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Condylomata from leucorrhoea. Mrs. --, æt. thirty-five, the mother of several children, had suffered from leucorrhoea for more than two years, the discharge being so profuse as to render her constantly wet and uncomfortable ; lumps formed on the labia, and about the anus, gradually increasing in size; the adjacent parts became excoriated and painful. Before coming under my care she had taken various medicines, and used lotions and ointments without benefit. It being evident that the morbid growths on the external parts arose from irritation, produced by the discharge froin the vagina, an examination was made with a speculum, and ulceration of the os uteri discovered, which was also congested and enlarged; there was profuse muco-purulent secretion from the uterus and vagina.
The treatment adopted was leeches and the application of nitrate of silver, and afterwards alum injections ; cicatrization of the ulcerated surface took place, and a healthy condition of the uterus and vagina restored. When the vaginal discharge had diminished, the condylomata were removed by excision, and a fold of lint, saturated with lead lotion, applied : the wounds healed in a few days.
Condylomata from leucorrhoea. M. A. P., æt. twenty-six, single, applied at the Blenheim Dispensary, May 24th, 1853. She had been for some time subject to vaginal leucorrhæa, the discharge being very profuse. Tumours formed about the anus ; they were not painful at first, but latterly she had experienced much smarting and discomfort. She was chlorotic; her eyes were dull ; skin, gums, lips, and tongue pale ; arms flabby; menstruation irregular, and almost devoid of colour. Mild purgatives, chalybeates, and vaginal injections were prescribed ; the condylomata were excised, and a slightly astringent lotion applied ; ablutions with soap and water were used night and morning : the local disease was cured, and in a few weeks her general health had greatly improved.
Condylomata from irritation by contact of opposed
cutaneous surfaces. W. G., æt. thirty-one, very stout, occupation sedentary, being engaged in a merchant's office in the City. Perspires freely; has always suffered from excoriation between the buttocks in warm weather ; some excrescences had formed around the anus; he had been told they were external piles, and directed to use gall ointment, and to take sulphur and treacle ; he experienced no relief, and the tumours increased in size, attended with great smarting and pain. His bowels were regular, and, in other respects, he enjoyed good health. On examination, three condylomata on the verge of the anus presented; they were dense, and about the size of beans ; the surrounding skin was excoriated, and bedewed with a copious secretion. I excised the tumours, and ordered a fold of lint, saturated in lead lotion, to be kept applied till the parts had healed. I also advised ablution, with soap and water, night and morning, and keeping the buttocks separated by a single fold of lint between them. The treatment adopted had the effect in a few days of removing all the discomfort he had previously suffered.
Condylomata resulting from the folds of integument left
by the collapsing of external hæmorrhoids.
Dr. Ashwell brought to my house the husband of a patient of his, the Rev. Mr. --, who wished to consult me respecting an affection from which he had suffered for some years. This gentleman was stout, with the muscular system largely developed. He informed me he had for a long time experienced the most intolerable itching about the anus, and was also annoyed by a constant watery discharge : he had consulted several surgeons; various lotions had been prescribed, and the solid nitrate of silver applied twice, which caused him most severe pain, without any beneficial effect. Many years previously he had been the subject of hæmorrhoids, and had had several large piles form at the verge of the anus; when. these subsided, loose folds of skin remained, which occasioned him no inconvenience for some time, but at length he began to experience the symptoms which now caused him such severe annoyance. On making an examination, I. observed the skin around the anus, and for about three inches posteriorly, inflamed and cracked, and bedewed with a serous secretion ; three dense condylomata, the size of the shell of an almond, were connected with the anal margin, the whole of which was indurated, but not contracted. He was informed that excision of the tumours was the only means of freeing him of the disease, and he readily consented to the operation. Being somewhat affected with flatulence, and the bowels not acting freely, he was directed to take three grains of blue pill and a grain of ipecacuanha every night, and a draught, twice a day, composed of infusion of cinchona, infusion of senna, tartrate of potash, with some aromatic tinctures ; by these means the bowels were freely acted on, and on the fourth day I removed the growths, cutting them off with a probe-pointed bistoury ; Dr. Ashwell was present, and very kindly assisted me. No ligatures were required, a compress, retained firmly by a T bandage, restraining the little hæmorrbage that ensued. On the following day the wounds were dressed with oxide of zinc and spermaceti ointment, and in a week were quite healed, as well as the cracks in the surrounding integument; a lotion of the bichloride of mercury in bitter-almond mixture was directed to be applied, and in a short time all induration of the anus had disappeared.
It is evident these growths had their origin in the folds of skin left by the collapsing of the external piles; and had the treatment hereinafter advocated been adopted, of incising external hæmorrhoidal tumours when large, this gentleman would have escaped the sufferings he subsequently experienced.
Condylomata of large size, attended by severe symptoms..
A gentleman, aged 54, residing in one of the principal squares at the West End, applied to me in May 1856. He is very stout, and plethoric, rides much op horseback, and subject to attacks of gout. Three years before applying to me, and shortly after an attack of gout, he lost a considerable quantity of blood per anum ; subsequently had a mucous discharge, and excrescences formed at the margin of the anus, which gradually increased in size. He experienced intolerable irritation in the part, aching down the thighs, and at stool had severe ulcerated and acutely painful to the touch ; the integument around was of a purple colour, and bedewed with a copious secretion; the margins of the anus were indurated. No internal hæmorrhoids existed, but the mucous membrane of the rectum was congested, his tongue was coated, eyes dull, sclerotic conjunctivæ yellow.
Pilulæ Hydrargari, gr. iv; Pulveris Ipecacuanhæ, gr. j.
Misce fiat pilula j. Hora somni sumenda.
He was directed to use ablutions with soap and water locally night and morning, and afterwards to apply powdered starch. The medicines were repeated for four consecutive days, and on May 22nd, with the assistance of Mr. Hulme, I excised the tumours with a bistoury. The hæmorrhage was restrained by a pad of lint secured by a T bandage. He remained on the sofa two days, experiencing little inconvenience. In six days the wounds were healed, but the induration around the anus remained.