TUBERCULOSIS AND TUMORS Tuberculosis of the female genital organs is generally a secondary affection in n-hich the tuberculous virus reaches the peritoneum first, and from there spreads to the Fallopian tubes or else it reaches the intestines and then the vagina and peritoneum, and finally involves the tubes. According to Bruning, who collected 40 cases, the tubes generally show a caseous alteration, and then the uterus, vagina, ovaries, and vulva. He is of the opinion that primary genital tuberculosis, as described by Demme, Schlenk, v. Karjahn, and others, has not yet been proven to occur, because the diagnosis was only established clinically. Vierordt in one case established the diagnosis by finding tubercle bacilli in the discharge. It may be impossible to establish the diagnosis when symptoms of general peritoneal infection are present.
Among the benign tumors are to be mentioned in the first place, the vaginal polypi which are characterized by hamorrhages. Malignant tumors of the genital organs are found more often in girls than in boys. The majority of the cases are seen in the first six years, according to Steffen, who collected 33 cases from the literature. The favorite seat is the vagina, where 15 out of the 33 tumors collected by Steffen, were located. The uterus was affected in 4 cases. In 9 cases malignant
tumors of the ovaries were found, a condition to which the age of pub erty seems to have a predisposing influence. The majority of the tumors observed during the early years of life seemed to be congenital.
Sarcoma of the, vagina and its variations are amongst the most important forms. According to Pick, who observed 15 eases of polypoid vaginal sarcoma, they have a tendeney to spread with great rapid ity, to intrude into the neighboring tissues, ancl to infiltrate them with cancerous degeneration. Before they are visible, the, symptoms are profuse Inemorrhage, disturbances in nneturition, and pains in the abdominal region. Even a very early operation will not protect the patient from recurrence.
The uterus may be affected by both sarcoma and carcinoma. The symptoms are the same as those of the same affections in adults. The malignant tumors of the ovaries are generally carcinoma. The diagnosis cannot often be confused with malignant tumor of the abdomen. The prognosis, in .spite of operative interference, is bad owing to the tendency to recurrence.