Journal : Photographic review of medicine & surgery ; vol. 1, no. 2.
Philadelphia : J. B. Lippincott & Co., 1870-71.
Description : pp. 11-12,  pl. ; ill.: 1 photo. ; 24 cm.
Photograph : mounted albumen.
Subject : Clitoris — Fibroma.
CAROLINE MEYER, German, aet. 24, was admitted into Charity Hospital, Blackwell's Island, in January, 1868.
She reported that, three years before, she contracted a chancre upon the right labium majus, which was cauterized. In spite of reiterated questions, she affirmed that she had never had any eruption until three weeks ago, when the present eruption — one of ecthyma — appeared upon the scalp, face, arms, and breast. Cicatrices, however, of an older eruption were found upon various parts of the integument, and of what were probably condylomata in the neighborhood of the genital organs.
A year since an enlargement appeared at the upper commissure of the vulva, and continued to increase until two or three months ago, when it became stationary. The growth is larger or smaller, according to the length of time she has been standing or sitting. It is never painful except in warm weather, when it becomes excoriated and sore.
On examination there is found a tuberculated, lobulated tumor, attached to a pedicle, which is evidently the hyper- trophied clitoris. Indeed, on turning the tumor upwards towards the abdomen, the two corpora cavernosa of the clitoris, separated by a longitudinal furrow, are beautifully seen. The growth is attached to the right labium minus. The left labium minus is pierced with four openings or slits, varying in size, the largest admitting the passage of two fingers. How these originated I do not know : there is no history of any ulceration except the chancre three years ago ; and the integumental surface of the tumor and its neighborhood is everywhere intact.
Both labia minora and majora are generally hypertrophied. There is no line of demarcation between the tumor and the surrounding healthy tissues.
The clitoris, surmounted by the lobulated mass, protrudes from between the labia, and is three inches in length ; is pendent, and never becomes erect or turgent. The vagina is filled with acuminated (simple, non-specific) vegetations. The lobulated mass measures six and one-quarter inches in circumference.
February 1. The patient was etherized and the growth, including the labia minora, removed. The flow of blood was considerable, but was easily arrested by the application of the perchloride of iron.
The patient soon after left the hospital, and her subsequent history is unknown.
The microscopical examination of the tumor, for which I am indebted to Dr. J. G. Curtis, reveals the same to be entirely fibro-cellular.
It is hardly necessary to say that this tumor was by no means directly due to syphilis ; but it is an interesting question how far venereal lesions in the neighborhood of the genital organs may indirectly result in such outgrowths, in the same manner as they are known to produce thickening and hypertrophy of the prepuce in the male, of the labia in the female, and that form of stricture of the rectum improperly called syphilitic.
Among those authors who have treated of tumors of this nature, I would refer especially to Förster, " Handbuch der speciellen Pathologischen Anatomie," p. 465, and to Paget, " Lectures on Surgical Pathology," third edition, London, 1870, pp. 458 and 467.
Bumstead specialized in venereal disease, his Pathology and treatment of venereal diseases, the standard on the subject, issued in five editions from 1861 to 1883. He was the professor of venereal diseases at the College of Physicians and Surgeons in New York from 1867 till 1871 and translated Cullerier's and Ricord's writings on the subject.