WITH THE COMPLIMENTS OF THE AUTHOR 
VASCULAR GROWTHS 
OF THE 
FEMALE MEATUS URINARIUS. 
BY 
AUGUSTUS P. CLARKE, A.M., M.D., 
OP CAMBRIDGE, MASS., V. S. A., 
Vice-President of the Gynaecological Society of Boston ; Member of the Massachusetts Medical 
Society; Member of the American Academy of Medicine; Member of the Cambridge Society 
for Medical Improvement; Member of the American Medical Association; Member 
of the Ninth International Medical Congress; Member of the American Public 
Health Association; Late Surgeon of the Sixth Regiment, New York 
Cavalry; Late Surgeon-in-Chief of the First Cavalry Division 
of the Army of the Potomac ; Brevet Lieutenant-Colonel 
New York State Volunteers; etc. 
Bead before the Section of Gynaecology of the Ninth International Medical Congress, Washington, D. C., 
September 8th, 1887. 
PRES8 OF WM. F. FELL d CO.f 1220-24 6AN80M 8T., PHILA., PA. VASCULAR GROWTHS 
OF THE 
FEMALE MEATUS URINARIUS. 
BT 4/ 
AUGUSTUS P. CLARKE, A.M., M.D., 
Vice-President of the Gynecological Society of Boston ; Member of the Massachusetts Medical 
Society; Member of the American Academy of Medicine; Member of the Cambridge Society 
for Medical Improvement; Member of the American Medical Association; Member 
of the Ninth International Medical Congress; Member of the American Public 
Health Association; Late Surgeon of the Sixth Regiment, New York 
Cavalry; Late Surgeon-in-Chief of the First Cavalry Division 
of the Army of the Potomac ; Brevet Lieutenant-Colonel 
New York State Volunteers; etc. 
CAMBRIDGE, MASS. 
1888. VASCULAR GROWTHS OF THE FEMALE MEATUS URINARIUS. 
EXCROISSANCES VASCULAIRES DU CANAL URINAIRE FEMININ 
BY AUGUSTUS P. CLARKE, A. M., M. D., 
Cambridge, Mass. 
ERECTILE GEWACHSE DEI! WEIBLICHEN HARNROHRE. 
Vascular growths which usually occur near the meatus urinarius are recognized as 
the most common neoplasms that invade the female urethra. They are the source of 
much suffering, and the treatment employed for their radical cure or even for the 
amelioration of the suffering has often proved quite unsatisfactory. As yet the cause 
for the appearance of these growths has not heen satisfactorily explained. Some 
authors call the growth a caruncle, while M. Gosselin and others denominate the 
growth a polype cellule vaseulaire du mdat urinaire. M. Gosselin* says the growth differs 
from a common polypus in its structure not being so limited ; for it often embraces 
fibrous and muscular tissues. The growth also differs from the classic polypus, he 
remarks, by the peculiarity of the pedicle. The vascular growth is usually irregularly 
shaped and appears as an excrescence, highly injected, and through its structure is dis- 
tributed a peculiar arrangement of cells and tissues which at length acquire a most 
exalted state of hypersesthesia. Some authors f have conjectured that fibres of the sym- 
pathetic must undergo some peculiar change in their intimate relation to the vessels of 
these growths, that they are capable of producing such exquisite sensibility. The dis- 
placed and gravid uterus pressing upon a venous plexus or upon the capillaries of the part 
may induce urethral hyperaemia, and consequently give rise to hypertrophied papillae. 
The growth is surmounted with basement epithelium, and the long-continued congestion 
no doubt causes an undue and altered development of the nervous tissue. These 
growths do not always make their appearance at the meatus, but often occur some dis- 
tance within the urethra. 
Authors are not agreed as to whether nerves enter into these tumors. Some obser- 
claiming to find a free distribution of nerve element; others in their investigations 
have denied the presence of the nerve element altogether, or that the seat of the great 
sensitiveness is in any part of their own 'tissue, $ but only into that portion of the 
* Clinique Chirurgical hopital, de la Charite Service de M. C., Professeur Gosselin, Samedi 8 
Juillet, 1876. 
f Emmet’s “ Principles and Practice of Gynaecology,” 1879. 
| “ Diseases of Women,” 1879, by Lawson Tait, f. r. c. s. “Wood’s Library of Standard 
Medical Authors.” 
§ “ Vascular Tumors of the Female Urethra,” 1877. By A. Reeves Jackson, Chicago, 111. mucous membrane to which they are attached, do the nerves fibres enter. There are still 
others who have made very careful investigations, and, though they do not deny the pres- 
ence of the nerve tissue, they have failed to find it. That these growths are penetrated by 
nervelets, some observers maintain, is evidenced by the fact that even when lightly 
touched, without influencing the basement membrane, extreme suffering often results. 
Skene mentions a case of an old lady, who, though married, was still a virgin. The 
growth was so exquisitely sensitive that coition was impossible. Even the clothes 
coming in contact with the parts produced vaginal and anal spasms. Pepper* refers to 
Hart and Barbour, f who define these neoplasms as “consisting of dilated capillaries in 
connective tissue, the whole being covered with squamous epithelium.” Skene % says 
one case is recorded in which the pavement was replaced by the columnar epithelium. 
Nerve tissue entering into the structure of these growths has long been believed to be 
a fact. Thus, J. Braxton Hicks \ remarked that the difference in the suffering depends 
whether the sensitive papillae (Pacinian bodies) are hypertrophied or not. In some the 
growth of the vascular element is in excess, in some—the majority—the nerve tissue; 
in others the basement layer. In those which are most sensitive the Pacinian bodies 
are hypertrophied and distinct. The beautifully injected state of these growths can be 
seen to the best advantage when they are carefully removed by the snare or wire noose. 
Keference to the anatomical structure of the Pacinian corpuscles, as they are situated 
on the peripheral extremities of the nerve fibres in their various localities, and especially 
in the perineum, and in the bulb and meatus of the urethra, will readily explain why 
such exquisitely acute sensibility is experienced when these little pyriform masses have 
undergone a prolonged and marked pathological change, and the reason why, even after 
extensive excision, unless the parts are thoroughly cauterized, repullulation so often 
ensues. Jonathan Hutchinson|| says that these growths often cause very serious con- 
stitutional disturbance, and that in one case he knew urethral or urinary paraplegia to 
result. speaks of these polypoid tumors as occasionally being of a gonor- 
rhoeal origin. He says they are composed of a spongy kind of erectile tissue, and are 
not unfrequently accompanied by a vast deal of sympathetic irritation. It is said that 
the erectile element often markedly increases at the menstrual period.** The nature 
and structure of these growths should not be considered so much a question of literary 
curiosity, as of one affecting prognosis and the causation of other morbid processes, 
such as insanity, epilepsy, etc. Professor Gosselin says we should always consider the 
question whether they are of a benign character, and also whether we can generalize 
and refer them to an infectious and septic class of diseases, especially when they are 
prone to suppuration. Sir James Y. Simpsonff was the first author who brought the 
disease into prominent notice, although, upward of fourscore years ago, Sir Charles 
Clarke, in his work on diseases of women, gave a description of an abnormal growth 
occasionally occurring at the meatus urinarius. 
The little tumors which that author described were of a reddish color, and raised 
above the surface of the urethral mucous membrane. They were prone to bleed and 
were the cause of much dySuria. The same affection is also mentioned by earlier writers, 
but their descriptions are, for the most part, very vague and indefinite. Authors are now 
quite well agreed upon the nature of these growths being benign. In the cases in which 
* William Pepper’s “ System of Medicine,” 1886. Yol. iv, page 403. 
f “ Manual Gynaecology,” 1883. Edinburgh. 
J Skene’s “ Diseases of the Bladder and Urethra in Women.” 
§ “ Braithwaite’s Retro.” Part 56, page 261. 
|| “Surgical Diseases of Women.” By J. Hutchinson, Esq., F. R. s., London. Yol. 2 Holmes’ 
“System of Surgery,” 1881. Erichsen's “Science and Art of Surgery.” 
**'Skene, op. cit. Also mentioned by A. R. Jackson, in his article referred to. repullulation ensues, it occurs in the parts nearest the growth and where the disease at 
first does not show itself; hut where later it becomes developed, and then has a sem- 
blance of malignancy. Their disposition to bleed from slight causes, owing to their 
friable and vascular character, often impresses the patient with the thought that she is 
the subject of a malignant disease. As already stated, these growths are the cause of 
much suffering. Cases of temporary insanity have been reported resulting from the 
severe local and constitutional symptoms. Cases occasionally occur, in which other 
lesions or morbid processes are present, and which are mistaken for the real cause of 
the suffering until the patient is nearly worn out or has become miserable. In some of 
the cases reported attention was at first directed to the vulva, uterus and its append- 
ages, and, in fact, the whole routine of treatment has been gone through without the 
least benefit, until the removal or destruction of the little intruder, when the entire 
train of ills disappeared, as by magic. Goodell says the affection does not appear until 
after the prime of life, and is more common in married women than in virgins. Vas- 
cular growths may be single or multiple, and may be attached by a pedicle or by a 
sessile base. The color varies from a raspberry to a strawberry hue. They vary also 
as to size. Sometimes they are so exceedingly small as to be no larger than the head 
of a pin, and are consequently overlooked. Others attain to the size of a quite large 
cherry. The usual site is at the lower angle of the meatus ; but they often extend into 
the urethra for quite a distance, and so may remain undiscovered. Goodell says he 
has seen the whole rim of the meatus studded with them. Lawson Tait * says their 
attachment is at the mucous membrane, and that the growths are most generally 
pedunculated. He further says, these growths are very frequently associated, in women 
at their middle period of life, with the vascular degeneration of the mucous membrane, 
and from a number of observations which that author has made on their structure, he 
concludes that they have much the same origin. The chief histological characters of 
these growths, he remarks, are the abundance of loops of capillaries, irregularly dilated, 
and having very thin walls, with a singular deficiency of cell element and fibrous 
stroma. He had also seen nerve fibres in them. These facts explain a great many of 
the features of these growths, and it is quite possible that they are progressive in the 
same way as is the vascular degeneration and atrophy of the nymph®, for their recur- 
rence is not the recurrence of malignancy, but rather the invasion of another though 
neighboring district. This last statement, it will be observed, coincides pretty nearly 
with the conclusions of M. Gosselin. Tait had seen no indication, however, that these 
growths ultimately cease to recur, for almost the last case in which he had operated, 
before he wrote out his investigations, was one in which, during a period of nearly forty 
years, they had been removed at intervals of every four or five years. In a footnote 
the same author observes, the fact that they never reach any great size is in support of 
the view he had advanced, that they are really dilated capillaries from atrophy of the 
surrounding tissues. Tait, speaking of the peculiar degenerative and atrophic change 
to which the nymph ae are subject when associated with vascular growths, says, in one 
instance he was enabled to remove a fragment of mucous membrane presenting a patch 
of this vascular change, and he found enough to display the pathology of this myste- 
rious disease. He placed the fresh fragment in a freezing microtome, and having stained 
the section with hsematoxylin, silver lactate, gold perchloride and carmine, he found 
that at the site of the spot all the texture had been removed save a few fibres; the 
walls of the capillaries and the superficial epithelium under which the loops of the 
capillaries with thinned and dilated wall lays, almost unprotected. These observa- 
tions, he further says, explain the three chief clinical facts the disease presents, viz. : 
the great pain, the abnormal vascularity of the spots and their tendency to bleed when 
* Lawson Tait, f.r.c.s., op." cit. touched, and the contraction of the surface as the third stage. It is, in fact, a progres- 
sive atrophy of the mucous membrane, the last texture affected being the blood vessels 
and nerves, for Avhen the process has been completed, the pain ceases, redness disap- 
pears, and nothing remains but a vestibulum vaginae so narrow that incredulity may 
be excused when the patient states that she has borne children. Tait had the good 
fortune in two cases to watch the complete course of the disease almost from the com- 
mencement to its perfect recovery, and had seen all the stages described. He bears tes- 
timony to the view that the degenerative process often works its own cure. Becoming 
interested in the researches of Tait and of others who have studied these growths with 
so much care, the subject seemed to me worthy of further investigation. I accordingly 
succeeded in obtaining the services of Dr. S. N. Nelson, of Boston, to assist me in prose- 
cuting the work, and in illustrating the result of the following original investigations. 
The caruncles of the female urethra on which these investigations have been made 
were about the siA of a pea. Histologically they had the characteristics of papillo- 
mata, i. e., connective tissue base growing outward more or less irregularly, with papillae, 
and all covered with epithelium. When the surface is comparatively smooth the papillae 
are of quite uniform size and length, forming pouches between them. When the sur- 
face is uneven the papillae vary in size and length, and direction of growth. Typical 
arrangement of epithelium: columnar cells, oval nuclei in surface layers, i.e., next to 
the surface of the papillae. These are separately arranged—one or two layers; round 
cells with round nuclei in their middle portion irregularly disposed ; large flat cells 
with large nuclei on outer surface, or squamous epithelium. In the pouches the same 
arrangement exists, and as they are always filled with the epithelium the flat cells pre- 
dominate in the centre, which correspond to the outer surface. In any given section 
the majority of the papillae are cut longitudinally, but owing to their irregularity cer- 
tain ones with their intervening pouches may be cut transversely, and the pouches thus 
cut may frequently be seen surrounded on all sides by the connective tissue base. 
These will be recognized as such by being filled with epithelium, which has the same 
arrangement as the epithelium on the outside. These pouches should not be confounded 
with glands filled up, or with the lobules of a carcinoma. The connective tissue base 
is composed of connective tissue cells, and in addition always has more or less of the 
small, indifferent or wandering cells with small, round nuclei. These are generally 
irregularly disposed, and their number is dependent on the amount of irritation to 
which the individual caruncle is exposed, being few and scattered or very abundant. 
They are besides also found aggregated in certain localized spots of varying size. The 
vascularity of the caruncle is a varying factor, but the vessels were larger than the 
capillaries, abundant in no case, and in none were they as plentiful as in the submucosa 
of the normal mucous membrane of the urethra (see specimens and photos). The 
supply of nerves seems to be very questionable, contrary to the opinions heretofore 
advanced by J. Braxton Hicks, Lawson Tait, Read and others. Osmic acid failed to 
stain them, thus showing that there was no myeline present, and it is known that 
nerves near their terminations lose their myeline and tubular sheath, and the fibrillse 
are composed of axis cylinder only. This was seen in the connective tissue base some- 
times, but none of the terminal organs could be found, either as tactile corpuscles or 
Pacinian bodies. There is a question if the Pacinian bodies may not be found lower 
down in the tissues than the portion shown, which was excised to relieve the symptoms. 
The specimens examined were only those removed during such operations. Glands 
are not found in these growths, as in the normal mucous membrane of the urethra. 
From the microscopic studies of the histology of these growths, urethral caruncles 
may be defined as neoplasms, new growths, papillomata, which do not tend toward 
retrograding, but remain as tumors, and this is true, although they have numerous 
points of contact, thus differing from ordinary inflammatory granulations. The treatment of vascular growths must he adapted to their varying phases. In 
some cases the application of ligatures has proved very effective. In other cases a resort 
to excision, either by the knife or scissors, when followed by the free use of caustics, 
such as fuming nitric acid, has often resulted in effecting a cure. When the growth is 
sessile or quite flat we have to rely chiefly upon caustics or upon the actual cautery. 
The galvano-cautery formerly was highly praised, but since the appearance of the 
thermo-cautery of Paquelin it is now seldom used. 
Electricity or galvanism has been useful in the dispersion of tumors, and when 
applied, the object was not to effect their decomposition hut to modify their nutrition. 
An electric current was passed through them for a length of time, varying with the 
size of the growth and the strength. According to Dr. Althaus,* the negative pole, 
the zinc end of the battery, was the one applied to the growth, while the positive pole 
was applied to some neighboring part. The operation sometimes had to he repeated 
until the growth was completely obliterated. Carbolic acid in the solid form or as a 
saturated solution has been much used as a mummifying agent. A saturated solution 
of chromic acid, applied by pressing it firmly on the surface, has been used. This 
is said, however, to cause some inconvenience and to require cotton wool, soaked 
in a solution of carbonate of soda, to neutralize any excess of acid. Nitrate of silver is 
notnow regarded as sufficiently potent to destroy the growth, and applications of nitrate 
of mercury and potassa fusa are often followed by painful effects. Sometimes* the use 
of a red-hot needle, followed by a careful application of nitric acid, may result in a 
cure. Painting the growth and the area surrounding its attachment with a twenty per 
cent, solution of cocaine has been done, and the operation f of cutting off the gro*wth 
with curved scissors was painless. A five per cent, solution has been used, rendering 
the growth painless in five minutes. There was no pain during or after the operation 
of excision. This case was reported by J. D. Eggleston, M. D., i Worsham, Va., Feb. 
1st, 1887. 
The following cases are reported, illustrating the treatment employed:— 
Case i.—Mrs. II., aged 42 years; of good physique and constitution; was married ten 
years, without children. Was first seen by the writer August 10th, 1870. There was 
dysuria and pain about the pelvis and loins. Patient had suffered more or less for the 
last five years. Noticed there was an occasional escape of blood at the close of mictur- 
ition and also a discharge from the vulva. Considerable inconvenience was experienced 
in walking. Careful examination of the parts revealed an irregular excrescence, about 
the size of a pea, at the meatus urinarius. The growth was highly sensitive and blood 
flowed freely on the lightest touch. It was flat and without any pedicle, and was 
attached to the mucous membrane at the lower verge of the meatus. After sponging 
the part with a dilute solution of soda chlorinata the growth was removed, including a 
portion of the mucous membrane on each side. Fuming nitric acid was freely used. 
Subsequently, tannin and glycerine were frequently applied, until October 10th, when 
all unpleasant symptoms had disappeared, and the meatus and the urethra appeared 
nearly normal. Since that time the patient’s family have been under my care, but 
there has been no return of the disease. 
Case ii.—Mrs. K., aged sixty years; mother of six children. Labors were normal, 
and the only affection retarding her recovery was an attack of phlegmasia dolens. The 
patient began, about five years ago, to have smarting and pain in micturition. She had 
a ‘ ‘ dragging sensation ’ ’ and other uncomfortable feelings about the hips and loins. 
Later there was a slight discharge of blood after urinating. This gradually became 
% British Medical Journal, 1867. 
f Clement Godson, British Med. Jour., Jan., 1885 ; also “ Braithwaite’s Retrospect,” part 91, 
p. 257. J See Journal American Medical Association, Yol. vm, page 223. more profuse. Patient became dejected and impressed with the thought that she was 
the subject of cancerous disease. Examination showed that the uterus was slightly 
retroverted, and that the vestibulum vaginae was unusually narrowed, owing to the 
degenerative and atrophic changes of the mucous membrane. The capillaries in the 
vulva were dilated, and there were also several small patches of mucous membrane, quite 
red, and the redness only partially disappeared on pressure. Immediately in front of 
the meatus was a mass of veins and capillaries, quite flat and firmly held together by 
strong connective tissue. This mass was painless and of a deep bluish color. Just 
within the meatus was a flat or sessile excrescence, acutely sensitive, friable, and bled 
freely however lightly touched. As the patient had a weak heart and was a bad sub- 
ject for ether, I began my treatment by applying fuming nitric acid to the painful 
growth, and the parts around were immediately sponged with tepid water. The appli- 
cations of the acid were made at intervals of two to six weeks, covering a period of 
eighteen months,* since which time nearly all unpleasant symptoms have disappeared. 
There is now no bleeding and the excrescence has also disappeared. The matted mass 
of veins and capillaries described as in front of the growth has not as yet very sensibly 
diminished, but is still painless, and no trouble of consequence is experienced from its 
presence. 
Case hi.—Mrs. G., aged fifty years, mother of five children, began to suffer in May, 
1880, from dysuria. She was frequently disturbed at night, and had a “bearing-down 
sensation of the bladder.” She also complained of heat and burning in the vulva. 
There was a slight leucorrhoeal discharge, and the urine was occasionally tinged with 
blood. She gradually became more restless and nervous, and by July, when I was first 
called, she was suffering extreme pain and other constitutional symptoms. Yaginal 
examination showed that the uterus and its appendages were in fair condition, but just 
within the meatus urinarius there was a vascular growth the size of a cherry, red and 
extremely sensitive, and raised above the mucous surface of the parts. The growth was 
partially pedunculated, and could be raised somewhat from the surrounding mucous 
membrane. The excrescence was friable and bled profusely when touched with forceps. 
The patient was etherized next day, and under antiseptic precautions the growth was 
removed by means of scissors. The mucous membrane on either side of the growth 
was also excised, and the parts freely cauterized by means of the galvano-cautery. 
Cicatrization was speedy and complete, aud the patient considered herself not only 
relieved, but entirely cured. After a lapse, however, of five months, considerable 
sensitiveness began to return in the immediate vicinity of the former growth. Several 
enlarged papillae appeared. These were removed, aud their bases touched with strong 
nitric acid. This gave only slight relief, and she required enormous doses of morphia 
and other sedatives to overcome the nervous and sympathetic disturbance. The severe 
irritation now appeared to be chiefly centred in the nerve fibres and in the Pacinian 
bodies, in the vulva, and at or near the rim of the meatus. The patient’s suffering from 
these little bodies at length became so augmented that whenever my visits were inter- 
rupted for a few days she sent for me in haste, informing me that she had found another 
growth, which gave her such uneasiness and suffering that she wished me to remove it. 
These different papilla; or sensitive points were removed with the point of scissors curved 
on the flat, and the parts were touched with crystals of carbolic acid liquefied by heat 
and strong nitric acid. The patient’s suffering was so severe that her mind became 
unbalanced, and several months’ treatment was required before she showed marked 
signs of improArement. Before recovery was complete the patient died of an intercur- 
rent disease. The mucous membrane of the nymphse and of the vestibule of the vagina 
had undergone gradual atrophy and degeneration. 
I have also seen another case in which the mental condition was similar, and in 
which another surgeon had previously operated for urethral caruncle. This patient also suffered a long time from sympathetic constitutional disturbance before she made much 
progress toward recovery. 
Case iy.—MissB., aged tbirty-six years, and of nervous temperament, bad been 
in delicate health for several years. Her menses appeared at the age of thirteen and 
continued to appear quite regularly.afterward. During the summer of 1881 the patient 
began to suffer from pain in micturition and from uncomfortable feelings in the pelvic 
region. She consulted a female physician, who attributed her suffering to uterine dis- 
placement, and put the patient on a course of treatment for such complaints. The 
patient gradually grew worse, and was unable to go up and down stairs or to take 
exercise in the open air, owing to an impairment of the power of locomotion. This 
latter symptom was regarded as resulting from a perverted condition of the uterus. The 
pain and other sympathetic symptoms grew worse and she became totally helpless. 
Patient, though naturally possessing an amiable disposition, grew excitable and 
betrayed symptoms of insanity. When I was called, in June, 1883, I found her help- 
less, emaciated and having been confined to her bed and room, for the most part, for 
several months. When I first called the patient had some cough, and that morning a 
profuse haemoptysis. She had rales, bu tot here was no marked dullness nor any history 
of hereditary predisposition to pulmonary disease. Patient rallied at length from this 
attack, and later vaginal examination showed that the uterus was somewhat anteverted, 
but not sufficiently to justify the opinion that it was a pathological factor of her dis- 
ease. She complained of dysuria and extreme sensitiveness of the urethra. All parts 
of the vulva were markedly sensitive, and pressure of clothes produced severe pain. 
Microscopic examination of the urine revealed the presence of blood and epithelium, 
which undoubtedly came from the urethra. Exploration of the urethra by means of a 
small speculum and by Ellinger’s dilator, under anaesthetics, revealed a urethral neo- 
plasm, flat at the anterior aspect of the canal, but less sessile beyond. When lifted from 
the mucous membrane it seemed about the size of a strawberry, red and friable. Both 
growth and mucous membrane on either side were dissected away and the parts thor- 
oughly cauterized with Paquelin’s instrument. Much hemorrhage ensued, hut was 
controlled by tampon in the vagina. Cicatrization followed, dysuria disappeared, and 
recovery was complete. No relapse has occurred and the anteversion gives no trouble. 
Case V.—Mrs. D., aged thirty-seven years, and married eight years, gave birth to 
a child two years after marriage; since then has not been pregnant. Previous to my 
attendance, for the last four years, she had suffered more or less from dysuria. She 
often had spells of unconsciousness. She suffered very much from nervous exhaustion. 
I was first called January 2d, 1886. At that time the patient had a well-marked 
seizure of epilepsy. She was unconscious and the pupils were dilated and immovable 
when I reached the house. Her husband informed me that she had had other similar 
attacks, varying at intervals from one to three months; that he had “ tried all sorts of 
treatment for her relief.” There was foaming at the mouth, convulsions of the limbs, 
and the tongue was bitten early in the paroxysm. The patient at length rallied, and 
next day was quite well. Careful examination of the various organs only gave nega- 
tive results, and no pathological factors as to the cause of the epileptic seizures could be 
discovered, except that complained of as being connected with micturition. May 10th 
following, the patient had another epileptic attack, immediately after which a thorough 
examination of the meatus and urethra revealed the presence of a urethral vascular 
growth, situated just within the meatus urinarius. It was irregularly shaped, highly 
sensitive, and bled when touched with forceps. A 10 per cent, solution of hydrochlor- 
ate of cocaine was applied, and the growth and mucous membrane on either side were 
dissected away "with curved scissors, and the parts were freely cauterized by means of 
the thermo-cautery. The patient recovered wholly from the effects of the operation, 
and the dysuria ceased after the third week. The patient after this had three attacks, but they were only petit mat, and for the last eight months has had no indications what- 
ever of an epileptic attack. There has been no return of the dysuria, though there is 
some hypersesthesia in the vicinity of the cicatrix when the parts are touched. The 
patient considers herself as cured. 
I have notes of another case of grand mol occurring in a patient aged forty-seven 
years, who was cured after the removal of a urethral vascular growth. 
Six months since I was called in consultation to see a case of a married lady, aged 
twenty-nine years, who had frequent attacks of petit mat, and who was relieved after the 
removal of the vascular neoplasm of the urethra. In the last case a four per cent, solu- 
tion of cocaine and fuming nitric acid, applied at intervals of three weeks for three 
times, appeared quite sufficient to arrest the local disturbance and the epileptic 
paroxysms. 
Urethral vascular growths are not always attended with local suffering in the parts 
invaded; for sometimes the manifestations of the augmented sensitiveness is experi- 
enced only at a distance from the part invaded. 
I am in possession of notes of a case of vaginismus which I was called to see in consul- 
tation. All the exalted sensitiveness complained of was at or near the hymen, and at 
the entrance of the vagina. The woman, though married, was unable to fulfill her 
marital duties, and coition at length became impossible. Examination of the parts 
disclosed the existence of an exceedingly small and irregularly shaped urethral caruncle 
within the urethra. Three months after its removal the vaginismus disappeared alto- 
gether. Occasionally the local manifestations of a urethral vascular growth are only in 
the bladder, the uterus, or the tissues of the rectum. When the disturbance is centred 
in the rectum the cause of the trouble may be suspected at first to arise from fissure in 
ano; but the suffering occurring in the sphincter of the anus will not be as intense 
and constant as that which is experienced from a fissure of that part. Not long since 
a distinguished medical friend invited me to see a case of urethral vascular growth 
occurring in a married lady, who felt no inconvenience from the growth, except pain 
and dull aching in the hypogastric and lumbar regions. The patient was aged twenty- 
seven years, and was the mother of three children, but no cause for her suffering could 
be discovered except this growth, which was situated just beyond the meatus, in the 
urethra. It was sessile, extremely sensitive when touched. There was occasionally a 
slight admixture of blood with the urine, which finally led to the discovery of the 
growth. Thorough cauterization soon gave marked relief to the patient’s distressing 
symptoms. 
As a patient often gives a vague and indefinite description as to the seat of the 
affection, it is always necessary to make a careful examination, to insure the certainty 
of the existence of the growth. 
I well remember hearing the late Dr. Charles H. Allen, of Cambridge, say that he 
had cured a woman of paralysis of both legs by treating her for a urethral polypus. 
Jonathan Hutchinson, as already stated, mentions, as occurring in his practice, a case 
of paraplegia resulting from a vascular growth at the meatus urinarius. 
Recently I have used a saturated solution of cocaine, made solely by the use of 
strong nitric acid, with happy effect. This has enabled removal, even by scissors, if 
necessary, without other anaesthetic, and hemorrhage was easily controlled, no pain 
being complained of during, or subsequent to, operation. Of course, a general anaes- 
thetic cannot be dispensed with in any but exceptional cases. Fig. 1. 
Caruncle of female urethra, 12 X . Outline regular. 
Papilla and crypts. Foci of inflammatory cells. 
Fig. 2. 
Caruncle of female urethra. 100 X • Outline of papilla very irregular. $To distinct crypts. Fig. 3. 
Caruncle of female urethra, 100 X • Outline regular. Ditto papillae and crypts. A portion 
of Fig. 1 more highly magnified. 
Fig. 4. 
Caruncle of female urethra, 500 X • Two papillae and crypts from Fig. 3 more highly 
magnified. Showing arrangement of epithelial cells on mucous surface, being from 
within outward: cylindrical, round and flat squamous cells.