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Autopsy, tumor projecting from right wall and most prominent in upper part of vagina, whole mucous membrane of vagina studded with hundreds of polypi size of pea, adjoining organs congested; microscope shows healthy condition of serous and muscular coats of vagina, sub-mucous connective tissue soft and gelatinous, filled with numerous small cells, the denser polypi of vagina are round cell sarcoma with a great deal of fibroid tissue.

He cites twenty-four cases collected from various sources. They are characterized by formation of numerous polypi resembling clustered grapes which arise from the walls of the vagina, malignancy usually local only. Treatment unsatisfactory, repeated currettings give temporary relief, most cases fatal in from one to two years after onset of symptoms.

Rabe, in 1902, reports a case six months of age, which had symptoms of intermittent pain, accompanied by frequent and difficult micturition. Upon examination found a tumor size of a small nut, reddish in color at site of vestibule. It involved the urinary meatus, diagnosis sarcoma. Removal of uterus and vagina per laparotomy. Death from broncho-pneumonia.

Strassman, in 1899, reports case, eighteen months. Suffered for about four months previous to examination from hemorrhage and foul-smelling discharge from vagina. Pain on micturition, no fever, partly gangrenous tumor was projecting from vagina. Curretted and tamponed with iodoform gauze; microscope showed large round and spindle cell sarcoma. Proposed to remove vagina and uterus per sacrum, gives no results.

Dr. A. W. Lee, in 1901, reports a case of primary sarcoma in a child two and a half years first seen in 1899; watery and bloody discharge had been observed for some


months previous, several polypi projected from vulva. Around vaginal and urethal entrance numerous growths of firm consistency.

Elastic tumor felt in abdomen reaching to umbilicus. Vagina dilated and filled with soft growth, many pedunculated, recto-vaginal and vescico-vaginal walls involved; microscopical findings, sarcoma. Died in thirteen months after first seen.

E. H. Starfinger cites a case reported by Steinthall, child two years, duration of disease twelve months. Tumor removed after eight months' duration. Recurrence in eight weeks. Death six months later from uremia. Tumor originated from anterior vaginal wall. Microscopical findings, round cell sarcoma.

He also reports a case, age eighteen months. Duration of disease six months, first seen in sixth month of disease. Soft, friable tumor occupies whole of posterior vaginal wall. Removal with currette, tamponed; death in three weeks. Microscope showed large, round and spindle cell sarcoma.

Hesterman cites a number of cases by other authors, among them:

Dr. March, child two years seven months, tumor on anterior vaginal wall, polypi growth, metastasis on posterior wall of bladder. Course of disease six months. Operation; seven recurrences, death.

Case by Sathman, age two years six months, tumor on anterior wall of vagina, base size of a dollar, polypi growth protruding from vagina. Small tumor also in posterior wall of bladder. During course of disease experienced difficulty in walking, painful micturition, intermittent fever and hemorrhage. Operation; recurrence, death. Microscope, round cell sarcoma.

Case by Hauser, child aged twelve months, tumor on

anterior vaginal wall towards right. Microscope, round spindle cell sarcoma. First symptom at six months of age. Operation; recurrence at short intervals, death.

Dr. B. Brown presented a sarcoma of vagina in a child three years old to the Gynecological and Obstetrical Society of Baltimore, and Dr. Kelly, in discussing it, said: "They begin as more or less irregular flat, sessile tumors in the anterior wall of vagina. They occur usually in the very young. In two cases tumor appeared to be congenital. They are found in the majority of cases on the anterior wall. They do not spread by metastasis. The metastasis being local, or only a short distance from the area of infection. In another respect they are peculiar, in that they contain straight muscular fibres."

Dr. Munz discusses the occurrence of sarcoma in children and adults and says: "The majority occur between six months and three and a half years. Prognosis grave, disturbances produced are slight in beginning, but soon become serious. Recurrences always follow operations from several weeks to two months after operation. The recurrent growths have same character, only they grow more rapidly and degenerate sooner than the primary tumor. Average duration about twelve months. Treatment is operative always. Life is prolonged, but death finally results." In addition to the above statements, we may add that they are composed principally of round and spindle-shaped cells.

In closing this paper, I wish to thank Major McCaw, Surgeon-General U. S. Army; Dr. Charles A. Pfender, of the U. S. Army Medical Museum, of Washington, D. C.; Dr. Claude Smith, of Atlanta, Ga., and A. W. Shaw, of Monticello, Ga., and Mr. Lamar, of Covington, for valuable assistance.

The authorities quoted herein will be found on record. in the United States Army Medical Museum Library.




Animal protoplasm, a highly complex organic molecule, depends for existence upon metabolism-upon the assimilation of elements represented in its structure, and the liberation of radicals whose formulae have, through chemical alteration physically produced, lost the valency of union. A veritable citadel, then, of continuous molecular change is protoplasm. So long, however, as assimilation equals expenditure the quality of the compound remains unaltered; when expenditure outstrips assimilation, the course is clearly that of exhaustion. Again, the quality of protoplasm is perverted to the extent of any heterologous radical that disease may cause to be appropriated. Complete exhaustion differs from dissolution in that the molecule in the latter instance is rapidly torn asunder through the exceeding valency of its component radicals for a foreign agent.

Like animal protoplasm, the vegetable organism represents a highly complex organic molecule, and the same conditions govern its existence. An important exception, however, is derived from the fact that the organism never being put to physical wear, its molecular change is always a phase of dissolution; so long as the agent with exceeding valency is not applied, no molecular change occurs.


Digestion is periodic, but assimilation is continuous, and fluctuates according to demand, i. e., according to the quantity of katabolic radicals exertion is causing to be liberated through its physical alteration of their formulae. These radicals are not excreted in their nascent form; oxyhemoglobin loses its oxygen to their greater valency and combustion obtains. The result is summed up in excrementitious matter on the one hand, and deoxygenated blood on the other.


When animal protoplasm and the vegetable organism are brought in contact, each contributes one or more radicals to the formation of a new moleculethe toxin whose constituent radicals are of sufficient valency to have effected their severance from the original compounds, leaving the progenitors in an altered condition varying in extent from slight lameness to absolute dissolution, depending upon the importance to the structure of the radical lost, and upon whether assimilation will effect readjustment. When the process is sufficiently active to demand an extraordinary supply of assimilative material, reflex congestion occurs and the sum total of phenomena is styled irritation.


Toxins are readily soluble and pass into the general circulation, where a second chemical change is undergone. Radical “A” of the toxic molecule is appropriated; radical "B" remains free in the circulation. (A complex organic molecule is separable into radicals dissimilar in formulæ to those that originally effected the compound.) Protoplasm appropriates radical "A" at the

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