INFECTIOUS GENITAL TUMORS 489 



a swelling can be felt, partly due to the fragments of the tumor introduced 

 and partly to inflammatory exudation. In some cases this swelling 

 completely subsides, so that nothing can be felt until the appearance of 

 a small nodule indicates that inoculation has been successful. In other 

 cases the swelling persists, and it is difficult to decide whether the inocu- 

 lation has been successful until a definite increase in the size of the 

 swelling has taken place. The usual time at which there is distinct 

 evidence of the first appearance of the growth after inoculation is about 

 three weeks, but it varies between twelve days and a month. * * * 

 The small firm nodules which first appear gradually increase in size, and 

 form rounded lobulated masses. At the commencement they are freely 

 movable beneath the skin, but at a later period the latter become thinned 

 out, of a bluish-red color, and firmly adherent to the growths. * * * 

 The maximum growth is attained in about three months. A curious 

 regularity obtains in this respect. * * * Having reached this stage, 

 retrograde stages are not long in appearing; the growth becomes soft 

 and flabby, and slowly dwindles until nothing is left to indicate its 

 former presence. * * * j^ nearly half the cases the subsidence of the 

 tumor was accompanied by ulceration; the thinned-out reddened skin 

 giving way over the growth, which has previously undergone softening, 

 and there results a deep ulcer, from which a thin grumous discharge flows. 

 Even when these retrograde changes are occurring, fresh growths occa- 

 sionally take place at the periphery of the tumor. " 



Clake, who has carefully examined the tumors, likens them to the 

 alveolar sarcoma of the human breast and classes them as granulomata. 

 He describes three stages and shows marked changes in each. And 

 concludes that they may be divided into three stages: 



1. "The early granulation-tissue stage — i.e., a filling out of the 

 shrunken connective-tissue cells. 



2. "A stage in which the granulation-tissue cells have assumed the 

 character of sarcoma-cells. Some of these cells exhibit a mitotic activity 

 comparable to that seen in the earlier stages of invasion of the cells of 

 the cornea by the protozoa of vaccinia in their hyaline or chromidial 

 phase. Among the tumor-cells in this stage are bodies of typical proto- 

 zoon characters; and — 



3. ''A final stage in which chromidial parasites escape from the 

 nuclei of the tumor-cells, rapidly enlarge, become nucleated, and subdi- 

 vide; this process terminates in the formation of minute bodies, most of 

 which are in the chromidial condition." 



Treatment. — In the male it is comparatively easy. If the tumor 

 has not broken down it should be removed by filling the prepuce with 

 cocaine solution, then have an assistant retract the prepuce and expose 

 the free portion of the penis. The tumors must be freely cut away with 



