and the success, as a general rule, attending so unfortunate and disgusting a disease occurring in the female.

Search through the annals of medical science, or the special works on gynæcology, without an exception, and you will be surprised at the silence respecting the Bartholinus glands, or the tonsillar bodies of the vulva, as they are sometimes called, and the diseases which appertain to them, and more especially the consequences of those diseases.

Take a retrospective view from the pages of Morgagni, Couper, and Haller on the anatomy of these glands, and the astonishment is increased. From the works of John Hunter, and, not to enlarge, we find that small abscesses, he considered, took place in these glandular bodies when the patient had blenorrhagia.

M. Robert, in 1840, called the attention of the profession to the glands of the vulva, but it was more especially to the follicular.

To M. Huguier, in 1848, we owe the credit for inviting the attention, in a special and clear manner, to the diseases of these glands. We all know the great influence physiologically these active glandular bodies play in the female economy.

We also know pathologically how frequent abscesses may and do occur in the labial region, through various causes, and that in almost all the cases a favorable termination is looked for, and ensues; every member of this Association has presumably

seen several cases.

From the records and testimony I have adduced of some eminent surgical authorities in private practice, the unfortunate sequel I have to consider is believed to be rare. Huguier, nevertheless, in his memoir on the diseases of the secretory glands of the external organs in the female, acknowledges the not infrequent fact of recto-labial or vulvar fistula occurring as a sequence of abscess of these glands of Bartholinus. With all this he has not suggested any operative or surgical treatment for the benefit of the patient.1

1 "Mémoire sur les Maladies des Appareils Sécréteurs des Organes Génitaux Externals de la Femme."

Labial or vulvar abscesses are most generally considered as of trivial occurrence. Suppuration in the usual time takes place, the abscess bursts, or may be opened by the attending physician, and that is the end of it, or presumed to be so.

FIG. 1.-A, Probe in the orifice of the gland. B, Gland; inflammation of
the duct. C, Ligature, tied and shotted.-(After Huguier.)

Locally these glands, as we are all aware, are situated in the lateral and posterior part of the vagina and vulva, near the

entrance of the vagina, about one third of an inch beyond the hymen and the carunculæ myrtiformes, in the triangular space formed on each side by the union of the rectum and vagina, on which they repose. They are placed between the two superficial and middle layers of the aponeurosis of the perinæum. The minute orifice of the duct of the gland opens at the lateral and inferior part of the vulva, just outside of the hymen and the carunculæ myrtiformes.

In my remarks in this paper I have directed attention solely to the inflammatory affections. Under the influence of various causes an inflammatory state of these glands occurs. The inflammation may be confined simply and solely to the excretory duct or the gland itself; eventually the cellular tissue which surrounds the gland becomes implicated. In many cases the abscess originates from the first conjugal approaches, or the act has been repeated many times after short intervals, or from a more direct excitation of the vulva, or from the use of artificial coverings, or the largeness of the male and the smallness of the female organs. Excessive masturbation claims a share in the causes. It is recognized also after confinement. It is seldom the result of extreme violence, or blows, or falls, though they do occur, or it may be through cold.

Labial abscesses, when the areolar tissue is engaged, do not open, as Huguier informs us, on the external face of the labia; they open seldom, or not at all, into the vagina, but on its inner mucous surface, or on the edge of the labia. (See Figs. 1 and 2.) My own experience corroborates this view of Huguier. To account for the non-opening of the abscess in the vagina, Huguier says: When the gland is dissected from within outward, we find successively, between the internal face and the vagina, three membranes:

1. The mucous membrane.

2. The proper tissue of the vagina, the fibrous.

3. The expansion which we see on the inferior extremity of the middle layer of the aponeurosis of the perinæum. It is for this reason why the abscess of this organ does not open into the vagina. Now, while the abscess does not open into the vagina,

it does, however, find an opening into the rectum two and a half or three and a half inches high up the gut. (See Figs. 4 and 5.)

To account for this, we should remember that the anterior half of the inferior extremity of the rectum is united, at the posterior part of the vagina, by a cellular tissue on the median line, occupying a space of two and three quarters or three inches in length and one and a half or one and three quarters inches in breadth. It is dense, firm as fibrous structure, and never fatty, while outside, or beyond, the tissues become soft, cellular, and adipose, and approaches the lateral sides of the vagina, the rectum, and the excavation of the pelvis. We have, however, another form of abscess and, to all appearance, nearly allied to those arising from the gland-the pre-rectal—and to which Velpeau was considered the first to have called attention. They occupy the lower part of the labia, adjoining the rectum and the anus. They have by some been associated, or mistaken for the glandular abscess. This variety of abscess has for its origin other causes than the glandular, arising chiefly from diseases of the anus, though it may have sprung sometimes from the same causes, most generally from cold, or blows, and other outward influences.

Should an early inflammatory stage of these glands not go on to suppuration, but remain passive, they may become cystic, and, what is not very infrequent, continue in this cystic state for some considerable time, eventually passing into suppuration almost imperceptibly to the patient. (See Fig. 2.)

Should this be the result, the tumor presents the same appearance in form and shape as the early stage of inflammation.

The gland assumes an oval form, about the size of a small egg, presenting no redness on the cuticular surface. It is not painful to the touch on examination, and is movable. It is so movable as to be gently pushed upward to the pubes and downward to the perinæum, and sometimes partially up the rectum. With this feature of the swelling or tumor under examination, it is a very difficult matter to form a true estimate of the case. The movability of the tumor may incline one to consider it a prolapsed ovary, having passed down through Broca's canal,

which commences at the pubes and goes down through the whole length of the labia externa; or it might be viewed as an inguinal hernia, or a hydrocele, as it is in the canal of Broca that serous cysts or tumors occur, and continue for a shorter or

FIG. 2.-A, Catheter in the urethra. B, Gland, cystic.-(After Huguier.) longer time, and sometimes pass into suppuration. They are a different form of tumor from those which are seen in the canal of Nuck, which seldom or never suppurate. The following case is of some interest, as bearing on this point, the future course and treatment necessary: