. Clinical gyncology, medical and surgical. oderate size. NEOPLASMS OF THE VULVA AND VAGINA. 533 The growth does not annoy the patient until it has reached a size sufficientto produce inconvenience and pain by reason of its weight. Tumors whichreach to the base of the urethra usually produce incontinence of or papillary tumors arc especially annoying because of secretionsaccumulating between the projections of the papilla?. Ulcerations, althoughnot infrequent, have a tendency to heal spontaneously if the parts are keptclean. In some cases very large quantities of scro-albiunino
. Clinical gyncology, medical and surgical. oderate size. NEOPLASMS OF THE VULVA AND VAGINA. 533 The growth does not annoy the patient until it has reached a size sufficientto produce inconvenience and pain by reason of its weight. Tumors whichreach to the base of the urethra usually produce incontinence of or papillary tumors arc especially annoying because of secretionsaccumulating between the projections of the papilla?. Ulcerations, althoughnot infrequent, have a tendency to heal spontaneously if the parts are keptclean. In some cases very large quantities of scro-albiuninous fluid exudefrom the neoplasm, necessitating frequent changes of clothing and thewearing of napkins. Eventually the general health of the patient willbecome more or less undermined, according to the amount and kind of dis-comfort caused by the tumor. The prognosis as to longevity is good, although the tumors, when onceestablished, never disappear spontaneously. They seldom recur if inguinal glands are always enlarged. Fig. Elephantiasis of vulva, after operation. (Schroeder.) Diagnosis.—If the pathology is borne in mind the diagnosis canreadily be made. As stated under the head of etiology, frequent attacks oflocal inflammation mark the beginning, which cause the derma to be verymuch thickened, and consequently large condvlomatous tumors which mightotherwise be mistaken for the products of elephantiasis are distinguishedfrom them by the presence of normal skin around the base of the condy-loma. Ulcerated tumors may be mistaken for malignant growths andhypertrophic lupus. The microscope will aid in deciding the question ifthe clinical history alone is not satisfactory. The characteristic forms of 534 NEOPLASMS OF THE VULVA AXD VAGINA. the latter diseases as compared with elephantiasis should be sufficient. Wemust not forget, however, that one variety of elephantiasis may becomecarcinomatous: hence when we find a warty tumor ulcerating it is well tobe on our g
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