentary development of Miller's ducts have been collected in which the ovaries were re moved to relieve menstrual molimina. In all but 2 the breasts and external genitals were fully and normally devel oped; in 1 of these there was simply a deficiency of fat-tissue in the labia majora and minora. In 11 cases the urethra was of unusually large calibre, readily admitting the index finger; and in these there was total absence of the vagina. II. N. Vineherg (Amer. Jour. Obstet. and Dis. of Women and Child., Oct., '95).
Inflammatory disease of the vagina (erysipelas, diphtheria, sequelte of severe. labor, etc.) may cause extensive ing and exfoliation of the mucous mem brane, followed by complete adhesive union of the anterior and posterior walls_ Acquired atresia of the vagina may be caused by difficult, especially tedious, labor, falling astride, injuries from for eign bodies, burns and scalds, syphilis, vaginal diphtheria, variola, and possibly pneumonia, yellow fever, and typhus. Kummer (Corres. f. Schweizer Aerzte, Jan. 1, 15, '99).
Complete closure by surgical proced ure has been recommended for certain diseased conditions, e.g., for extensive and inoperable vesico-vaginal fistula,— the menstrual fluid being discharged through the bladder. There are no troublesome symptoms with congenital absence of the vagina if there is also ab sence of the ovaries. There are no symp toms before puberty in any case, as a rule, nor after the menopause. Trouble, difficulty, is usually due to the accumu lation of menstrual blood within the uterus, a tumor being formed which may be of considerable size. I have seen it extend nearly to the umbilicus in a girl of 16.