April
1899.]
SCLEROTISING GRANULOMA OF PUDENDA?POWELL.
NOTES ON SKIN DISEASES
:
SCLER0T1SING GRANULOMA OF THE PUDENDA. By ARTHUR POWELL, F.R.C.S., Cachar.
notes.
it as a sclerotising, possibly keloid of some new growth, the situation degeneration of the tumour suggesting elephantiasis, though the filarial! and that disease does not prevail in either of our districts. In 189G I had the pleasure of seeing Dr. Galloway's beautiful preparations, and also lumps of the growth sent from Guiana, and I think pieces from Dr. Pringle's case. Drs. Daniels and Conyer's ([b) account of the disease, their photographs, and especially the microscopic appearance of the tumours con vinced me that Cunningham's and my cases were of the same nature. I got a section from one of my cases and shewed it to Dr. Galloway. We both came to the conclusion that histologically they were distinct as in my slide there was thinning of the epidermis instead of proliferation ; almost the entire section was of dense fibrous scar-like tissue, and shewed 110 marked granuloma, but a slight roundcelled infiltration which I thought due to irritation in the neighbourhood of an ulcerated
regarded
patch.
has written taking exception Dr. Galloway's description (d), and points out that the elongation of the interpapillary processes is bj7 110 means characteristic or essential, and that this layer may be so thinned as to be quite flat. He also regards the sclerotising factor as an essential feature and proposes the name I have above adopted. 1 have since found an old section from another part of the same tumour which I shewed Dr. Galloway. This quite conforms to Dr. Galloway's type" in the extent of round-celled growth, in the length of the interpapillary processes, and " especially in the pigment dust-storm to which he d rew attention. I have not had the fortune to see a case since I learned of the Guiana disease, but I am making efforts to trace this case as the growth was Dr. Daniels
to
some
(c) points in
"
"
(?.) (b.) (c )
(cl.)
If found, I shall have try to send her to Calcutta, if possible, during Dr. Daniel's visit, and get his opinion on the case.
only partially
her
removed. and
photographed
Case VI.?Hindu F., aged 37. No evidence of The right labium major is hypertrophied and covered with a fine nodular growth presenting the appearance of a piece ot mammi Hated haematite. The nodules are smooth, shin}r, covered with epithelium, firm and closely packed together. They vary in size from a No. 8 shot to a small marble, the majority being the size of a small buckshot. The inner surface is pale and smooth from pressure against a smaller growth on the left labium. The labia minora are enlarged, flattened, pale in colour except on the margin which is crenated by the small tumours which compose it. The figure is a tracing of the outline of one when removed. Both were of fairly uniform thickness, about quarter inch. A bridge of similar new
syphilis.
I have met with five or six cases of a disease which seemed to me distinct from anything, described previous to Major J. A. Cunningham's account at the Indian Medical Congress in 1894 (a). Our cases seemed quite similar, and I have always since thought of the disease as "Cunningham's Tumour" and called it so in my I
117
Transactions Ind. Med. Congress, 1894, p. -00. Brit. Guiana Med. Annual. Brit. Journal Dermatology, Sept. 1897. ib. April 1897.
growth,
more
finely
mammi Hated, joined the labia across the labium inons and extended a MINOR. short distance along the folds of the groin. The growth felt firm and fibroid, and presented little ulceration, considering the strong stench from accumulated ' sinequra' and dirt. The ulceration was mainly in the crevices between the nodules, and on the opposed surfaces of the labia,
suggesting
an intertriginous origin. growth formed a valve over the urinary meatus making the patient retromingent, and
The
spiking the urine over the anus and buttocks. The right major and both smaller labia were removed, skewers were passed below the larger
labium and surrounded by a rubber band in anticipation of hemorrhage which was, however, not excessive. The raw surface granulated over rapidly. The patient was satisfied with the result of the operation, as she was able to keep the parts clean and make water in a straightforward manner. With Dr. Daniel, I think it a pity to adopt " the adjective, ulcerating as characteristic of this disease. Ulceration occurs in most if not all of the infective granulomata, tubercle, lepra,
syphilis, mycetoma, actinomycosis, glanders, and (?) yaws, yet
we
do not think it necessary
to use the
adjective to indicate this possibility. Unfortunately once given, a bad name seems to
stick to a disease, as firmly as to the proverbial dog. This unhappy name has, I fear, lead some writers into error. I hope Capt. Williams (/) will excuse my venturing the opinion that under this title he has described a granulating ulcer, not an ulce-
(e)
(e.) Ind. Med. Gazette, Nov. (/.) ib. May 1898.
1898.
THE INDIAN MEDICAL GAZETTE.
118
rating granuloma, as lie mentions no new growth previous to the ulceration. The same remark would apply to Colonel Maitland's cases (g), though a critic, (h) considers them similar to the granuloma of Guiana. as soft sores or suprather ulcers of a high purating granulative character than new growths breaking clown by ulceration. I cannot follow Major Cunningham's argument that localisation to the pudenda indicates a
Apart
from their
origin
buboes, they
are
syphilitic, presumably tertiary origin.
Dermatology, Nov. 1898. Tropical Diseases," Colcott Fox,Med. Annual," 1898. Buchanan, Intl." Med. Gazette, Deo. 1898, have all adopted the term Ulcerating/' Fo.x/ as ((/.)
(A.)
an
Brit. Journal
Manson,
"
affix in brackets.
.
,
[April
1800.
1899.]
SCLEROTISING GRANULOMA OF PUDENDA?POWELL.
NOTES ON SKIN DISEASES
:
SCLER0T1SING GRANULOMA OF THE PUDENDA. By ARTHUR POWELL, F.R.C.S., Cachar.
notes.
it as a sclerotising, possibly keloid of some new growth, the situation degeneration of the tumour suggesting elephantiasis, though the filarial! and that disease does not prevail in either of our districts. In 189G I had the pleasure of seeing Dr. Galloway's beautiful preparations, and also lumps of the growth sent from Guiana, and I think pieces from Dr. Pringle's case. Drs. Daniels and Conyer's ([b) account of the disease, their photographs, and especially the microscopic appearance of the tumours con vinced me that Cunningham's and my cases were of the same nature. I got a section from one of my cases and shewed it to Dr. Galloway. We both came to the conclusion that histologically they were distinct as in my slide there was thinning of the epidermis instead of proliferation ; almost the entire section was of dense fibrous scar-like tissue, and shewed 110 marked granuloma, but a slight roundcelled infiltration which I thought due to irritation in the neighbourhood of an ulcerated
regarded
patch.
has written taking exception Dr. Galloway's description (d), and points out that the elongation of the interpapillary processes is bj7 110 means characteristic or essential, and that this layer may be so thinned as to be quite flat. He also regards the sclerotising factor as an essential feature and proposes the name I have above adopted. 1 have since found an old section from another part of the same tumour which I shewed Dr. Galloway. This quite conforms to Dr. Galloway's type" in the extent of round-celled growth, in the length of the interpapillary processes, and " especially in the pigment dust-storm to which he d rew attention. I have not had the fortune to see a case since I learned of the Guiana disease, but I am making efforts to trace this case as the growth was Dr. Daniels
to
some
(c) points in
"
"
(?.) (b.) (c )
(cl.)
If found, I shall have try to send her to Calcutta, if possible, during Dr. Daniel's visit, and get his opinion on the case.
only partially
her
removed. and
photographed
Case VI.?Hindu F., aged 37. No evidence of The right labium major is hypertrophied and covered with a fine nodular growth presenting the appearance of a piece ot mammi Hated haematite. The nodules are smooth, shin}r, covered with epithelium, firm and closely packed together. They vary in size from a No. 8 shot to a small marble, the majority being the size of a small buckshot. The inner surface is pale and smooth from pressure against a smaller growth on the left labium. The labia minora are enlarged, flattened, pale in colour except on the margin which is crenated by the small tumours which compose it. The figure is a tracing of the outline of one when removed. Both were of fairly uniform thickness, about quarter inch. A bridge of similar new
syphilis.
I have met with five or six cases of a disease which seemed to me distinct from anything, described previous to Major J. A. Cunningham's account at the Indian Medical Congress in 1894 (a). Our cases seemed quite similar, and I have always since thought of the disease as "Cunningham's Tumour" and called it so in my I
117
Transactions Ind. Med. Congress, 1894, p. -00. Brit. Guiana Med. Annual. Brit. Journal Dermatology, Sept. 1897. ib. April 1897.
growth,
more
finely
mammi Hated, joined the labia across the labium inons and extended a MINOR. short distance along the folds of the groin. The growth felt firm and fibroid, and presented little ulceration, considering the strong stench from accumulated ' sinequra' and dirt. The ulceration was mainly in the crevices between the nodules, and on the opposed surfaces of the labia,
suggesting
an intertriginous origin. growth formed a valve over the urinary meatus making the patient retromingent, and
The
spiking the urine over the anus and buttocks. The right major and both smaller labia were removed, skewers were passed below the larger
labium and surrounded by a rubber band in anticipation of hemorrhage which was, however, not excessive. The raw surface granulated over rapidly. The patient was satisfied with the result of the operation, as she was able to keep the parts clean and make water in a straightforward manner. With Dr. Daniel, I think it a pity to adopt " the adjective, ulcerating as characteristic of this disease. Ulceration occurs in most if not all of the infective granulomata, tubercle, lepra,
syphilis, mycetoma, actinomycosis, glanders, and (?) yaws, yet
we
do not think it necessary
to use the
adjective to indicate this possibility. Unfortunately once given, a bad name seems to
stick to a disease, as firmly as to the proverbial dog. This unhappy name has, I fear, lead some writers into error. I hope Capt. Williams (/) will excuse my venturing the opinion that under this title he has described a granulating ulcer, not an ulce-
(e)
(e.) Ind. Med. Gazette, Nov. (/.) ib. May 1898.
1898.
THE INDIAN MEDICAL GAZETTE.
118
rating granuloma, as lie mentions no new growth previous to the ulceration. The same remark would apply to Colonel Maitland's cases (g), though a critic, (h) considers them similar to the granuloma of Guiana. as soft sores or suprather ulcers of a high purating granulative character than new growths breaking clown by ulceration. I cannot follow Major Cunningham's argument that localisation to the pudenda indicates a
Apart
from their
origin
buboes, they
are
syphilitic, presumably tertiary origin.
Dermatology, Nov. 1898. Tropical Diseases," Colcott Fox,Med. Annual," 1898. Buchanan, Intl." Med. Gazette, Deo. 1898, have all adopted the term Ulcerating/' Fo.x/ as ((/.)
(A.)
an
Brit. Journal
Manson,
"
affix in brackets.
.
,
[April
1800.
